Reduced hospitalizations for ACS following smoking ban in Scotland
July 30, 2008 | Michael O'Riordan
Glasgow, Scotland - A ban that prohibits smoking in all enclosed places throughout Scotland has led to a decrease in the number of hospital admissions for acute coronary syndrome (ACS), and the benefit of the smoking ban has extended to smokers, former smokers, and those who never smoked, a new study has shown [1].
"The reaction to the smoking ban has been remarkably positive in Scotland," lead investigator Dr Jill Pell (University of Glasgow, Scotland) told heartwire. "It was implemented more easily here than it was in England, where legislation has now also been passed. There has also been very good compliance, with other studies showing that within a couple of weeks 86% of pubs were complying voluntarily with the ban."
The Smoking, Health, and Social Care Act was passed in 2005 and prohibited smoking in all enclosed public spaces and workplaces in Scotland after March 2006. The purpose of this study was to document the number of admissions for ACS before and after the implementation of the national legislation. The analysis looked at nine hospitals that served a population of three million and captured 64% of all ACS events.
In the 10 months after the implementation of the legislation, there was a 14% reduction in number of admissions for ACS among smokers, a 19% reduction among former smokers, and a 21% reduction among those who never smoked. Among those who never smoked, there was a reduction in exposure to secondhand smoke; this self-reported finding was confirmed by reductions in their mean serum cotinine concentrations.
Relative risk reduction after smoking-ban legislation
Relative reduction in ACS
Current smokers (95% CI)
Former smokers (95% CI)
People who never smoked (95% CI)
In men <55 years and women <65 years
9 (6-12)
7 (2-12)
8 (3-13)
In men >55 years and women >65 years
18 (15-21)
21 (18-24)
23 (20-26)
In all patients
14 (12-16)
19 (17-21)
21 (18-24)
To download table as a slide, click on slide logo above
"The ban appears to be working in two ways," said Pell. "It is protecting nonsmokers, but it also appears to be getting existing smokers to quit or reduce smoking."
One concern about the legislation was whether or not it would displace smoking into the home. Pell told heartwire that two large studies have since been performed—one in children and the other in an adult population—and have shown this hasn't happened. "Overall exposure has gone down, so it isn't displacement," she said.
Pell added that the smoking ban is changing social norms; there is now less acceptance of smoking. "There needs to be more clinical support to help individuals to quit," she said. "In the three months leading up to the ban, calls to a national smoking hotline went up 67%. Obviously, there is a willingness to use the legislation as an impetus to give up smoking, and that should be supported."
More studies will be needed to determine whether these early improvements are sustained, said Pell. Smokers who quit could relapse, but with the changing social attitudes toward smoking, there is hope that younger people will be discouraged from starting.
From Glasgow, Scotland to Glasgow, Kentucky
Despite the efforts of one cardiologist, theheart.org's forum moderator Dr Melissa Walton-Shirley (TJ Samson Community Hospital, Glasgow, KY), the city council in Glasgow, Kentucky, nearly 4000 miles from Glasgow, Scotland, recently voted against a proposal that would have banned smoking in public places and indoor workplaces in the city. The 6-5 vote that put the proposed ordinance on hold indefinitely was conducted on May 12, 2008.
In the lead-up to the vote, Walton-Shirley literally went door to door seeking support for the ordinance and trying to convince people of the dangers of smoking and secondhand smoke. The drive for a smoke-free Glasgow, Kentucky was supported by patients dying of secondhand-smoke exposure and by lung specialists, cancer specialists, cardiologists, family practice doctors, and representatives from the American Lung Association. The campaign is documented in a lengthy exchange in the theheart.org's forum [2].
"One in four high-school teenagers smokes here," she wrote in mid April. "One in four pregnant women smokes here. We have the lowest level of education in the industrialized world and the highest smoking rates. College degrees are gone for most of our teenagers because their parents purchased two decades worth of cancer sticks, then suck out even more dollars from Medicaid to fund their treatments. Grandparents are approaching extinction. A 39-year-old with a PCI or CABG is not uncommon."
With her canvassing and advertisements in the local newspaper, Walton-Shirley and her group of volunteers were accused of being dishonest, deceitful, and vindictive, despite obtaining approximately 500 signatures supporting the smoke-free legislation. Although the vote was disappointing, Walton-Shirley said the campaign has been positive because secondhand smoke has become a topic of conversation and a concern of many, especially parents, who want to see the city have a smoke-free future. Some restaurants and supermarkets have voluntarily gone smoke-free.
"There was definitely some political jockeying going on there, but politics is as expected," she wrote the day after the vote. "This type of discussion is necessary and very helpful to let the public know exactly who is and is not going to vote on the side of protection."
Sources
Pell JP, Haw S, Cobbe S, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med 2008; 359:482-491. Available at content.nejm.org.
Journey to a smoke-free city. theheart.org forum. Available at theheart.org.
Related links
Smoke-free policies bring health benefits
[HeartWire > Prevention; Jul 01, 2008]
Social networks influence smoking cessation
[HeartWire > Clinical cardiology; May 23, 2008]
A million deaths from smoking in India by 2010s
[HeartWire > Prevention; Feb 13, 2008]
Coronary events drop in Italy after smoking ban
[HeartWire > Prevention; Feb 11, 2008]
Major MI benefit of smoking ban seen in nonsmokers
[HeartWire > Cardiometabolic risk; Nov 21, 2007] |
