The Impact of Smoke-Free Air Laws and Conventional Cigarette Taxes on Cardiovascular Hospitalizations

Abstract

Abstract Introduction Smoke-free air legislation and conventional cigarette taxes have long been used to reduce smoking initiation, prevalence, and conventional cigarette consumption. However, the extent to which these policies affect population health across a range of diagnoses and age groups remains less well understood. Methods Analyses use 2005–2014 hospital inpatient discharge data from up to 40 US states to estimate the effects of smoke-free air laws and conventional cigarette taxes on cardiovascular hospitalizations among working age and older adults. Results An increase in the percent of a county’s population covered by smoke-free air laws yielded a significant decline of 2.4% (Relative risk [RR]: 0.976, 95% confidence interval [95% CI]: 0.954, 0.997) in acute cerebrovascular disease hospitalizations among older adults. Moreover, significant declines of 2.0% (RR: 0.980, 95% CI: 0.967, 0.994) and 2.8% (RR: 0.972, 95% CI: 0.949, 0.996) in acute cerebrovascular disease were observed among older adults in the first year and subsequent years after smoke-free air legislation was implemented, respectively. Conventional cigarette taxes did not yield a significant change in acute cerebrovascular disease hospitalizations, nor did either tobacco control policy lead to a significant decline in acute myocardial infarction hospitalizations. Conclusions Smoke-free air laws play an important role in reducing adult cardiovascular hospitalizations. These findings confirm existing research on acute cerebrovascular disease outcomes, as well as the modest effects on acute myocardial infarction hospitalizations observed in state- and national-level analyses. Implications Current research at the local level finds smoke-free air laws yield 40% declines in acute myocardial infarction hospitalizations and 29% declines in acute cerebrovascular disease. State- and national-level analyses find smaller effects of smoke-free air laws, and largely omit analyses of working age adults. Existing research likely suffers from omitted variable bias, including state-level tobacco control funding and local-level conventional cigarette taxes. Using adult hospitalization data from up to 40 states, this study confirms existing evidence at the national and state level, and provides new evidence that smoke-free air laws significantly reduce acute cerebrovascular disease hospitalizations among older adults.