Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction

Abstract

Objective: To measure the short term impact on hospital admissions for myocardial infarction of the introduction of smoke-free legislation in England on 1 July 2007. Design: An interrupted time series design with routinely collected hospital episode statistics data. Analysis of admissions from July 2002 to September 2008 (providing five years' data from before the legislation and 15 months' data from after) using segmented Poisson regression. Setting: England. Population: All patients aged 18 or older living in England with an emergency admission coded with a primary diagnosis of myocardial infarction. Main outcome measures: Weekly number of completed hospital admissions. Results: After adjustment for secular and seasonal trends and variation in population size, there was a small but significant reduction in the number of emergency admissions for myocardial infarction after the implementation of smoke-free legislation (-2.4%, 95% confidence interval -4.06% to -0.66%, P=0.007). This equates to 1200 fewer emergency admissions for myocardial infarction (1600 including readmissions) in the first year after legislation. The reduction in admissions was significant in men (3.1%, P=0.001) and women (3.8%, P=0.007) aged 60 and over, and men (3.5%, P less than 0.01) but not women (2.5% P=0.38) aged under 60. Conclusion: This study adds to a growing body of evidence that smoke-free legislation leads to reductions in myocardial infarctions. It builds on previous work by showing that such declines are observed even when underlying reductions in admissions and potential confounders are controlled for. The considerably smaller decline in admissions observed in England compared with many other jurisdictions probably reflects aspects of the study design and the relatively low levels of exposure to secondhand smoke in England before the legislation

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

“…This legislation has resulted in substantial population health gain, including reductions in workplace exposure to secondhand smoke (SHS), 1 increased smoking quit rates, 2 and decreased hospital admissions for acute myocardial infarction. 3,4 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.…”

Theories of practice and public health: understanding (un)healthy practices

“…In this instance, smoking's reproduction was dependent on the various practices that make up the life of a Samurai, including craftsmanship, combat training and ceremony. More recently, practices of smoking and drinking in pubs and clubs or smoking and going out for a meal in a restaurant were strongly interconnected in the UK, until the ban on smoking in public places (Bauld, 2011;Sims, Maxwell, Bauld, & Gilmore, 2010). In various other parts of the world, these close connections persist; but in the UK at least, eating at a restaurant and smoking, and drinking in a bar and smoking, are currently incompatible.…”

“…by making it more difficult to find a place to smoke), affect competences (knowing where and when not to smoke) and even meanings (by reducing the sociability of smoking for example). Banning smoking in public places has consequently made a real difference (Bauld, 2011;Sims et al, 2010) not only to levels of smoking, but also to understandings of where smoking might go on.…”

The freeze on mass media campaigns in England: a natural experiment of the impact of tobacco control campaigns on quitting behaviour

“…This powerful quasiexperimental design is able to estimate intervention effects while taking into account underlying trends, thus ensuring that post-intervention changes are not merely continuations of longer-term trends. This method has been employed recently in the evaluation of a range of tobacco control policies [18][19][20][21][22]. While an interrupted time-series analysis cannot disentangle the effects of multiple interventions that are introduced at the same time, we are unaware of any interventions being implemented around the time of the freeze that are likely to have substantially influenced our outcomes.…”