204874 A 10 year population based study of the impact of anti-smoking legislation on cardiovascular and respiratory outcomes

Wednesday, November 11, 2009: 11:06 AM

Alisa B. Naiman, MHSc, MD , Department of Family Medicine, Toronto East General, Toronto, ON, Canada
Richard H. Glazier, MD, MPH , Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
Rahim Moineddin, PhD , Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

Recently second hand smoke (SHS) been shown to be a risk factor for numerous medical conditions and in response countries throughout the world have introduced public smoking bans. Few studies have looked at the impact of anti-smoking legislation on respiratory conditions or cardiovascular conditions other than acute myocardial infarction (AMI) and no evidence exists as to which bans are more effective in reducing SHS exposure.


We calculated crude hospitalization rates and used an Autoregressive Integrated Moving Average (ARIMA) model to test the impact of various smoking bans on six cardiovascular and respiratory hospital admissions for Toronto, Ontario from January 1996 to March 2006. We compared these results with two large Ontario municipalities with no smoking bans.


After a full restaurant ban, there were reductions of 17.4%, 39.1% and 31.7% in crude hospitalization rates for AMI, cardiovascular and respiratory conditions, respectively, and significant decreases (p<0.05) in hospital admissions for all six respiratory and cardiovascular conditions. There were no consistent decreases in these rates in Toronto after bans in public places and bars and no significant decrease in these rates in control cities.


This study expands existing knowledge in two important ways: the breadth of conditions affected and the effectiveness of bans based on their location. Our study confirms the detrimental health impacts of SHS and expands the list of health outcomes that can be ameliorated with smoking bans. Anti-smoking legislation appears most effective in locations where large segments of the population are exposed such as restaurants.

Learning Objectives:
1. Describe the health impacts of SHS 2. Identify which ban location is most effective in decreasing hospital admission rates

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a practising family doctor completing a 2-year family medicine research fellowship. I am the principal investigator on this study and have been involved in all aspects of this paper.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.