Abstract
BackgroundPrevious studies have reported a reduction in acute coronary events following smoke-free legislation. Evidence is lacking on whether stroke is also reduced. The aim was to determine whether the incidence of stroke, overall and by sub-type, fell following introduction of smoke-free legislation across Scotland on 26 March 2006.Methods and FindingsA negative binomial regression model was used to determine whether the introduction of smoke-free legislation resulted in a step and/or slope change in stroke incidence. The model was adjusted for age-group, sex, socioeconomic deprivation quintile, urban/rural residence and month. Interaction tests were also performed. Routine hospital administrative data and death certificates were used to identify all hospital admissions and pre-hospital deaths due to stroke (ICD10 codes I61, I63 and I64) in Scotland between 2000 and 2010 inclusive. Prior to the legislation, rates of all stroke, intracerebral haemorrhage and unspecified stroke were decreasing, whilst cerebral infarction was increasing at 0.97% per annum. Following the legislation, there was a dramatic fall in cerebral infarctions that persisted for around 20 months. No visible effect was observed for other types of stroke. The model confirmed an 8.90% (95% CI 4.85, 12.77, p<0.001) stepwise reduction in cerebral infarction at the time the legislation was implemented, after adjustment for potential confounders.ConclusionsFollowing introduction of national, comprehensive smoke-free legislation there was a selective reduction in cerebral infarction that was not apparent in other types of stroke.
Highlights
In Scotland, the Smoking, Health and Social Care (Scotland) Bill prohibited smoking in virtually all wholly and substantially enclosed public places and workplaces from 26 March 2006, including bars, restaurants, cafes and private members clubs
Following introduction of national, comprehensive smoke-free legislation there was a selective reduction in cerebral infarction that was not apparent in other types of stroke
The primary aim of the legislation was to protect non-smokers from the adverse health effects of exposure to environmental tobacco smoke (ETS), but it was anticipated that health benefits might accrue from a reduction in tobacco consumption and smoking prevalence in the general population
Summary
In Scotland, the Smoking, Health and Social Care (Scotland) Bill prohibited smoking in virtually all wholly and substantially enclosed public places and workplaces from 26 March 2006, including bars, restaurants, cafes and private members clubs. The law is enforced by Environmental Health Officers. It became illegal both to smoke and to permit smoking in smoke-free premises. The primary aim of the legislation was to protect non-smokers from the adverse health effects of exposure to environmental tobacco smoke (ETS), but it was anticipated that health benefits might accrue from a reduction in tobacco consumption and smoking prevalence in the general population. Previous studies have reported a reduction in acute coronary events following smoke-free legislation. The aim was to determine whether the incidence of stroke, overall and by sub-type, fell following introduction of smoke-free legislation across Scotland on 26 March 2006
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