Smoking ban in Scotland has greater impact than expected

In a recent issue of the New England Journal of Medicine, Mackay et al. (N Engl J Med 2010, 363:1139-1145) follow up on the outcome of a 2006 smoking ban in enclosed public places in Scotland. The law was enacted to protect workers exposed to occupational smoke, such as bar workers. To examine evidence for a wider impact, data from the Scottish Morbidity Record (SMR) was pulled for asthma-attributed hospital admissions for infants and children up to 14 years.

Banning smoking in public places has been shown to reduce acute myocardial infarction deaths and hospitalizations as well as decrease hospital admissions because of respiratory conditions, but there have been no studies on how the bans affect asthma in children.

In Scotland, prior to the 2006 ban, there was an increasing trend in admissions for childhood asthma symptoms. After the ban, Mackay et al. report a significant reduction in asthma-related admissions by 13%. They discuss previous studies that have reported significant reduction in respiratory symptoms of workers exposed to occupational smoke as well – even if they are smokers.

Of particular interest, Mackay et al. discuss concerns among Scottish public health officials that the ban would cause increased smoking in the home. In fact, studies had found that voluntary smoking bans in the home increased after the legislation based on objective findings of salivary cotinine in children from those homes.

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