Radó Márta K, van Lenthe Frank J, Sheikh Aziz, Been Jasper V
Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, PO Box 2060, 3000 CB Rotterdam, the Netherlands.
Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
EClinicalMedicine. 2020 Oct 2;27:100560. doi: 10.1016/j.eclinm.2020.100560. eCollection 2020 Oct.
Almost all of the evidence on the benefits of smoke-free legislation on child health comes from evaluations in high-income countries. We investigated the effects of Thailand's 2010 comprehensive smoke-free legislation on neonatal and infant mortality.
To overcome some of the methodological issues inherent to traditional quasi-experimental methods, we applied the novel synthetic control approach. Using 2001-2017 country-level panel data from the World Bank and Penn World datasets, we estimated the effects of smoke-free legislation as the difference between the outcome trends in Thailand versus those in a synthetic control country. The synthetic control country was composed of 'control' middle-income countries without comprehensive smoke-free legislation to recreate trends in Thailand in the 2001-2009 pre-legislation outcomes and covariates. We compared the legislation effects to 'placebo effects' obtained for each control country by fictitiously assuming that comprehensive smoke-free legislation was introduced there in 2010, similar to Thailand.
Neonatal and infant mortality decreased by 2.9% and 2.8%/year respectively following smoke-free legislation, with an estimated 7463 infant deaths (including 4623 neonatal deaths) having been averted over eight years. The results were robust to different specifications of the control countries. Comparison with placebo effects indicated that the findings were unlikely to be attributable to factors other than the smoke-free legislation.
Expanding comprehensive smoke-free policies to middle-income countries can support national efforts to achieve Sustainable Development Goal 3.2 for reducing preventable early-life deaths.
Netherlands Lung Foundation, HDRUK, Asthma UK center for Applied Research and NIHR Global Respiratory Health Unit (RESPIRE).
几乎所有关于无烟立法对儿童健康益处的证据都来自高收入国家的评估。我们调查了泰国2010年全面无烟立法对新生儿和婴儿死亡率的影响。
为克服传统准实验方法固有的一些方法学问题，我们应用了新颖的合成控制法。利用世界银行和佩恩世界数据集2001 - 2017年的国家层面面板数据，我们将无烟立法的影响估计为泰国与合成控制国家结果趋势的差异。合成控制国家由没有全面无烟立法的“对照”中等收入国家组成，以重现泰国在2001 - 2009年立法前结果和协变量的趋势。我们将立法效果与通过虚拟假设每个对照国家在2010年引入了与泰国类似的全面无烟立法而获得的“安慰剂效应”进行比较。
无烟立法实施后，新生儿和婴儿死亡率分别每年下降2.9%和2.8%，估计在八年内避免了7463例婴儿死亡（包括4623例新生儿死亡）。结果对于对照国家的不同设定具有稳健性。与安慰剂效应的比较表明，这些发现不太可能归因于无烟立法以外的因素。
将全面无烟政策扩展到中等收入国家可以支持各国为实现可持续发展目标3.2（减少可预防的早期死亡）所做的努力。
荷兰肺部基金会、英国健康数据研究中心、英国哮喘应用研究中心和英国国家卫生研究院全球呼吸健康部门（RESPIRE）。
