Association of anti-smoking legislation with rates of hospital admission for cardiovascular and respiratory conditions

Naiman, Alisa; Glazier, Richard H.; Moineddin, Rahim

doi:10.1503/cmaj.091130

Cited by 119 publications

(121 citation statements)

References 17 publications

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“…A small number of studies conducted in North America have found that making public places and workplaces smokefree reduces hospital admissions and emergency department visits for asthma. [5][6][7] A Scottish study also found that the introduction of comprehensive smoke-free legislation in March 2006 was associated with a reduction in hospital admissions for childhood asthma. 8 These findings are consistent with evidence that SHS exposure increases the incidence and severity of childhood asthma 9 and that smokefree legislation is associated with reductions in SHS exposure in the home.…”

Section: Resultsmentioning

confidence: 99%

“…5 The extension of smoke-free legislation to cover restaurants was associated with a significant additional decline in hospital admissions for asthma in Toronto. 6 After taking the secular trends into account, emergency department visits for asthma declined by 22% in Lexington-Fayette County, Kentucky, after the introduction partial smoking ban in public places. 7 The decline in asthma admissions identified in this and previous studies are likely due to reductions in SHS exposure among children in their homes associated with the introduction of smoke-free legislation.…”

Section: Resultsmentioning

confidence: 99%

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Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: A small number of studies have found that the introduction of smoke-free legislation has been associated with a reduction in hospital admissions and emergency department visits for asthma. WHAT THIS STUDY ADDS:The implementation of smoke-free legislation in England was associated with an immediate 8.9% reduction in hospitalizations for asthma along with a decrease of 3.4% per year. abstract OBJECTIVE: To assess whether the implementation of English smokefree legislation in July 2007 was associated with a reduction in hospital admissions for childhood asthma. METHODS:Interrupted time series study using Hospital Episodes Statistics data from April 2002 to November 2010. Sample consisted of all children (aged #14 years) having an emergency hospital admission with a principle diagnosis of asthma. RESULTS:Before the implementation of the legislation, the admission rate for childhood asthma was increasing by 2.2% per year (adjusted rate ratio 1.02; 95% confidence interval [CI]: 1.02-1.03). After implementation of the legislation, there was a significant immediate change in the admission rate of 28.9% (adjusted rate ratio 0.91; 95% CI: 0.89-0.93) and change in time trend of 23.4% per year (adjusted rate ratio 0.97; 95% CI: 0.96-0.98). This change was equivalent to 6802 fewer hospital admissions in the first 3 years after implementation. There were similar reductions in asthma admission rates among children from different age, gender, and socioeconomic status groups and among those residing in urban and rural locations.CONCLUSIONS: These findings confirm those from a small number of previous studies suggesting that the well-documented population health benefits of comprehensive smoke-free legislation appear to extend to reducing hospital admissions for childhood asthma. Pediatrics 2013;131:e495-e501 AUTHORS:

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

2013

PEDIATRICS

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“…These findings complement an existing body of literature that has generally indicated that smoke-free policy implementation is associated with lower rates of hospital admissions or mortality for cardiovascular disease. 16,17,[19][20][21][22][27][28][29][30][31][32][33][34][35] Prior studies have typically been ecological in nature [14][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][34][35][36] and have not had access to detailed individual-level information on sociodemographic characteristics and cardiovascular disease risk factors. Our findings that patterns were largely similar after controlling for a large number of potential confounders suggest that differences in cardiovascular disease risk among those in areas with and without smoke-free policies are not explained by differences in individual sociodemographics or traditional cardiovascular disease risk factors.…”

Section: Original Research Articlementioning

confidence: 99%

“…13 Prior studies have examined changes in hospital admissions and mortality resulting from cardiovascular events, most commonly acute myocardial infarction, from before to after smoke-free policy implementation. Results generally indicated that policies were associated with lower rates of cardiovascular admissions, although a few studies found no association, 24,25 found results to be sensitive to linearity assumptions, 14 or found associations in only certain settings 18 or subgroups of the population. 26 In addition, several prior studies have shown stronger associations of smoke-free policies with lower rates of cardiovascular disease admissions among younger age groups, [26][27][28][29] suggesting that these policies may be an effective means of reducing premature cardiovascular disease.…”

mentioning

confidence: 97%

“…Prior studies have used primarily ecological designs, [14][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][34][35][36] and have lacked access to detailed individual-level data on sociodemographic characteristics and cardiovascular disease risk factors. Interpretation of results from ecological studies is limited by the potential for unmeasured confounding by individuallevel characteristics, a drawback that could be reduced by using data from ongoing cohort studies.…”

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confidence: 99%

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Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease

et al. 2018

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Editorial, see p 567BACKGROUND: Smoke-free legislation has been associated with lower rates of cardiovascular disease hospital admissions in ecological studies. However, prior studies lacked detailed information on individuallevel factors (eg, sociodemographic and clinical characteristics) that could potentially confound associations. Our objective was to estimate associations of smoke-free policies with incident cardiovascular disease in a longitudinal cohort after controlling for sociodemographics, cardiovascular disease risk factors, and policy covariates. METHODS:Longitudinal data from 3783 black and white adults in the CARDIA study (Coronary Artery Risk Development in Young Adults; 1995 were linked to state, county, and local 100% smoke-free policies in bars, restaurants, and nonhospitality workplaces by Census tract. Extended Cox regression estimated hazard ratios (HRs) of incident cardiovascular disease associated with time-dependent smoke-free policy exposures. Models were adjusted for sociodemographic characteristics, cardiovascular disease risk factors, state cigarette tax, participantreported presence of a smoking ban at their workplace, field center, and metropolitan statistical area poverty. RESULTS:During a median follow-up of 20 years (68 332 total personyears), 172 participants had an incident cardiovascular disease event (2.5 per 1000 person-years). Over the follow-up period, 80% of participants lived in areas with smoke-free policies in restaurants, 67% in bars, and 65% in nonhospitality workplaces. In fully adjusted models, participants living in an area with a restaurant, bar, or workplace smoke-free policy had a lower risk of incident cardiovascular disease compared with those in areas without smoke-free policies (HR, 0.75, 95% confidence interval, HR, 0.76, 95% confidence interval, HR, 0.54, 95% confidence interval, respectively; HR, 0.58, 95% confidence interval, for living in an area with all 3 types of policies compared with none). The estimated preventive fraction was 25% for restaurant policies, 24% for bar policies, and 46% for workplace policies. CONCLUSIONS:Consistent with prior ecological studies, these individualbased data add to the evidence that 100% smoke-free policies are associated with lower risk of cardiovascular disease among middle-aged adults.

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Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes

et al. 2023

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ImportanceSmoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality.ObjectiveTo investigate the associations of population-level tobacco-control policies with health outcomes.Data SourcesPubMed, EMBASE, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and EconLit were searched from inception to March 2021 (updated on 1 March 2022). References were manually searched.Study SelectionStudies reporting on associations of population-level tobacco control policies with health-related outcomes were included. Data were analyzed from May to July 2022.Data Extraction and SynthesisData were extracted by 1 investigator and cross-checked by a second investigator. Analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.Main Outcomes and MeasuresThe primary outcomes were respiratory system disease (RSD), cardiovascular disease (CVD), cancer, mortality, hospitalization, and health care utilization. The secondary outcomes were adverse birth outcomes, such as low birth weight and preterm birth. Random-effects meta-analysis was used to estimate pooled odds ratios (ORs) and 95% CIs.ResultsOf 4952 records identified, 144 population-level studies were included in the final analysis; 126 studies (87.5%) were of high or moderate quality. The most frequently reported policies were smoke-free legislation (126 studies), followed by tax or price increases (14 studies), multicomponent tobacco control programs (12 studies), and a minimum cigarette purchase age law (1 study). Smoke-free legislation was associated with decreased risk of all CVD events (OR, 0.90; 95% CI, 0.86-0.94), RSD events (OR, 0.83; 95% CI, 0.72-0.96), hospitalization due to CVD or RSD (OR, 0.91; 95% CI, 0.87-0.95), and adverse birth outcomes (OR, 0.94; 95% CI, 0.92-0.96). These associations persisted in all sensitivity and subgroup analyses, except for the country income category, for which a significant reduction was only observed in high-income countries. In meta-analysis, there was no clear association of tax or price increases with adverse health outcomes. However, for the narrative synthesis, all 8 studies reported statistically significant associations between tax increases and decreases in adverse health events.Conclusions and RelevanceIn this systematic review and meta-analysis, smoke-free legislation was associated with significant reductions in morbidity and mortality related to CVD, RSD, and perinatal outcomes. These findings support the need to accelerate the implementation of smoke-free laws to protect populations against smoking-related harm.

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Association of anti-smoking legislation with rates of hospital admission for cardiovascular and respiratory conditions

Cited by 119 publications

References 17 publications

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease

Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes

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