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Extension of Smoke-Free Laws to Restaurants and Bars Leads to Less Babies Being Born with Low Birth Weight, Dutch Study Suggests

Date:10 May 2016
Author:GHLG Blog

By Brigit Toebes, University of Groningen, b.c.a.toebes(at)

An investigation into the effects of tobacco control laws by a group of medical researchers sends an important message to law and policy makers. The study reveals that tighter tobacco control laws and policies, especially those introducing an extension of the smoke-free law to the hospitality industry, in combination with a tax increase and a public campaign, leads to less babies being born with low birth weight.

The researchers investigated whether there were changes in perinatal outcomes following the introduction of a set of tobacco control laws and policies in the Netherlands. These measures included the implementation of smoke-free legislation for workplaces, combined with a tobacco tax increase and mass media campaign (January –February 2004), and an extension of the smoke-free law to the hospitality industry, accompanied by another tax increase and mass media campaign (July 2008). The study covered a population of more than two million births, approximately 96% of all pregnancies in the Netherlands over a 12-year period (making it one of the largest studies on this subject to date). Three indicators were measured: perinatal mortality, preterm birth, and being small for gestational age (SGA).

In 2004, the researchers did not observe changes in pregnancy outcomes following the introduction of the national smoke-free workplace law, mass media campaign and tax increase. Yet extending the legislation to include the hospitality industry in 2008, together with another tax increase and mass media campaign, was associated with a significant reduction in babies exhibiting SGA. This finding is consistent with earlier studies. The researchers did not find an impact of the aforementioned legislative and policy amendments on overall preterm births or perinatal mortality. More importantly, the authors observe that the overall benefits of these laws and measures in the Netherlands was less pronounced than those observed in countries with a more comprehensive smoke-free regulatory framework and a better compliance-record.

The study shows that extension of the smoke-free law from workplaces to bars and restaurants together with the mass media campaign had a positive effect on the birth weight of newborn babies. This finding has major implications for law and policy makers around the world who are planning to adopt new tobacco control measures or are aiming for stricter implementation of the existing ones.

More generally, this approach, in which the effects of law and policies on health outcomes are measured, is innovative and holds an important promise for future research and practice.


Myrthe Peelen and others, ‘Tobacco Control Policies and Perinatal Health: A National Quasi-Experimental Study’ (2016) 6 Nature Scientific Reports, available at <>.


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