The implementation of public health policies related to tobacco smoke legislation may be associated with lower preterm births and rates of adverse health events in children, according to findings from a systematic review published in the Lancet Public Health.

Investigators analyzed a total of 41 studies to determine the effect of the World Health Organization’s recommended tobacco control policies on public health. These policies included providing services for smoking cessation (n=3), introducing tobacco taxation (n=11), and implementing smoke-free legislation (n=35).

In 10 studies that included a total of 27,530,183 individuals, investigators found smoke-free legislation to be associated with reduced rates of preterm birth (–3.77%; 95% CI, –6.37 to –1.16). Smoke-free legislation was also associated with lower rates of pediatric hospital admissions for asthma difficulties in 5 studies (–9·83%; 95% CI, –16.62 to –3.04) and lower hospital admissions for all respiratory tract infections (–3.45%; 95% CI, –4.64 to –2.25).

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According to the investigators, associations between smoke-free legislation and lower rates of health-related events were stronger with the implementation of comprehensive smoke-free laws vs partial smoke-free laws.

Investigators showed that a degree of bias was present in studies that evaluated the correlation between smoke-free legislation and preterm birth. In addition, many studies had varying follow-up durations and often failed to evaluate the causal relationship between smoke-associated policies and their impact on public health.

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When planning policy changes in tobacco legislation to improve health outcomes of children, the investigators believe the most beneficial effect occurs when “various policies [are] implemented at the highest recommended levels.”


Faber T, Kumar A, Mackenbach JP, et al. Effect of tobacco control policies on perinatal and child health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(9):e420-e437.