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7. Smoke-free legislation and neonatal and infant mortality in Brazil:longitudinal quasi-experimental study

Author

Hone, Thomas, Szklo, Andre Salem, Filippidis, Filippos T., Laverty, Anthony A., Sattamini, Isabela, Been, Jasper, Vianna, Cristiane, Souza, Mirian, de Almeida, Liz Maria, Millett, Christopher, Hone, Thomas, Szklo, Andre Salem, Filippidis, Filippos T., Laverty, Anthony A., Sattamini, Isabela, Been, Jasper, Vianna, Cristiane, Souza, Mirian, de Almeida, Liz Maria, and Millett, Christopher

Abstract

ObjectiveTo examine the associations of partial and comprehensive smoke-free legislation with neonatal and infant mortality in Brazil using a quasi-experimental study design.DesignMonthly longitudinal (panel) ecological study from January 2000 to December 2016.SettingAll Brazilian municipalities (n=5565).ParticipantsInfant populations.InterventionSmoke-free legislation in effect in each municipality and month. Legislation was encoded as basic (allowing smoking areas), partial (segregated smoking rooms) or comprehensive (no smoking in public buildings). Associations were quantified by immediate step and longer term slope/trend changes in outcomes.Statistical analysesMunicipal-level linear fixed-effects regression models.Main outcomes measuresInfant and neonatal mortality.ResultsImplementation of partial smoke-free legislation was associated with a -3.3 % (95% CI -6.2% to -0.4%) step reduction in the municipal infant mortality rate, but no step change in neonatal mortality. Comprehensive smoke-free legislation implementation was associated with -5.2 % (95% CI -8.3% to -2.1%) and -3.4 % (95% CI -6.7% to -0.1%) step reductions in infant and neonatal mortality, respectively, and a -0.36 (95% CI -0.66 to-0.06) annual decline in the infant mortality rate. We estimated that had all smoke-free legislation introduced since 2004 been comprehensive, an additional 10 091 infant deaths (95% CI 1196 to 21 761) could have been averted.ConclusionsStrengthening smoke-free legislation in Brazil is associated with improvements in infant health outcomes-particularly under comprehensive legislation. Governments should accelerate implementation of comprehensive smoke-free legislation to protect infant health and achieve the United Nation's Sustainable Development Goal three.

Published
2020

12. Smoke- free legislation and neonatal and infant mortality in Brazil: longitudinal quasiexperimental study.

Author

Hone, Thomas, Szklo, Andre Salem, Filippidis, Filippos T., Laverty, Anthony A., Sattamini, Isabela, Been, Jasper V., Vianna, Cristiane, Souza, Mirian, de Almeida, Liz Maria, and Millett, Christopher

Subjects
SMOKING laws, CONFIDENCE intervals, ECOLOGICAL research, INFANT mortality, LONGITUDINAL method, RESEARCH methodology, PASSIVE smoking, PUBLIC spaces, REGRESSION analysis, DESCRIPTIVE statistics
Published
2020
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15. Smoke-free legislation and neonatal and infant mortality in Brazil: longitudinal quasi-experimental study.

Author

Hone T, Szklo AS, Filippidis FT, Laverty AA, Sattamini I, Been JV, Vianna C, Souza M, de Almeida LM, and Millett C

Subjects
Adolescent, Adult, Aged, Brazil epidemiology, Female, Humans, Infant, Infant Health, Infant, Newborn, Linear Models, Male, Middle Aged, Pregnancy, Smoke adverse effects, Smoking Cessation, Smoking Prevention legislation & jurisprudence, Tobacco Products legislation & jurisprudence, Tobacco Smoke Pollution adverse effects, Infant Death etiology, Infant Mortality, Perinatal Death etiology, Smoke-Free Policy legislation & jurisprudence, Smoking legislation & jurisprudence, Smoking Prevention methods, Tobacco Smoke Pollution legislation & jurisprudence
Abstract

Objective: To examine the associations of partial and comprehensive smoke-free legislation with neonatal and infant mortality in Brazil using a quasi-experimental study design., Design: Monthly longitudinal (panel) ecological study from January 2000 to December 2016., Setting: All Brazilian municipalities (n=5565)., Participants: Infant populations., Intervention: Smoke-free legislation in effect in each municipality and month. Legislation was encoded as basic (allowing smoking areas), partial (segregated smoking rooms) or comprehensive (no smoking in public buildings). Associations were quantified by immediate step and longer term slope/trend changes in outcomes., Statistical Analyses: Municipal-level linear fixed-effects regression models., Main Outcomes Measures: Infant and neonatal mortality., Results: Implementation of partial smoke-free legislation was associated with a -3.3 % (95% CI -6.2% to -0.4%) step reduction in the municipal infant mortality rate, but no step change in neonatal mortality. Comprehensive smoke-free legislation implementation was associated with -5.2 % (95% CI -8.3% to -2.1%) and -3.4 % (95% CI -6.7% to -0.1%) step reductions in infant and neonatal mortality, respectively, and a -0.36 (95% CI -0.66 to-0.06) annual decline in the infant mortality rate. We estimated that had all smoke-free legislation introduced since 2004 been comprehensive, an additional 10 091 infant deaths (95% CI 1196 to 21 761) could have been averted., Conclusions: Strengthening smoke-free legislation in Brazil is associated with improvements in infant health outcomes-particularly under comprehensive legislation. Governments should accelerate implementation of comprehensive smoke-free legislation to protect infant health and achieve the United Nation's Sustainable Development Goal three., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2020
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