Effect of Uruguay’s National 100% Smokefree Law on Emergency Visits for Bronchospasm

Kalkhoran, Sara; Sebrié, Ernesto M; Sandoya, Edgardo; Glantz, Stanton A.

doi:10.1016/j.amepre.2014.12.009

Cited by 11 publications

(23 citation statements)

References 23 publications

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“…Ten (58.8%) were non-experimental and 15 (88.2%) evaluated comprehensive SFL. One was conerned asthma treatment use (5.9%)[ 79 ]. Evaluation periods ranged from 11 months to seven years.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies focused on adult populations[ 48 , 49 , 53 , 66 , 79 ], they all evaluated comprehensive SFL and had a non-experimental design. Three of them (60.0%) found significant reduction rates from 4.9%[ 53 ] to 36.0%[ 49 ] (all except one in hospital admissions[ 79 ]). One study reviewed the incidence rate ratio in non-hospital admissions [ 79 ] and reported a decrease of 15.0% in admissions after SFL.…”

Section: Resultsmentioning

confidence: 99%

“…Three of them (60.0%) found significant reduction rates from 4.9%[ 53 ] to 36.0%[ 49 ] (all except one in hospital admissions[ 79 ]). One study reviewed the incidence rate ratio in non-hospital admissions [ 79 ] and reported a decrease of 15.0% in admissions after SFL. In the two remaining studies[ 48 , 66 ], results were discordant with no significant differences.…”

Section: Resultsmentioning

confidence: 99%

“…In the two remaining studies[ 48 , 66 ], results were discordant with no significant differences. With respect to asthma treatment in adults, the use of salbutamol and ipratropium descended in non-hospital emergency settings[ 79 ].…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, the effect of SFL with respect to respiratory symptomatology in children was only evaluated in two studies without conclusive results. It is notable that non-hospital setting was monitored in only two studies[ 34 , 79 ]. Neither are there data about respiratory mortality in worker and child populations.…”

Section: Discussionmentioning

confidence: 99%

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Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis

et al. 2017

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AimsThe 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 methodsSystematic 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.ResultsA 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.ConclusionsSmokefree 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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“…Ten (58.8%) were non-experimental and 15 (88.2%) evaluated comprehensive SFL. One was conerned asthma treatment use (5.9%)[ 79 ]. Evaluation periods ranged from 11 months to seven years.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis

et al. 2017

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Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes

et al. 2023

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ImportanceSmoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality.ObjectiveTo investigate the associations of population-level tobacco-control policies with health outcomes.Data SourcesPubMed, 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 SelectionStudies 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 SynthesisData 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 MeasuresThe 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.ResultsOf 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 RelevanceIn 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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Effect of tobacco control policies on perinatal and child health: a systematic review and meta-analysis

Faber

Kumar

Mackenbach

et al. 2017

The Lancet Public Health

164

130

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SummaryBackgroundTobacco smoking and smoke exposure during pregnancy and childhood cause considerable childhood morbidity and mortality. We did a systematic review and meta-analysis to investigate whether implementation of WHO's recommended tobacco control policies (MPOWER) was of benefit to perinatal and child health.MethodsWe searched 19 electronic databases, hand-searched references and citations, and consulted experts to identify studies assessing the association between implementation of MPOWER policies and child health. We did not apply any language restrictions, and searched the full time period available for each database, up to June 22, 2017. Our primary outcomes of interest were perinatal mortality, preterm birth, hospital attendance for asthma exacerbations, and hospital attendance for respiratory tract infections. Where possible and appropriate, we combined data from different studies in random-effects meta-analyses. This study is registered with PROSPERO, number CRD42015023448.FindingsWe identified 41 eligible studies (24 from North America, 16 from Europe, and one from China) that assessed combinations of the following MPOWER policies: smoke-free legislation (n=35), tobacco taxation (n=11), and smoking cessation services (n=3). Risk of bias was low in 23 studies, moderate in 16, and high in two. Implementation of smoke-free legislation was associated with reductions in rates of preterm birth (–3·77% [95% CI −6·37 to −1·16]; ten studies, 27 530 183 individuals), rates of hospital attendance for asthma exacerbations (–9·83% [–16·62 to −3·04]; five studies, 684 826 events), and rates of hospital attendance for all respiratory tract infections (–3·45% [–4·64 to −2·25]; two studies, 1 681 020 events) and for lower respiratory tract infections (–18·48% [–32·79 to −4·17]; three studies, 887 414 events). Associations appeared to be stronger when comprehensive smoke-free laws were implemented than when partial smoke-free laws were implemented. Among two studies assessing the association between smoke-free legislation and perinatal mortality, one showed significant reductions in stillbirth and neonatal mortality but did not report the overall effect on perinatal mortality, while the other showed no change in perinatal mortality. Meta-analysis of studies on other MPOWER policies was not possible; all four studies on increasing tobacco taxation and one of two on offering disadvantaged pregnant women help to quit smoking that reported on our primary outcomes had positive findings. Assessment of publication bias was only possible for studies assessing the association between smoke-free legislation and preterm birth, showing some degree of bias.InterpretationSmoke-free legislation is associated with substantial benefits to child health. The majority of studies on other MPOWER policies also indicated a positive effect. These findings provide strong support for implementation of such policies comprehensively across the world.FundingChief Scientist Office Scotland, Farr Institute, Netherlands Lung Foundation, Erasmus...

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Effect of Uruguay’s National 100% Smokefree Law on Emergency Visits for Bronchospasm

Cited by 11 publications

References 23 publications

Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis

Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis

Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes

Effect of tobacco control policies on perinatal and child health: a systematic review and meta-analysis

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