Has the smoking ban reduced child asthma admissions?
Thursday, September 16, 2010 Yesterday I was asked by the Scottish Daily Mail to comment on a new study by the Centre for Population Health Studies at the University of Glasgow that claims that child asthma admissions have dropped 18 per cent per year in Scotland since the introduction of the smoking ban.
Superficially the press release seemed quite plausible:
The rate of hospitalisations for children with asthma in Scotland has dropped by more than 18 per cent year-on-year since the introduction of the ban on smoking in public places in 2006, according to scientists.
Before the smoking ban came into force, admissions for asthma were increasing at a mean rate of 5.2 per cent a year. After the ban, admissions decreased by 18.2 per cent per year, relative to the rate on March 26, 2006.
Professor Pell said: "The aim of the study was to determine whether the smoking ban produced benefits for people who do not have occupational exposure to tobacco smoke. We found a reduction in asthma admissions among both preschool and school-age children.
"It is clear that smoke-free legislation has resulted in a reduction in the rate of respiratory disease in populations other than those with occupational exposure to environmental tobacco smoke."
But wait. Professor Pell has history. It was her study in 2007 that suggested that the smoking ban was responsible for a big cut in heart attack admissions in Scotland. Not everyone agreed - see Has the smoking ban reduced heart attacks by Tessa Mayes in the Spectator (October 2007) and Health fears go up in smoke by Chris Snowdon, published by Spiked (December 2008).
Anyway, let's take a closer look at Jill Pell's latest study. On page 36 there's a graph and it shows the daily hospital admissions for asthma among children between January 2000 and October 2009:
2000 ..... 2391
2001 ..... 2142
2002 ..... 2034
2003 ..... 1803
2004 ..... 2621
2005 ..... 2103
2006 ..... 2633
2007 ..... 2056
2008 ..... 2235
2009 ..... 1397
Let's re-jig that list with the smallest number of hospital admissions at the top and the largest number at the bottom:
2009 ..... 1397
2003 ..... 1803
2002 ..... 2034
2007 ..... 2056
2005 ..... 2103
2001 ..... 2142
2008 ..... 2235
2000 ..... 2391
2004 ..... 2621
2006 ..... 2633
If Jill Pell is correct in her assertion that "It is clear that smoke-free legislation has resulted in a reduction in the rate of respiratory disease in populations other than those with occupational exposure to environmental tobacco smoke" you would expect the years 2006-2009 to be at the top of the table because the smoking ban was introduced in Scotland in March 2006.
But they're not. They are spread evenly over the period. In fact, some of the years with the lowest hospital admissions for child asthma were before the smoking ban!!
According to Professor Pell's own study there is only one year in which hospital admissions for child asthma fell substantially and that is 2009, a full three years after the smoking ban was introduced.
Given this evidence I defy any reasonable person to state with conviction that the smoking ban (a) caused the sudden drop in admissions in 2009 or (b) is responsible for lowering child asthma admissions in Scotland.
Anyway, here's the comment I eventually gave the Scottish Daily Mail:
"This study doesn't prove anything. We're told that child asthma admissions have dropped 18 per cent per year since the smoking ban, yet their own figures show that, prior to the smoking ban in March 2006, admissions were more often than not lower than after the ban.
"The only significant drop in admissions took place in 2009, three years after the smoking ban. It would extremely foolish, based on these figures, to assume that the smoking ban was primarily responsible.
"This is another example of figures being massaged to justify a draconian piece of legislation that has helped to close 700 pubs in Scotland and ruined a great many people's social lives."
If he hasn't done so already Chris Snowdon will be posting a rather fuller analysis on his blog Velvet Glove Iron Fist.
Update: Chris has posted HERE.
Simon Clark
The Mail didn't use my quote but I'll let you into a little secret. The reporter told me that he was "sceptical" about Jill Pell's study but the paper felt "obliged" to run with it.
Simon Clark
Needless to say the story has been picked up by an unquestioning media. The Scotsman, for example, has it HERE. You can comment. Pathetic.
Reader Comments (46)
What interests me about this is the fact that it's children she is talking about. I assume that the majority of children in Scotland don't frequent pubs [correct me if I'm wrong], which would presuppose that their exposure would come within the home environment.
Now, as we keep hearing that smokers are now drinking at home, then there is only one conclusion [if the figures had been correct] and that is that the increased level of smoking at home has been responsible for the drop in asthma levels.
Heh!
If I thrutched about enough, I suppose that I could produce a graph and embed it, but I do not know how. But a graph is not necessary in this case – the situation can be illustrated quite simply thus:
Taking the number 2000 (asthma cases admitted) as a median-----
CASES ABOVE/ BELOW THE MEDIAN
2000 +400
2001 +150
2002 +0
2003 -200
2004 +600
2005 +100
2006 +600
2007 +0
2008 +200
2009 -600
Totals
Above the median 2050 Below the median 800
Thus, between the years 2000 and 2009, when smoking overall has been decreasing, asthma cases admitted to hospitals has increased. (NB. The decrease in smoking overall has been attested by government figures, therefore it must be true (?)).
It seems to me that much is being made of ‘the blip’ of (minus) -600 in 2009. That is the crux of the matter. But that ‘blip’ is no less a ‘blip’ than the ( plus) +600 in 2006, along with the (plus) +600 in 2004, and the +400 in 2000. Blips are blips, regardless of whether they are plus or minus.
Statisticians must be hiding their heads in shame to see such nonsense published. Only if the ‘blip’ (-600) continues for a couple of years (at least) can a trend be established.
One cannot help but ask, given sufficient funds, if there is any way in which these assertions can be contested in the public arena? It really ought to be possible to force Pell to withdraw her conclusions, by going to court of necessary (although not realistic).
I cannot help but feel that there is a serious need for a simple association of smokers, preferably UK based.
The important word is SIMPLE. Are you a smoker or sympathetic? Then join! Strength in numbers. There would be only two important questions:
1. Are you happy to risk harm to your health (if any) by smoking?
2. Do you agree that your smoke (if any) harms nobody?
If the answer to 1 is 'no' and the answer to 2 is 'yes, then you should join the movement. For the time being, whether or not the smoking ban should be repealed or amended is not important. In due course, pressure could be brought to bear.
All who post or read posts should be members. Thereafter, it is simply a matter of accretion, and in due course, some influence.
Dear God - more Kindercrap !
Over the last few decades the smoking rate has halved while the the number of people with asthma has increased threefold.
This is soooooooo infuriating, Simon. What's to be done? Can't you put out anything about Prof Pell being at it again with her desperate statistics, which show anything but what she claims they do?
Reading the comments already posted on the paper's site - its clear the average Scotsman reader is more questioning and probing than the average Scotsman journalist.
Glad you've linked to Chris' analysis of the "study." This piece of toilet paper is so flawed it beggars belief.
1) As your figures above show, the rates are spread evenly across the years, both pre and post-ban.
2) She only used 10 months of 2009 (and there are fewer cases in 10 months than 12? Say it ain't so!)
3) Other issues (like increasingly wet summers and the change from carpeting to floorboards) are unaccounted for.
4) Their own figures show that smoking rates have declined since 2000. Certainly places where you can smoke have. So why are 4 of the top 6 years pre-Ban? Isn't she actually proving that smoke has a protective effect ( as has been proven by several other studies)?
As annoying as I find the whole "not smoking in pubs" thing, it's this perversion of science that I find truly disturbing. Hopefully these things come in cycles and eventually these fraudsters will be found out. But while the media employ journalists with no scientific background I can't see when this might happen.
I would say that the extremely cold frosty weather experienced last winter that killed off a lot of air pollution i.e, carbon monoxide and diesel and petrol fumes in the atmosphere, as well as killing off nearly all my plants and shrubs, would prove, if some other 'expert' took a survey, that this had more to do with the drop in hospital admissions than the harmless fag.
The point to hammer home here is that made by Grandad. Especially as the anti-smoking leviathan is turning its attention to banning smoking in the home. We had an article in the local newspaper recently (I live in Norway) claiming that we should accept home smoking bans in the same way that we accept that there are myriad other things we cannot do in our own homes. This chap claimed that if we accepted that we could not use heroin or physically abuse children or commit acts of violence in our own home we should have no problem accepting not being allowed to smoke at home. I did point out that the other activities he had mentioned are illegal everywhere and that tobacco use is not, in fact, illegal. He did not reply.
Here are some studies which suggest that cigarette smoke protecs you form getting asthma in the first place.
“Children of mothers who smoked at least 15 cigarettes a day tended to have lower odds for suffering from allergic rhino-conjunctivitis, allergic asthma, atopic eczema and food allergy, compared to children of mothers who had never smoked (ORs 0.6-0.7)
CONCLUSIONS: This study demonstrates an association between current exposure to tobacco smoke and a low risk for atopic disorders in smokers themselves and a similar tendency in their children.”
“MedWire News: Parental smoking during childhood and personal cigarette smoking in teenage and early adult life lowers the risk for allergic sensitization in those with a family history of atopy, according to the results of a study from New Zealand. Writing in the Journal of Allergy and Clinical Immunology, Robert Hancox (University of Otago, Dunedin) and colleagues explain that "the findings are consistent with the hypothesis that the immune-suppressant effects of cigarette smoke protect against atopy." The authors write: "We found that children who were exposed to parental smoking and those who took up cigarette smoking themselves had a lower incidence of atopy to a range of common inhaled allergens.
"These associations were found only in those with a parental history of asthma or hay fever." They conclude: "The harmful effects of cigarette smoke are well known, and there are many reasons to avoid it.” Our findings suggest that preventing allergic sensitization is not one of them."
http://www.ncbi.nlm.nih.gov/pubm...pubmed/ 11422156
http://www.medwire-news.md/48/72330/Respiratory/Smoking_linked_to_reduced_allergic_sensitization_.html
If one really wants to see some real publication bias please enjoy this slide show from the Royal College Of Physicians. This was the "proof" that SHS causes a whole variety of childhood diseases such as asthma and middle ear disease . The RCP must assume I and the rest of the poplulation are fools.
The left hand axis is the factor by which the incidence is raised.For example 1.25 means a 25% raised risk. However the bottom axis is a poverty index which by inference means that the children on the right hand column (poorest) are exposed by 100% to more SHS. Poorer people are twice as likely to smoke as richer people.
Also please note none of the graph lines exceed 2.0 and therefore are epidemiologically statistially insigniciant anyway.
Also if you are poor you are more likely to live in unsanitary houses and estates where greater concentrations of people live. Ergo a greater number of viral and bacterial exposure and to people with infections.
Middle ear infection: 100% increase in SHS exposure actually leads to less MEI and if anything is protective to it.
Lower Respiratory Tract Infection: At 100% SHS increase in SHS LRTI incidence increases to 50%. Hence if anything SHS gives a protection of 25%
Wheeze: At 100% raised SHS exposure the incidence of wheeze rises by 30%, and therefore approx 33% protective reduction in wheeze.
Asthma 3-4 year olds: This is a straight line and proves entirley that asthma is not caused by SHS and reduces for the higher levels of exposure to SHS.
Asthma 5 year olds. This too is a straight line and proves entirley that asthma is not caused by SHS and reduces for the higher levels of exposure to SHS.
Meningitis: The only example that reaches at some stage statistical significance at 2.25. Curious however that at the greatest levels of exposure to SHS the incidence falls.
This level of publication bias in my opinion brings the RCP and its scientists into serious disrepute.
http://www.rcplondon.ac.uk/professional-Issues/Public-Health/Documents/How-much-disease-in-children-is-caused-by-passive-smoking.ppt#263,5,Socioeconomic status
For the love of God more bullshit from a so called professor!!
I find Dave's post interesting. Many years ago, I gave up smoking for more than three years. Shortly after stopping, I developed bronmchial asthma and had to carry inhalers with me at al times. Then I started smoking again (long story, not relevant). My asthma gradually improved to where I was only getting one attack a year - and I could see it was linked to air quality/weather. I have not had an attack for around 10 years, despite being a heavy smoker. No-one believes me of course - except for my doctor during those years, who has my records - unfortunately in Germany where I was living at the time. Interesting, eh?
The answer to the headline is who the hell knows but based on the last 10 years figures it certainly doesn't look like it.
Perhaps this is Pell's game. Cause confusion, demand more time and hope.
Here is the full text of a letter written by a Dr.K.W.E.Denson and published in The Daily Telegraph in July 2003. It contains some rather interesting facts - including some about asthma.

Re: Smoking is not all evil
Date: 9 July 2003

Sir - Sir Liam Donaldson (report, July 4) is misinformed.
A recent study of 118,094 Californian participants of the American Cancer Prevention Study concluded that non-smokers exposed to environmental tobacco smoke (ETS) had no greater risk of heart disease or lung cancer than those not exposed.
The largest and most recent assessment of ETS exposure by the US National Centre for Environmental Health showed that exposed non-smokers had on average only 1/500th of the exposure of the active smoker. How, then, does Sir Liam substantiate a 70 per cent increase in risk of heart disease for an active smoker and 30 per cent for an ETS exposed non-smoker?
Cot deaths are weakly linked to passive smoking, but much more strongly linked to low maternal age, low maternal education and paternal unemployment, which are highly linked to parental smoking. It thus becomes impossible statistically to say whether passive smoking has any effect on cot deaths. The association between ETS and middle ear disease is equally tenuous.
Far from it causing asthma, many studies have shown a reduced incidence of asthma, eczema, and hay fever with maternal or pre-natal smoking. In the largest study of its kind, involving 56 countries, those with the greatest air pollution (and ETS exposure) had by far the lowest incidence of asthma, and those with the cleanest air had the highest.
How does Sir Liam explain the more than twofold increase in childhood asthma in Britain during the past two decades, when active smoking has been halved and ETS exposure reduced even more?
Smoking is not all evil. Compared with non-smokers, smokers have half the risk of Parkinson's disease and a reduced risk of Alzheimer's disease. Women who smoke after their first full-term pregnancy have half the risk of developing breast cancer. Would it not be more honest to allow smokers the choice of an increased risk of lung cancer and heart disease, or an increased risk of Parkinson's or Alzheimer's diseases?
From:
Dr K W E Denson, Thame Thrombosis and Haemostasis Research Foundation, Thame, Oxon
Most interesting!
My niece has been an asthmatic from birth.
Her husband and two children pleaded with her to stop smoking and she would always tell them to fuck off and mind their own business.
She's still quite happy using her inhaler, which I might add has decreased enormously as she gets older, while still enjoying smoking her cigarettes.
This study is particularly insightful as it is a meta analysis from multiple countries.
"The ecological relationship of tobacco smoking to the prevalence of symptoms of asthma and other atopic diseases in children: the International Study of Asthma and Allergies in Childhood (ISAAC)."
"...countries that have high adult male smoking rates have a lower risk of asthma and rhinitis symptoms in children."
http://www.ncbi.nlm.nih.gov/pubmed/12086081
What have a so called drop in asthma cases in children got to do with the politition's smoking ban in adult's pubs and clubs? It sounds like more properganda from groups like ASH and thier health gurus to try and justify thier discriminative, disasterous dictatorship smoking ban.
Hang on a minute - the ban on smoking is in 'public places'; most notably offices, pubs, clubs and restaurants. Who takes pre-school and school-age children regularly to any of those places? But smokers do, of course, still smoke at home. What utter nonsense.
clif e
I'm guessing, but I think it may be a prelude to demands for a ban on smoking in homes containing children. I expect they'll argue that most people now go outside for a smoke so everyone else can too. And then childhood asthma will be a thing of the past.
Only it won't. Here's a lab-based study:
Nicotine Primarily Suppresses Lung Th2 but Not Goblet Cell and Muscle Cell Responses to Allergens
Okay. I can't do links :(
Here's the URL:
http://www.jimmunol.org/cgi/content/abstract/180/11/7655
Three excellent points have come up in these comments, which I would think ought to be included in your press release: (a) the effects of the smoking ban would apply almost entirely to pubs, clubs and other places kids don't go to, (b) that being the case, people are smoking more at home, so if anything one would expect asthma to increase, and (c) the overall rate of asthma has been going up for ages, at the same time as smoking has gone down.
I also agree that there HAS to be something that can be done about people getting away, over and over again, with such outrageous lying. Can't someone sue Jill Pell?! For fraud or something? How could they possibly lose when it is so easy to demonstrate the lies? And why is the tobacco industry, for instance, silent when it comes to arguments that they would surely be able to win? Something just doesn't add up!
It has all been said, above.: Dont' smoke at home where the kids are; smoke in pubs where the kids are not allowed. My son had asthma and when they more or less cured that he got exzema which the doctors said was normal for asthmatics when the asthma was controlled. Tell Dr. Pell that by reducing asthma she is increasing the risk of exzema - it goes away as they get into the teens. Tell her to put that in her pipe and smoke it.
"Who takes pre-school and school-age children regularly to any of those (public) places?" You beat me to it, Peta! So, let's put it another way: How many 'CHILDREN' visit pubs? How many 'CHILDREN' go to work? How many 'JOURNALISTS' know how to ask The Obvious Question? How will Jilly-The-Prof explain any future RISE in child asthma? How Simon keeps his rag, I'll never understand ......
Hear, hear Joe. I would so love to see these people's press releases exposed for the shameless propaganda they are. And when they take such outrageous risks with the truth, surely that can't be impossible?
"This level of publication bias in my opinion brings the RCP and its scientists into serious disrepute." Fear not, Dave. Should any of these 'scientists' get blown out, they'll find plenty of employment opportunities with the IPCC!
But all the available evidence shows that children growing up in non-smoking households are 3 to 6 times more likely to develop asthma as an adult ????
Joe Jackson, think the Tobacco Industry's lawyers have told them NEVER to walk into the spotlight suing researchers: they'd not only be seen as bullies, but as "interfering with honest scientific research" (even if the courts decided it was NOT honest scientific research). Plus, a good bit of their legal strategy nowadays seems to hinge on "We're SORRY! We were BAD! Please don't HURT us any MORE! We'll be GOOD! Look! Look! SEE how GOOD we are nowadays? We're ANGELS!"
Michael J. McFadden
Author of "Dissecting Antismokers' Brains"
The greatest thing about the world wide attempt at a smoking ban is that the people finally have to pay attention to the encroaching tyranny... kind of a dumb move on the part of the globalists... don't you think?
More junk science. Why does this woman not attribute or even mention the affect of traffic fumes to asthma figures? Why? Because she has an anti-smoking agenda. Her professional judgement is undoubtably clouded by her personal prejudice against smoking. Maybe she was paid by big pharma to say this?
Seems you have the same problem we do. When the govt. stats that the anti- smoking, drinking, hunting, fur, meat whatever crowd love so much and use to support their arguments prove them wrong they then ignore or dismiss said stats. I hate Political Correctness.
@Karen
What a terrific post. I am writing a paper on passive smoking and that will definitely be included.
"The results unequivocally show that, even after multiple allergen sensitizations, nicotine dramatically suppresses inflammatory/allergic parameters in the lung.."
Do people honestly believe that smoking is one of the sole causes of asthma? Back in the 1970s, when the majority of pubs and clubs never had air conditioning or smoke extractors, when teachers use to smoke in the classrooms, when people use to smoke everywhere "on buses, on trains and planes" WHO HEARD IF ASTHMA? i for one never knew anyone who had asthma then, so ASH and the other health gurus, tell us another one, they may be some gullible idiots who would believe you, but i for know rubbish when i hear it.
@CathyK
Thanks for Dr Denson's letter. I keep re-reading it to cheer myself up. So nice to see a doctor willing to break ranks and tell the truth.
@Rose
If you google Dr Denson you will find many learned papers written by him. Unlike Prof.Pell, he's a true scientist, is honest in his representation of statistics and has no axe to grind. Only some of his papers concern tobacco, the vast majority are about other matters, and he is painstakingly objective and truthful.
Others here have suggested that Prof.Pell be openly challenged - she should be. She occupies a position of public trust AND public payment for her work for The Centre for Population Health Studies at the University of Glasgow. Her 'work' would be risible were it not so shamefully dishonest and she should be fired.
@Cathy and Rose
The late Dr K. W. E. Denson came from a time when science was evidence based and not political spin. Dr. Denson was a 10 a day smoker who, I think, died at the age of 82.
After he retired he founded the Thame Thrombosis and Haemostasis Research Foundation, to look into the claims of ASH and the other anti smoking organisations. As you can expect he found them wanting.
The world is a poorer place without him and Joe Jackson was one of the last people to meet him in a professional capacity.
May God bless.
Joe Jackson
Your point (c) the overall rate of asthma has been going up for ages, isn't quite so anymore - and certainly not for children.
My comment over at Chris Snowdon's place:
"... the rates [of asthma] are declining, particularly for little children. But the decline started long before the introduction of smoking bans - around the end of the 'eighties, if memory serves.
I suggest that the rise and fall of asthma has a lot to do with the fashion for floor coverings. A sudden, sharp rise from c.1970 when wall-to-wall carpeting became all the rage; an almost equally impressive dip with the trend for wooden laminates. About the only cause of asthma that all researchers seem to agree on is the presence of house-dust mites, pollens and pet dander, all of which settle comfortably into the soft pile of carpets."
Of course, for twenty-odd years there was both a massive increase in asthma and a massive decrease in smoking. But if Simon's going into battle with people who will certainly know the stats - and will use them the way Pell has - he needs know that the asthma picture is changing.
Could also add that nictine is an effective insecticide. Has anyone looked to see if there's a difference in the number of house-dust mites between your typical smoking and non-smoking households?
About a year after the ban in Scotland, figures came out about the smoking ban reducing heart problems. I thought at that time - wow - not a year past but enough info' to prove that cigs cause heart problems. (which idiot did this peice of reasearch belong to)
Now, I belive the same person has stated that the smoking ban has reduced childhood asthma. One look at the figures shows the woman is an idiot.
I can only ponder on what her objective is - and more to the point who funds her waste of time research.
Dr. Denson invented the machine that measures blood to determine the correct dose of Warfarin for those who've had blood clots.
He's saved far, far more lives than tobacco control ever has.
@ Dave Atherton
I am so sorry to hear that Dr. Denson has passed on - 82 years is not a bad innings, particularly as he 'shortened his life with cigarettes'....... What a loss he is, not only to this particular cause, but to the cause of objectivity, rationality & truthseeking overall.
@ Karen
You raise some interesting points. And you are quite right: Simon needs to be armed with current info.
@Cathy and Rose
Is not tobacco control and the internet one of the greatest stimuli to learning? I had no idea that Dr. Denson was that clever.
I had an email from a person in the media who I wrote a stinging email to on his "evidence." He completely failed to answer my main points and fell back on anecdotal evidence of his nurses.
We may win yet.
These numbers on their own do not stand up.
If we are an aging population, then the number of 'children' is decreasing proportiionally year on year, and yet the numbers are not.
What we should be looking at, is the 'proportion of asthma suffering children' this would show if the number is increasing or decreasing.
So assuming the number of 'children' has decreased, then with the figure in 2009 going up - then it would actually show that the proportion of asthma sufferers has 'increased' since the smoking ban!!
It's just another way of someone providing 'statistics' that show a picture that they want people to believe.
It's a shame that so many people are fooled by 'statistics' that are actually not showing the true trend - and as many are totally fooled by them, and use them to base illigimate arguments on.
The truth is out there - it's a question of wether you want to hear it - and reading some of the comments on here, it looks to me like most people have already made their minds up, before they read the facts. These people should read 'Scared to Death' a brilliant book that has a chapter on the largest passive smoking survey ever undertaken - that is, if you're not scared of the truth!!
"That the people finally have to pay attention to the encroaching tyranny... " Neat point, Doug. Perhaps, after all, it IS possible to be 'too clever for your own good'.....
To all who fight the smoking bans and strike a cry for freedom ... I applaude you!
If Smoking isn't responsible for Asthma (and it seems patently obvious that it isn't), isn't this woman guilty of being professionally negligent by using SHS as a catch-all for every form of heart/lung desease.
I think her time would be better spent trying to determine the real reasons for Asthma amongst children rather than appease a political agenda!
Smoking & the Tabacco industry is now deemed immoral and nobody of any weight will ever question anybody that provides 'evidence' that undermines smoking.
Poor Jill, She really has got her knickers in a twist. She has just created a most intiguing paradox. Is she anti-smoking or pro-smoking? She claims to be anti-smoking, yet sets out to prove that smoke is beneficial to children by forcing the smoker-drinkers to stay at home with the kids so they can smoke and drink in comfort. Perhaps her next objective should be to advocate the return of the ashtrays, and for all the pubs to have non- smoking rooms for the wimps and smoking rooms for us with adjoining play rooms so the kids can still enjoy the benefits.