Associations of Smoke-Free Policies in Restaurants, Bars, and Workplaces With Blood Pressure Changes in the CARDIA Study

Evaluation of Federally Mandated Smoke-Free Housing Policy and Health Outcomes Among Adults Over the Age of 50 in Low-Income, Public Housing in New York City, 2015-2022

INTRODUCTION

Effective July 2018, the U.S. Department of Housing and Urban Development issued a rule requiring all public housing authorities to implement smoke-free housing (SFH) policies in their developments. We examined the differential impacts of SFH policy on hospitalizations for myocardial infarction (MI) and stroke among adults aged ≥50 years old living in New York City (NYC) Housing Authority (NYCHA) versus a matched-comparison population in NYC.

AIMS AND METHODS

We identified census block groups (CBGs) comprised solely of 100% NYCHA units (N = 160) and compared NYCHA CBGs to a selected subset of CBGs from all CBGs with no NYCHA units (N = 5646). We employed propensity score matching on distributions of key CBG-level sociodemographic and housing covariates. We constructed incident rates per 1000 persons by aggregating 3-month "quarterly" counts of New York State all-payer hospitalization data from October 2015 to December 2022 and dividing by the population aged ≥50 in selected CBGs, ascertained from 2016 American Community Survey 5-year estimates. We selected a difference-in-differences (DID) analytic approach to examine pre- and post-policy differences in incident hospitalizations between the intervention and matched-comparison groups.

RESULTS

Matching results indicated a balanced match for all covariates, with standardized mean differences <0.10. In DID analyses, we observed small declines in both MI (DID = -0.26, p = .02) and stroke (DID = -0.28, p = .06) hospitalization rates for NYCHA CBGs compared to non-NYCHA CBGs from pre-to post-54 months' policy.

CONCLUSIONS

SFH policies in NYC were associated with small reductions in CVD-related hospitalizations among older adults living in housing subject to the policy.

IMPLICATIONS

Housing remains a key focal setting for interventions to reduce SHS exposure and associated morbidities. Ongoing monitoring is warranted to understand the long-term impacts of SFH policies in public housing developments.

A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour

This preregistered systematic review and meta-analysis (PROSPERO: CRD 42022311392) aimed to synthesize the effectiveness of all available population-level tobacco policies on smoking behaviour. Our search across 5 databases and leading organizational websites resulted in 9,925 records, with 476 studies meeting our inclusion criteria. In our narrative summary and both pairwise and network meta-analyses, we identified anti-smoking campaigns, health warnings and tax increases as the most effective tobacco policies for promoting smoking cessation. Flavour bans and free/discounted nicotine replacement therapy also showed statistically significant positive effects on quit rates. The network meta-analysis results further indicated that smoking bans, anti-tobacco campaigns and tax increases effectively reduced smoking prevalence. In addition, flavour bans significantly reduced e-cigarette consumption. Both the narrative summary and the meta-analyses revealed that smoking bans, tax increases and anti-tobacco campaigns were associated with reductions in tobacco consumption and sales. On the basis of the available evidence, anti-tobacco campaigns, smoking bans, health warnings and tax increases are probably the most effective policies for curbing smoking behaviour.

Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes: A Systematic Review and Meta-Analysis

Importance

Smoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality.

Objective

To investigate the associations of population-level tobacco-control policies with health outcomes.

Data Sources

PubMed, 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 Selection

Studies 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 Synthesis

Data 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 Measures

The 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.

Results

Of 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 Relevance

In 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.

Residential proximity to major roadway and progression in physical disability in older adults in China

Evidence of a connection between living near major roadway and adverse health outcome has come to light. However, little is known about the effect of residential traffic exposure on aging-related physical disability and whether this effect can be modified. We used data derived from Chinese Longitudinal Healthy Longevity Surveys in 2018, with a total of 15,771 participants aged ≥ 65. Residential proximity to major roadway was used as a surrogate for traffic-related air pollution and physical function was measured using basic and instrumental activities of daily living. Logistic regression models were adopted for the analyses. Compared with those living > 300 m from major road, participants living within 200 m had higher risk of poorer physical functioning. The peak odds ratio was observed in severe disability caused by 101-200 m distance (OR = 1.34, 95% CI: 1.08, 1.66). And this association got stronger with longer duration of living close to major road. In dichotomized analyses using 200 m as a cutoff point, the effect associated with living close to major road was greater in male and current smoker. Specially, poor physical function appears earlier in female, but less severe than that in male. The result emphasizes the adverse effect of residential proximity to major roadways to aging-related declines in health-especially for basic living ability. This association was more pronounced in male and current smokers, which cannot be reversed by lowering the indoor air pollution.

Associations of exposure to secondhand smoke with hypertension risk and blood pressure values in adults

Background

The effects of environmental chemical exposure on blood pressure (BP) have been confirmed, but the association between exposure to secondhand smoke (SHS) and hypertension risk and BP in the general population remains unknown.

Methods

Cross-sectional associations between SHS exposure and hypertension risk and BP values were evaluated using data for subjects who participated in the National Health and Nutrition Examination Survey (NHANES), 1999–2016. Logistic regression and linear regression were performed after adjusting for age, sex, race, alcohol consumption, poverty-to-income ratio (PIR), body mass index (BMI), estimated glomerular filtration rate, physical activity, diabetes, cardiovascular disease, and NHANES cycle. Restricted cubic spline models were created to display the potential nonlinear association between SHS and BP levels.

Results

Higher risk of hypertension was found at the highest SHS concentrations (OR = 1.13, 95% CI 1.04, 1.24, P for trend = 0.007). Additionally, SHS exposure had a strong positive association with systolic blood pressure (SBP) but was negatively associated with diastolic blood pressure (DBP). Furthermore, the nonlinear model result showed a significant association between SHS and SBP (P = 0.017); however, the nonlinear model result was not significant for SHS or DBP.

Conclusions

Our results suggest a potential association between high SHS exposure and the risk of hypertension. Further research is needed to elucidate the underlying mechanisms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12199-021-01009-0.

Association between secondhand smoke exposure and hypertension: nearly as large as smoking

: Active smoking is a widely accepted risk factor for cardiovascular disease and is recognized as a major public health problem. Passive smoking, also known as secondhand smoke exposure (SHSE), is thought to have similar cardiovascular consequences and the risk has been postulated to be equivalent to that of active smoking. A major component of this risk involves the connection with chronic hypertension. There are several population-based observational studies investigating the relationship between SHSE and chronic hypertension, all of which demonstrate a positive association. Given that SHSE appears to be a risk factor for chronic hypertension, SHSE should also be a risk factor for hypertensive end-organ disease. Many studies have sought to investigate this relationship, but this has yet to be fully elucidated. In this review, we focus on the current evidence regarding the association between SHSE and hypertension as well as exploration of the links between SHSE and hypertensive end-organ damage.

Associations of Smoke-Free Policies in Restaurants, Bars, and Workplaces With Blood Pressure Changes in the CARDIA Study

Background

Smoke‐free legislation has been associated with reductions in secondhand smoke exposure and cardiovascular disease. However, it remains unknown whether smoke‐free policies are associated with reductions in blood pressure (BP).

Methods and Results

Longitudinal data from 2606 nonsmoking adult participants of the CARDIA (Coronary Artery Risk Development in Young Adults) Study (1995–2011) were linked to state, county, and local‐level 100% smoke‐free policies in bars, restaurants, and/or nonhospitality workplaces based on participants’ census tract of residence. Mixed‐effects models estimated associations of policies with BP and hypertension trajectories over 15 years of follow‐up. Fixed‐effects regression estimated associations of smoke‐free policies with within‐person changes in systolic and diastolic BP and hypertension. Models were adjusted for sociodemographic, health‐related, and policy/geographic covariates. Smoke‐free policies were associated with between‐person differences and within‐person changes in systolic BP. Participants living in areas with smoke‐free policies had lower systolic BP on average at the end of follow‐up compared with those in areas without policies (adjusted predicted mean differences [in mm Hg]: restaurant: −1.14 [95% confidence interval: −2.15, −0.12]; bar: −1.52 [−2.48, −0.57]; workplace: −1.41 [−2.32, −0.50]). Smoke‐free policies in restaurants and bars were associated with mean within‐person reductions in systolic BP of −0.85 (−1.61, −0.09) and −1.08 (−1.82, −0.34), respectively. Only restaurant policies were associated with a significant within‐person reduction in diastolic BP, of −0.58 (−1.15, −0.01).

Conclusions

While the magnitude of associations was small at the individual level, results suggest a potential mechanism through which reductions in secondhand smoke because of smoke‐free policies may improve population‐level cardiovascular health.

See Editorial by https://10.1161/JAHA.118.011120

Necessity of Preventing Cardiovascular Disease by Smoke-Free Policies

See Article by https://10.1161/JAHA.118.009829

Partial Smoking Ban and Secondhand Smoke Exposure in Japan

Implementing smoking bans is a worldwide common practice for tobacco control. However, if the policy prohibits smoking partially rather than comprehensively, it may increase nonsmokers’ exposure to secondhand smoke (SHS) in nonprohibited places. This paper investigates how a partial smoking ban affected nonsmokers’ SHS exposure (measured by frequency of having exposure to SHS in days per month) in households, workplaces, and restaurants by examining the case of a partial smoking ban introduced in a large Japanese prefecture in 2013. Using data from the National Health and Nutrition Survey (NHNS) in 2010, 2013, and 2016 (n = 30,244) and the Comprehensive Survey of Living Conditions (CSLC) from 2001 to 2016 (n = 2,366,896), this paper employs a difference-in-differences (DID) approach. We found that the partial smoking ban significantly increased their SHS exposure in households and workplaces by 2.64 days and 4.70 days per month, respectively, while it did not change nonsmokers’ SHS exposure in restaurants. The results imply that the smoking ban displaced smokers from public places to private places. We also found that neither smokers’ smoking status nor smoking intensity changed significantly after implementing the partial smoking ban. Comprehensive smoking bans are needed to better protect nonsmokers from SHS exposure.