Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome
Open accessAbstract
BACKGROUND: Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome after the enactment of legislation banning smoking in public places. However, it is unknown whether the reduction in admissions involved nonsmokers, smokers, or both. METHODS: Since the end of March 2006, smoking has been prohibited by law in all enclosed public places throughout Scotland. We collected information prospectively on smoking status and exposure to secondhand smoke based on questionnaires and biochemical findings from all patients admitted with acute coronary syndrome to nine Scottish hospitals during the 10-month period preceding the passage of the legislation and during the same period the next year. These hospitals accounted for 64% of admissions for acute coronary syndrome in Scotland, which has a population of 5.1 million. RESULTS: Overall, the number of admissions for acute coronary syndrome decreased from 3235 to 2684--a 17% reduction (95% confidence interval, 16 to 18)--as compared with a 4% reduction in England (which has no such legislation) during the same period and a mean annual decrease of 3% (maximum decrease, 9%) in Scotland during the decade preceding the study. The reduction in the number of admissions was not due to an increase in the number of deaths of patients with acute coronary syndrome who were not admitted to the hospital; this latter number decreased by 6%. There was a 14% reduction in the number of admissions for acute coronary syndrome among smokers, a 19% reduction among former smokers, and a 21% reduction among persons who had never smoked. Persons who had never smoked reported a decrease in the weekly duration of exposure to secondhand smoke (P<0.001 by the chi-square test for trend) that was confirmed by a decrease in their geometric mean concentration of serum cotinine from 0.68 to 0.56 ng per milliliter (P<0.001 by the t-test). CONCLUSIONS: The number of admissions for acute coronary syndrome decreased after the implementation of smoke-free legislation. A total of 67% of the decrease involved nonsmokers. However, fewer admissions among smokers also contributed to the overall reduction.
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All 11 quasi-experimental studies demonstrated reductions in coronary event rates, with decreases ranging from approximately 6% to 47%.
“All studies demonstrated reductions in coronary event rates, with decreases ranging from ≈6% to 47%.”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [409]
The IOM report found substantial evidence that smoking bans were effective in reducing coronary events, based on critical reviews of 11 quasi-experimental studies.
“The IOM report also found substantial evidence that smoking bans were effective in reducing coronary events, based on critical reviews of 11 quasi-experimental studies that examined smoking bans and changes in acute coronary events.”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [409]
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- Authors
- Pell, J. P., Haw, S., Cobbe, S., Newby, D. E., Pell, A. C. H., Fischbacher, C., McConnachie, A., Pringle, S., Murdoch, D., Dunn, F., Oldroyd, K., MacIntyre, P., O'Rourke, B., & Borland, W.
- Affiliations
- University of Glasgow (GB)
- University of Edinburgh (GB)
- Monklands Hospital (GB)
- Ninewells Hospital (GB)
- Southern General Hospital (GB)
- Stobhill Hospital (GB)
- Western Infirmary (GB)
- Royal Alexandra Hospital (GB)
- Hairmyres Hospital (GB)
- Western General Hospital (GB)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2008-07-31
- Volume
- 359
- Issue
- 5
- Pages
- 482-491
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2140251732
- Cited by
- 446
- References
- 29
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 8 · 2023: 9 · 2022: 16 · 2021: 8 · 2020: 12 · 2019: 14 · 2018: 18 · 2017: 20 · 2016: 13 · 2015: 22 · 2014: 27 · 2013: 45 · 2012: 50
- FWCI
- 39.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, public-domain)
- Funders
- Wellcome Trust
- British Heart Foundation
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- smoking bans, acute coronary syndrome, hospitalization, passive smoking, non-smokers, smokers, former smokers, serum cotinine, public smoking bans, Scotland
- MeSH terms
- Age Factors, Aged, Cotinine, Female, Hospitalization, Humans, Male, Middle Aged, Prospective Studies, Scotland, Sex Factors, Smoking, Tobacco Smoke Pollution, Acute Coronary Syndrome
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