Tuesday, March 24, 2009

Do smoking bans work?

CHANGES IN U.S. HOSPITALIZATION AND MORTALITY RATES FOLLOWING
SMOKING BANS Kanaka D. Shetty et al Working Paper 14790 NBER

This is a really interesting paper, brought to my attention by Ian Irvine. The authors say " In contrast with smaller regional studies, we find that workplace bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases. An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a workplace ban are as common as the large decreases reported in the published literature." They also make the intriguing suggestions that " publication bias could plausibly explain why dramatic short‐term public health improvements were seen in prior studies of smoking bans."

Has any one looked at the Irish case? Daily or weekly data on hospitalization with some break-down by cause might be sufficient.

6 comments:

Liam Delaney said...

if you were going to look at the effect of the irish workplace smoking ban, what would be your prior? We dont expect heart attacks to respond immediately in a simple time series break sense? in fact, is there anything really that we expect would be affected immediately? perhaps breathing quality among bar staff and regular patrons, which has been looked at? the cumulative nature of the effect of cigarette smoking and the fact that most of the effects are long-terms would pose a challenge to this analysis. The HIPE data would allow you to model this stuff though if you could specify the relationship. This has information on inpatient admissions.

Jerome Adda started a big debate in the UK with a paper that suggested that children end up inhaling more smoke following public bans.

Kevin Denny said...

Apparently some people do expect AMI (Acute Myocardial Infarction) and hospitalization (maybe due to asthma attacks, other pulmonary conditions) to respond fairly quickly to smoking bans & there are papers to that effect. The long term effects are going to be harder to identify as you suggest.
This would make a nice project for a bright undergrad.

Michael Daly said...

previous post from the blog Effects of the Irish Smoking Ban on Respiratory Health of Bar Workers and Air Quality in Dublin Pubs

Michael Daly said...
This comment has been removed by the author.
Michael Daly said...

Just reading commentary on the Goodman article: "The article by Goodman and colleagues adds to the irrefutable body of evidence showing that smoke-free air policies improve air quality, save lives, improve health, and are cost-effective and popular."

Clearly no body of evidence is irrefutable (I've just seen a review of evolutionary
"philosophy" that's not open to "criticisms" such as creationism on the 'good life' channel here in the states!).

There's some evidence from Ireland that smoking restrictions may not transfer smoking to the home rather than other areas smoke in homes



This study from NEJM is one of those showing large decreases in admissions for acute coronary syndrome after the implementation of smoke-free legislation Pell et al., 2008. It would certainly be interesting if studies such as this represented publication bias..

other studies summarised briefly here:

Indicators to Measure Success of Smoke-free Policies

Anonymous said...

About the Pell et al. 2008 study from Scotland:

http://news.bbc.co.uk/2/hi/uk_news/magazine/7093356.stm

http://www.spiked-online.com/index.php?/site/article/5988/

http://tobaccoanalysis.blogspot.com/2008/09/new-data-from-scotland-show-that-pell.html