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‘What are the current and predicted effects on mortality and morbidityin England following the introduction of smoking legislation?Analysis of the current data’N J Oliver RN BSc Hons. Public HealthFreelance investigative writer/consultant in medical statistics for theactuarial and medical professions.
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AbstractBackground
 
Smoking, both passive and active, is a well established risk factor for coronary vascular disease, and is a known direct cause of lung cancer, aswell as a causal link in numerous other cancers. Smoking legislation invarious countries has resulted in reductions in associated morbidities and has generated an impact upon subsequent mortality.
Methods
Data from a variety of sources was gathered in order to establish the levelof benefit conferred through smoking legislation and to hypothesise on the potential benefits to be gained following the smoking ban in England.
Results
Most studies agree that there are significant health benefits fromenforcement of a smoking ban in public places, but methods used toevaluate these benefits appear to lack consistency.
Conclusion
The tobacco industry remains a strong lobby, so evidence-based data presented with a systematic approach is required in order to establishsmoking legislation as an effective public health policy. The Scottish modelidentifies a comprehensive approach to evaluation, and appears to provide for a greater understanding of the wide-ranging impact of smoke-freelegislation.
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Introduction
Smoking and environmental tobacco smoke (ETS) exposure remain a majorpublic health issue and the increased risks of coronary vascular disease(CVD) and lung cancer associated with smoking are well established. TheBritish Doctors’ Study provided convincing proof regarding smokingattributable risk; almost half of all persistent cigarette smokers are killed bytheir habit and, on average, cigarette smokers die about 10 years youngerthan non-smokers
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. The negative vascular effects of smoking includevascular dysfunction, progression of atherosclerosis, development of thrombi and potential oxidative stress
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,
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,
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,
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,
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,
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. Smoking is one of the sixmajor modifiable risk factors for CVD, and, according to the SystemicCoronary Risk Evaluation (SCORE) project
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, the 10-year fatal cardiovascularrisk is approximately doubled for smokers vs. non-smokers for any given age,systolic blood pressure and cholesterol level. Smoking is second only todyslipidaemia as a risk factor for myocardial infarction (MI),
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and findingsfrom the WHO-MONICA project revealed that overall incidence of CVDincreases with age; though the risk is increased more than fivefold in thoseunder 50 years of age compared to a doubling of the risk for smokers over60 years of age
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.Exposure to environmental tobacco smoke (ETS), or ‘passive smoking’, hasalso demonstrated increased risk of coronary heart disease among non-smokers. A number of reports over the last 20 years have investigated therelationship between CVD and passive smoking; though estimations of theactual risk depend heavily on the definition of underlying parameters.Results are influenced by settings of exposure, different reported relativerisks and different definitions of the population at risk (never smokers,former smokers, current smokers)
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. Data from the British regional heartstudy found an increased risk of coronary heart disease (CHD) for thoseexposed to environmental tobacco smoke of at least 30%
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throughassessment of cotinine, a nicotine metabolite and accurate biomarker of passive exposure to smoke. Estimates from the UK suggest that passive
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