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Researcher profile: Kate Frazer - The impact of smoking bans on health

25 August 2016

Health research is full of nuances, and we need strong evidence and communication to influence policy, as Dr Kate Frazer is finding out from her analysis of smoking bans. She talks to Claire O'Connell.

When Dr Kate Frazer found herself in the spotlight at the Science Media Centre in the UK earlier this year, she admits she was a little nervous. 

Yes, the Cochrane Review she worked on with colleagues had shown strong evidence that banning smoking in public places is good for cardiovascular health, but facing the media was still a daunting task. (See bit.ly/2bCsW0F)

‘I needed to give the journalists specific results, but there were so many nuances in the data’, recalls Dr Frazer of the press event in February. (See bit.ly/2bkhXYW)

‘I had to make sure I explained everything clearly and that I stayed with the central message from the study’. 

The road to public health

The experience was a new one for Dr Frazer, to add to the many she has already built up during a career in nursing and public health research.

She qualified as a registered nurse at Royal Victoria Hospital, Belfast and subsequently started with a degree in Health Studies at Queen’s University Belfast, then moved to St Vincent’s University Hospital in Dublin in the early 1990s to work at the new liver transplant unit.

Around that time it emerged that women in Ireland had been infected with the Hepatitis C virus through receiving contaminated ‘anti-D’ and men and women had received contaminated blood products, and this became a research focus for the Hepatitis C unit. Dr Frazer went on to do a Higher Diploma in Risk Management and a Masters in Public Health at University College Dublin.

‘I really enjoyed the broad perspective, looking at inequalities in health and why things happen, and how you can make a difference at a policy level’, she says.  

A career in academia beckoned, and so she decided to do a HRB-funded PhD, returning to the topic of Hepatitis C.

‘I developed an education programme for public health nurses and this was adopted by the HSE’, she explains. ‘I completed a study of public health nurses’ knowledge and attitudes and I talked to people who had Hepatitis C, so the research was based on both the patient and the nurse perspectives’. 

Smoking bans and health 

By now a Lecturer at the School of Nursing, Midwifery & Health Systems in University College Dublin, Dr Frazer successfully applied to the HRB for a Cochrane Training Fellowship. This involved learning how to systematically examine multiple published studies to answer a focused research question and present the best evidence.  

Dr Frazer worked with Professor Cecily Kelleher to update Professor Kelleher’s 2010 review of the evidence of the effect of legislative smoking bans in indoor public spaces (including the pioneering law introduced in Ireland in 2004). Now that the bans had been in effect for longer, was the evidence mounting for their effects on reducing passive smoke exposure and improving health outcomes?

‘We looked at 77 studies across 21 countries and we found the evidence was stronger for a positive effect on health  than in the previous review’, says Dr Frazer. ‘Specifically for cardiovascular disease – which is where the studies were strongest - we could see the legislative smoking ban had reduced admissions for cardiovascular disease for both smokers and non-smokers. The largest reductions in admissions were in non-smokers. We also found evidence, though the evidence was less consistent, pointing to positive effects on respiratory health and perinatal or birth outcomes’.  (You can read the full study at this link bit.ly/2bnLwVM.)

Since then in a separate review, Dr Frazer and Professor Kelleher found evidence of an effect of smoking policies in workplaces that may have been exempt from smoking bans, such as prisons, psychiatric hospitals and universities, enforcing a ban was linked to reduced passive smoke exposure and lower active smoking rates, though the evidence was not as strong. (See bit.ly/25zqfle)

‘The evidence base needs to improve, more robust studies assessing the evidence of smoking bans and policies are required, but our review has presented the current evidence and the need for more research from these specialist settings’, says Dr Frazer. 

Importance of evidence 

It may seem intuitive that the longer indoor public smoking is banned from a locality the healthier people will become, but it is important that we continue to review evidence from methodologically strong studies, according to Dr Frazer.

‘From a policy perspective, countries need to know that legislative smoking bans reduce passive smoke exposure and improve health outcomes’, she says. ‘Studies reporting evidence of longer term impact on specific groups are now required.  

It’s also important to spread the message about research findings', she adds, 'so that the public and policy makers are familiar with the facts. In my experience I saw how important that dissemination was, when our findings were reported in the news media’, says Dr Frazer. ‘And what I had not anticipated is how many members of the public got in touch with me after those news reports, telling me how much the smoking ban had benefited their lives’.  

Find the message  

Dr Frazer encourages other researchers to step forward and talk about their work to help ensure it can influence thinking and policy. 

‘Liaise with media relations experts in the funding agency or in your institution’, she says. ‘They can guide you through and help you present your results and pin down your key message. In my case it was how smoking bans reduce people’s exposure to passive smoke, improves health outcomes and are of benefit for countries and their populations’.

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