Smoking Bans Appear to Improve Health

Posted: 2/4/2016

By: Cochrane Review

Smoking bans aimed at reducing secondhand smoke exposure appear to have a positive impact on cardiovascular disease rates and outcomes across the globe, according to an updated Cochrane review of 77 observational studies from 21 countries.

The systematic review represents the most robust evidence yet that legislative action banning smoking in public places may be improving health outcomes, Cecily Kelleher, MD, of the University College Dublin, and colleagues wrote in the Cochrane Database of Systematic Reviews 2016.

The report updates a 2010 Cochrane review, which found smoking bans in work places and public spaces had a positive impact on secondhand smoke exposures. Since 2010, the research emphasis has shifted from smoke exposures to health outcomes in places that have enacted smoking bans, Kelleher told MedPage Today in a telephone interview.
She said most studies in the updated review showed declines in hospital admission rates due to cardiovascular disease following the initiation of smoking bans.

"It is clear that cardiovascular disease admission rates have been falling in temporal association with the bans," she said, adding that the impact appears to be greatest among nonsmokers.

The World Health Organization estimates that 6 million people die each year due to tobacco-related diseases, with 600,000 deaths due to passive smoking.

The systematic review included studies designed to investigate the effect of smoking bans on any measure of health or on smoking behavior, conducted in nations, states, and municipalities with smoking bans in place for at least 6 months. Sixty-five of the 77 identified studies were new and 12 were included in the 2010 review.

Seventy-two studies reported health outcomes, including cardiovascular (44), respiratory, (21) and perinatal (7) outcomes. Eleven studies reported death rates, and none were randomized controlled trials.

"We found consistent temporal trends with evidence of significant reductions in acute myocardial infarction (AMI)/acute coronary syndrome (ACS) admissions following the introduction of national smoking bans," the researchers wrote. "Significant reductions in rates of admissions and discharges were evident in 12 studies."

Results from several studies suggest the greatest health benefits occur in nonsmokers.
A registry study from Germany, published in 2014, showed a 26% decline in hospital admissions due to ST-elevation MI in nonsmokers after smoking bans went into effect and a 16% decline overall, Kelleher noted.
"The evidence signifies that legislative smoking bans are justified, given that we are looking at a significant degree of consistency in these findings," she said.

She added that there is a need for more high-quality studies examining the impact of smoking bans on respiratory and neonatal health outcomes and smoking-related mortality.
The review found "low quality evidence" of reduced mortality for smoking-related illness, and the researchers concluded that the evidence of an association between smoking bans and improved respiratory and perinatal health outcomes is lacking.

"We need research on the continued longer-term impact of smoking bans on the health outcomes of specific subgroups of the population, such as young children, disadvantaged, and minority groups," the researchers wrote. "More robust research on the