Smoking bans in public places and socioeconomic inequalities in smoking prevalence and cessation: a population-based cross-sectional study in Geneva, Switzerland (1995-2014)

José Luis Sandoval, Teresa Leão, Stéphane Cullati, Jean-Marc Theler, Stéphane Joost, Jean-Paul Humair, Jean-Michel Gaspoz , Idris Guessous.
Public smoking ban and socioeconomic inequalities in smoking prevalence and cessation: a cross-sectional population-based study in Geneva, Switzerland (1995-2014)., Tobacco Control, November 2018, doi: 10.1136/tobaccocontrol-2017-053986.

Abstract

Introduction: Smoking bans have been introduced with the aim of reducing smoking prevalence and boosting quit rates, but their impact in terms of equity remains uncertain. We sought to characterise inequalities related to socio-economic status (SES) in smoking prevalence and cessation rates before and after the implementation of a smoking ban in public places.

Methods: We included data from 17,544 people participating in the population-based, cross-sectional "Health Bus" study in Geneva, Switzerland, between 1995 and 2014. We considered education level (primary, secondary and tertiary) as an indicator of SES. The study measured smoking prevalence (proportion of current smokers) and quit rate (proportion of ex-smokers among people who had ever smoked). We used segmented linear regression to assess the overall impact of the smoking ban on the measures. We calculated two inequality indices: relative (RII) and slope (SII, absolute difference), quantifying the disparities between education levels in terms of overall results (1995-2014), before and after the ban was implemented (November 2009).

Results: Participants with the lowest level of education showed a higher prevalence of smoking (RII=2.04, P<0.001; SII=0.15, P<0.001) and a lower quit rate (RII=0.73, P<0.001; SII=-0.18, P<0.001). As in other studies, implementation of the smoking ban coincided with a temporary reduction in smoking prevalence (P=0.003) and an increase in the quit rate (P=0.02), with a gradual return to pre-ban levels. Inequalities increased (P<0.05) in relative terms for smoking prevalence (RII before=1.84, P<0.001 and RII after=3.01, P<0.001) and in absolute terms for both outcomes (smoking prevalence: SII before=0.14, P<0.001 and SII after=0.19, P<0.001; quit rate: SII before=-0.15, P<0.001 and SII after=-0.27, P<0.001).

Conclusions: The implementation of a smoking ban in public places coincided with a decrease in smoking prevalence and an increase in short-term cessation rates, but also with an increase in SES-related inequalities in smoking-related outcomes.

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