The public health benefits of smoking ban policies: epidemiologic analyses of mortality effects and differentials by socioeconomic status

Abstract

Background: The implementation of comprehensive smoking ban policies results in reduced population exposure to secondhand smoke, yielding health benefits such as improved respiratory function and decreased risk of cardiovascular events. However, smoking ban effects on respiratory and cerebrovascular mortality and effect differences by socioeconomic status (SES) are unknown. Methods: A literature review was conducted to understand the health benefits of smoking ban policies and to identify areas of research that needed to be addressed. Subsequently, an epidemiologic study employing an interrupted time-series approach was conducted with a national mortality dataset from the Republic of Ireland to determine effects following the implementation of the national workplace smoking ban. Irish census data were used to calculate frequencies of deprivation at the level of the local authority and principal component analysis was conducted to generate a composite SES index. To determine whether the smoking ban policy impacted inequalities, Poisson regression with interrupted time-series analysis was conducted to examine mortality rates, stratified by tertiles of discrete SES indicators and the composite index. Results: The review identified strong evidence for post-ban reductions in cardiovascular morbidity and mortality, and suggestive evidence of reductions in respiratory morbidity following smoking ban implementation. Few studies assessed ban effects by SES and findings were inconsistent; hence, insufficient evidence was available to determine smoking ban policy impacts on health inequalities. Epidemiologic analyses demonstrated that the national Irish smoking ban was associated with immediate reductions in early mortality for cardiovascular, cerebrovascular, and respiratory causes. Further analyses by discrete socioeconomic indicators and a composite index indicated that the national Irish smoking ban was associated with decreased inequalities in smoking-related mortality. Conclusions: Smoking ban policies are effective public health interventions for the prevention of cardiovascular, cerebrovascular, and respiratory mortality. Furthermore, findings indicate that smoking ban policies have the potential to reduce inequalities in mortality.