Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis
Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis
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DOI：
10.1016/s0140-6736(14)60082-9
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发表时间：
2014-05-03
期刊：
影响因子：
168.9
通讯作者：
Sheikh, Aziz
中科院分区：
文献类型：
--
作者：
Been, Jasper V.;Nurmatov, Ulugbek B.;Sheikh, Aziz
无烟立法有可能减少与二手烟暴露相关的实质性疾病负担，特别是儿童。我们调查了无烟立法对围产期和儿童health.Methods的影响，我们搜索了14个在线数据库，从1975年1月至2013年5月，没有语言限制，发表的研究，和世界卫生组织国际临床试验注册平台未发表的研究。筛选了感兴趣文章的引文和参考文献列表，并联系了一个国际专家小组，以确定其他研究。我们纳入了由科克伦有效实践和护理组织批准的设计进行的研究，这些研究报告了工作场所、公共场所或两者的禁烟与一个或多个预先定义的早期健康指标之间的关联。主要结局为早产、低出生体重和哮喘住院率。效应估计值与随机效应荟萃分析合并。该研究在PROSPERO注册，编号CRD 42013003522。结果我们确定了11项合格的研究（2008-13年发表），涉及超过250万例出生和247168例哮喘急性发作。所有研究均采用中断时间序列设计。五项北美研究描述了地方禁令，六项欧洲研究描述了国家禁令。1项研究的偏倚风险较高，6项研究为中度，4项研究为低。无烟立法与早产（4项研究，1366862人; -10.4% [95%CI-18.8至-2.0]; p=0.016）和哮喘住院率（3项研究，225753起事件：-10.1% [95%CI-15.2至-5.0]; p=0.0001）减少相关。没有发现对低出生体重的显著影响（6项研究，> 190万人：-1.7% [95%CI-5.1至1.6]; p=0.31）。解释无烟立法与早产和哮喘住院率的大幅降低有关。连同对成人的健康益处，这项研究为世卫组织关于创造无烟环境的建议提供了有力支持。
Background Smoke-free legislation has the potential to reduce the substantive disease burden associated with second-hand smoke exposure, particularly in children. We investigated the effect of smoke-free legislation on perinatal and child health.Methods We searched 14 online databases from January, 1975 to May, 2013, with no language restrictions, for published studies, and the WHO International Clinical Trials Registry Platform for unpublished studies. Citations and reference lists of articles of interest were screened and an international expert panel was contacted to identify additional studies. We included studies undertaken with designs approved by the Cochrane Effective Practice and Organisation of Care that reported associations between smoking bans in workplaces, public places, or both, and one or more predefined early-life health indicator. The primary outcomes were preterm birth, low birthweight, and hospital attendances for asthma. Effect estimates were pooled with random-effects meta-analysis. This study is registered with PROSPERO, number CRD42013003522.Findings We identified 11 eligible studies (published 2008-13), involving more than 2.5 million births and 247 168 asthma exacerbations. All studies used interrupted time-series designs. Five North American studies described local bans and six European studies described national bans. Risk of bias was high for one study, moderate for six studies, and low for four studies. Smoke-free legislation was associated with reductions in preterm birth (four studies, 1 366 862 individuals; -10.4% [95% CI -18.8 to -2.0]; p=0.016) and hospital attendances for asthma (three studies, 225 753 events: -10.1% [95% CI -15.2 to -5.0]; p=0.0001). No significant effect on low birthweight was identified (six studies, >1.9 million individuals: -1.7% [95% CI -5.1 to 1.6]; p=0.31).Interpretation Smoke-free legislation is associated with substantial reductions in preterm births and hospital attendance for asthma. Together with the health benefits in adults, this study provides strong support for WHO recommendations to create smoke-free environments.