Correlation between tobacco control policies and preterm births and low birth weight in Europe

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To assess the correlation between tobacco control policies— particularly smoking bans in work and public places—and the prevalence of preterm births and low birth weight in the European countries.


This is an ecological study and the unit of analysis set at the country level. Tobacco control data in Europe were obtained for the years 2010 and 2013 as measured by the Tobacco Control Scale (TCS), which reflects the level of implementation of tobacco control policies. Prevalence data for preterm births and low birth weight were obtained from two sources: the European Perinatal Health Report (EPHR), which provides data for 2010, and the Eurostat data, which includes the years 2013 and 2014. We analyzed the correlation between the TCS score and the prevalence of preterm birth and low birth weight in the European countries by means of Spearman (rsp) rank-correlation coefficients and their 95% confidence intervals (95%CI).


The 2010 TCS was negatively correlated with the prevalence of preterm births before week 37 (rsp = −0.51; 95% CI: −0.77, −0.15; p = 0.006) and week 32 (rsp = −0.42; 95%CI: −0.73, −0.01; p = 0.030) and with the prevalence of the low birth weight (< 2500 g, (rsp = −0.42; 95% CI: −0.66, −0.09; p = 0.028) in European countries in 2010. We found a statistically significant inverse correlation between the level of restrictions on smoking in public places and the prevalence of low birth weight (< 2500 g rsp: −0.54; 95%CI: −0.72, −0.10; p = 0.017).


The level of smoke-free legislation in European countries correlates with lower preterm birth prevalence rates at the ecological level. Given the important negative effects of premature births for the public health system, these data support greater implementation of smoke-free policies and tend to support the implementation of tobacco control policies, but more research is needed.

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