Impact of smoke-free legislation on perinatal and infant mortality: a national quasi-experimental study

• Published in: Scientific reports Vol. 5; no. 1; p. 13020
• Main Authors: Been, Jasper V, Mackay, Daniel F, Millett, Christopher, Pell, Jill P, van Schayck, Onno CP, Sheikh, Aziz
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 13.08.2015; Nature Publishing Group
• Subjects: 692/308/3187; 692/700/1538; 692/700/1720/3186; 692/700/478; Birth weight; Births; England; Female; Humanities and Social Sciences; Humans; Infant; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Legislation; Low birth weight; Mortality; multidisciplinary; Neonates; Perinatal Mortality; Pregnancy; Quasi-experimental methods; Regression analysis; Science; SIDS; Smoke; Smoke-Free Policy - legislation & jurisprudence; Smoking - adverse effects; Studies; Sudden infant death syndrome; England; United Kingdom > UK
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/srep13020

Smoke-free legislation is associated with improved early-life outcomes; however its impact on perinatal survival is unclear. We linked individual-level data with death certificates for all registered singletons births in England (1995–2011). We used interrupted time series logistic regression analysis to study changes in key adverse perinatal events following the July 2007 national, comprehensive smoke-free legislation. We studied 52,163 stillbirths and 10,238,950 live-births. Smoke-free legislation was associated with an immediate 7.8% (95%CI 3.5–11.8; p < 0.001) reduction in stillbirth, a 3.9% (95%CI 2.6–5.1; p < 0.001) reduction in low birth weight and a 7.6% (95%CI 3.4–11.7; p = 0.001) reduction in neonatal mortality. No significant impact on SIDS was observed. Using a counterfactual scenario, we estimated that in the first four years following smoke-free legislation, 991 stillbirths, 5,470 cases of low birth weight and 430 neonatal deaths were prevented. In conclusion, smoke-free legislation in England was associated with clinically important reductions in severe adverse perinatal outcomes.