NOT PEER REVIEWED
We welcome the timely review published by Hill et al. [1], and agree
that more research is needed to assess the equity impacts of tobacco
control interventions. The results of the review indicated that "increases
in tobacco price have a pro-equity effect on socioeconomic disparities in
smoking", but that "evidence on the equity impact of other interventions
was inconclusive [...]". The inconclusiveness o...
NOT PEER REVIEWED
We welcome the timely review published by Hill et al. [1], and agree
that more research is needed to assess the equity impacts of tobacco
control interventions. The results of the review indicated that "increases
in tobacco price have a pro-equity effect on socioeconomic disparities in
smoking", but that "evidence on the equity impact of other interventions
was inconclusive [...]". The inconclusiveness of findings with regard to
smoking ban policies may be partly due to date limitations for the
database searches, which included evidence from January 2006 through
November 2010. It may also be partly due to the assessment of equity in
outcomes that related only to active smoking. Although a benefit of
smoking ban policy implementation may be a reduction in active smoking,
this outcome is dependent upon an individual's personal response to the
intervention. However, the primary purpose for implementing comprehensive
smoking ban policies is to reduce secondhand smoke exposure among the
population through environmental change. It is therefore important to
assess whether the successful implementation of smoking ban policies has
pro-equity health effects.
Our previous research indicated that the national smoking ban policy
in the Republic of Ireland was associated with immediate reductions in all
-cause and cause-specific cardiovascular, cerebrovascular, and respiratory
mortality, and that these mortality reductions were primarily due to
reductions in population exposure to secondhand smoke [2]. Our subsequent
assessment of the socioeconomic differentials of these mortality
reductions in the Republic of Ireland suggested that inequalities in
smoking-related mortality were immediately reduced following smoking ban
implementation [3]. Furthermore, given the higher rates of smoking-related
mortality in the most deprived group, even equitable reductions across
socioeconomic groups resulted in decreased inequalities in mortality [3].
Partial smoking ban policies do not fully protect health [4], and are
likely to yield negative equity effects as a result of policy exclusions
for workplaces and hospitality venues located in more deprived areas [5].
In contrast, comprehensive smoking ban policies provide equal protection
for all against secondhand smoke exposure. Indeed, previous studies have
indicated that comprehensive smoking ban policies are effective public
health interventions for reducing both exposure to secondhand smoke and
other indoor air pollutants [6-11], the benefits of which are experienced
by all employees and patrons of restaurants, bars, and other public
places, regardless of individual socioeconomic group. Therefore, we wish
to highlight that the evidence for pro-equity effects of comprehensive
smoking ban policies may be more conclusive when additional health-related
outcomes are considered.
References
1. Hill S, Amos A, Clifford D, Platt S (2014) Impact of tobacco
control interventions on socioeconomic inequalities in smoking: review of
the evidence. Tob Control 23: e89-e97.
2. Stallings-Smith S, Zeka A, Goodman P, Kabir Z, Clancy L (2013)
Reductions in cardiovascular, cerebrovascular, and respiratory mortality
following the national irish smoking ban: interrupted time-series
analysis. PLoS One 8: e62063.
3. Stallings-Smith S, Goodman P, Kabir Z, Clancy L, Zeka A (2014)
Socioeconomic differentials in the immediate mortality effects of the
national Irish smoking ban. PLoS One 9: e98617.
4. Tan CE, Glantz SA (2012) Association between smoke-free
legislation and hospitalizations for cardiac, cerebrovascular, and
respiratory diseases: a meta-analysis. Circulation 126: 2177-2183.
5. Lewis GH, Osborne DC, Crayford TJ, Brown AC (2006) Partial smoking
ban would worsen health inequalities. Bmj 332: 362.
6. Fong GT, Hyland A, Borland R, Hammond D, Hastings G, et al. (2006)
Reductions in tobacco smoke pollution and increases in support for smoke-
free public places following the implementation of comprehensive smoke-
free workplace legislation in the Republic of Ireland: findings from the
ITC Ireland/UK Survey. Tob Control 15 Suppl 3: iii51-58.
7. Connolly GN, Carpenter CM, Travers MJ, Cummings KM, Hyland A, et
al. (2009) How smoke-free laws improve air quality: a global study of
Irish pubs. Nicotine Tob Res 11: 600-605.
8. Goodman P, Agnew M, McCaffrey M, Paul G, Clancy L (2007) Effects
of the Irish smoking ban on respiratory health of bar workers and air
quality in Dublin pubs. Am J Respir Crit Care Med 175: 840-845.
9. Mulcahy M, Evans DS, Hammond SK, Repace JL, Byrne M (2005)
Secondhand smoke exposure and risk following the Irish smoking ban: an
assessment of salivary cotinine concentrations in hotel workers and air
nicotine levels in bars. Tob Control 14: 384-388.
10. Valente P, Forastiere F, Bacosi A, Cattani G, Di Carlo S, et al.
(2007) Exposure to fine and ultrafine particles from secondhand smoke in
public places before and after the smoking ban, Italy 2005. Tob Control
16: 312-317.
11. Eisner MD, Smith AK, Blanc PD (1998) Bartenders' respiratory
health after establishment of smoke-free bars and taverns. JAMA 280: 1909-
1914.
NOT PEER REVIEWED We welcome the timely review published by Hill et al. [1], and agree that more research is needed to assess the equity impacts of tobacco control interventions. The results of the review indicated that "increases in tobacco price have a pro-equity effect on socioeconomic disparities in smoking", but that "evidence on the equity impact of other interventions was inconclusive [...]". The inconclusiveness o...
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