Five years after the English smoking ban drove nicotine addicts out of pubs and on to pavements, the fug-filled restaurants and bars are a hazy memory. But it is not just our clothes that smell better – evidence is accumulating to show the UK population is in better health too.
The ban did not, as opponents warned, drive people out of pubs and into their homes to smoke. If anything, the ban, which brought more awareness of the dangers of secondhand smoke to friends and family as well as a greater degree of social disapproval, appears to have encouraged people to try to cut down.
A review of the benefits by Professor Linda Bauld of Bath University, published last year, found "no significant evidence of increased smoking at home among study participants after the law was in place. In contrast, some participants increased restrictions on smoking at home."
The big worry was that an increase in smoking at home would harm children. But a study carried out in Scotland, published in the New England Journal of Medicine in 2010, suggested their health had improved. Fewer have been admitted to hospital with asthma attacks since the Scottish ban on 26 March 2006, more than a year before its English counterpart.
The researchers looked at more than 21,000 asthma admissions between 2000 and 2009 for children under 15 years. Before the legislation, admissions among preschoolers were rising by more than 9% a year, while for older children they were stable. After the ban, they dropped by 18.4% for preschool children and 20.8% for those aged five to 14.
The authors admit they do not know if parents of the children smoked, so there is no direct link to the ban, and the admissions drop may have another cause, but they say: "We are not aware of any national educational campaigns, changes in healthcare delivery or clinical management, or changes in other exposures, such as air pollution, that coincided with the date on which the legislation was introduced."
The biggest health impact has been a drop in heart attack emergency admissions – the "Montana effect", which has since been identified in many other places that have brought in smoking bans. Helena, in Montana, introduced a smoking ban in June 2002, but it was scrapped that December. In those six months, however, researchers publishing in the British Medical Journal found a drop in heart attack admissions to hospital.
Anna Gilmore and her colleagues, at Bath's school for health, analysed heart attack hospital admissions for England between July 2002 and September 2008 and found a significant drop of 2.4% after the July 2007 ban. It was the equivalent of 1,200 fewer heart attack patients, they said in their paper in the BMJ.
It was a considerably smaller drop in admissions than that found in a study in Scotland by Jill Pell and colleagues. In her review Baud suggested that either less secondhand smoke was being inhaled in England before the ban than in Scotland, or the authors of the Scottish study did not take into account other reasons for declining coronary rates.
But overall, it is clear that smoking bans have made a difference to heart health. A Cochrane review, which scrutinised the data from 10 studies from North America, Italy and Scotland, found a drop in hospital heart attack admissions in all of them and a drop in the numbers of deaths in two.
Peers yesterday gave a second reading to a Bill proposed by Lord Ribiero, the ex-president of the Royal College of Surgeons, which would ban smoking in cars containing children, raising hopes among campaigners that it may secure enough support to pass the Lords and be discussed by MPs.
It will take many more years to find out what the effect is on preventing cancers and lung diseases, which take much longer to show up.
Robin Hewings, Cancer Research UK's tobacco control manager, said the smokefree legislation had already saved lives.
"Although we won't see a reduction in cancer rates for some years to come, the health gains that we have seen are very encouraging – such as the reduction in admissions to hospital for heart attacks. People no longer have to breathe cancer-causing chemicals from smoky air in their workplace. The law banning smoking in public places triggered around 300,000 smokers to try to kick the habit. There are now fewer public triggers that might tempt a smoker to fall off the wagon."
Hewings said the ban had changed the social norms around smoking indoors.
"Research has shown that far fewer people now allow smoking in their own homes – meaning that more children are benefiting from a smokefree environment too."
Meanwhile, according to new polling data which Cancer Research UK says shows "shocking levels of ignorance about smoking and cancer", it has emerged that fewer than one in five people realise that smoking causes many different forms of cancer. In a YouGov poll of 4,099 adults, weighted to make it representative of the UK population, only 12% knew that smoking can cause ovarian cancer, while the proportions who knew that smoking was linked to cancer of the bowel (13%), cervix (13%), kidney (15%) and liver (19%) were almost as small. However, 89% knew it can cause lung cancer. The Guardian
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