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Chua ZX, Yeh Lai Amanda C, Lam TJR, Ong JSP, Lim SYW, Kumar S, Lim MJR, Tan BYQ, Aik J, Ho AFW. Impact of smoke-free legislation on stroke risk: A systematic review and meta-analysis. Eur Stroke J 2024:23969873241293566. [PMID: 39475361 PMCID: PMC11556582 DOI: 10.1177/23969873241293566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 10/08/2024] [Indexed: 11/14/2024] Open
Abstract
PURPOSE Secondhand smoke significantly increases the risk of cerebrovascular diseases, prompting recent public smoking bans. We aimed to ascertain the effects of smoke-free legislation on stroke incidence and mortality. METHODS We systematically searched Medline, Embase, Cochrane Library, and Scopus up to August 13, 2023, for studies reporting changes in stroke incidence following partial or comprehensive smoking bans. A random-effects meta-analysis was conducted on hospital admissions and mortality for stroke, stratified based on comprehensiveness of the ban ((i) workplaces-only, (ii) workplaces and restaurants, (iii) workplaces, restaurants and bars). The effect of post-ban follow-up duration was assessed visually by a forest plot, while meta-regression was employed to evaluate for any dose-response relationship between ban comprehensiveness and stroke risk. FINDINGS Of 3987 records identified, 15 studies analysing bans across a median follow-up time of 24 months (range: 3-67) were included. WRB bans were associated with reductions in the rates of hospital admissions for stroke (nine studies; RR, 0.918; 95% CI, 0.872-0.967) and stroke mortality (three studies; RR, 0.987; 95% CI, 0.952-1.022), although the latter did not reach statistical significance. There was no significant difference in the risk of stroke admissions for studies with increased ban comprehensiveness and no minimum duration for significant post-ban effects to be observed. DISCUSSION AND CONCLUSION Legislative smoking bans were associated with significant reductions in stroke-related hospital admissions, providing evidence for its utility as a public health intervention.
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Affiliation(s)
- Zhuo Xun Chua
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
| | | | | | - Jamie Si Pin Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Shivaram Kumar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mervyn Jun Rui Lim
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Benjamin Yong Qiang Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Joel Aik
- Environmental Epidemiology and Toxicology Division, National Environment Agency, Singapore
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Andrew Fu Wah Ho
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Singapore Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore
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Montes de Oca D, Paraje G, Cuadrado C. Impact of Total Indoor Smoking Ban on Cardiovascular Disease Hospitalizations and Mortality: The Case of Chile. Nicotine Tob Res 2024; 26:1166-1174. [PMID: 38457437 PMCID: PMC11339173 DOI: 10.1093/ntr/ntae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 01/22/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION The harmful effects of first and secondhand smoking are well-established. Smoke-free laws aim at protecting nonsmokers. This study aimed to assess the impact of the 2013 total ban on indoor smoking in Chile on hospitalizations and deaths of major cardiovascular events. AIMS AND METHODS The logarithm of the monthly hospitalization and death rates, standardized by age for every 100 000 inhabitants, were estimated for ischemic heart disease, acute myocardial infarction, strokes, and a composite outcome of ischemic heart diseases (which includes acute myocardial infarction) and strokes. In addition, interrupted time series with synthetic control groups were used to assess changes in levels and trends after the intervention. RESULTS The total ban on indoor smoking caused significant reductions in death rates for the three diseases studied for age groups above 20 years old. In addition, there were substantial decreases in the post-intervention hospitalization rates for ischemic heart disease: for the 20-44 age group, the decrease was 8.7% compared to the pre-intervention period (p < .01). In comparison, such a reduction was 4% (p < .01) for the ≥65 age group. For acute myocardial infarction, the decrease was 11.5% (p < .01) for the 20-44 age group, while for stroke, it was a 1.2% (p < .01) decrease for the total population. It is estimated that the smoking ban averted 15.6% of the deaths compared with the synthetic control groups. CONCLUSIONS The implementation of total smoke-free environments in Chile contributed to the reduction of mortality for main cardiovascular diseases. This study provides additional evidence of causality linking the policy to health outcomes. IMPLICATIONS The total indoor smoking ban significantly affected age-standardized hospitalization and deaths. The number of deaths averted by this policy is estimated at approximately 4758 and 5256 for IHD and stroke, respectively, during the 2013-2017 period (15.6% fewer deaths than predicted by the synthetic control groups). The study contributes to the body of evidence that supports total indoor smoking bans.
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Affiliation(s)
| | - Guillermo Paraje
- Business School, Universidad Adolfo Ibáñez, Peñalolén, Santiago de Chile, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Peñalolén, Santiago de Chile, Chile
| | - Cristóbal Cuadrado
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Peñalolén, Santiago de Chile, Chile
- School of Public Health, Universidad de Chile, Santiago de Chile, Chile
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de Castro Moita MD, da Silva Júnior FMR, da Silva Pereira T, Marinho RB, Vitorio EO, Pellegrino ÉFC, da Conceição Nascimento Pinheiro M, Santos OS. Mercury exposure in riverine populations of Terra do Meio Extractive Reserves in the Xingu basin, Amazon, Brazil. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2024; 46:88. [PMID: 38367142 DOI: 10.1007/s10653-024-01853-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/01/2024] [Indexed: 02/19/2024]
Abstract
Amazon is a hotspot for mercury (Hg) contamination and Terra do Meio region, despite its protected status for sustainable use, has never been monitored for this element. Looking to address this gap, this study aimed to quantify capillary Hg concentration in riverine populations of Terra do Meio (Xingu Basin, Central Amazon, Brazil) and associated factors with high Hg levels (90 percentile). Hair samples from 182 individuals from Iriri, Riozinho do Anfrísio and Xingu Extractive Reserves (RESEX), aged between 18 and 70 years old, were collected to measure total mercury levels (HgT), and socioeconomic, demographic, and clinical-epidemiological data were annotated. Overall, high levels of Hg were observed (mean 4.985 µg/g, median 3.531 µg/g) with significant differences between localities. Among the factors related to high capillary Hg levels, male gender, smoking habit, work in agriculture, livestock or extractivism, and residence in Iriri and Riozinho do Anfrísio RESEX were highlighted. A high prevalence of symptoms related to Hg intoxication, including anxiety, memory deficit, and lower limb problems, was observed. Overall, the results reveal that communities in these RESEXs are exposed to Hg and appear to be suffering from chronic health effects. Considering the increased anthropogenic alterations observed recently in the Amazon region and the subsequent amplified environmental bioavailability of Hg, further studies and mitigating actions are critical. This includes better surveillance of illegal anthropic activities and provision of ongoing education on this matter and incentives for dietary adaptations.
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Affiliation(s)
| | | | - Tatiana da Silva Pereira
- Universidade Federal do Pará - Campus Altamira, Rua Coronel José Porfírio, 2515, Altamira, PA, CEP: 68372-040, Brazil
| | - Renatta Barbosa Marinho
- Universidade Federal do Pará - Campus Altamira, Rua Coronel José Porfírio, 2515, Altamira, PA, CEP: 68372-040, Brazil
| | - Emanuely Oliveira Vitorio
- Universidade Federal do Pará - Campus Altamira, Rua Coronel José Porfírio, 2515, Altamira, PA, CEP: 68372-040, Brazil
| | | | | | - Ozélia Sousa Santos
- Universidade Federal do Pará - Campus Altamira, Rua Coronel José Porfírio, 2515, Altamira, PA, CEP: 68372-040, Brazil.
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Flor LS, Anderson JA, Ahmad N, Aravkin A, Carr S, Dai X, Gil GF, Hay SI, Malloy MJ, McLaughlin SA, Mullany EC, Murray CJL, O'Connell EM, Okereke C, Sorensen RJD, Whisnant J, Zheng P, Gakidou E. Health effects associated with exposure to secondhand smoke: a Burden of Proof study. Nat Med 2024; 30:149-167. [PMID: 38195750 PMCID: PMC10803272 DOI: 10.1038/s41591-023-02743-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
Despite a gradual decline in smoking rates over time, exposure to secondhand smoke (SHS) continues to cause harm to nonsmokers, who are disproportionately children and women living in low- and middle-income countries. We comprehensively reviewed the literature published by July 2022 concerning the adverse impacts of SHS exposure on nine health outcomes. Following, we quantified each exposure-response association accounting for various sources of uncertainty and evaluated the strength of the evidence supporting our analyses using the Burden of Proof Risk Function methodology. We found all nine health outcomes to be associated with SHS exposure. We conservatively estimated that SHS increases the risk of ischemic heart disease, stroke, type 2 diabetes and lung cancer by at least around 8%, 5%, 1% and 1%, respectively, with the evidence supporting these harmful associations rated as weak (two stars). The evidence supporting the harmful associations between SHS and otitis media, asthma, lower respiratory infections, breast cancer and chronic obstructive pulmonary disease was weaker (one star). Despite the weak underlying evidence for these associations, our results reinforce the harmful effects of SHS on health and the need to prioritize advancing efforts to reduce active and passive smoking through a combination of public health policies and education initiatives.
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Affiliation(s)
- Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Jason A Anderson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Noah Ahmad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gabriela F Gil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew J Malloy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chukwuma Okereke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joanna Whisnant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Woo DH, Park M, Jang SY, Park S, Jang SI. Association between smoking status and subjective quality of sleep in the South Korean population: a cross-sectional study. Sleep Breath 2023; 27:1519-1526. [PMID: 36214946 DOI: 10.1007/s11325-022-02726-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This study aimed to investigate the relationship between smoking and subjective sleep quality in the Korean adult population. METHODS We designed a cross-sectional survey using data from the 2018 Korean Community Health Service Conditions Survey and selected smoking status as our variable of interest. We divided the participants into people who currently, never, and formerly smoked, those who smoked < 20 cigarettes/day, and those who smoked > 20 cigarettes/day. Subjective sleep quality was analyzed using the Pittsburgh Sleep Quality Index. Multiple logistic regression analysis was performed for statistical analysis. RESULTS A total of 174,665 participants were enrolled. People who formerly and currently smoked were found to have poorer subjective sleep quality than those who never smoked. The odds of poor subjective sleep quality in people who smoked > 20 cigarettes/day were 1.15 times (95% confidence interval: 1.09-1.21) for men and 1.51 times (95% confidence interval: 1.22-1.86) for women, compared with men and women who never smoked. CONCLUSIONS Smoking was negatively associated with subjective sleep quality. Smoking cessation programs and lifestyle improvement education may be justifiable to improve the quality of sleep in Korean adults.
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Affiliation(s)
- Do Hee Woo
- Graduate School of Public Health, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Minah Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, South Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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Akter S, Islam MR, Rahman MM, Rouyard T, Nsashiyi RS, Hossain F, Nakamura R. Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2322341. [PMID: 37418258 PMCID: PMC10329215 DOI: 10.1001/jamanetworkopen.2023.22341] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 07/08/2023] Open
Abstract
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.
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Affiliation(s)
- Shamima Akter
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md. Rashedul Islam
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md. Mizanur Rahman
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Thomas Rouyard
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | | | - Fahima Hossain
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Ryota Nakamura
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
- Graduate School of Economics, Hitotsubashi University, Tokyo, Japan
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Keogan S, Alonso T, Sunday S, Hanafin J, Tigova O, Fernandez E, Lopez MJ, Gallus S, Semple S, Tzortzi A, Boffi R, Gorini G, Lopez-Nicolas A, Arvind DK, Radu-Loghin C, Soriano JB, Clancy L. Particle Exposure Hazards of Visiting Outdoor Smoking Areas for Patients with Asthma or COPD Even in EU Countries with Comprehensive Smokefree Laws. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5978. [PMID: 37297582 PMCID: PMC10252725 DOI: 10.3390/ijerph20115978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/19/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Smokefree laws are intended to protect against second-hand smoke (SHS) in outdoor areas. We examined if exposure to PM2.5 particles in outdoor smoking areas changed breathing rates in 60 patients with asthma (n = 30) or with COPD (n = 30), in an open, non-randomised, interventional study model in Czechia, Ireland and Spain. The patients wore a PM2.5 particle monitor (AirSpeck) and a breath monitor (RESpeck) for 24 h to determine changes in breathing rates (Br) at rest and during a visit to an outside smoking area. Spirometry and breath CO were measured before and the day after visiting an outdoor smoking area. The PM2.5 levels at the 60 venues were highly variable, ranging from ≥2000 µg/m3 (in 4 premises) to ≤10 µg/m3 (in 3 premises, which had only a single wall in the structure). At 39 venues, the mean PM 2.5 levels were ≥25 µg/m3. The breathing rate changed significantly in 57 of the 60 patients, resulting in an increase in some patients and a decrease in others. Comprehensive smokefree laws were ineffective in protecting asthma and COPD patients from exposure to high levels of SHS in outside areas of pubs and terraces, which should be avoided by these patients. These findings also support the extension of smokefree laws to outside areas.
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Affiliation(s)
- Sheila Keogan
- TobaccoFree Research Institute Ireland (TFRI), D02 HW71 Dublin, Ireland
| | - Tamara Alonso
- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- CIBER Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Salome Sunday
- TobaccoFree Research Institute Ireland (TFRI), D02 HW71 Dublin, Ireland
| | - Joan Hanafin
- TobaccoFree Research Institute Ireland (TFRI), D02 HW71 Dublin, Ireland
| | - Olena Tigova
- CIBER Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Esteve Fernandez
- CIBER Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Maria Jose Lopez
- Public Health Agency of Barcelona (ASPB), 08023 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB St. Pau), 08025 Barcelona, Spain
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), 20156 Milano, Italy
| | - Sean Semple
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling (UNISTIR), Stirling FK9 4LA, UK
| | - Anna Tzortzi
- Institute of Public Health, The American College of Greece, GR-153 42 Athens, Greece
| | - Roberto Boffi
- Fondazione IRCCS Istituto Nazionale dei Tumori (INT), 20133 Milan, Italy
| | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione, e la Rete Oncologica (ISPRO), 50139 Firenze, Italy
| | - Angel Lopez-Nicolas
- Department of Economics, Polytechnic University of Cartagena (UPCT), 30202 Cartagena, Spain
| | - D. K. Arvind
- School of Informatics, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Cornel Radu-Loghin
- European Network on Smoking and Tobacco Prevention (ENSP), 1050 Brussels, Belgium
| | - Joan B. Soriano
- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- CIBER Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Luke Clancy
- TobaccoFree Research Institute Ireland (TFRI), D02 HW71 Dublin, Ireland
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Peng X, Tang X, Zhang JH, Chen Y. Smoking Bans and Circulatory System Disease Mortality Reduction in Macao (China): Using GRA Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4516. [PMID: 36901524 PMCID: PMC10001606 DOI: 10.3390/ijerph20054516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 05/13/2023]
Abstract
This study evaluates the association between smoking rates and mortality from circulatory system diseases (CSD) after implementing a series of smoking bans in Macao (China). (1) Background: Macao phased in strict total smoking bans since 2012. During the past decade, smoking rates among Macao women have dropped by half. CSD mortalities in Macao also show a declining trend. (2) Method: Grey relational analysis (GRA) models were adopted to rank the importance of some key factors, such as income per capita, physician density, and smoking rates. Additionally, regressions were performed with the bootstrapping method. (3) Results: Overall, smoking rate was ranked as the most important factor affecting CSD mortality among the Macao population. It consistently remains the primary factor among Macao's female population. Each year, on average 5 CSD-caused deaths were avoided among every 100,000 women, equivalent to about 11.45% of the mean annual CSD mortality. (4) Conclusions: After the implementation of smoking bans in Macao, the decrease in smoking rate among women plays a primary role in the reduction in CSD mortality. To avoid excess CSD mortality due to smoking, Macao needs to continue to promote smoking cessation among the male population.
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Affiliation(s)
- Xinxin Peng
- School of Business, Macao University of Science and Technology, Macao 999078, China
- School of Management, Jiangsu University of Technology, Changzhou 213001, China
| | - Xiaolei Tang
- School of Business, Macao University of Science and Technology, Macao 999078, China
| | - Jing Hua Zhang
- School of Business, Macao University of Science and Technology, Macao 999078, China
| | - Yijun Chen
- Faculty of Social Sciences, University of Macau, Macao 999078, China
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Wu Y, Wang Z, Zheng Y, Wang M, Wang S, Wang J, Wu J, Wu T, Chang C, Hu Y. Trends in Hospital Admissions for Chronic Obstructive Pulmonary Diseases After Comprehensive Tobacco Control Policies in Beijing, China. Nicotine Tob Res 2022; 24:1978-1984. [PMID: 35808957 DOI: 10.1093/ntr/ntac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/12/2022] [Accepted: 05/30/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Only a few studies have examined the effectiveness of tobacco control policies on respiratory conditions, and the results were less consistent. The 2015 Beijing tobacco control policy package incorporating all six components of MPOWER has been implemented since Jun 2015. The present study aimed to evaluate the impact of a comprehensive tobacco control policy package on hospital admissions for chronic obstructive pulmonary disease (COPD) in Beijing, China. AIMS AND METHODS An interrupted time-series study was conducted based on the hospital admission information for about 18 million residents, who were covered by the Beijing Medical Claim Data for Employees from January 2013 to June 2017. The average percentage change of COPD hospital admission rates and reductions in hospital admission numbers were estimated by segmented Poisson regression models. RESULTS There were 54 040 COPD hospital admissions with a crude rate of 67.2 per 100 000 residents during the observational period. After the implementation of the policy package, the hospital admission rates of COPD were reduced by -14.7% (95%CI: -17.8%, -11.5%) immediately. The secular trend was slowed down by -3.0% (95% CI: -5.6%, -0.4%) annually. A total of 5 581 reductions in COPD hospital admissions were estimated during the 25 months post-law period, accounting for 17.5% (95% CI: 12.5%, 22.5%) of overall COPD hospital admissions. More reductions were shown in males and those aged over 65 years old. CONCLUSIONS The results indicated significant protections against hospitalization of COPD after the 2015 Beijing comprehensive tobacco control policy package. The results provide support for public health benefits for respiratory conditions from WHO-recommended tobacco control measures. IMPLICATIONS Only a few studies have examined the effectiveness of tobacco control policies on respiratory conditions, and the results were less consistent. Based on medical records for about 18 million residents, this study showed an association between comprehensive tobacco control policies and significant reductions of hospital admissions for chronic obstructive pulmonary disease. The results provide support for public health benefits for respiratory conditions from WHO-recommended tobacco control measures.
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Affiliation(s)
- Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Zijing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Yunting Zheng
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Mengying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Siyue Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Jiating Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Junhui Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Tao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
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10
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Zhang J, Ren D, Wang S, Zhu S, Qu K, Yuan Y. Effects of air pollution on cardiovascular health in patients with type 2 diabetes mellitus: Evidence from a large tertiary hospital in Shandong Province, China. Front Public Health 2022; 10:1050676. [PMID: 36438234 PMCID: PMC9682228 DOI: 10.3389/fpubh.2022.1050676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
Air pollution has posed serious threats to human health. Based on the microdata of a large tertiary hospital in Shandong Province from 2016 to 2021, combined with the macro data such as air quality monitoring data, meteorological data, and city-level regional socio-economic data, this paper empirically tests the impact of air pollution instrumented by thermal inversions on the cardiovascular health of patients with type 2 diabetes mellitus (T2DM) and its group differences. The results show that: (1) Air pollution has a negative impact on the cardiovascular health of patients with T2DM, that is, the cardiovascular health of patients with T2DM will decline in regions with high air pollution; (2) The impact of air pollution on cardiovascular health in T2DM patients is heterogeneous, with males and older patients bearing greater air pollution health losses; (3) From the perspective of the external environment, the negative effects of environmental pollution on patients' health were significantly reduced in areas with higher environmental regulation intensity and better public health conditions, indicating the necessity of strengthening environmental governance and increasing public health expenditure.
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Affiliation(s)
- Jitian Zhang
- Clinical Nutrition Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Dong Ren
- Scientific Research Management Department, Shandong Academy of Macroeconomic Research, Jinan, China
| | - Shuo Wang
- The Center for Economic Research, Shandong University, Jinan, China
| | - Sha Zhu
- Medical Administration Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Kai Qu
- Shandong Provincial Eco-environment Monitoring Center, Jinan, China
| | - Yuan Yuan
- Clinical Nutrition Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,*Correspondence: Yuan Yuan
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11
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Marthias T, McPake B, Carvalho N, Millett C, Anindya K, Saputri NS, Trisnantoro L, Lee JT. Associations between Indonesia's national health insurance, effective coverage in maternal health and neonatal mortality: a multilevel interrupted time-series analysis 2000-2017. J Epidemiol Community Health 2022; 76:jech-2021-217213. [PMID: 36288996 DOI: 10.1136/jech-2021-217213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND We assessed the effect of Indonesia's national health insurance programme (Jaminan Kesehatan Nasional (JKN)) on effective coverage for maternal and child health across geographical regions and population groups. METHODS We used four waves of the Indonesia Demographic and Health Survey from 2000 to 2017, which included 38 880 women aged 15-49 years and 144 000 birth records. Key outcomes included antenatal and delivery care, caesarean section and neonatal and infant mortality. We used multilevel interrupted time-series regression to examine changes in outcomes after the introduction of the JKN in January 2014. FINDINGS JKN introduction was associated with significant level increases in (1) antenatal care (ANC) crude coverage (adjusted OR (aOR) 1.81, 95% CI 1.44 to 2.27); (2) ANC quality-adjusted coverage (aOR 1.66, 95% CI 1.38 to 1.98); (3) ANC user-adherence-adjusted coverage (aOR 1.80, 95% CI 1.45 to 2.25); (4) safe delivery service contact (aOR 1.83, 95% CI 1.42 to 2.36); and (5) safe delivery crude coverage (aOR 1.45, 95% CI 1.20 to 1.75). We did not find any significant level increase in ANC service contact or caesarean section. Interestingly, increases in ANC service contact and crude coverage, and safe delivery crude coverage were larger among the poorest compared with the most affluent. No statistically significant associations were found between JKN introduction and neonatal and infant mortality (p>0.05) in the first 3 years following implementation. INTERPRETATION Expansion of social health insurance led to substantial improvements in quality of care for maternal health services but not in child mortality. Concerted efforts are required to equitably improve service quality and child mortality across the population in Indonesia.
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Affiliation(s)
- Tiara Marthias
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Carvalho
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Comprehensive Health Research Center and Public Health Research Centre, National School of Public Health, NOVA University Lisbon, Lisbon, Portugal
| | - Kanya Anindya
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Laksono Trisnantoro
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - John Tayu Lee
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Department of Health Service Research and Policy, Australia National University, Canberra, Canberra, Australia
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12
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Hamadi H, Stallings-Smith S, Apatu E, Peterson B, Spaulding A. Smoke-Free Policies and 30-Day Mortality Rates for Chronic Obstructive Pulmonary Disease. Int J Health Policy Manag 2022; 11:1695-1702. [PMID: 34380194 PMCID: PMC9808222 DOI: 10.34172/ijhpm.2021.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 06/23/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Smoke-free policies have been shown to impact 30-day readmission rates due to chronic obstructive pulmonary disease (COPD) among adults aged ≥65 years. However, little is known about the association between smokefree policies and 30-day mortality rates for COPD. Therefore, we investigated the association between comprehensive smoke-free policies and 30-day mortality rates for COPD. METHODS We used a cross-sectional study design and retrospectively examined risk-adjusted 30-day mortality rates for COPD across US hospitals in 1171 counties. Data were sourced from Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) Program, American Hospital Association (AHA) Annual Surveys, US Census Bureau Current Population Survey, and US Tobacco Control Laws Database from the American Nonsmokers' Rights Foundation (ANRF). Data were averaged at the county level for years 2015-2018. Hierarchical Poisson models adjusted for differences in hospital characteristics and accounted for the clustering of hospitals within a county were used. RESULTS Our findings show a consistent association between stronger smoke-free policies and a reduction in COPD mortality. When evaluating smoke-free policy, county characteristics, and hospital characteristics individually, we found that counties with full coverage or partial coverage had a reduced incidence rate of COPD mortality compared to no coverage counties. After adjusting for the county and hospital characteristics, counties with full coverage of smoke-free policies had a reduced rate of 30-day COPD mortality (adjusted incidence rate ratio [IRR]: 0.87, 95% CI: 0.79, 0.96) compared to counties with no policy coverage. CONCLUSION Comprehensive smoke-free policies are associated with a reduction in 30-day mortality following hospital admission for COPD. Partial smoke-free legislation is an insufficient preventative measure. These findings have strong implications for hospital policy-makers, suggesting that policy interventions to reduce COPD-related 30-day mortality should include implementing smoke-free policies and public health policy-makers to incentivize comprehensive smokefree policies.
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Affiliation(s)
| | | | - Emma Apatu
- McMaster University, Hamilton, ON, Canada
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13
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Chu M, Liu Z, Fang X, Wu Y, Liu H, Zhao X, Zhang T, Wu Q, Tan F. Effects of a Smoke-Free Policy in Xi'an, China: Impact on Hospital Admissions for Acute Ischemic Heart Disease and Stroke. Front Public Health 2022; 10:898461. [PMID: 35801245 PMCID: PMC9253815 DOI: 10.3389/fpubh.2022.898461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Smoking and secondhand smoke (SHS) exposure rates are much higher in China than in other countries. A smoke-free policy was implemented in Xi'an, a city in Shaanxi Province, China, on November 1, 2018. This study aimed to evaluate the effect of the smoke-free policy on changes in hospital admissions for acute ischemic heart disease (AIHD) and stroke in Xi'an. Methods All subjects had been hospitalized for AIHD or stroke from February 9, 2017 to December 25, 2019 (study period: 150 weeks) in six randomly selected public hospitals out of 36 tertiary hospitals in Xi'an. A generalized additive model developed using an interrupted time series design was used to compare immediate and annual percent changes in hospital admissions before and after policy implementation. Results The study included 31,400 cases (16,656 cases of AIHD and 14,744 cases of stroke) from 6 hospitals in Xi'an. Immediately after implementation of the smoke-free policy, AIHD admissions were reduced significantly (−31.66%, 95% CI: – 39.45 to −22.86%), but stroke admissions were not (−4.94%, 95% CI: −13.26 to 4.17%). The annual reduction in stroke-related admissions (−14.54%, 95% CI: −23.53 to −4.49%) and the annual increase in AIHD-related admissions (40.58%, 95% CI: 22.08 to 61.87%) were significant. Although there was no significant reduction in AIHD admissions, stroke admissions were significantly reduced by −15.73% (from 7,350 to 6,194) after implementation of the smoke-free policy in Xi'an. Conclusion The smoke-free policy had different effects on hospital admissions for AIHD and stroke in Xi'an. Xi'an should improve its smoke-free legislation and expand the measures to maintain or achieve additional significant health benefits. These findings can guide the formulation and implementation of regional and national smoke-free policies.
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Affiliation(s)
- Meng Chu
- Department of Epidemiology, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Zhiyan Liu
- Department of Respiratory and Critical Care Medicine, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Xinzhu Fang
- Ministry of Health Education, Xi'an Health Education Institute, Xi'an, China
| | - Yajun Wu
- Department of Epidemiology, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Huannan Liu
- Department of Epidemiology, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Xuan Zhao
- Department of Epidemiology, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Tianxiao Zhang
- Department of Epidemiology, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
- Center for Infectious Disease Control and Prevention, Global Health Institute, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Qian Wu
- Department of Epidemiology, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
- Center for Infectious Disease Control and Prevention, Global Health Institute, Health Science Center, Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Qian Wu
| | - Fang Tan
- Ministry of Health Education, Xi'an Health Education Institute, Xi'an, China
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14
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Vellakkal S, Khan Z, Alavani H, Fledderjohann J, Stuckler D. Effects of public policies in the prevention of cardiovascular diseases: a systematic review of global literature. Public Health 2022; 207:73-81. [PMID: 35567826 DOI: 10.1016/j.puhe.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/28/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Given the growing interest worldwide in applying public policies to improve human health, we undertook a systematic review of studies investigating whether public policies targeting unhealthy products could reduce cardiovascular diseases. STUDY DESIGN This study was a systematic review of the literature. METHODS We searched research studies published in 2000-2020 from major databases, including MEDLINE and Embase. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and narratively synthesized the studies based on vote counting and direction of the intervention effect. RESULTS Ninety-eight studies, mostly from high-income countries, met the inclusion criteria. Most studies were on public policies targeting sugar-sweetened beverages and tobacco, followed by alcohol, sugar, salt, and junk foods. Overall, many reported that several fiscal, regulatory, and educational policies generated beneficial effects of reducing the diseases. Those studies that reported no or limited effects highlighted several sociodemographic and health risk characteristics and design and implementation aspects of the policy interventions as factors limiting the policy effects; most of these are modifiable with appropriate policy interventions. For instance, low magnitude of tax, substitution with other unhealthy products, firms' competitive response strategies, pre-existence of smoking bans, incremental enactment of smoking regulations, degree of enforcement, and various sociocultural factors minimized the effects of the policies. CONCLUSION The literature supports a growing consensus on the beneficial effects of public policy for improving human health. The design and implementation of public policies must address various impeding factors and incorporate appropriate remedial measures. Further research is needed from low- and middle-income countries and on whether and how multiple policy instruments work in tandem.
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Affiliation(s)
- S Vellakkal
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kalyanpur, Uttar Pradesh, India.
| | - Z Khan
- IIPH Bhubaneshwar, Bhubaneshwar, Odisha, India
| | - H Alavani
- Department of Economics and Finance, BITS Pilani, KK Birla Goa Campus, Zuarinagar, Goa, India
| | - J Fledderjohann
- Department of Sociology, Lancaster University, Lancaster, UK
| | - D Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
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15
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Ye S, Wang R, Zhang B. Comparison of estimation methods and sample size calculation for parameter-driven interrupted time series models with count outcomes. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2022. [DOI: 10.1007/s10742-021-00267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Accelerating cancer clinical trial recruitment through a financial reimbursement program integrated with patient navigation: an interrupted time series analysis. J Cancer Policy 2021; 30:100305. [DOI: 10.1016/j.jcpo.2021.100305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022]
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17
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Xiao H, Augusto O, Wagenaar BH. Reflection on modern methods: a common error in the segmented regression parameterization of interrupted time-series analyses. Int J Epidemiol 2021; 50:1011-1015. [PMID: 33097937 DOI: 10.1093/ije/dyaa148] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 11/13/2022] Open
Abstract
Interrupted time-series (ITS) designs are a robust and increasingly popular non-randomized study design for strong causal inference in the evaluation of public health interventions. One of the most common techniques for model parameterization in the analysis of ITS designs is segmented regression, which uses a series of indicators and linear terms to represent the level and trend of the time-series before and after an intervention. In this article, we highlight an important error often presented in tutorials and published peer-reviewed papers using segmented regression parameterization for the analyses of ITS designs. We show that researchers cannot simply use the product between their calendar time variable and the indicator variable indicating pre- versus post-intervention time periods to represent the post-intervention linear segment. If researchers use this often-presented parameterization, they will get an erroneous result for the level change in their time-series. We show that researchers must take care to use the product between their intervention variable and the time elapsed since the start of the intervention, rather than the time since the beginning of their study. Thus, the second linear segment of the time-series indexing the post-intervention level and trend should be zero before intervention implementation and begin by counting from zero, rather than counting from the time elapsed since the beginning of the study. We hope that this article can clarify segmented regression parameterization for the analysis of ITS designs and help researchers avoid confusing and erroneous results in the level changes of their time-series.
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Affiliation(s)
- Hong Xiao
- Department of Global Health, University of Washington, Seattle, WA, USA.,School of Public Health, Zhejiang University, Zhejiang, China
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, WA, USA.,Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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18
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Saieva P, Jenkins LS. When people do not 'Zol': Reduced emergency centre attendance of patients with chronic obstructive pulmonary disease during coronavirus disease 2019 lockdown with the accompanying tobacco sales ban in South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e3. [PMID: 33764140 PMCID: PMC8008033 DOI: 10.4102/phcfm.v13i1.2750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has spread throughout the world, with devastating effects of the virus as well as the repercussions of the resulting ‘lockdowns’. South Africa went into a national lockdown in March 2020 to mitigate the impact of the virus. This included a ban on the sales of tobacco and electronic cigarette products. The ban has been a highly contentious issue in South Africa, discussed worldwide, which has drawn many criticisms. The prevalence rate of smoking in South Africa was around 21.5%, with the Western Cape province having a prevalence rate of 39%. We compared the number of chronic obstructive pulmonary disease (COPD) presentations at a large regional referral hospital in the Western Cape province from January to August 2019 with the same period in 2020. Electronic emergency centre data showed a reduction of 69.28% in COPD presentations. To control for some confounders for the same period, we also reviewed patients presenting with urinary tract infections, which showed only a 30.60% reduction. This notable reduction in COPD presentations reduced service pressure of emergency centre and most likely benefitted patients’ health. Further research and policies are needed to ensure ongoing reduction in the prevalence of smoking.
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Affiliation(s)
- Piero Saieva
- Department of Family and Emergency Medicine, George Regional Hospital, Western Cape Department of Health, George.
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19
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Bíró A, Hajdu T, Kertesi G, Prinz D. Life expectancy inequalities in Hungary over 25 years: The role of avoidable deaths. Population Studies 2021; 75:443-455. [PMID: 33527888 DOI: 10.1080/00324728.2021.1877332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Using mortality registers and administrative data on income and population, we develop new evidence on the magnitude of life expectancy inequality in Hungary and the scope for health policy in mitigating this. We document considerable inequalities in life expectancy at age 45 across settlement-level income groups, and show that these inequalities have increased between 1991-96 and 2011-16 for both men and women. We show that avoidable deaths play a large role in life expectancy inequality. Income-related inequalities in health behaviours, access to care, and healthcare use are all closely linked to the inequality in life expectancy.Supplementary material for this article is available at: https://doi.org/10.1080/00324728.2021.1877332.
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Affiliation(s)
- Anikó Bíró
- Centre for Economic and Regional Studies
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20
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Eighan J, Walsh B, Connolly S, Wren MA, Keegan C, Bergin A. The great convergence? Mortality in Ireland and Europe, 1956-2014. Eur J Public Health 2020; 30:1090-1097. [PMID: 32361721 DOI: 10.1093/eurpub/ckaa060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Until recently, Irish age-standardized mortality rates (ASMRs) were amongst the highest in the EU-15. This study examines changes in ASMRs in Ireland from 1956 to 2014. METHODS Using data from the World Health Organization Mortality Database, we compare ASMRs in Ireland to other EU-15 countries from 1956 to 2014. ASMRS are used to plot the relative ranking of Ireland within the EU-15, and illustrate trends in which Ireland diverged with, and converged to, the EU-15 average. ASMRS are estimated across sex, age groups (15-64 and 65+ years) and cause of death. RESULTS Between 1956 and 1999, ASMRs in Ireland were amongst the highest in the EU-15. ASMRs in Ireland saw slower improvements during this period as compared to other EU-15 countries. However, post-2000, a sharp reduction in Irish ASMRs resulted in an accelerated convergence to the EU-15 average. As a consequence of improvements in ASMRs between 2000 and 2014, there were an estimated 15 300 fewer deaths in 2014. The majority of these averted deaths were due to lower mortality rates for diseases of the circulatory system and respiratory system. CONCLUSIONS Rather than converging to the EU-15 average during the latter half of the 20th century, there was a divergence in ASMRs between Ireland and the EU-15. However, in recent years, Ireland experienced accelerated improvements in mortality rates with large reductions in mortality observed for diseases of the circulatory system and respiratory system, especially amongst older people.
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Affiliation(s)
- James Eighan
- Economic and Social Research Institute, Dublin, Ireland
| | - Brendan Walsh
- Economic and Social Research Institute, Dublin, Ireland
| | | | - Maev-Ann Wren
- Economic and Social Research Institute, Dublin, Ireland
| | - Conor Keegan
- Economic and Social Research Institute, Dublin, Ireland
| | - Adele Bergin
- Economic and Social Research Institute, Dublin, Ireland
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21
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Králíková E, Pánková A. Barriers to introduction of smoke-free workplaces in Central Europe: example of the Czech Republic. Cent Eur J Public Health 2020; 28 Suppl:S22-S25. [PMID: 33069177 DOI: 10.21101/cejph.a6160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/26/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Smoking at the workplace has a negative impact both on employers' economic interests and employees' health. The aim of this study is to describe the current situation, mainly barriers in implementation and resources in the Czech Republic as an example of a Central European country. METHODS We synthesised relevant review papers with our knowledge of the local situation based upon professional experience of both authors. RESULTS Despite smoke-free laws, some EU workers are still exposed to passive smoking during working hours. The main barriers towards smoke-free workplace implementation are the lack of resources, perception of smoking as a norm, and exceptions for leading personalities and their smoking. Social support increases smoking cessation effectiveness. Low availability of local smoking cessation services is an overall problem in Central Europe. CONCLUSIONS The working environment influences smoking habits. Smoking cessation support is cost-effective not only for the smoking employee but for employers as well. Smoking cessation resources should be available during the working day. No exceptions should be made as they serve as barriers to a smoke-free working environment.
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Affiliation(s)
- Eva Králíková
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Centre for Tobacco Dependence, Third Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Alexandra Pánková
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Centre for Tobacco Dependence, Third Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Abstract
Air pollution is a grave risk to human health that affects nearly everyone in the world and nearly every organ in the body. Fortunately, it is largely a preventable risk. Reducing pollution at its source can have a rapid and substantial impact on health. Within a few weeks, respiratory and irritation symptoms, such as shortness of breath, cough, phlegm, and sore throat, disappear; school absenteeism, clinic visits, hospitalizations, premature births, cardiovascular illness and death, and all-cause mortality decrease significantly. The interventions are cost-effective. Reducing factors causing air pollution and climate change have strong cobenefits. Although regions with high air pollution have the greatest potential for health benefits, health improvements continue to be associated with pollution decreases even below international standards. The large response to and short time needed for benefits of these interventions emphasize the urgency of improving global air quality and the importance of increasing efforts to reduce pollution at local levels.
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23
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Li S, Keogan S, Clancy L. Does smoke-free legislation work for teens too? A logistic regression analysis of smoking prevalence and gender among 16 years old in Ireland, using the 1995-2015 ESPAD school surveys. BMJ Open 2020; 10:e032630. [PMID: 32801188 PMCID: PMC7430408 DOI: 10.1136/bmjopen-2019-032630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 02/27/2020] [Accepted: 04/21/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To assess the role of tobacco control legislation (TCL) in youth smoking in Ireland. To examine the effects of smoke-free legislation in youth. To consider whether TCL contributed to the gender equalisation in prevalence in 16 years old seen between 2003 and 2015. SETTING Data are from the 4 yearly European School Survey Project on Alcohol and Other Drugs from 1995 to 2015. Total sample size was 12.394. A logistic regression model on grouped data was used. Dependent variable is whether a student was a smoker in last 30 days. Independent variables are time, gender and the policy indicators, workplace ban on smoking, point-of-sale (POS) display ban, the introduction of graphical images on packs and the average real price of cigarettes. RESULTS Smoking prevalence dropped from 41% in 1995 to 13% in 2015. The effects of policies differed between boys and girls. For girls, estimates for workplace bans, graphical images on packs and a unit real (Consumer Price Index adjusted) price increase reduced prevalence by 7.31% (95% CI 2.94% to 11.68%), 8.80% (95% CI 2.60% to 15.01%) and 5.87 (95% CI 2.96 to 8.79), respectively. The POS ban did not have a significant effect in girls. For boys, estimates for workplace bans and a unit real price increase, reduced prevalence by 8.41% (95% CI 5.16% to 11.66%) and 4.93% (95% CI 0.77% to 9.08%), respectively, POS gave an increase of 7.02% (95% CI 1.96% to 12.40%). The introduction of graphical images had an insignificant effect. CONCLUSIONS TC legislation helps to explain the out-of-trend reduction in youth smoking prevalence. The estimated differential effects of the workplace ban, POS displays, real price changes and graphical images on packs help to explain the sharper decline in girls than boys. These findings should remind policy-makers to give increased consideration to the possible effects on young people of any legislative changes aimed at adults in TCL.
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Affiliation(s)
- Shasha Li
- TU Dublin, TobaccoFree Research Institute Ireland, Kevin Street, Dublin 8, Dublin, Ireland
| | - Sheila Keogan
- TU Dublin, TobaccoFree Research Institute Ireland, Kevin Street, Dublin 8, Dublin, Ireland
| | - Luke Clancy
- TU Dublin, TobaccoFree Research Institute Ireland, Kevin Street, Dublin 8, Dublin, Ireland
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Xiao H, Qi F, Jia X, Wang Y, Zhang H, Li S, Yang G, Wan X, Naghavi M. Impact of Qingdao's smoke-free legislation on hospitalizations and mortality from acute myocardial infarction and stroke: an interrupted time-series analysis. Addiction 2020; 115:1561-1570. [PMID: 31961014 DOI: 10.1111/add.14970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/31/2019] [Accepted: 01/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS More than 20 cities in China have enacted local smoke-free laws that prohibit smoking in public places. Only two of these cities have examined the health impact of the law. Enacted in 2013, Qingdao's smoke free-law was stricter than most other municipal smoke-free laws because it did not allow designated smoking rooms. This study aimed to estimate the impact of Qingdao's smoke-free legislation on acute myocardial infarction (AMI) and stroke. DESIGN, SETTING AND PARTICIPANTS We used an interrupted time-series design adjusting for underlying secular trends, seasonal patterns and meteorological factors to estimate the impact of the smoke-free law on AMI and stroke events among permanent residents aged 35 years or older in Qingdao, China. The study period was from 1 January 2010 to 31 December 2015, with a post-ban follow-up of approximately 2.5 years. MEASUREMENT Outcome measures were weekly numbers of hospitalizations and deaths due to AMI/stroke. FINDINGS A total of 10 371 and 56 101 patients were hospitalized, with a principal discharge diagnosis of AMI and stroke, respectively; 32 196 AMI and 49 711 stroke deaths occurred during the study period. Following the smoke-free legislation, an incremental 20% [95% confidence interval (CI) = 14-26%] and 8% (95% CI = 3-13%) decrease per year was observed in AMI and stroke hospitalization rates, respectively. Neither the immediate nor gradual change in AMI nor stroke mortality rates associated with the law was statistically significant (P > 0.05). Post-hoc subgroup analyses indicated that statistically significant reductions in AMI hospitalizations were evident among both the 35-64 (18% per year, 95% CI = 12-27%) and 65-84 (20% per year, 95% CI = 12-27%) age groups. Statistically significant reductions in stroke hospitalization were only in the older subgroup (13% per year, 95% CI = 8-18%). CONCLUSIONS The 2013 smoke-free legislation in Qingdao, China was associated with reduction in hospitalization from acute myocardial infarction and stroke among permanent residents aged 35 years or older. There was no statistically significant reduction in mortality from acute myocardial infarctions or stroke.
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Affiliation(s)
- Hong Xiao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Fei Qi
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Xiaorong Jia
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Yani Wang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Hua Zhang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Shanpeng Li
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Gonghuan Yang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Abreu D, Sousa P, Matias-Dias C, Pinto F. Impact of public health initiatives on acute coronary syndrome fatality rates in Portugal. Rev Port Cardiol 2020; 39:27-34. [PMID: 32143997 DOI: 10.1016/j.repc.2019.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/22/2019] [Accepted: 05/26/2019] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Every year cardiovascular disease (CVD) causes 3.9 million deaths in Europe. Portugal has implemented a set of public health policies to tackle CVD mortality: a smoking ban in 2008, a salt reduction regulation in 2010 and the coronary fast-track system (FTS) for acute coronary syndrome (ACS) in 2007. Our goal in this study was to analyze the impact of these three public health policies in reducing case-fatality rates from ACS between 2000 and 2016. METHODS The impact of these policies on monthly ACS case-fatalities was assessed by creating individual models for each of the initiatives and implementing multiple linear regression analysis, using standard methods for interrupted time series. We also implemented segmented regression analysis to test which year showed a significant difference in the case-fatality slopes. RESULTS Separate modeling showed that the smoking ban (beta=-0.861, p=0.050) and the FTS (beta=-1.27, p=0.003) had an immediate impact after implementation, but did not have a significant impact on ACS trends. The salt reduction regulation did not have a significant impact. For the segmented model, we found significant differences between case-fatality trends before and after 2009, with rates before 2009 showing a steeper decrease. CONCLUSIONS The smoking ban and the FTS led to an immediate decrease in case-fatality rates; however, after 2009 no major decrease in case-fatality trends was found. Coronary heart disease constitutes an immense public health problem and it remains essential for decision-makers, public health authorities and the cardiology community to keep working to reduce ACS mortality rates.
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Affiliation(s)
- Daisy Abreu
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal; Department of Epidemiology of the Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal.
| | - Paulo Sousa
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal; Department of Epidemiology of the Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Centro de Investigação em Saúde Pública - ENSP-UNL, Lisboa, Portugal
| | - Carlos Matias-Dias
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal; Department of Epidemiology of the Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Centro de Investigação em Saúde Pública - ENSP-UNL, Lisboa, Portugal
| | - Fausto Pinto
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte - EPE, Centro Académico Medicina de Lisboa, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa, Lisboa, Portugal
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Abreu D, Sousa P, Matias-Dias C, Pinto F. Impact of public health initiatives on acute coronary syndrome fatality rates in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kwon DS, Kim TH, Byun MK, Kim HJ, Lee HS, Park HJ. Positive Effects of the National Cigarette Price Increase Policy on Smoking Cessation in South Korea. Tuberc Respir Dis (Seoul) 2020; 83:71-80. [PMID: 31905434 PMCID: PMC6953490 DOI: 10.4046/trd.2019.0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/10/2019] [Accepted: 08/30/2019] [Indexed: 01/15/2023] Open
Abstract
Background In January 2015, South Korea's government raised the cigarette tax, and the retail price of cigarettes abruptly increased by 80% compared to the previous year. This research aimed to determine the effect of this increase on smoking cessation among South Korean smokers. Methods We analyzed data collected by the 2013–2015 South Korea National Health and Nutrition Examination Survey of 15,203 South Koreans over 19 years old using regression analysis. We examined the recent non-smoking period of nonsmoking people, prepared according to the survey, and analyzed the recent smoking cessation ratio. Results Among smokers, from 2013 to 2014, the smoking cessation rate was 7.2%, and it increased to 9.9% in 2015 after the increase in the cigarette tax. In 2015, the recent smoking cessation rate was higher among people over the age of 60 (odds ratio [OR], 2.67) compared to those between the ages of 40 and 49. The recent smoking cessation rate was higher among people with below elementary education (OR, 2.28) and above university education (OR, 1.94) compared to high school, higher for those with apartments (OR, 1.74) compared to general type residences, and higher among those with a household income in the low-middle quartile (Q2) (OR, 2.32) compared to the highest quartile (Q4). Conclusion This innovative policy including increase in cigarette prices affected smoking cessation, and its impact varied by sub-group of smokers in South Korea.
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Affiliation(s)
- Do Sun Kwon
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Tae Hee Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Min Kwang Byun
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Hyung Jung Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea.
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Stallings-Smith S, Hamadi HY, Peterson BN, Apatu EJI, Spaulding AC. Smoke-Free Policies and 30-Day Readmission Rates for Chronic Obstructive Pulmonary Disease. Am J Prev Med 2019; 57:621-628. [PMID: 31564604 DOI: 10.1016/j.amepre.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Previous evidence has shown that smoke-free policies reduce hospital admissions due to respiratory causes, but the impact on 30-day readmission has not been determined. As 25 states in the U.S. have not adopted comprehensive smoke-free legislation, it is likely that patients return to an environment that increases risk of a secondary event. The aim of this study is to investigate the impact of smoke-free policies on 30-day readmission rates for adults aged ≥65 years following hospitalization for chronic obstructive pulmonary disease in the U.S. METHODS Data from the U.S. Tobacco Control Laws Database, Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program, American Hospital Association, Area Health Resource File, and U.S. Census Bureau Current Population Survey were merged at the county level for years 2013-2016 and analyzed in 2018. Hierarchical Poisson regression models were utilized to calculate incidence rate ratios to determine the impact of full, partial, and no smoke-free policies on 30-day readmission rates after chronic obstructive pulmonary disease hospitalization. RESULTS Multivariable analysis adjusting for both county and hospital characteristics revealed that the presence of full (incidence rate ratio=0.81, 95% CI=0.76, 0.88) and partial (incidence rate ratio=0.87, 95% CI=0.81, 0.92) smoke-free policies were associated with fewer 30-day readmissions for chronic obstructive pulmonary disease-related hospitalizations when compared with counties with no smoke-free policy. CONCLUSIONS The implementation of smoke-free policies is an effective measure for reducing 30-day readmissions following hospitalization due to chronic obstructive pulmonary disease, with stronger policies resulting in decreased risk. Efforts to reduce chronic obstructive pulmonary disease-related 30-day readmissions should include the implementation of smoke-free policies.
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Affiliation(s)
- Sericea Stallings-Smith
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, Florida.
| | - Hanadi Y Hamadi
- Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | - Breck N Peterson
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | - Emma J I Apatu
- Department of Health Research Methods, Evidence, and Impact, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aaron C Spaulding
- Department of Health Sciences Research, Division of Health Care Policy and Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
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Acute myocardial infarction and stoke after the enactment of smoke-free legislation in public places in Bibai city: data analysis of hospital admissions and ambulance transports. Hypertens Res 2019; 42:1801-1807. [DOI: 10.1038/s41440-019-0299-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/31/2019] [Accepted: 06/09/2019] [Indexed: 11/08/2022]
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Gao M, Li Y, Wang F, Zhang S, Qu Z, Wan X, Wang X, Yang J, Tian D, Zhang W. The effect of smoke-free legislation on the mortality rate of acute myocardial infarction: a meta-analysis. BMC Public Health 2019; 19:1269. [PMID: 31533693 PMCID: PMC6749716 DOI: 10.1186/s12889-019-7408-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/31/2019] [Indexed: 12/29/2022] Open
Abstract
Background Several studies have demonstrated that smoke-free legislation is associated with a reduced risk of mortality from acute myocardial infarction (AMI). This study aimed to examine and quantify the potential effect of smoke-free legislation on AMI mortality rate in different countries. Methods Studies were identified using a systematic search of the scientific literature from electronic databases, including PubMed, Web of Science, ScienceDirect, Embase, Google Scholar, and China National Knowledge Infrastructure (CNKI), from their inception through September 30, 2017. A random effects model was employed to estimate the overall effects of smoke-free legislation on the AMI mortality rate. Subgroup analysis was performed to explore the possible causes of heterogeneity in risk estimates based on sex and age. The results of meta-analysis after excluding the studies with a high risk of bias were reported in this study. Results A total of 10 eligible studies with 16 estimates of effect size were included in this meta-analysis. Significant heterogeneity in the risk estimates was identified (overall I2 = 94.6%, p < 0.001). Therefore, a random effects model was utilized to estimate the overall effect of smoke-free legislation. There was an 8% decline in AMI mortality after introducing smoke-free legislation (RR = 0.92, 95% confidence interval (CI): 0.90–0.94). The results of subgroup analyses showed that smoke-free legislation was significantly associated with lower rates of mortality for the following 5 diagnostic subgroups: smoke-free in workplaces, restaurants and bars (RR = 0.92, 95% CI: 0.90–0.95), smaller sample size (RR = 0.92, 95% CI: 0.89–0.95), study location in Europe (RR = 0.90, 95% CI: 0.85–0.94), regional study area (RR = 0.92, 95% CI: 0.89–0.94), and no previous local smoke-free legislation (RR = 0.91, 95% CI: 0.90–0.93). However, there was not much difference in AMI mortality rates after the legislation between the longer (RR = 0.92, 95% CI: 0.86–0.98) and shorter follow-up duration subgroups (RR = 0.92, 95% CI: 0.89–0.94). Conclusion Smoke-free legislation could significantly reduce the AMI mortality rate by 8%. The reduction in the AMI mortality rate was more significant in studies with more comprehensive laws, without prior smoke-free bans, with a smaller sample size, at the regional level, and with a location in Europe. Electronic supplementary material The online version of this article (10.1186/s12889-019-7408-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Min Gao
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Yanyu Li
- School of Humanities and Social Sciences, North China Electric Power University, Baoding, 071000, China
| | - Fugang Wang
- People's Bank of China Jinan Branch, Jinan, 250021, China
| | - Shengfa Zhang
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Zhiyong Qu
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Xiaohua Wang
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Jie Yang
- Tobacco control office, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Donghua Tian
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Weijun Zhang
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China.
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Kobyakova OS, Kulikov ES, Malykh RD, Chernogoryuk GE, Deev IA, Starovoytova EA, Kirillova NA, Zagromova TA, Balaganskaya MA. Strategies for the prevention of chronic non-communicable diseases: a modern look at the problem. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-4-92-98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Mason TG, Chan KP, Schooling CM, Sun S, Yang A, Yang Y, Barratt B, Tian L. Air quality changes after Hong Kong shipping emission policy: An accountability study. CHEMOSPHERE 2019; 226:616-624. [PMID: 30954896 DOI: 10.1016/j.chemosphere.2019.03.173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND On July 1st, 2015, Hong Kong became the first city in Asia to implement a policy regulating sulfur dioxide (SO2) in shipping emissions. We conducted an accountability study assessing the improvement in ambient air quality and estimating the effect on health outcomes of the policy. METHOD We used interrupted time series (ITS) with segmented regression to identify any change in ambient concentrations of SO2 in contrast to other ambient pollutants (particulate matter <10 μm in diameter (PM10), nitrogen dioxide (NO2) and ozone (O3)) at 10 monitoring stations in Hong Kong from 2010 to 2017. We validated these findings using cumulative sum control (CUSUM) charts. We used a validated risk assessment model to estimate effects of changes in air quality on death for natural causes, cardiovascular and respiratory diseases. RESULTS Mean monthly concentrations of SO2 fell abruptly at the monitoring station closest to the main shipping port (Kwai Chung (KC)) by -10.0 μgm3 p-value = 0.0004, but not elsewhere. No such changes were evident for the other pollutants (PM10, NO2, O3). CUSUM charts confirmed a change in July 2015. Estimated deaths avoided per year as a result of the policy were 379, 72, 30 for all natural causes, respiratory and cardiovascular diseases respectively. CONCLUSION Implementation of the shipping emission policy in Hong Kong successfully reduced ambient SO2, with the potential to reduce mortality. However, to gain full benefits, restrictions on shipping emissions need to be implemented throughout the region.
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Affiliation(s)
- Tonya G Mason
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - King Pan Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shengzhi Sun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Aimin Yang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yang Yang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Benjamin Barratt
- MRC-PHE Centre for Environment and Health & NIHR GSTFT/KCL Biomedical Research Centre, Analytical and Environmental Sciences Division, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Linwei Tian
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Chung-Hall J, Craig L, Gravely S, Sansone N, Fong GT. Impact of the WHO FCTC over the first decade: a global evidence review prepared for the Impact Assessment Expert Group. Tob Control 2019; 28:s119-s128. [PMID: 29880598 PMCID: PMC6589489 DOI: 10.1136/tobaccocontrol-2018-054389] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To present findings of a narrative review on the implementation and effectiveness of 17 Articles of the WHO Framework Convention on Tobacco Control (FCTC) during the Treaty's first decade. DATA SOURCES Published reports on global FCTC implementation; searches of four databases through June 2016; hand-search of publications/online resources; tobacco control experts. STUDY SELECTION WHO Convention Secretariat global progress reports (2010, 2012, 2014); 2015 WHO report on the global tobacco epidemic; studies of social, behavioural, health, economic and/or environmental impacts of FCTC policies. DATA EXTRACTION Progress in the implementation of 17 FCTC Articles was categorised (higher/intermediate/lower) by consensus. 128 studies were independently selected by multiple authors in consultation with experts. DATA SYNTHESIS Implementation was highest for smoke-free laws, health warnings and education campaigns, youth access laws, and reporting/information exchange, and lowest for measures to counter industry interference, regulate tobacco product contents, promote alternative livelihoods and protect health/environment. Price/tax increases, comprehensive smoking and marketing bans, health warnings, and cessation treatment are associated with decreased tobacco consumption/health risks and increased quitting. Mass media campaigns and youth access laws prevent smoking initiation, decrease prevalence and promote cessation. There were few studies on the effectiveness of policies in several domains, including measures to prevent industry interference and regulate tobacco product contents. CONCLUSIONS The FCTC has increased the implementation of measures across several policy domains, and these implementations have resulted in measurable impacts on tobacco consumption, prevalence and other outcomes. However, FCTC implementation must be accelerated, and Parties need to meet all their Treaty obligations and consider measures that exceed minimum requirements.
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Affiliation(s)
- Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Natalie Sansone
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Lee PN, Fry JS, Thornton AJ. Updating the evidence relating smoking bans to incidence of heart disease. Regul Toxicol Pharmacol 2019; 101:172-186. [PMID: 30500390 DOI: 10.1016/j.yrtph.2018.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 11/18/2022]
Abstract
In our latest update of the evidence on smoking bans and heart disease we summarize 59 studies. We take account of the underlying trends in incidence rates as far as possible by using control data in eight studies, and by adjustment based on observed trends in cases pre- and post-ban in 40 studies, being unable to make an adjustment in the remaining 11 studies. Overall, based on 62 independent estimates from the 59 studies, we estimate that bans reduce incidence by 5.0% (95% CI 3.2-6.8%), though this estimate reduces to 2.9% (0.01-5.6%) when we exclude regional estimates where national estimates are available, and studies where trend adjustment is not possible. For 25 of the studies, quadratic rather than linear adjustment is possible, but this hardly affects the overall estimates. Ban effects are somewhat greater when the pre-ban period studied is relatively short, and in smaller studies. We compare our findings with those in other recent reviews, one of which totally ignored underlying trends and results from control populations. We discuss reasons why we believe there is likely to be a true small effect of smoking bans, and weaknesses in the data which preclude reaching any very confident conclusion.
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Affiliation(s)
- Peter N Lee
- P.N. Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK.
| | - John S Fry
- ROELEE Statistics Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK
| | - Alison J Thornton
- Independent Consultant, Oak Cottage, Beer Farm, Okehampton, Devon, EX20 1SG, UK
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Xiao H, Zhang H, Wang D, Shen C, Xu Z, Zhang Y, Jiang G, Yang G, Wan X, Naghavi M. Impact of smoke-free legislation on acute myocardial infarction and stroke mortality: Tianjin, China, 2007-2015. Tob Control 2019; 29:61-67. [PMID: 30692165 PMCID: PMC6952839 DOI: 10.1136/tobaccocontrol-2018-054477] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Smoke-free legislation is an effective way to protect the population from the harms of secondhand smoke and has been implemented in many countries. On 31 May 2012, Tianjin became one of the few cities in China to implement smoke-free legislation. We investigated the impact of smoke-free legislation on mortality due to acute myocardial infarction (AMI) and stroke in Tianjin. METHODS An interrupted time series design adjusting for underlying secular trends, seasonal patterns, population size changes and meteorological factors was conducted to analyse the impact of the smoke-free law on the weekly mortality due to AMI and stroke. The study period was from 1 January 2007 to 31 December 2015, with a 3.5-year postlegislation follow-up. RESULTS Following the implementation of the smoke-free law, there was a decline in the annual trends of AMI and stroke mortality. An incremental 16% (rate ratio (RR): 0.84; 95% CI: 0.83 to 0.85) decrease per year in AMI mortality and a 2% (RR: 0.98; 95% CI: 0.97 to 0.99) annual decrease in stroke mortality among the population aged ≥35 years in Tianjin was observed. Immediate postlegislation reductions in mortality were not statistically significant. An estimated 10 000 (22%) AMI deaths were prevented within 3.5 years of the implementation of the law. CONCLUSION The smoke-free law in Tianjin was associated with reductions in AMI mortality. This study reinforces the need for large-scale, effective and comprehensive smoke-free laws at the national level in China.
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Affiliation(s)
- Hong Xiao
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Hui Zhang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Dezheng Wang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Chengfeng Shen
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Zhongliang Xu
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Ying Zhang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Guohong Jiang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Gonghuan Yang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Mayne SL, Widome R, Carroll AJ, Schreiner PJ, Gordon-Larsen P, Jacobs DR, Kershaw KN. Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease: CARDIA Study. Circulation 2018; 138:557-566. [PMID: 29735485 PMCID: PMC6202173 DOI: 10.1161/circulationaha.117.032302] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/21/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Smoke-free legislation has been associated with lower rates of cardiovascular disease hospital admissions in ecological studies. However, prior studies lacked detailed information on individual-level 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; 1995-2015) 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, participant-reported 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 person-years), 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, 0.49-1.15; HR, 0.76, 95% confidence interval, 0.47-1.24; HR, 0.54, 95% confidence interval, 0.34-0.86, respectively; HR, 0.58, 95% confidence interval, 0.33-1.00 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 individual-based 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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Affiliation(s)
- Stephanie L Mayne
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.L.M., A.J.C., K.N.K.)
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneap-olis (R.W., P.J.S., D.R.J.)
| | - Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.L.M., A.J.C., K.N.K.)
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneap-olis (R.W., P.J.S., D.R.J.)
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina Gillings School of Public Health, Chapel Hill (P.G.-L.)
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneap-olis (R.W., P.J.S., D.R.J.)
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.L.M., A.J.C., K.N.K.)
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Hanigan IC, Cochrane T, Davey R. Impact of scale of aggregation on associations of cardiovascular hospitalization and socio-economic disadvantage. PLoS One 2017; 12:e0188161. [PMID: 29182618 PMCID: PMC5705072 DOI: 10.1371/journal.pone.0188161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/01/2017] [Indexed: 11/18/2022] Open
Abstract
Background There are numerous studies that show an increased incidence of cardiovascular disease with increasing levels of socio-economic disadvantage. Exposures that might influence the relationship include elements of the built environment and social systems that shape lifestyle risk behaviors. In Canberra (the Australian capital city) there has been a particular housing policy to create ‘mixed-tenure’ neighborhoods so that small pockets of disadvantage are surrounded by more affluent residences (known as a ‘salt-and-pepper’ pattern). This may contribute to a scatter of higher incidence rates in very small areas in this population that may be obscured if aggregated data are used. This study explored the effect of changing the scale of the spatial units used in small area disease modelling, aiming to understand the impact of this issue and the implications for local public health surveillance. Methods The residence location of hospitalized individuals were aggregated to two differently scaled area units. First, the Australian Bureau of Statistics Statistical Area 2 (SA2) which is normally used as the basis for deidentification and release of health data. Second, these data were aggregated to a smaller level: the Statistical Area 1 (SA1). Generalized Additive Models with penalized regression splines were used to assess the association of age-sex-standardized rates for cardiovascular disease hospital admissions with disadvantage. Results The relationships observed were different between the two types of spatial units. The SA1 level exposure-response curve for rates against the disadvantage index extended in a linear fashion above the midrange level, while that found at SA2-level suggested a curvilinear form with no evidence that rates increased with higher disadvantage beyond the midrange. Conclusion Our result supports findings of other work that has found disadvantage increases risk of cardiovascular disease. The shape of the curves suggest a difference in associations of cardiovascular disease rates with disadvantage scores between SA1 versus SA2. From these results it can be concluded that scale of analysis does influence the understanding of geographical patterns of socio-economic disadvantage and cardiovascular disease morbidity. Health surveillance and interventions in Canberra should take into account the impact of the scale of aggregation on the association between disadvantage and cardiovascular disease observed.
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Affiliation(s)
- Ivan C. Hanigan
- Spatial Epidemiology Group, Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
- University Centre for Rural Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Thomas Cochrane
- Spatial Epidemiology Group, Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Rachel Davey
- Spatial Epidemiology Group, Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
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Yang YN, Huang YT, Yang CY. Effects of a national smoking ban on hospital admissions for cardiovascular diseases: a time-series analysis in Taiwan. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2017; 80:562-568. [PMID: 28880815 DOI: 10.1080/15287394.2017.1367085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
On January 11, 2009, a comprehensive smoking ban was implemented in Taiwan. The aim of this study was to evaluate the effect of this ban on hospital admissions for ischemic heart disease (IHD). Trends in the country-level monthly hospital admission rates for IHD were determined and frequency compared to other conditions such as control conditions cholecystitis, bowel obstruction, and appendicitis from January 1997 (1 year before the first phase of smoke-free laws was implemented) to December 2012 (3 years after the second phase of the ban). Poisson regression with a monthly time-series model was used to determine alterations in the trend of admission rates for IHD with comparison to rates of other disorders after the ban. Hospital admissions for IHD decreased by 0.8% (incidence rate ratio [RR]: 0.992; 95% confidence interval [CI] = 0.991-0.994) and 1.1% (incidence RR: 0.989; 95% CI = 0.988-0.991) following the first (September 19, 1997 to January 10, 2009) and second (January 11, 2009 to December 31, 2012) phases of the ban, respectively, compared with those prior to the pre-ban period, the corresponding values for the control conditions were 0.6% (95% CI = 0.5%-0.7%) and 0.7% (95% CI = 0.6%-0.9%). The admission rates significantly fell for both men and women and for all examined age categories after both first and second phases of the ban. The present findings provide evidence of a significant reduction in hospital admissions for IHD in Taiwan following smoking bans.
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Affiliation(s)
- Yue-Nin Yang
- a Department of Public Health , College of Health Sciences, Kaohsiung, Medical University , Kaohsiung , Taiwan
| | - Yu-Tung Huang
- b Master program in Aging and Long-term Care , College of Nursing, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Chun-Yuh Yang
- c Faculty of Public Health , College of Health Sciences, Kaohsiung, Medical University , Kaohsiung , Taiwan
- d Division of Environmental Health and Occupational Medicine , National Health Research Institute , Miaoli , Taiwan
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Rando-Matos Y, Pons-Vigués M, López MJ, Córdoba R, Ballve-Moreno JL, Puigdomènech-Puig E, Benito-López VE, Arias-Agudelo OL, López-Grau M, Guardia-Riera A, Trujillo JM, Martin-Cantera C. Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis. PLoS One 2017; 12:e0181035. [PMID: 28759596 PMCID: PMC5536320 DOI: 10.1371/journal.pone.0181035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 06/26/2017] [Indexed: 11/22/2022] Open
Abstract
Aims The aim of this systematic review and meta-analysis is to synthesize the available evidence in scientific papers of smokefree legislation effects on respiratory diseases and sensory and respiratory symptoms (cough, phlegm, red eyes, runny nose) among all populations. Materials and methods Systematic review and meta-analysis were carried out. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. Inclusion criteria were: 1) original scientific studies about smokefree legislation, 2) Data before and after legislation were collected, and 3) Impact on respiratory and sensory outcomes were assessed. Paired reviewers independently carried out the screening of titles and abstracts, data extraction from full-text articles, and methodological quality assessment. Results A total number of 1606 papers were identified. 50 papers were selected, 26 were related to symptoms (23 concerned workers). Most outcomes presented significant decreases in the percentage of people suffering from them, especially in locations with comprehensive measures and during the immediate post-ban period (within the first six months). Four (50%) of the papers concerning pulmonary function reported some significant improvement in expiratory parameters. Significant decreases were described in 13 of the 17 papers evaluating asthma hospital admissions, and there were fewer significant reductions in chronic obstructive pulmonary disease admissions (range 1–36%) than for asthma (5–31%). Six studies regarding different respiratory diseases showed discrepant results, and four papers about mortality reported significant declines in subgroups. Low bias risk was present in 23 (46%) of the studies. Conclusions Smokefree legislation appears to improve respiratory and sensory symptoms at short term in workers (the overall effect being greater in comprehensive smokefree legislation in sensory symptoms) and, to a lesser degree, rates of hospitalization for asthma.
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Affiliation(s)
- Yolanda Rando-Matos
- Centre d'Atenció Primària (CAP) Florida Nord. Gerència d’Àmbit d’Atenció Primària Metropolitana Sud, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
- * E-mail:
| | - Mariona Pons-Vigués
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Universitat de Girona, Girona, Spain
| | - María José López
- Public Health Agency of Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Biomèdic (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Rodrigo Córdoba
- Centro de Salud Universitario Delicias Sur, Servicio Aragonés de Salud (SALUD), Zaragoza, Spain
- Universidad de Zaragoza, Zaragoza, Spain
| | - José Luis Ballve-Moreno
- Centre d'Atenció Primària (CAP) Florida Nord. Gerència d’Àmbit d’Atenció Primària Metropolitana Sud, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
| | - Elisa Puigdomènech-Puig
- Agència de Qualitat i Avaluació Sanitàries, AQuAS, Generalitat de Catalunya, Barcelona, Spain
| | - Vega Estíbaliz Benito-López
- Servicio de Medicina Preventiva, Complejo Asistencial Universitario de Salamanca, Sanidad de Castilla y Leon (SACYL), Salamanca, Spain
- Grupo de investigación: Trastornos sensoriales y neuroplasticidad cerebral (UIC: 083), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Instituto de Neurociencias de Castilla y León (INCYL), Salamanca, Spain
| | - Olga Lucía Arias-Agudelo
- Centre d'Atenció Primària (CAP) San Martí de Provençals, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Mercè López-Grau
- Centre d'Atenció Primària (CAP) Passeig de Sant Joan, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Anna Guardia-Riera
- Àrea Bàsica de Salut l'Hospitalet de Llobregat 6—Sta. Eulàlia sud, Gerència d’Àmbit d’Atenció Primària Hospitalet de Llobregat, Institut Català de la Salut, Barcelona, Spain
| | | | - Carlos Martin-Cantera
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Centre d'Atenció Primària (CAP) Passeig de Sant Joan, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut (ICS), Barcelona, Spain
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Pandey S, Murugan V, Karki YB, Mathur A. In-home Smoking in Households with Women of Reproductive Age in Nepal: Does Women's Empowerment Matter? HEALTH & SOCIAL WORK 2017; 42:32-40. [PMID: 28395076 DOI: 10.1093/hsw/hlw057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/09/2016] [Indexed: 06/07/2023]
Abstract
Authors examined the prevalence and predictors of in-home smoking in households with women of reproductive age. They analyzed data from 9,837 ever married women from 2011 Nepal Demographic Health Survey. About 17 percent of women and 66 percent of their husbands smoked and 58 percent of the women lived in homes that permitted in-home smoking. About 6 percent of the women were pregnant and 42 percent had given birth within the past five years. In-home tobacco use was equally prevalent in homes with and without young children and irrespective of women's pregnancy status. Husband's use of tobacco doubled the odds of in-home smoking (odds ratio [OR] = 2.36; 95% confidence interval [CI] = 1.52-3.69) and wife's use of tobacco quadrupled the odds of in-home smoking controlling for other factors (OR = 3.94; 95% CI = 3.30-4.70). In addition, employed women were 39 percent more likely to allow in-home smoking than their unemployed counterparts (OR = 1.39; 95% CI = 1.19-1.63). Protective factors against in-home smoking were women's education, intrahousehold decision-making ability, household wealth, and urban residence. To reduce in-home smoking, social workers should increase awareness about the adverse consequences of secondhand smoke by providing counseling services to male and female tobacco users.
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Affiliation(s)
- Shanta Pandey
- Professor, Boston College School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - Vithya Murugan
- Doctoral student, George Warren Brown School of Social Work, Washington University in St. Louis, USA
| | - Yagya B Karki
- Executive director, Population, Health and Development Group, Kathmandu, Nepal
| | - Amit Mathur
- Professor of pediatrics and codirector, Neurodevelopmental Research Group, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, USA
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Stone ECA, Zhou C. Slowing the Titanic: China's Epic Struggle with Tobacco. J Thorac Oncol 2016; 11:2053-2065. [PMID: 27498288 DOI: 10.1016/j.jtho.2016.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 06/28/2016] [Accepted: 07/15/2016] [Indexed: 12/18/2022]
Abstract
China is home to a third of the world's smokers and, correspondingly, to a third of the world's cases of lung cancer. Beginning in the mid-1990s, a generation or so later than in many Western countries, the Chinese government commenced measures to control tobacco, limiting advertising, banning smoking in many public venues, and increasing taxation. At the time of this review, there are signs that these policies are having some effect, but hundreds of millions of Chinese continue to smoke and rates of diagnosis of lung cancer continue to rise. There is much work to be done and much premature death to be suffered before the epidemic is slowed to the levels reached in Australia or the United States. This article aims to provide, particularly for practicing lung cancer clinicians, a description of patterns of smoking in China, the lung cancer epidemic there, and the stimuli for and barriers to tobacco control imposed by the highly complex and unique regulatory setting of the Chinese tobacco industry. A particular challenge in developing this description has come from the variability of studies published about a huge nation that has enormous diversity in wealth, education, urbanization, and tradition. The studies vary because the data vary. Much information on lung cancer and smoking rates in China comes, for example, from studies of cohorts that may number in the millions yet represent only a small percentage of the population and sometimes only a tiny geographic area of such a vast nation. National registry data on lung cancer in China do not yet cover even a fifth of the national population. Even so, we argue that several major trends can be identified: (1) more than 50% of men smoke regularly; (2) there are more than 300 million smokers in China; (3) almost half a million new cases of lung cancer are diagnosed in China each year; (4) secondhand smoking is a significant problem in China (as elsewhere), accounting for a high proportion of lung cancer cases among women, most of whom do not smoke; (5) corrected for age and sex, lung cancer rates in the Chinese population are as least as high as in Western countries and arguably higher; and (6) a shift over time from squamous cell carcinoma (SCC) to adenocarcinoma is occurring in parallel with that noted in Western populations. Looking to the future, measures to control tobacco in China are strengthening but remain relatively weak. The reinforcement of control is hampered by the circumstance that the tobacco industry remains a powerful state-owned monopoly that participates, through its membership of key government bodies, in the processes that oversee the implementation of tobacco control. The conflict between the government's dual responsibilities for both the production and distribution of tobacco and for the implementation of tobacco control carries inherent contradictions and bias. How long the Chinese government chooses to live with these contradictions will determine how quickly the smoking of tobacco will be reduced and how soon the burden of disease that tobacco inflicts on individuals and society as a whole will be eased.
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Affiliation(s)
- Emily C A Stone
- Department of Thoracic Medicine, St. Vincent's Hospital, Kinghorn Cancer Centre, Sydney, Australia; University of New South Wales, Sydney, Australia.
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Cancer Institute of Tongji University Medical School, Shanghai, China
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Bakolis I, Kelly R, Fecht D, Best N, Millett C, Garwood K, Elliott P, Hansell AL, Hodgson S. Protective Effects of Smoke-free Legislation on Birth Outcomes in England: A Regression Discontinuity Design. Epidemiology 2016; 27:810-8. [PMID: 27428672 PMCID: PMC5424880 DOI: 10.1097/ede.0000000000000534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Environmental tobacco smoke has an adverse association with preterm birth and birth weight. England introduced a new law to make virtually all enclosed public places and workplaces smoke free on July 1, 2007. We investigated the effect of smoke-free legislation on birth outcomes in England using Hospital Episode Statistics (HES) maternity data. METHODS We used regression discontinuity, a quasi-experimental study design, which can facilitate valid causal inference, to analyze short-term effects of smoke-free legislation on birth weight, low birth weight, gestational age, preterm birth, and small for gestational age. RESULTS We analyzed 1,800,906 pregnancies resulting in singleton live-births in England between 1 January 2005 and 31 December 2009. In the 1 to 5 months following the introduction of the smoke-free legislation, for those entering their third trimester, the risk of low birth weight decreased by between 8% (95% confidence interval [CI]: 4%, 12%) and 14% (95% CI: 5%, 23%), very low birth weight between 28% (95% CI: 19%, 36%) and 32% (95% CI: 21%, 41%), preterm birth between 4% (95% CI: 1%, 8%) and 9% (95% CI: 2%, 16%), and small for gestational age between 5% (95% CI: 2%, 8%) and 9% (95% CI: 2%, 15%). The estimated impact of the smoke-free legislation varied by maternal age, deprivation, ethnicity, and region. CONCLUSIONS The introduction of smoke-free legislation in England had an immediate estimated beneficial impact on birth outcomes overall, although we did not observe improvements across all age, ethnic, or deprivation groups.See video abstract at http://links.lww.com/EDE/B85.
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Affiliation(s)
- Ioannis Bakolis
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- Department of Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Ruth Kelly
- Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
- The Medical Research Council, 14th floor, One Kemble Street, London, WC2B 4AN
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
| | - Nicky Best
- Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
| | - Christopher Millett
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Kevin Garwood
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
| | - Paul Elliott
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
- Directorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London, UK
| | - Anna L Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
- Directorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London, UK
| | - Susan Hodgson
- MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
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Abe TMO, Scholz J, de Masi E, Nobre MRC, Filho RK. Decrease in mortality rate and hospital admissions for acute myocardial infarction after the enactment of the smoking ban law in São Paulo city, Brazil. Tob Control 2016; 26:656-662. [PMID: 27794066 DOI: 10.1136/tobaccocontrol-2016-053261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/26/2016] [Accepted: 10/03/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Smoking restriction laws have spread worldwide during the last decade. Previous studies have shown a decline in the community rates of myocardial infarction after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in hospitality venues. OBJECTIVE To evaluate whether the 2009 implementation of a comprehensive smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction. METHODS We performed a time-series study of monthly rates of mortality and hospital admissions for acute myocardial infarction from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modelled by environmental variables and atmospheric pollutants to evaluate the effect of smoking ban law in mortality and hospital admission rate. We also used Interrupted Time Series Analysis (ITSA) to make a comparison between the period pre and post smoking ban law. RESULTS We observed a reduction in mortality rate (-11.9% in the first 17 months after the law) and in hospital admission rate (-5.4% in the first 3 months after the law) for myocardial infarction after the implementation of the smoking ban law. CONCLUSIONS Hospital admissions and mortality rate for myocardial infarction were reduced in the first months after the comprehensive smoking ban law was implemented.
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Affiliation(s)
- Tania M O Abe
- Medicine Faculty, Heart Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Jaqueline Scholz
- Medicine Faculty, Heart Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Eduardo de Masi
- Municipal Health Secretary, Municipality of São Paulo, São Paulo, São Paulo, Brazil
| | - Moacyr R C Nobre
- Medicine Faculty, Heart Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Medicine Faculty, Heart Institute, University of São Paulo, São Paulo, São Paulo, Brazil
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Fok CCT, Henry D, Allen J. Research Designs for Intervention Research with Small Samples II: Stepped Wedge and Interrupted Time-Series Designs. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:967-77. [PMID: 26017633 DOI: 10.1007/s11121-015-0569-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The stepped wedge design (SWD) and the interrupted time-series design (ITSD) are two alternative research designs that maximize efficiency and statistical power with small samples when contrasted to the operating characteristics of conventional randomized controlled trials (RCT). This paper provides an overview and introduction to previous work with these designs and compares and contrasts them with the dynamic wait-list design (DWLD) and the regression point displacement design (RPDD), which were presented in a previous article (Wyman, Henry, Knoblauch, and Brown, Prevention Science. 2015) in this special section. The SWD and the DWLD are similar in that both are intervention implementation roll-out designs. We discuss similarities and differences between the SWD and DWLD in their historical origin and application, along with differences in the statistical modeling of each design. Next, we describe the main design characteristics of the ITSD, along with some of its strengths and limitations. We provide a critical comparative review of strengths and weaknesses in application of the ITSD, SWD, DWLD, and RPDD as small sample alternatives to application of the RCT, concluding with a discussion of the types of contextual factors that influence selection of an optimal research design by prevention researchers working with small samples.
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Affiliation(s)
| | - David Henry
- University of Illinois at Chicago, Chicago, IL, USA
| | - James Allen
- University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
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Martin WP, Sharif F, Flaherty G. Lifestyle risk factors for cardiovascular disease and diabetic risk in a sedentary occupational group: the Galway taxi driver study. Ir J Med Sci 2016; 185:403-12. [PMID: 26984791 DOI: 10.1007/s11845-016-1442-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/07/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Taxi drivers are at increased risk of cardiovascular disease (CVD), something which persists after correcting for the overrepresentation of traditional risk factors for CVD in this cohort. The contribution of lifestyle risk factors to this residually elevated CVD risk remains under-evaluated. AIMS We aimed to determine the prevalence of lifestyle risk factors for CVD, self-reported medical risk factors for CVD, and future risk of type 2 diabetes amongst Irish taxi drivers. METHODS Male taxi drivers with no history of CVD and type 2 diabetes and working in Galway city in the west of Ireland were invited to participate. Physical activity levels, dietary patterns, anthropometry, smoking, hypertension, hypercholesterolaemia, and Finnish Diabetes Risk Score (FINDRISC) values were recorded in a cross-sectional manner. RESULTS 41 taxi drivers (mean age 56.7 ± 9.8 years) participated. 37 % were insufficiently active based on self-report, although only 8 % objectively achieved 10, 000 steps per day. Mean modified Mediterranean diet score (mMDS) was 4.6 ± 2.2, and only 13 % of participants had a normal body mass index (BMI) or waist circumference (WC). Those who worked for taxi companies tended to have a higher BMI (p = .07) and WC (p = .04) by multivariable regression. 22 % were current smokers, although a quit rate of 72 % was observed amongst the 78 % of taxi drivers who had ever smoked. 25 % were at high or very high risk of future type 2 diabetes. CONCLUSION Lifestyle risk factors for CVD and dysglycaemia are prevalent amongst Irish taxi drivers.
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Affiliation(s)
- W P Martin
- School of Medicine, National University of Ireland, Galway, Ireland. .,National Institute for Preventive Cardiology, Galway, Ireland.
| | - F Sharif
- School of Medicine, National University of Ireland, Galway, Ireland
| | - G Flaherty
- School of Medicine, National University of Ireland, Galway, Ireland.,National Institute for Preventive Cardiology, Galway, Ireland
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Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C, Cochrane Tobacco Addiction Group. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2016; 2:CD005992. [PMID: 26842828 PMCID: PMC6486282 DOI: 10.1002/14651858.cd005992.pub3] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and the smoking behaviour of those populations they affect. Since the first version of this review in 2010, more countries have introduced national smoking legislation banning indoor smoking. OBJECTIVES To assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL and reference lists of included studies. We also checked websites of various organisations. Date of most recent search; February 2015. SELECTION CRITERIA We considered studies that reported legislative smoking bans affecting populations. The minimum standard was having an indoor smoking ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. Our search included a broad range of research designs including: randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), controlled before-and-after studies, interrupted time series as defined by the Cochrane Effective Practice and Organisation of Care Group, and uncontrolled pre- and post-ban data. DATA COLLECTION AND ANALYSIS One author extracted characteristics and content of the interventions, participants, outcomes and methods of the included studies and a second author checked the details. We extracted health and smoking behaviour outcomes. We did not attempt a meta-analysis due to the heterogeneity in design and content of the studies included. We evaluated the studies using qualitative narrative synthesis. MAIN RESULTS There are 77 studies included in this updated review. We retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes randomized controlled trials. Thirty-six studies used an interrupted time series study design, 23 studies use a controlled before-and-after design and 18 studies are before-and-after studies with no control group; six of these studies use a cohort design. Seventy-two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking-related diseases. A number of the studies report multiple health outcomes. There is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking-related illnesses. Effects on respiratory and perinatal health were less consistent. We found 24 studies evaluating the impact of national smoke-free legislation on smoking behaviour. Evidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long-term change in existing trends in prevalence. AUTHORS' CONCLUSIONS Since the first version of this review was published, the current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in SHS for countries and their populations. The clearest evidence is observed in reduced admissions for acute coronary syndrome. There is evidence of reduced mortality from smoking-related illnesses at a national level. There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption.
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Affiliation(s)
- Kate Frazer
- University College DublinSchool of Nursing, Midwifery & Health SystemsHealth Sciences CentreBelfieldDublin 4Ireland
| | - Joanne E Callinan
- Milford Care CentreLibrary & Information Service, Education, Research & Quality DepartmentPlassey Park RoadCastletroyLimerickIreland000
| | - Jack McHugh
- University College DublinSchool of Public Health, Physiotherapy and Sports ScienceBelfieldDublin 4Ireland
| | - Susan van Baarsel
- University College DublinSchool of Medicine and Medical ScienceDublinIreland
| | - Anna Clarke
- National Immunisation OfficeManor StreetDublin 7Ireland
| | - Kirsten Doherty
- Education and Research CentreDepartment of Preventive Medicine and Health PromotionSt Vincent's University HospitalElm ParkDublin 4Ireland
| | - Cecily Kelleher
- University College DublinSchool of Public Health, Physiotherapy and Sports ScienceBelfieldDublin 4Ireland
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Castaldelli-Maia JM, Ventriglio A, Bhugra D. Tobacco smoking: From 'glamour' to 'stigma'. A comprehensive review. Psychiatry Clin Neurosci 2016; 70:24-33. [PMID: 26449875 DOI: 10.1111/pcn.12365] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 01/08/2023]
Abstract
In this narrative review, we explore the history of tobacco smoking, its associations and portrayal of its use with luxury and glamour in the past, and intriguingly, its subsequent transformation into a mass consumption industrialized product encouraged by advertising and film. Then, we describe the next phase where tobacco in parts of the world has become an unwanted product. However, the number of smokers is still increasing, especially in new markets, and increasingly younger individuals are being attracted to it, despite the well-known health consequences of tobacco use. We also explore current smoking behaviors, looking at trends in the prevalence of consumption throughout the world, discrimination against smokers, light and/or intermittent smokers, and the electronic cigarette (e-cigarette). We place these changes in the context of neuroscience, which may help explain why the cognitive effects of smoking can be important reinforcers for its consumption despite strong anti-smoking pressure in Western countries.
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Affiliation(s)
- João Mauricio Castaldelli-Maia
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- Department of Neuroscience, Medical School, ABC Foundation, Santo André, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Changes in the Effect of Heat on Mortality in the Last 20 Years in Nine European Cities. Results from the PHASE Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15567-83. [PMID: 26670239 PMCID: PMC4690942 DOI: 10.3390/ijerph121215006] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 12/17/2022]
Abstract
The European project PHASE aims to evaluate patterns of change in the temperature–mortality relationship and in the number of deaths attributable to heat in nine European cities in two periods, before and after summer 2003 (1996–2002 and 2004–2010). We performed age-specific Poisson regression models separately in the two periods, controlling for seasonality, air pollution and time trends. Distributed lag non-linear models were used to estimate the Relative Risks of daily mortality for increases in mean temperature from the 75th to 99th percentile of the summer distribution for each city. In the recent period, a reduction in the mortality risk associated to heat was observed only in Athens, Rome and Paris, especially among the elderly. Furthermore, in terms of heat-attributable mortality, 985, 787 and 623 fewer deaths were estimated, respectively, in the three cities. In Helsinki and Stockholm, there is a suggestion of increased heat effect. Noteworthy is that an effect of heat was still present in the recent years in all cities, ranging from +11% to +35%. In Europe, considering the warming observed in recent decades and population ageing, effective intervention measures should be promoted across countries, especially targeting vulnerable subgroups of the population with lower adaptive resources.
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Pischke CR, Helmer SM, McAlaney J, Bewick BM, Vriesacker B, Van Hal G, Mikolajczyk RT, Akvardar Y, Guillen-Grima F, Salonna F, Orosova O, Dohrmann S, Dempsey RC, Zeeb H. Normative misperceptions of tobacco use among university students in seven European countries: baseline findings of the 'Social Norms Intervention for the prevention of Polydrug usE' study. Addict Behav 2015; 51:158-64. [PMID: 26275842 DOI: 10.1016/j.addbeh.2015.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/14/2015] [Accepted: 07/22/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Research conducted in North America suggests that students tend to overestimate tobacco use among their peers. This perceived norm may impact personal tobacco use. It remains unclear how these perceptions influence tobacco use among European students. The two aims were to investigate possible self-other discrepancies regarding personal use and attitudes towards use and to evaluate if perceptions of peer use and peer approval of use are associated with personal use and approval of tobacco use. METHODS The EU-funded 'Social Norms Intervention for the prevention of Polydrug usE' study was conducted in Belgium, Denmark, Germany, Slovak Republic, Spain, Turkey and United Kingdom. In total, 4482 students (71% female) answered an online survey including questions on personal and perceived tobacco use and personal and perceived attitudes towards tobacco use. RESULTS Across all countries, the majority of students perceived tobacco use of their peers to be higher than their own use. The perception that the majority (>50%) of peers used tobacco regularly in the past two months was significantly associated with higher odds for personal regular use (OR: 2.66, 95% CI: 1.90-3.73). The perception that the majority of peers approve of tobacco use was significantly associated with higher odds for personal approval of tobacco use (OR: 6.49, 95% CI: 4.54-9.28). CONCLUSIONS Perceived norms are an important predictor of personal tobacco use and attitudes towards use. Interventions addressing perceived norms may be a viable method to change attitudes and tobacco use among European students, and may be a component of future tobacco control policy.
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Affiliation(s)
- Claudia R Pischke
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany.
| | - Stefanie M Helmer
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany.
| | - John McAlaney
- Division of Psychology, University of Bradford, Bradford, BD7 1DP, United Kingdom.
| | - Bridgette M Bewick
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, 101 Clarendon Road, West Yorkshire, LS2 9LJ, Leeds, United Kingdom.
| | - Bart Vriesacker
- Research & Development, Occupational Health Services Mensura, Italiëlei 2, 2000 Antwerp, Belgium; Epidemiology and Social Medicine, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - Guido Van Hal
- Epidemiology and Social Medicine, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 33824 Braunschweig, Germany.
| | - Yildiz Akvardar
- Department of Psychiatry, Marmara University School of Medicine, 34899 Istanbul, Turkey.
| | - Francisco Guillen-Grima
- Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Avda de Baranain s/n, 31008 Pamplona, Navarra, Spain.
| | - Ferdinand Salonna
- Institute of Active Lifestyle, Palacky University of Olomouc, 771 47 Olomouc, Czech Republic.
| | - Olga Orosova
- Department of Educational Psychology and Health Psychology, PJ Safarik University, Kosice, Slovakia.
| | - Solveig Dohrmann
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9, 6700 Esbjerg, Denmark.
| | - Robert C Dempsey
- Division of Psychology, University of Bradford, Bradford, BD7 1DP, United Kingdom; School of Psychology, Sport and Exercise, Staffordshire University, Science Center, Leek Road, Stoke-On-Trent ST4 2DF, United Kingdom.
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany.
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Das SK, Chisti MJ, Ahmed AMS, Malek MA, Ahmed S, Shahunja KM, Ferdous F, Farzana FD, Das J, Rahman A, Al Mamun A, Faruque ASG. Diarrhoea and smoking: an analysis of decades of observational data from Bangladesh. BMC Public Health 2015; 15:646. [PMID: 26164796 PMCID: PMC4499450 DOI: 10.1186/s12889-015-1906-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 06/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although cigarette smoking affects all biological systems of the human body including the gastrointestinal tract, there is a lack of evidence regarding its effect on the severity of diarrhoeal disease and whether a dose-response relationship exists. We therefore tested for the presence of specific causative pathogens for infectious diarrhoea, assessed the independent effect of smoking on its severity and tested whether any dose-response relationship existed while controlling for subjects' age, sociodemographic characteristics and presence of causative pathogens in an urban setting in Bangladesh. METHODS A total of 20,757 patients aged 15 years and above with diarrhoea were enrolled into the Diarrhoeal Disease Surveillance System, managed by the International Centre for Diarrhoeal Disease Research, Bangladesh, from 1993 to 2012. We collected data on individuals' current daily consumption of cigarettes and bidis (traditional hand-rolled cigarettes) and conducted an ordered logistic regression to determine the effect of smoking on diarrhoeal disease severity and whether a dose-response relationship exists. RESULTS We identified 19 % of patients with diarrhoea as smokers, of whom 52 % smoked 1-9 cigarettes per day. While 97 % of smokers were male, 41 % were aged 15-30 years of age. Smokers were found to have a significantly lower severity of diarrhoeal disease (OR: 0.92, 95 % CI: 0.85-0.99, p = 0.025) after adjusting for age, wealth quintile, illiteracy and the presence of specific causative pathogens (Vibrio cholerae and Shigella). We observed no dose-response relationship between the number of cigarettes smoked per day and disease severity when adjusting for the same covariates. Smokers were more frequently infected with Shigella (7 vs. 6 %, p < 0.001) and less often with Vibrio cholerae (22 vs. 26 %, p < 0.001) than their non-smoking counterparts. CONCLUSIONS The aetiology and severity of diarrhoeal disease differed between smokers and non-smokers in our sample. However, we found no dose-response relationship between disease severity and the number of cigarettes smoked per day.
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Affiliation(s)
- Sumon Kumar Das
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. .,School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Mohammod Jobayer Chisti
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - A M Shamsir Ahmed
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. .,School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Mohammad Abdul Malek
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Shahnawaz Ahmed
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - K M Shahunja
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Farzana Ferdous
- Department of Clinical Trial and Clinical Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
| | - Fahmida Dil Farzana
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Jui Das
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Aminur Rahman
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Abdullah Al Mamun
- School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Abu Syed Golam Faruque
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
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