Behind the ban: how Glasgow’s research helped promote smoke-free policy
Published: 14 April 2021
Leading the rest of the UK by over a year, on 26 March 2006, Scotland prohibited smoking in all enclosed public places.
Leading the rest of the UK by over a year, on 26 March 2006, Scotland prohibited smoking in all enclosed public places. Though there was initial scepticism about whether a ban would have any effect on smokers and public health, the research undertaken by the University of Glasgow’s Institute of Health & Wellbeing into evaluating the impact of Scotland’s ban on smoking in public places proved its undeniable success.
Getting to the heart of the matter
In a multi-centre study, Director of the Institute of Health & Wellbeing Professor Jill Pell and her team examined the impact of smoke-free legislation on hospitalisations for heart attacks.
Drawing on questionnaire and biochemical data, the researchers collected details on smoking status and exposure to second-hand smoke from patients admitted to hospital with acute coronary syndrome. This information was collated from nine Scottish hospitals during the 10 months before the smoking ban and the same 10 months of the following year, after the legislation was in place.
Between these two periods, Pell found that the number of admissions decreased from 3235 to 2684. This represented a 17% reduction in cases, compared to a 4% reduction in England, which at that time had yet to introduce any such legislation.
Dissecting the results further, Professor Pell discovered that there was a 14% reduction in the number of admissions for acute coronary syndrome among smokers, a 19% reduction among former smokers, and a 21% reduction among people who had never smoked.
These results were particularly significant, since these patient numbers accounted for 64% of all admissions for acute coronary syndrome in Scotland.
Expanding the evidence
Following on from the successful research on heart attack admissions, the Institute of Health & Wellbeing conducted further studies, using electronic health records to explore whether smoke-free legislation had impacted on rates of asthma in children, pregnancy complications and stroke.
Most notably, the Institute highlighted that although childhood asthma admissions had been rising by around 5% each year prior to the smoking ban, they declined by 18% in the year after. They also demonstrated a reduction in clot-related strokes as a result of the new legislation.
In a ten-year follow-up on the impact of the Scottish smoking ban on heart disease, the Institute’s Professor Daniel Mackay found that the reductions in heart attacks observed a year after the ban had been maintained over time among those over 60 years of age.
Measuring the impact
As well as being used to support policy decisions in Scotland, the evidence from the University of Glasgow has provided guidance for the introduction of smoke-free legislation in the rest of the UK and internationally.
As an indication of its global impact, in 2011 the World Health Organization cited Professor Pell’s original research in a document entitled ‘Making Cities Smoke-free’, addressed to city mayors around the world. It was the only UK-based research used to highlight the benefit of measuring indicators of worker health pre- and post-ban. The American Heart Association voted Professor Pell’s paper the most significant research paper published that year.
As well as supporting smoke-free health advice and campaigns by the WHO and other international bodies, the research sparked public debate over smoking cessation, particularly in the press.
For example, the Wall Street Journal detailed the research findings when it covered the smoking ban debate in the USA: ‘A new study from Scotland provides what public-health experts in the US say is the strongest evidence yet that public bans on smoking – being debated in several locales – improve health by reducing exposure to second-hand smoke.’
Shaping policy for the better
There is no denying the success that smoke-free legislation has had on public health in Scotland and around the world. As Dr Garth Reid, principal public health adviser at NHS Health Scotland, said at the time, ‘The evidence shows the positive impact of tobacco policy, ranging from the display ban which put tobacco out of sight in small shops and supermarkets to the introduction of smoke free NHS grounds.’
Large-scale empirical research, as conducted by the University of Glasgow, is vital in substantiating the benefits of new healthcare policy, as well as guiding its future direction.
If you want to get hands on with the latest public health research and be inspired to forge your own – find out more about the Online MSc Population Health Sciences led by Professor Daniel Mackay from the University of Glasgow.
First published: 14 April 2021
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