The Union in Brazil marks World No Tobacco Day by releasing impactive study results

On World No Tobacco Day (WNTD), results from a new study were released, showing that Brazil’s tobacco control actions may have contributed to significant reductions in neonatal and infant mortality over the last two decades. Additionally, it was estimated that had all smokefree legislation introduced since 2004 been comprehensive, a further 10,091 infant deaths could have been averted.

The study, titled Smoke-free legislation and neonatal and infant mortality in Brazil: a longitudinal quasi-experimental study, was published in the BMJ Tobacco Control. Cristiane Vianna, The Union’s Brazil representative is one of the authors of the study and she was one of the speakers at the Brazilian National Cancer Institute’s (INCA) event marking WNTD on 31 May 2019. INCA is one of The Union’s tobacco control grantees in the region.

Brazil is a recognised global leader in tobacco control, with a strengthening of smokefree legislation which occurred in a phased manner across Brazilian states and municipalities, followed by a comprehensive federal law in 2014. The study took advantage of this unique natural experiment of comprehensive smokefree legislation implementation in Brazil, and was able to examine both partial and comprehensive restrictions, from January 2000 to December 2016, across all Brazilian municipalities. Comprehensive smokefree legislation prohibits smoking in enclosed public places, and consequently reduces second-hand smoke exposure.

In this context, this study examined changes in neonatal and infant mortality associated with strengthening smokefree legislation in Brazil over the study period; essentially the first study to analyse early life outcomes in relation to such legislation in a low and middle-income country (LMIC). Results showed that the introduction of the legislation was associated with significant and important reductions in neonatal and infant mortality. The implementation of partial smoke free legislation was associated with a 3.3 percent step reduction in the municipal infant mortality rate. Comprehensive smoke free legislation implementation was associated with 5.2 percent and 3.4 percent step reductions in infant and neonatal mortality respectively, and a 0.36 percent annual decline in infant mortality. The findings were found to be consistent with previous research undertaken in high-income countries.

Prior to the study, there was little evidence on whether the implementation of smokefree legislation would support the achievement of the Sustainable Development Goal (SDG) target of reducing neonatal mortality in LMICs.  In LMICs the smoking rates and exposure to second-hand smoke is often high, and the implementation of tobacco control policies can be poor. One-third of LMIC countries are not expected to meet SDG targets on neonatal mortality. In addition, previous studies have not compared the health benefits obtained from partial and comprehensive smokefree legislation, important since only 20 percent of the global population is covered by the comprehensive form.

There are obvious implications for similar tobacco control activities in other countries, with such measures being an important part of the policies required to achieve the infant health targets within SDG three. Tobacco control measures, such as smokefree legislation, increased taxation, and banning of advertising and promotion are either cost neutral or revenue raising, and can be successfully implemented where there is the political impetus to do so.

The Union has supported tobacco control in Brazil for more than a decade, having worked alongside INCA and the Oswaldo Cruz Foundation (Fiocruz) in a major nationwide tobacco control policy reform, making Brazil a regional leader for tobacco control, with an associated drop in adult smoking rates.