Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
Health Sciences Bremen, University of Bremen, Bremen, Germany.
Nicotine Tob Res. 2019 Oct 26;21(11):1462-1472. doi: 10.1093/ntr/nty139.
A systematic review was conducted to evaluate the impact of public smoking bans on social inequalities in children's secondhand smoke (SHS) exposure at home.
Five databases were electronically searched for articles on children's SHS exposure at home related to public smoking bans. In addition, the gray literature and German public health journals were considered. Search was restricted to English and German publications. Of 3037 records screened, 25 studies fulfilled the inclusion criteria by either measuring SHS exposure before and after public smoking ban introduction or by comparing exposure between regions with and without smoke-free legislation. Studies were further examined whether they additionally reported on impacts on social inequalities in SHS exposure. Information on children's SHS exposure at home in relation to smoke-free legislation were extracted by one reviewer and checked for accuracy by a second reviewer. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) guidelines for equity-focused systematic reviews, the PROGRESS-Plus framework was applied to data extraction and analysis with focus on social inequalities in SHS exposure. Results were visualized by a harvest plot.
Eight studies gave results on the impact of public smoking bans on social inequalities in children's SHS exposure. Whereas only one study indicated widening of the social gap in exposure, seven studies showed no impact or a reduction of social inequalities in exposure.
First evidence on short-term impact of public smoking bans does not support the assumption of intervention-generated inequalities in children's SHS exposure at home. Future studies should focus on long-term equity impacts of smoke-free legislation.
There are substantial social inequalities in children's SHS exposure in many countries. Both hypotheses on the effect of smoke-free legislation on children's SHS exposure at home, the displacement hypothesis and the social diffusion hypothesis, did not take social inequalities into account. Up to now, only few studies analyzed the effects of smoke-free legislation on social inequalities in children's SHS exposure at home. Public smoking bans had overall no negative impact on social inequalities in children's SHS exposure at home. More consistent reporting of absolute and relative inequalities is needed to comprehensively assess equity impact of smoke-free legislation.
本系统评价旨在评估公共场所禁烟令对儿童家庭二手烟（SHS）暴露社会不平等的影响。
通过电子检索 5 个数据库，查找与公共场所禁烟令相关的儿童家庭 SHS 暴露的文章。此外，还考虑了灰色文献和德国公共卫生期刊。检索仅限于英文和德文出版物。在筛选出的 3037 条记录中，有 25 项研究符合纳入标准，这些研究要么测量了公共场所禁烟令实施前后的 SHS 暴露情况，要么比较了有无无烟立法地区的暴露情况。此外，这些研究还进一步考察了它们是否报告了对 SHS 暴露社会不平等的影响。一位评审员提取了与无烟立法相关的儿童家庭 SHS 暴露信息，并由第二位评审员进行准确性检查。根据专门针对系统评价和荟萃分析的公平性（PRISMA-E）指南，采用 PROGRESS-Plus 框架进行数据提取和分析，重点关注 SHS 暴露的社会不平等。结果以收获图表示。
8 项研究报告了公共场所禁烟令对儿童 SHS 暴露社会不平等的影响。只有一项研究表明暴露的社会差距扩大，而 7 项研究表明没有影响或暴露的社会不平等程度降低。
公共场所禁烟令的短期影响的初步证据不支持干预导致儿童家庭 SHS 暴露不平等的假设。未来的研究应关注无烟立法的长期公平影响。
在许多国家，儿童 SHS 暴露存在显著的社会不平等。关于无烟立法对儿童家庭 SHS 暴露的影响的两种假设，即转移假设和社会扩散假设，都没有考虑到社会不平等。到目前为止，只有少数研究分析了无烟立法对儿童家庭 SHS 暴露社会不平等的影响。公共场所禁烟令总体上对儿童家庭 SHS 暴露的社会不平等没有负面影响。为了全面评估无烟立法的公平影响，需要更一致地报告绝对和相对不平等。
