Adult Exposure Study (Health Education Population Survey - HEPS)

A pre- post- repeat cross-sectional household survey to determine adult non-smokers´ exposure to second-hand smoke (SHS) and associated changes in public and private spaces was conducted.

This study, conducted by NHS Health Scotland and British Market Research Bureau Social Research (BMRB), uses the Health Education Population Survey (HEPS) - an annual survey - to collect the data.

Principal Investigator: Sally Haw

Study Aims

  • Determine if there was a measurable change in adult non-smokers´ exposure to second-hand smoke (SHS) in public and private places post-implementation of smoke-free legislation in Scotland.
  • Assess whether any overall changes in SHS exposure were related to changes in exposure in public or private spaces.
  • Determine if there was any evidence of displacement of smoking from public places into the home.

Study Design

  • Repeat cross-sectional household survey of nationally representative samples of 1800 adults (ages 16-74 years) pre-legislation and 1800 adults post-legislation.
  • Data were collected by trained interviewers using computer assisted personal interviewing (CAPI).
  • Samples of saliva were also collected for testing for cotinine - a biomarker of second-hand smoke (SHS) exposure in non-smokers.
  • Main outcome measures included: salivary cotinine concentrations; self-reported exposure to tobacco smoke in public and private places; and self-reported smoking restrictions in homes and cars.

Research Instruments and Protocols

Main Outcomes

  • Geometric mean cotinine concentrations in adult non-smokers fell by 39% from 0.43 ng/ml at baseline to 0.26 ng/ml post-legislation.
  • The reduction in mean cotinine was greatest in non-smokers from non-smoking households (49%). Among non-smokers from smoking households the reduction was much smaller (16%) and did not reach statistical significance.
  • Pre-legislation, levels of exposure to SHS amongst non-smokers living in smoking households was 2.6 times higher than among non-smokers living in non-smoking households. Post-legislation the difference in SHS exposure between non-smokers living in non-smoking and smoking households was 4.5 times higher.
  • Reduction in SHS exposure was reported in public places (pubs, other workplaces and public transport) but not in cars and homes, but there was no evidence of a displacement of smoking from public places into the home.

Updated 17th July 2014

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