Strong tobacco control program requirements and secure funding are not enough: lessons from Florida

Public responses to a comprehensive smoking ban

Purpose

– The purpose of this paper is to report public reactions to a total workplace smoking ban, including smoking behavior, attendance at bars and clubs, and attitudes toward a broader ban.

Design/methodology/approach

– Surveys were conducted in two adjacent jurisdictions, one of which instituted a total workplace smoking ban. Surveys took place before (n=1,609) and after (n=1,600) enactment of the ban in the relevant jurisdiction.

Findings

– No change in smoking prevalence occurred in the jurisdiction enacting the ban. Strong majorities of non-smokers supported the ban, while strong majorities of smokers expressed opposition. In the jurisdiction that enacted the ban, smokers who appeared to be high-volume consumers at bars and clubs were most likely to report reducing attendance at these establishments and to oppose the ban.

Research limitations/implications

– Surveys depend on accurate self-reporting of behavior and attitudes.

Practical implications

– Some bars and clubs may incur financial losses due to smoking bans. A core of strong opponents can undermine public consensus regarding smoking bans. Licensing a limited number of bars and clubs to allow smoking can safeguard this consensus.

Social implications

– Limited smoking bans can serve as a means of harm reduction, as non-smokers are protected from environmental tobacco smoke, and accommodation of smokers reduces their motivation to oppose bans.

Originality/value

– This investigation makes use of detailed data on the public’s thinking and reactions to a comprehensive smoking ban and is a before-after study with controls.

The effect of tobacco control measures during a period of rising cardiovascular disease risk in India: a mathematical model of myocardial infarction and stroke

BACKGROUND

We simulated tobacco control and pharmacological strategies for preventing cardiovascular deaths in India, the country that is expected to experience more cardiovascular deaths than any other over the next decade.

METHODS AND FINDINGS

A microsimulation model was developed to quantify the differential effects of various tobacco control measures and pharmacological therapies on myocardial infarction and stroke deaths stratified by age, gender, and urban/rural status for 2013 to 2022. The model incorporated population-representative data from India on multiple risk factors that affect myocardial infarction and stroke mortality, including hypertension, hyperlipidemia, diabetes, coronary heart disease, and cerebrovascular disease. We also included data from India on cigarette smoking, bidi smoking, chewing tobacco, and secondhand smoke. According to the model's results, smoke-free legislation and tobacco taxation would likely be the most effective strategy among a menu of tobacco control strategies (including, as well, brief cessation advice by health care providers, mass media campaigns, and an advertising ban) for reducing myocardial infarction and stroke deaths over the next decade, while cessation advice would be expected to be the least effective strategy at the population level. In combination, these tobacco control interventions could avert 25% of myocardial infarctions and strokes (95% CI: 17%-34%) if the effects of the interventions are additive. These effects are substantially larger than would be achieved through aspirin, antihypertensive, and statin therapy under most scenarios, because of limited treatment access and adherence; nevertheless, the impacts of tobacco control policies and pharmacological interventions appear to be markedly synergistic, averting up to one-third of deaths from myocardial infarction and stroke among 20- to 79-y-olds over the next 10 y. Pharmacological therapies could also be considerably more potent with further health system improvements.

CONCLUSIONS

Smoke-free laws and substantially increased tobacco taxation appear to be markedly potent population measures to avert future cardiovascular deaths in India. Despite the rise in co-morbid cardiovascular disease risk factors like hyperlipidemia and hypertension in low- and middle-income countries, tobacco control is likely to remain a highly effective strategy to reduce cardiovascular deaths.