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Benefits of smoking bans on preterm and early-term births: a natural experimental design in Switzerland
  1. Ana M Vicedo-Cabrera1,2,
  2. Christian Schindler1,2,
  3. Dragana Radovanovic3,
  4. Leticia Grize1,2,
  5. Fabienne Witassek3,
  6. Julia Dratva1,2,
  7. Martin Röösli1,2,
  8. Laura Perez1,2
  1. 1Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
  2. 2University of Basel, Basel, Switzerland
  3. 3AMIS Plus Data Center. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
  1. Correspondence to Dr Ana M Vicedo-Cabrera, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, Basel CH-4002, Switzerland; anamaria.vicedocabrera{at}unibas.ch

Abstract

Background Birth outcomes are relevant for future children's heath. Capitalising on a natural experimental design in Switzerland, we evaluated how regional smoking bans introduced at different time points affected birth outcomes, including preterm and early-term births.

Methodology We used birth registry data of all singleton neonates born in Switzerland (2007–2012). We developed canton-specific interrupted time-series followed by random meta-analysis to evaluate the benefits of smoking bans on preterm (<37 gestational weeks) and early-term (37–38 gestational weeks) births. Heterogeneity across type of ban and contextual characteristics was explored through metaregression. A time-to-event approach was used for evaluating duration of pregnancy under the smoking bans and effects, taking into account individual maternal factors.

Results We observed a decrease in the risk of preterm birth of 3.6% (95% CI, −9.3% to 2.5%), and early-term birth of 5.0% (95% CI −7.5% to −2.5%). Results showed a clear dose–response relationship. Greater risk reductions were obtained for preterm births in areas with more comprehensive bans (−6.8%; 95% CI −12.1% to 0.1%), and for pregnancies with the longest gestational time under smoking bans (HR, 0.991; 95% CI 0.984 to 0.997 per 10% increase in duration). Benefits were unequal across outcomes and characteristics of cantons and mothers.

Conclusion Smoking bans resulted in improved birth outcomes in Switzerland with cantons that adopted more comprehensive smoking bans achieving greater benefits. Early-term births constitute a previously ignored though important group.

  • Secondhand smoke
  • Prevention
  • Public policy

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Footnotes

  • Contributors AMV-C contributed to the study design, data collection, performance of the statistical analysis and interpretation of the results, drafting and revision of the article. CS contributed to the study design, advisory in the statistical analysis, interpretation of the results and revision of the manuscript. DR contributed to the study design, and revision of the manuscript. LG contributed to data collection, interpretation of the results and revision of the manuscript. FW, JD contributed to the study design, and revision of the manuscript. MR advisory in the statistical analysis, and interpretation of the results and revision of the manuscript. LP designed the overall study idea, conceptualisation of the study design, advisory in the statistical analysis, interpretation of the results, writing and revision of the manuscript.

  • Funding This study was funded by the Tobacco Prevention Fund of the Federal Office of Public Health in Switzerland (decision number 13.008336).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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