Smokefree Scotland: Evaluation Outcomes

1
Smokefree Scotland Evaluation Outcomes

• Sally Haw
• Principal Public Health Adviser
• NHS Health Scotland

2
Evaluation Strategy

• Haw S, Gruer L, Amos A et al. Legislation on
  Smoking in Enclosed Public Places how will we
  evaluate its impact? Journal of Public Health
  20063824-30.

3
Primary Outcome Areas

• Compliance
• Knowledge attitudes
• Exposure to SHS
• Smoking prevalence and tobacco consumption
• Short and longer term health impacts
• Economic impact
• Health inequalities

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Compliance
5
Compliance

• Month Inspections
  Compliance
• Smoking Signage
• Apr-Jun 06 32,442 97
  80
• Jul-Sept 06 20,471 96
  80
• Oct-Dec 06 13,500 96
  85
• Jan-Mar 07 14,419 97 89
• Apr-Jun 07 10,470 94
  88

Source Environmental Health Officer Inspections
6
Qualitative Study of 8 Bars

• In 6 of 8 bars found evidence of minor
  contraventions
• Around doorways
• Contested areas
• Lock-ins
• More contraventions in bars in deprived areas
• Efforts to enforce legislation
• Major motivation fear of prosecution

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Observed Smoking in Different Locations
Scotland
Rest of UK
8
Air Quality and Exposure in General Population
9
Air Quality

• 106 (53 pre and 53 post) visits made to 41
  randomly selected bars
• TSI Sidepak aerosol sampler measured particulate
  matter less than 2.5 mm in size (PM2.5)

Source Barworkers Health ETS Exposure
(BHETSE)
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Cotinine Concentrations in Adult Non-smokers
39 reduction in mean cotinine
13
Change in Geometric Mean Cotinine by Household
Smoking Status
Non-smoking adjusted reduction 49 (95CI, 40
to 56 Plt0.001) Smoking adjusted reduction 16
(95CI, -11 to 37 NS)
14
Socio-cultural Change
15
Support for Legislation
Legislation
Source Health Education Population Survey (HEPS)
16
Smoking Restrictions in Homes
Smokers
Non-smokers
Source Health Education Population Survey (HEPS)
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Qualitative Study of Smoking in the Home

• More complex picture
• Participants had varied understandings of the
  risks of secondhand smoke
• Children were perceived as vulnerable to the
  effects of second-hand smoke.
• Most restricted smoking in their homes, with a
  range of restrictions across social classes and
  home smoking profiles.
• Children and grandchildren were important
  considerations in implementing these restrictions.

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In Summary

• High level of compliance with legislation
• 86 improvement in air quality in bars
• 39 reduction in SHS exposure in non-smoking
  adults and children.
• 17 reduction in heart attack admissions
• High level of support for legislation in
  non-smokers and increasing support post ban
  amongst smokers
• Evidence of change in acceptability of smoking in
  the home for both non-smokers and smokers
• Evidence of changing social norms about smoking
  behaviour.

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Clean-air Legislation Evaluation (CLEAN)
Collaboration
Sally Haw, Health Scotland (Coordinator) Laurence
Gruer, Health Scotland Colin Fischbacher, ISD
Scotland Diane Stockton, ISD Scotland Calum
Scott, Scottish Executive STOPIT Jill Pell,
University of Glasgow (PI) Stuart Cobbe, Glasgow
Royal Infirmary John Rodgers, Glasgow Royal
Infirmary Frank Dunn Stobhill Hospital Anne
Wright, Stobhill Hospital Nat Hawkins, Stobhill
Hospital Tim Gilbert, Hairmyres Hospital Jim
Young, Hairmyres Hospital Paul MacIntyre, Royal
Alexandra Hosp Jacqui Dougall, Royal Alexandra
Hosp
Dave Murdoch, Southern General Hosp Anne Andrews,
Southern General Hosp Dave Newby, Royal Infirmary
Edinburgh Sharon Cameron, Royal Infirmary
Edin Keith Oldroyd, Western Infirmary Glas Joanne
Kelly, Western Infirmary Glas Fiona Stevenson,
Western Infirmary Glas Alastair Pell Monklands
Hospital Judith Anderson, Monklands
Hospital Stuart Pringle, Ninewells Hospital Helen
Marshall, Ninewells Hospital BHETSE Jon Ayres,
University of Aberdeen (PI) Sean Semple,
University of Aberdeen Anne Ludbrook, University
of Aberdeen Fintan Hurley, IOM, Edinburgh
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Clean-air Legislation Evaluation (CLEAN)
Collaboration
Graeme Hughson, IOM Edinburgh Mark Petticrew,
MRC, Glasgow CHETS Candace Currie, CAHRU
(PI) Patricia Akhtar, CAHRU Dorothy Currie,
CAHRU HEPS Sally Malam, BMRB Ruth
Gosling Qualitative Bar Study Gerard Hastings,
Stirling University (PI) Douglas Eadie,
University of Stirling Susan MacAskill,
University of Stirling Derek Heim, University of
Strathclyde John Davies, University of
Strathclyde Alastair Ross, University of
Strathclyde
Qualitative Community Study Claudia Martin,
Scottish Centre for Social Research (PI) Amanda
Amos, University of Edinburgh Deborah Ritchie,
University of Edinburgh ITC Gerard Hastings,
Stirling University (PI) Louise Hassan, Stirling
University
Welcome Trust Research Lab, Edinburgh
Gordon Hill ABS Labs, London
Colin Fereyband
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Contender for Collins Dictionary?

• To smirt smirting (vb)
• Definition Flirting while smoking outside
  enclosed or partially enclosed public places
  where smoking is prohibited.

Source Professor Luke Clancy