Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands.
Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.
BMJ Open. 2020 Oct 19;10(10):e038234. doi: 10.1136/bmjopen-2020-038234.
Tobacco smoke exposure (TSE) has considerable adverse respiratory health impact among children. Smoke-free policies covering enclosed public places are known to reduce child TSE and benefit child health. An increasing number of jurisdictions are now expanding smoke-free policies to also cover outdoor areas and/or (semi)private spaces (indoor and/or outdoor). We aim to systematically review the evidence on the impact of these 'novel smoke-free policies' on children's TSE and respiratory health.
13 electronic databases will be searched by two independent reviewers for eligible studies. We will consult experts from the field and hand-search references and citations to identify additional published and unpublished studies. Study designs recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group are eligible, without restrictions on the observational period, publication date or language. Our primary outcomes are: self-reported or parental-reported TSE in places covered by the policy; unplanned hospital attendance for wheezing/asthma and unplanned hospital attendance for respiratory infections. We will assess risk of bias of individual studies following the EPOC or Risk Of Bias In Non-randomised Studies of Interventions tool, as appropriate. We will conduct separate random effects meta-analyses for smoke-free policies covering (1) indoor private places, (2) indoor semiprivate places, (3) outdoor (semi)private places and (4) outdoor public places. We will assess whether the policies were associated with changes in TSE in other locations (eg, displacement). Subgroup analyses will be conducted based on country income classification (ie, high, middle or low income) and by socioeconomic status. Sensitivity analyses will be undertaken via broadening our study design eligibility criteria (ie, including non-EPOC designs) or via excluding studies with a high risk of bias. This review will inform policymakers regarding the implementation of extended smoke-free policies to safeguard children's health.
Ethical approval is not required. Findings will be disseminated to academics and the general public.
CRD42020190563.
烟草烟雾暴露（TSE）对儿童的呼吸健康有相当大的不利影响。覆盖封闭公共场所的无烟政策已被证明可以减少儿童 TSE 并有益于儿童健康。越来越多的司法管辖区正在扩大无烟政策，以覆盖户外区域和/或（半）私人空间（室内和/或室外）。我们旨在系统地审查这些“新型无烟政策”对儿童 TSE 和呼吸健康影响的证据。
两名独立审查员将通过 13 个电子数据库搜索符合条件的研究。我们将咨询该领域的专家，并对手头的参考文献和引文进行检索，以确定其他已发表和未发表的研究。符合科克有效实践和组织护理（EPOC）组建议的研究设计，没有对观察期、出版日期或语言的限制。我们的主要结果是：政策覆盖范围内自我报告或父母报告的 TSE；因喘息/哮喘和因呼吸道感染而计划外住院就诊的次数。我们将根据 EPOC 或干预措施非随机研究的偏倚风险工具评估个别研究的偏倚风险，视情况而定。我们将对涵盖以下内容的无烟政策进行单独的随机效应荟萃分析：（1）室内私人场所；（2）室内半私人场所；（3）户外（半）私人场所；（4）户外公共场所。我们将评估这些政策是否与其他地点的 TSE 变化相关（例如，转移）。根据国家收入分类（即高、中或低收入）和社会经济地位进行亚组分析。敏感性分析将通过放宽我们的研究设计资格标准（即纳入非 EPOC 设计）或通过排除偏倚风险高的研究来进行。本综述将为决策者提供有关实施扩展无烟政策以保护儿童健康的信息。
不需要伦理批准。研究结果将传播给学者和公众。
PROSPERO 注册号：CRD42020190563。
