Impact of expanding smoke-free policies beyond enclosed public places and workplaces on children’s tobacco smoke exposure and respiratory health: protocol for a systematic review and meta-analysis

Introduction 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...

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Main Authors: Alex Burdorf, Aziz Sheikh, Christopher Millett, Jasper V Been, Frank J Van Lenthe, Márta K Radó, Famke JM Mölenberg, Wichor M Bramer
Format: Article
Language:English
Published: BMJ Publishing Group 2020-10-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/10/10/e038234.full
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author Alex Burdorf
Aziz Sheikh
Christopher Millett
Jasper V Been
Frank J Van Lenthe
Márta K Radó
Famke JM Mölenberg
Wichor M Bramer
author_facet Alex Burdorf
Aziz Sheikh
Christopher Millett
Jasper V Been
Frank J Van Lenthe
Márta K Radó
Famke JM Mölenberg
Wichor M Bramer
author_sort Alex Burdorf
collection DOAJ
description Introduction 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.Methods and analysis 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 We will consult experts from the field and hand-search references and citations to identify additional published and unpublished studies.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.Ethics and dissemination Ethical approval is not required. Findings will be disseminated to academics and the general public.PROSPERO registration number CRD42020190563.
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spelling doaj-art-74bac047b1fd49c9866499aef85d08492024-11-16T09:45:12ZengBMJ Publishing GroupBMJ Open2044-60552020-10-01101010.1136/bmjopen-2020-038234Impact of expanding smoke-free policies beyond enclosed public places and workplaces on children’s tobacco smoke exposure and respiratory health: protocol for a systematic review and meta-analysisAlex Burdorf0Aziz Sheikh1Christopher Millett2Jasper V Been3Frank J Van Lenthe4Márta K Radó5Famke JM Mölenberg6Wichor M Bramer71 Department of Public Health, Erasmus University Medical Center, Rotterdam, The NetherlandsAsthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK1 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UKDepartment of Paediatrics, Erasmus MC - Sophia Children`s Hospital, University Medical Centre Rotterdam, Rotterdam, NetherlandsDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, NetherlandsDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenDepartment of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, NetherlandsMedical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The NetherlandsIntroduction 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.Methods and analysis 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.Ethics and dissemination Ethical approval is not required. Findings will be disseminated to academics and the general public.PROSPERO registration number CRD42020190563.https://bmjopen.bmj.com/content/10/10/e038234.full
spellingShingle Alex Burdorf
Aziz Sheikh
Christopher Millett
Jasper V Been
Frank J Van Lenthe
Márta K Radó
Famke JM Mölenberg
Wichor M Bramer
Impact of expanding smoke-free policies beyond enclosed public places and workplaces on children’s tobacco smoke exposure and respiratory health: protocol for a systematic review and meta-analysis
BMJ Open
title Impact of expanding smoke-free policies beyond enclosed public places and workplaces on children’s tobacco smoke exposure and respiratory health: protocol for a systematic review and meta-analysis
title_full Impact of expanding smoke-free policies beyond enclosed public places and workplaces on children’s tobacco smoke exposure and respiratory health: protocol for a systematic review and meta-analysis
title_fullStr Impact of expanding smoke-free policies beyond enclosed public places and workplaces on children’s tobacco smoke exposure and respiratory health: protocol for a systematic review and meta-analysis
title_full_unstemmed Impact of expanding smoke-free policies beyond enclosed public places and workplaces on children’s tobacco smoke exposure and respiratory health: protocol for a systematic review and meta-analysis
title_short Impact of expanding smoke-free policies beyond enclosed public places and workplaces on children’s tobacco smoke exposure and respiratory health: protocol for a systematic review and meta-analysis
title_sort impact of expanding smoke free policies beyond enclosed public places and workplaces on children s tobacco smoke exposure and respiratory health protocol for a systematic review and meta analysis
url https://bmjopen.bmj.com/content/10/10/e038234.full
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