Smoke-free Legislation Research Articles

Twenty-year sociodemographic trends in lung cancer in non-smokers: A UK-based cohort study of 3.7 million people

Introduction: There are reports that lung cancer in non-smokers (LCINS) is increasing in the United Kingdom (UK) and other high-income countries but evidence from large-scale cohort studies to support this claim is limited. Material and methods: Using The Health Improvement Network (THIN) IQVIA™ Medical Research Data, we identified a cohort of 3,679,831 people from the UK self-reporting to their primary care physician as never or non-smokers. We estimated age-adjusted incidence rates for recorded lung cancer before (1998−2007) and after (2008−2018) the introduction of smoke-free legislation using multivariable Poisson regression. We also explored the impact of geographic location, social deprivation and urbanicity. Results: The analysis included 3,212 lung cancer events and 28 million person-years (PYs). Between 1998 and 2007, the age-adjusted rates in men declined by 9% per year (95 %CI: 7–11%) from an estimated 5.6 to 1.5 per 10,000 PYs and by 3% per year (95 %CI: 1–5%) between 2008 and 2018. These trends for men were similar across sociodemographic strata. Between 1998 and 2007, age-adjusted rates were stable for women at 1.5 per 10,000 PYs. However, there was evidence that time trends for women differed depending on levels of social deprivation with rates increasing by 5% per year (95 %CI: 2–9%) from an estimated 1.3–2.1 per 10,000 PYs for women living in the least socially deprived areas. Sex-specific time trends from 2008 to 2016 were broadly similar in a separate cohort of self-reported never smokers from UK Biobank with cancer events linked to national registries. ConclusionIn summary, the incidence of LCINS has reduced or remained stable for most of the UK with the possible exception of women living in the least socially deprived areas.

Evaluating the impact of the California 1995 smoke-free workplace law on population smoking prevalence using a synthetic control method.

The objective of this study is to assess the impact of the California 1995 Smoke-Free Workplace Act (SFWA) on cigarette smoking prevalence in the population. We used survey responses related to cigarette smoking from the Behavioral Risk Factor Surveillance System (BRFSS) from 1990 to 2000. We utilize a synthetic control method which creates a weighted combination of control states to produce a single ‘synthetic’ control group to best approximate the counterfactual trend in California in the absence of the SFWA. Variables known to be associated with smoking were included to weight each state in the pre-intervention period as medians by state and included: distribution of race/ethnicity (White, Black, Asian, Hispanic), sex (Male/Female), marital status (married/unmarried), high school education (yes/no) and employment status (yes/no).We find evidence that there was a small decrease in population smoking prevalence in California in the year immediately following the SFWA, but this effect was not sustained beyond 1995. We hypothesize that one potential explanation for the lack of prolonged impact on population smoking prevalence is that there are sustained effects from the passage of 1989 California Proposition 99, which enacted an excise tax on tobacco products. Understanding how workplace smoking ban legislation affects population smoking behaviors is necessary to better inform policy development in other states and counties and to improve existing policies. Future work should consider the impact of smoking legislation impacts subgroups of the population by socioeconomic status, occupation or race/ethnicity.

Racial/Ethnic Differences in Light of 100% Smoke-free State Laws: Evidence from Adults in the United States.

This study estimates racial/ethnic differences in the association between 100% smoke-free state laws and smoking, as well as self-reported health, to facilitate policy aimed at reducing disparities. Data pertain to adults aged 18 years and older, obtained from the public-use Behavioral Risk Factor Surveillance System (2002-2014). The authors exploit variation in the timing of 100% smoke-free state laws using a difference-in-differences model. Examining heterogeneity across racial/ethnic minority groups, the authors consider the association between smoke-free laws and the probability of being: a daily smoker (versus occasional); an occasional smoker (versus former); and at the top of the self-reported health scale (versus the bottom). The authors find that 100% smoke-free state laws were not correlated with smoking among women. Moreover, racial/ethnic minority men who smoked occasionally were less likely to quit than white men, and results suggest that smoke-free laws did not reduce these disparities. However, there is evidence that smoke-free laws reduced the probability of being a daily smoker for Asian and Hispanic/Latinx men, but not the probability of quitting or being at the top of the self-reported health scale. More generally, smoke-free laws were not associated with self-reported health, except that there may have been an improvement among nonsmoking American Indian/Alaska Native women. These findings underscore the importance of looking beyond average effects to consider how 100% smoke-free state laws impact racial/ethnic minorities. There is evidence that they reduced smoking and improved self-reported health for some groups, but a suite of tobacco control policies is necessary to reduce racial/ethnic disparities more broadly.

Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: a systematic review.

This article investigates the effects of tobacco control policies on smoking initiation, cessation and prevalence by examining the papers published in the last 5 years. Twenty-one articles have been selected by two authors and sorted by four types of tobacco control: tobacco prices, anti-smoking campaigns for young people, mass media intervention and public smoking bans. Price/tax increase has deterrent effect on smoking initiation but does not promote smoking cessation; intervention on young people could reduce the smoking initiation if carried out at an early age and if acted on social skills and with peer-led approach, as opposed to restraining measures which hare generally easily circumvented by young people. The mass media campaigns showed positive effect on attempts to quit among smokers if carried forward over time and by involving multiple communication channels (TV, internet, radio). The bans in public have little effect on smoking cessation but could improve the overall well-being of non-smokers. Heterogeneous results have been described by different studies probably because of different research methodologies, cultural aspects and the really effective implementation of the rules for each country. In conclusion, comprehensive tobacco control interventions to reduce smoking prevalence and modify the smoking behavior are recommended. Moreover, the use of e-cigarettes and heat-not-burn (HnB) products, as possible helping tool for smoke cessation, currently remains controversial.

Do smokers want to protect non-smokers from the harms of second-hand smoke in cars? Findings from the EUREST-PLUS ITC Europe Surveys.

There is currently no comprehensive legislation protecting non-smokers and children from second-hand smoke (SHS) exposure in private cars at the European Union (EU) level. This study aims to assess smokers' support for smoke-free cars legislation in six EU countries. Data come from the EUREST-PLUS ITC Europe Surveys: Wave 1 (2016, n = 6011) and Wave 2 (2018, n = 6027) conducted in Germany, Greece, Hungary, Poland, Romania and Spain. Support for smoke-free cars carrying pre-school children and non-smokers and voluntary implementation of smoke-free cars were assessed among adult smokers. Generalized estimating equations models were used to assess changes in support between waves. In 2018, 96.3% [95% confidence interval (CI) 95.4-97.0%] of the overall sample supported smoke-free legislation for cars carrying pre-school children, representing an increase of 2.4 percentage points in comparison to 2016. Smoke-free legislation for cars transporting non-smokers was supported by 85.2% (95% CI 83.1-87.1%) of smokers' in 2016 and 90.2% (95% CI 88.6-91.7%) in 2018. Among smokers who owned cars, there was a significant 7.2 percentage points increase in voluntary implementation of smoke-free cars carrying children from 2016 (60.7%, 95% CI 57.2-64.0%) to 2018 (67.9%, 95% CI 65.1-70.5%). All sociodemographic groups of smokers reported support higher than 80% in 2018. The vast majority of smokers in all six EU countries support smoke-free legislation for cars carrying pre-school children and non-smokers. This almost universal support across countries and sociodemographic groups is a clear indicator of a window of opportunity for the introduction of comprehensive legislation to protect non-smokers and children from SHS exposure in cars.

Secondhand Smoke Exposure among Nonsmokers in China.

China signed the World Health Organization Framework Convention on Tobacco Control and conducted a series of activities to protect people from secondhand smoke exposure. This paper explores the changes in prevalence of secondhand smoke exposure among nonsmokers between 2010 and 2015. Data from the 2010 Global Adult Tobacco Survey and 2015 National Adult Tobacco Survey were used in this study. Due to the complex sample design for these surveys, data were weighted and analyzed using the SAS 9.3 complex survey data analysis procedure. The Chi-square test was used for comparison among different groups. From 2010 to 2015, secondhand smoke exposure among nonsmokers decreased in restaurants, government buildings, health-care facilities, schools, and public transportation in China (p<0.05). The relative change was most significant for schools (52.1%), followed by public transportation (49.4%) and government buildings (42.2%). The percentage of secondhand smoke exposure reported in workplaces declined from 55.2% to 45.3%. Secondhand smoke exposure at home reduced from 58.3% to 46.7%. People's awareness that secondhand smoke could cause heart disease in adults, lung illness in children, and lung cancer in adults increased from 24.6% to 36.0%. Additionally, support for smoke-free policies is high among the Chinese population. Even for restaurants, where support for smoke-free policies was lowest, 75.1% of nonsmokers and 55.3% of smokers supported smoke-free policies. Secondhand smoke exposure declined from 2010 to 2015 in China but remains a serious problem. Public awareness about the hazards of secondhand smoke is increasing and Chinese people support smoke-free laws.

How Do Combustion and Non-Combustion Products Used Outdoors Affect Outdoor and Indoor Particulate Matter Levels? A Field Evaluation Near the Entrance of an Italian University Library.

Particulate Matter (PM) is a well-known health risk factor and pollutes both outdoor and indoor air. Using PM as an air pollution indicator, the aims were to assess outdoor and indoor air pollution due to combustion and/or non-combustion products used outdoors and to compare the PM levels emitted by different products. PM with an aerodynamic diameter ≤10, 4, 2.5 and 1 µm (PM10, PM4, PM2.5, PM1) was simultaneously measured in two areas, respectively, indoors (with smoking ban) and outdoors (where people commonly smoke) of a university library during the morning and the afternoon of two weekdays. Both combustion and non-combustion products determined a relevant worsening of outdoor air quality, with the highest PM1 levels achieved when a single traditional cigarette (9920 µg m−3), a single e-cigarette (9810 µg m−3) and three simultaneous traditional cigarettes (8700 µg m−3) were smoked. An increase of indoor PM1 levels was found during outdoor smoking/vaping sessions, persisting also after the end of sessions. The results highlighted the need for a revision of smoke-free laws, especially for outdoor areas, to include non-combustion products. In addition, it is essential to make society aware of the dangers of smoking outdoors by implementing health promotion interventions.

The interaction between personality and health policy: Empirical evidence from the UK smoking bans

We investigate whether responses to the UK public places smoking ban depend on personality. Drawing on individual level panel data from the British Household Panel Survey (BHPS) we exploit variation in the timing and location of these bans to establish their overall effect on smoking outcomes, and how this differs by personality. We measure personality using the Big Five personality traits. We are particularly interested in conscientiousness, given the evidence that it is a good proxy for self-control. Overall, we find that a one standard deviation increase in conscientiousness leads to a 1.4 percentage point reduction in the probability of smoking after the ban. Notably, this is the only Big Five personality trait that interacts with the smoking ban. This finding is very robust to different specifications.

Smoke-free hospitals in Poland - a cross-sectional survey.

In 2010, the government of Poland passed an amended smoke-free law that strengthened existing tobacco control policies and banned smoking in hospitals. The aims of our study are: to determine the state of smoke-free practices in Polish hospitals, and to identify challenges facing hospitals implementing smoke-free practices. In 2018, a cross-sectional survey was conducted on a representative sample of 100 hospitals operating in Poland. The research tool was the ENSH-Global Self-Audit Questionnaire. The questionnaire included 48 items related to the various aspects of smoke-free policy implementation in the hospital. Among the surveyed hospitals, public entities were the dominant group (79%). The mean score for all analyzed standards was 78.55 points (out of 144 maximum available), with no differences (p = 0.4) between public and private entities. All hospitals surveyed displayed signage with information about prohibited tobacco products and tobacco-free campus boundaries. Hospital staff (95%) and service users (98%) reported a basic level of understanding of the hospital's tobacco-free policy and the available tobacco cessation services. However, tobacco-free policies, in line with the ENSH-Global Standards, were implemented in 61% of surveyed hospitals. More than half of the hospitals (64%) do not currently assess tobacco use or provide tobacco dependence treatment services. Overall, smoke-free policies in hospitals operating in Poland are compliant with the National Tobacco Control Act and provide a smoke-free environment for service users and staff. However, continued monitoring and evaluation of tobacco control activities are necessary to promote the importance of smoke-free environments.

Pattern and quitting of tobacco smoking among Egyptian university students.

University students are at high risk of practicing the smoking habit being exposed to smoking peers and easier cigarette availability. This study aims to explore prevalence, attitude and pattern of tobacco smoking and quitting among Beni-Suef University students. A cross-sectional study was conducted from March to May 2019. A total of 4,599 students were selected by using randomized multi-stage sampling using self-administered questionnaire for data collection. The mean age of students found to be smokers was 20.8 ± 1.42 years. Males: Females' ratio was 2:1 (66 vs.34%). Prevalence of smoking was 17.4%. Students of non-medical and non-health colleges showed a significant high smoking rate (18.8 and 18.3% respectively) than students in health faculties (15.2%); p=0.017. Participants believed that they might smoke because of: peers' pressure (73.3%), stress (71.4%), imitating popular figures (61.7%) and availability of money (60.4%). Regarding smoking provinces; 86.1% did smoke in coffee-shops, 73.1% in university yards and only 16.87% used to smoke at home Regarding the attitudes of smokers and nonsmokers towards smoking; the acceptance of indoor smoking was significantly higher (85.6%) among smokers than non-smokers (6.42%); p=0.0001. Of note; 51.2% of smokers versus 86.3% of non-smokers agreed to ban smoking in public places (P=0.001). Majority of smokers (72.1%) had the desire to stop smoking while (57.8%) tried to stop smoking but failed. Smoking is becoming a habit among university students and initiative of a smoke free environment should be encouraged and subject and method.

Impact of UK Tobacco Control Policies on Inequalities in Youth Smoking Uptake: A Natural Experiment Study.

IntroductionUK countries implemented smoke-free public places legislation and increased the legal age for tobacco purchase from 16 to 18 years between 2006 and 2008. We evaluated the immediate and long-term impacts of these UK policy changes on youth smoking uptake and inequalities therein.Aims and MethodsWe studied 74 960 person-years of longitudinal data from 14 992 youths (aged 11–15 years) in annual UK household surveys between 1994 and 2016. Discrete-time event history analyses examined whether changes in rates of youth smoking transitions (initiation, experimentation, and escalation to daily smoking or quitting) or their inequalities (by parental education) were associated with policy implementation. Parallel analyses examined smoke-free legislation and the change in legal age. We interpret the results as a combined effect of the two pieces of legislation as their implementation dates were too close to identify separate effects. Models were adjusted for sex, age, UK country, historical year, tobacco taxation, and e-cigarette prevalence, with multiple imputation for missing data.ResultsFor both policies, smoking initiation reduced following implementation (change in legal age odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.55 to 0.81; smoke-free legislation OR: 0.68; 95% CI: 0.56 to 0.82), while inequalities in initiation narrowed over subsequent years. The legal age change was associated with annual increases in progression from initiation to occasional smoking (OR: 1.26; 95% CI: 1.07 to 1.50) and a reduction in quitting following implementation (OR: 0.57; 95% CI: 0.35 to 0.94). Similar effects were observed for smoke-free legislation but CIs overlapped the null.ConclusionsPolicies such as these may be highly effective in preventing and reducing socioeconomic inequalities in youth smoking initiation.ImplicationsUK implementation of smoke-free legislation and an increase in the legal age for tobacco purchase from 16 to 18 years were associated with an immediate reduction in smoking initiation and a narrowing of inequalities in initiation over subsequent years. While the policies were associated with reductions in the initiation, progression to occasional smoking increased and quitting decreased following the legislation.

Exposure to secondhand smoke in hospitality settings in Ghana: Evidence of changes since implementation of smoke-free legislation.

INTRODUCTIONGhana has a partial smoking ban with smoking allowed in designated smoking areas. Studies evaluating smoke-free laws are scarce in Sub-Saharan Africa. Evaluation of smoke-free laws is an effective means of measuring progress towards a smoke-free society. This study assessed the level of compliance to the provisions of the current smoke-free policy using air quality measurements for fine particulate matter (PM2.5) in hospitality venues in Ghana.METHODSThis was a cross-sectional observational study conducted in 2019 using a structured observational checklist complemented with air quality measurements using Dylos monitors across 152 randomly selected hospitality venues in three large cities in Ghana.RESULTSSmoking was observed in a third of the venues visited. The median indoor PM2.5 concentration was 14.6 μg/m3 (range: 5.2–349). PM2.5 concentrations were higher in venues where smoking was observed (28.3 μg/m3) compared to venues where smoking was not observed (12.3 μg/m3) (p<0.001). Hospitality locations in Accra, Ghana’s capital city, had the lowest compliance levels (59.5%) and poorer air quality compared to the cities of Kumasi and Tamale.CONCLUSIONSThe study shows that while smoking and SHS exposure continues in a substantial number of hospitality venues, there is a marked improvement in PM2.5 concentrations compared to earlier studies in Ghana. There is still a considerable way to go to increase compliance with the law. Efforts are needed to develop an action plan to build upon recent progress in providing smoke-free public spaces in Ghana.

Tobacco control policy and smoking among older Americans: An analysis of a nationally-representative longitudinal sample (1992–2014)

Smoking has decreased less rapidly among older adults than among the working age population in the United States. This study examines whether tobacco control policy, specifically smoke-free laws and increased cigarette prices, are associated with smoking cessation and lower smoking intensity among older adults. In addition, it considers whether the effect of smoke-free laws varied by labor force participation. Using geocoded longitudinal data from the Health and Retirement study collected from 1992 to 2014, I estimate survival models to evaluate the association between the implementation of city, county, and state smoke-free laws, changes in average state cigarette pack price, and smoking cessation among smokers. I then interact labor force status with smoke-free laws to assess whether the associations differ for retired versus employed respondents. Second, I estimate within-person fixed effects models to evaluate the association between the implementation of smoke-free laws, changes in average state cigarette pack price, and smoking intensity among smokers. Models were stratified by labor force status to assess whether the associations varied by labor force participation. All analyses were also stratified by age into younger (51–64) and older (65+) respondents. Neither the implementation of smoke-free laws nor increases in cigarette prices were associated with greater smoking cessation or lower smoking intensity. There was no evidence that labor force participation was associated with greater responsiveness to smoke-free laws. The results suggest that two of the most popular tobacco control policy tools in the US, smoke-free laws and cigarette prices, may be less effective among older adults.

Qualitative examination of the perceived effects of a comprehensive smoke-free law according to neighborhood socioeconomic status in a large city.

Smoke-free legislations aim to protect non-smokers from second-hand smoke (SHS) exposure and improve population health outcomes. The aim of this study was to explore residents’ perceptions to understand how people living in distinctive SES neighborhoods are differently affected by comprehensive smoke-free laws in a large city like Madrid, Spain.We conducted a qualitative project with 37 semi-structured interviews and 29 focus group discussions in three different SES neighborhoods within the city of Madrid. Constructivist grounded theory was used to analyze the transcripts.One core category arose in our analyses: Neighborhood inequalities in second-hand smoke (SHS) exposure in outdoor places. The enactment of the comprehensive smoke-free law resulted in unintended consequences that affected neighborhoods differently: relocation of smokers to outdoor setting, SHS exposure, noise disturbance and cigarette butt littering. Changes in the urban environment in the three neighborhoods resulted in the denormalization of smoking in outdoor public places, which was more clearly perceived in the high SES neighborhood. Changes in the built environment in outdoor areas of hospitality venues were reported to actually facilitate smoking. Comprehensive smoke-free laws resulted in denormalization of smoking, which might be effective in reducing SHS exposure. Extending smoking bans to outdoor areas like bus stops and hospitality venues is warranted and should include a public health inequalities perspective.

Assessment of Health Promotion Based on “PHBS” Marketplace Indicators in Kediri Regency

Background: Traditional markets are a place to fulfill basic daily needs with trading practices accompanied by direct interaction between sellers and buyers. Health promotion in public places needs to be carried out by providing facilities that can support healthy behavior for visitors. One of the effort is through the indicators of Clean and Healthy Behavior. Objective: This research aims to explore and seek appropriate recommendations so that it can be a reference in improving clean and healthy living in the traditional market environment. Method: The instruments used in this study were the field observation form, assessment form, and in-depth interview guide. Taking informants using purposive sampling techniques with inclusion criteria is the market manager. The assessment was carried out on the components of a Healthy Clean Lifestyle in traditional markets, namely 8 indicators including clean water supply, hand washing behavior with soap, healthy latrines, behavior to dispose of rubbish in its place, not smoking in public places, closing food and drinks, prohibiting indiscriminate spitting, and efforts to eradicate mosquito larvae. Results: The results of this study indicate that the four markets studied were in the Poor category. The Main Market gained 447 points, the Pamenang Market 350 points, the Pare Lama Market 352 points, the Bendo Market 366 points. There are four indicators that have the results with the lowest achievement score, namely indiscriminate spitting, smoking bans in public places, washing hands with soap, and combating mosquito larvae. Conclusion: several Traditional Markets in Pare Sub-district have not implemented 8 Indicators of Clean and Healthy Behavior in public places (Traditional Markets) properly.

Dose-related effect of secondhand smoke on cardiovascular disease in nonsmokers: Systematic review and meta-analysis.

Despite the positive association between secondhand smoke (SHS) and cardiovascular diseases (CVD), no comprehensive assessment on the dose-response relationship between SHS and CVD has yet been reported. Therefore, a meta-analysis was conducted to update the binary association, and to elucidate the dose-response relationship of both self-reported and objectively measured SHS exposure with CVD. PubMed and Embase databases were searched for articles published up to November 12, 2019. Random-effects models were used to assess the summary odds ratios (ORs) of CVD with SHS exposure. Restricted cubic splines were used to fit the dose-response relationship. Fifty-five eligible observational studies were included in this meta-analysis to investigate the association between SHS exposure and CVD. Based on the meta-analysis, the pooled OR of CVD was 1.22 (95% CI 1.17-1.28) for the self-reported SHS individuals as comparing to the non-exposed group. The result of restricted cubic splines showed a risk plateau of SHS exposure at 15 cigarettes per day (Pnon-linearity=0.042), while other characteristics s of SHS exposure (amount, daily and cumulative duration, and cotinine) were in linear relationships with CVD (Pnon-linearity >0.05). In addition, an estimated of 6.77% (95% CI: 5.31%-8.46%) of all CVD cases in men and 7.15% (95% CI: 5.62%-8.93%) in women might be attributed to SHS exposure worldwide. Exposure to SHS is associated with an increased risk of CVD regardless of the modes. And thus, well-enforced smoke-free laws could possibly reduce a substantial risk of CVD caused by SHS.

Characteristics of patients seeking outpatient smoking cessation treatment before and after the implementation of a smoke-free law in Valencia (Spain): a cross-sectional study

ObjectiveExplore potential changes in the characteristics of patients requesting smoking cessation treatment at an outpatient setting in Spain before and after Law 42/2010 was enacted.DesignThis is a cross-sectional study with...

Smoke-free legislation and neonatal and infant mortality in Brazil: longitudinal quasi-experimental study

ObjectiveTo examine the associations of partial and comprehensive smoke-free legislation with neonatal and infant mortality in Brazil using a quasi-experimental study design.DesignMonthly longitudinal (panel) ecological study from January 2000 to...

Impact of Qingdao's smoke-free legislation on hospitalizations and mortality from acute myocardial infarction and stroke: an interrupted time-series analysis.

More than 20 cities in China have enacted local smoke-free laws that prohibit smoking in public places. Only two of these cities have examined the health impact of the law. Enacted in 2013, Qingdao's smoke free-law was stricter than most other municipal smoke-free laws because it did not allow designated smoking rooms. This study aimed to estimate the impact of Qingdao's smoke-free legislation on acute myocardial infarction (AMI) and stroke. We used an interrupted time-series design adjusting for underlying secular trends, seasonal patterns and meteorological factors to estimate the impact of the smoke-free law on AMI and stroke events among permanent residents aged 35years or older in Qingdao, China. The study period was from 1January 2010 to 31December 2015, with a post-ban follow-up of approximately 2.5years. Outcome measures were weekly numbers of hospitalizations and deaths due to AMI/stroke. A total of 10 371 and 56 101 patients were hospitalized, with a principal discharge diagnosis of AMI and stroke, respectively; 32 196 AMI and 49 711 stroke deaths occurred during the study period. Following the smoke-free legislation, an incremental 20% [95% confidence interval (CI) =14-26%] and 8% (95% CI=3-13%) decrease per year was observed in AMI and stroke hospitalization rates, respectively. Neither the immediate nor gradual change in AMI nor stroke mortality rates associated with the law was statistically significant (P>0.05). Post-hoc subgroup analyses indicated that statistically significant reductions in AMI hospitalizations were evident among both the 35-64 (18% per year, 95% CI=12-27%) and 65-84 (20% per year, 95% CI=12-27%) age groups. Statistically significant reductions in stroke hospitalization were only in the older subgroup (13% per year, 95% CI=8-18%). The 2013 smoke-free legislation in Qingdao, China was associated with reduction in hospitalization from acute myocardial infarction and stroke among permanent residents aged 35years or older. There was no statistically significant reduction in mortality from acute myocardial infarctions or stroke.

Exposure to secondhand aerosol of electronic cigarettes in indoor settings in 12 European countries: data from the TackSHS survey

IntroductionExposure to secondhand aerosol from e-cigarette (SHA) may pose harmful effects to bystanders. This study aims to investigate the prevalence, duration and determinants of SHA exposure in various indoor settings...