Abstract
ObjectiveTo evaluate the impact of a complete smoking ban in enclosed spaces on the incidence of acute myocardial infarction in Chile.MethodsThe population-based study involved residents of urban areas, where 80% of the Chilean population live, aged 20 years or older who had a myocardial infarction. Monthly myocardial infarction incidence and mortality rates at health-care facilities between January 2011 and December 2014 were derived from admission and mortality databases. Regression discontinuity methods were used to estimate the near-immediate impact on disease incidence of enforcing smoke-free legislation in March 2013. The same analysis was performed for ischaemic stroke, degenerative disc disease and colon cancer. Data on the concentration of fine respirable particulates were included in an additional analysis of myocardial infarction incidence in the Santiago metropolitan area.ResultsThe enforcement of smoke-free legislation was associated with an abrupt, near-immediate decline of 0.639 cases of myocardial infarction per 100 000 adults per month (95% confidence interval, CI: 0.242 to 1.036; relative decline: 7.8%). Similar declines were observed in men and women and in people aged over and under 70 years. However, enforcement of the legislation was not associated with a significant change in the rate of ischaemic stroke, degenerative disc disease or colon cancer. The abrupt decline in myocardial infarction incidence was also observed when data on fine respirable particulates were included in an analysis for Santiago.ConclusionThe enforcement of extensive smoke-free legislation in Chile was associated with an abrupt, near-immediate decline in the incidence of myocardial infarction.
Highlights
After ratifying the World Health Organization’s Framework Convention on Tobacco Control in June 2005, Chile enacted its first round of tobacco control legislation in May 2006.1 The law completely prohibited smoking in public transport, in cinemas and in or near schools, but permitted designated smoking spaces in public facilities and workplaces with more than 10 employees.[2]
In February 2013, Chile enacted a second round of strengthened tobacco control legislation, which took effect on 1 March 2013.3 The new law extended the complete prohibition of smoking to all enclosed spaces accessible to the public, all enclosed commercial spaces and all open and closed sports arenas.[4]
Violations were identified in only 1.7% of inspections
Summary
After ratifying the World Health Organization’s Framework Convention on Tobacco Control in June 2005, Chile enacted its first round of tobacco control legislation in May 2006.1 The law completely prohibited smoking in public transport, in cinemas and in or near schools, but permitted designated smoking spaces in public facilities and workplaces with more than 10 employees.[2]. In February 2013, Chile enacted a second round of strengthened tobacco control legislation, which took effect on 1 March 2013.3 The new law extended the complete prohibition of smoking to all enclosed spaces accessible to the public, all enclosed commercial spaces and all open and closed sports arenas.[4] Compliance with the new prohibitions on public smoking was almost immediate and virtually complete. Among people aged 12 to 64 years, the proportion who reported smoking in the past month declined from 43.6% in 2002 to 34.0% in 2012, but rose to 39.7% in 2014.6
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