Smokefree laws followed by substantial reductions in preterm births and hospital admissions for asthma

On March 28, 2014, Lancet published "Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis,"  which found that "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)."
 
In an accompanying commentary, "Smoke-free policies: Clearing the air with money to spare,"  Sara Kalkohoran and I observed that this paper added to the already-strong evidence that smokefree laws were followed by immediate drops in hospital admissions for heart attacks, strokes, and other cardiopulmonary conditions.  All this evidence means that smokefree laws have large and rapid benefits in terms of improved health and, as a result, contribute toi medical care cost containment.
 
The results in the Lancet  paper were exactly what one would expect, based on the paper "Associations of lifetime active and passive smoking with spontaneous abortion, stillbirth and tubal ectopic pregnancy: a cross-sectional analysis of historical data from the Women's Health Initiative," that was published a week earlier in Tobacco Control. They found

When compared with never-smoking women, participants who were ever active smokers during their reproductive years had ORs (OR) of 1.16 (95% CI 1.08 to 1.26) for 1 or more spontaneous abortions, 1.44 (95% CI 1.20 to 1.73) for 1 or more stillbirths, and 1.43 (95% CI 1.10 to 1.86) for 1 or more ectopic pregnancies. Never-smoking women participants with the highest levels of lifetime SHS exposure, including childhood >10 years, adult home >20 years and adult work exposure >10 years, when compared with never-smoking women with no SHS exposure had adjusted ORs of 1.17 (95% CI 1.05 to 1.30) for spontaneous abortion, 1.55 (95% CI 1.21 to 1.97) for stillbirth, and 1.61 (95% CI 1.16 to 2.24) for ectopic pregnancy.

 
These new studies reinforce the fact that the economic argument has shifted to supporting smokefree policies.  These immediate effects on health and the associated medical care costs dwarf even the most aggressive (albeit unproven) claims of the tobacco industry and its allies and fronts that smokefree policies hurt the bar and casino business.
 
Public health forces should start using economics to justify smokefree (and other tobacco control) policies.