Academic journal article Canadian Journal of Public Health

Implications of a Public Smoking Ban

Academic journal article Canadian Journal of Public Health

Implications of a Public Smoking Ban

Article excerpt


Objectives: Legislation to ban smoking in public places is currently a major area of interest across Canada. The main objectives of the study were to 1) determine the effect of the smoking ban on incidence of acute myocardial infarction, 2) determine if the new legislation altered population-based smoking prevalence, and 3) measure public support for the public smoking ban.

Methods: The city of Saskatoon initiated a public smoking ban on July 1, 2004. We retrospectively reviewed all hospital discharges for acute MI from July 2000 to June 2005. We reviewed CCHS survey information on smoking prevalence for Saskatoon, Saskatchewan and Canada from 2003 to 2005. We prospectively contacted 1,255 Saskatoon residents by telephone to determine support for the public smoking ban.

Results: The age-standardized incidence rate of acute MI fell from 176.1 (95% CI 165.3-186.8) cases per 100,000 population (July 1, 2000 to June 30, 2004) to 152.4 (95% CI 135.3-169.3) cases per 100,000 population (July 1, 2004 to June 30, 2005). Smoking prevalence in Saskatoon fell from 24.1% in 2003 (95% CI 20.4-27.7) to 18.2% in 2005 (95% CI 15.7-20.9) while smoking prevalence in Saskatchewan remained unchanged at 23.8% (95% CI 22.6-25.3) and Canada reduced from 22.9% (95% CI 22.5-23.3) to 21.3% (95% CI 20.8-21.8). Seventy-nine percent of Saskatoon residents believed the smoking ban was a good idea.

Interpretation: The public smoking ban in Saskatoon, Canada, is associated with reduced incidence rates of acute MI, lower smoking prevalence and high levels of public support.

Key words: Tobacco smoke pollution; myocardial infarction; smoking cessation-legislation and jurisprudence; prevalence studies

Legislation to ban smoking in public places is currently a major area of interest across Canada with all provinces enacting some form of legislation. The purpose of the current study is to look at the overall impact of a public smoking ban on rates of acute myocardial infarction, smoking prevalence and public support.

Two separate meta-analyses suggest that exposure to second-hand smoke increases the risk of fatal and non-fatal coronary heart disease in non-smokers by 25% (RR = 1.25; 95% CI 1.17-1.32) to 30% (RR = 1.30; 95% CI 1.22-1.38).1,2 One review suggests the cardiovascular effects of second-hand smoke are nearly as damaging as those of smoking itself.3 Unlike with lung cancer, the risk of acute myocardial infarction (MI) associated with exposure to second-hand smoke is non-linear, increasing rapidly with relatively small doses such as those received from second-hand smoke.3-7 A recent study observed a 40% reduction in acute MI during a six-month period after a small American city initiated a public smoking ban.8 This study, however, had some methodological concerns including small sample size, short intervention period, brief historical trend and no information on intervention compliance or whether or not smoking habits were affected by the ban.9

The association between workplace legislation and reduction in smoking prevalence is well documented.10-13 One systematic literature review indicates smoke-free workplaces have reduced smoking prevalence by 3.8% (95% CI 2.8%-4.7%) and reduced smoking amounts by 3.1 cigarettes per day in continuing smokers.14 The association between public smoking bans and general population smoking prevalence is less known. Italy observed an 8.9% reduction in tobacco sales, and 80% of those who quit smoking in Ireland indicated the public smoking ban helped them quit.15,16

Regrettably, most of the research on public smoking bans has been conducted prior to legislation change. A Health Canada report found 77-79% overall support for bans on smoking in public places in Quebec, Ontario and Saskatchewan prior to smoking ban implementation.17

The City of Saskatoon, Canada, implemented a city-wide public smoking ban on July 1, 2004 (Bylaw 8286). The new bylaw prohibits smoking or holding lighted tobacco products in any enclosed public space that is open to the public or to which the public is customarily admitted or invited. …

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