Did Smokefree Legislation in England Reduce Exposure to Secondhand Smoke among Non-Smoking adults? Cotinine Analysis from the Health Survey for England
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Michelle Sims, Jennifer S. Mindell, Martin J. Jarvis, Colin Feyerabend, Heather Wardle, Anna Gilmore
Abstract
Background: On 1st July 2007, smokefree legislation was implemented in England, making virtually all enclosed public places and workplaces smokefree.
Objectives: To analyse trends in and predictors of secondhand smoke exposure among non-smoking adults, whether exposure changed after the introduction of smokefree legislation and whether these changes varied by socio-economic and household smoking status.
Methods: Analysis of salivary cotinine data from the Health Survey for England, collected in seven of 11 annual surveys undertaken between 1998 and 2008. We conducted multivariate regression analyses to examine secondhand smoke exposure as measured by the proportion of non-smokers with undetectable cotinine and by geometric mean cotinine.
Results: Secondhand smoke exposure was higher among those exposed at home and in lower socio- economic groups. Exposure declined markedly from 1998 to 2008 (the proportion with undetectable cotinine was 2.9 times higher and geometric mean cotinine declined by 80%). There was a significant fall in exposure after legislation was introduced – the odds of having undetectable cotinine were 1.5 times higher (95% CI: 1.3, 1.8) and geometric mean cotinine fell by 27% (95% CI: 17%, 36%) after adjustment for the pre-legislative trend and potential confounders. Significant reductions were not however seen in those living in lower social class households or homes where smoking occurs inside on most days.
Conclusions: England’s smokefree legislation impacted on secondhand smoke exposure above and beyond the underlying long-term decline demonstrating the positive effect of the legislation. Nevertheless, some population subgroups appear not to have benefitted significantly from the legislation, suggesting that these groups should receive more support to reduce their exposure.
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