Suchergebnisse

BACKGROUND: Smoke‐free legislation has been associated with reductions in secondhand smoke exposure and cardiovascular disease. However, it remains unknown whether smoke‐free policies are associated with reductions in blood pressure (BP). METHODS AND RESULTS: Longitudinal data from 2606 nonsmoking adult participants of the CARDIA (Coronary Artery Risk Development in Young Adults) Study (1995–2011) were linked to state, county, and local‐level 100% smoke‐free policies in bars, restaurants, and/or nonhospitality workplaces based on participants' census tract of residence. Mixed‐effects models estimated associations of policies with BP and hypertension trajectories over 15 years of follow‐up. Fixed‐effects regression estimated associations of smoke‐free policies with within‐person changes in systolic and diastolic BP and hypertension. Models were adjusted for sociodemographic, health‐related, and policy/geographic covariates. Smoke‐free policies were associated with between‐person differences and within‐person changes in systolic BP. Participants living in areas with smoke‐free policies had lower systolic BP on average at the end of follow‐up compared with those in areas without policies (adjusted predicted mean differences [in mm Hg]: restaurant: −1.14 [95% confidence interval: −2.15, −0.12]; bar: −1.52 [−2.48, −0.57]; workplace: −1.41 [−2.32, −0.50]). Smoke‐free policies in restaurants and bars were associated with mean within‐person reductions in systolic BP of −0.85 (−1.61, −0.09) and −1.08 (−1.82, −0.34), respectively. Only restaurant policies were associated with a significant within‐person reduction in diastolic BP, of −0.58 (−1.15, −0.01). CONCLUSIONS: While the magnitude of associations was small at the individual level, results suggest a potential mechanism through which reductions in secondhand smoke because of smoke‐free policies may improve population‐level cardiovascular health.

BACKGROUND: Smoke-free legislation has been associated with lower rates of cardiovascular disease hospital admissions in ecologic studies. However, prior studies lacked detailed information on individual-level factors (e.g. socio-demographic and clinical characteristics) that could potentially confound associations. Our objective was to estimate associations of smoke-free policies with incident cardiovascular disease in a longitudinal cohort after controlling for socio-demographics, cardiovascular disease risk factors, and policy covariates. METHODS: Longitudinal data from 3,783 black and white adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study (1995-2015) were linked to state, county and local 100% smoke-free policies in bars, restaurants, and non-hospitality workplaces by census tract. Extended Cox regression estimated hazard ratios (HRs) of incident cardiovascular disease associated with time-dependent smoke-free policy exposures. Models were adjusted for socio-demographic characteristics, cardiovascular disease risk factors, state cigarette tax, participant-reported presence of a smoking ban at their workplace, field center, and metropolitan statistical area poverty. RESULTS: During a median follow-up of 20 years (68,332 total person-years), 172 participants had an incident cardiovascular disease event (2.5 per 1,000 person-years). Over the follow-up period, 80% of participants lived in areas with smoke-free policies in restaurants, 67% in bars, and 65% in non-hospitality workplaces. In fully adjusted models, participants living in an area with a restaurant, bar, or workplace smoke-free policy had lower risk of incident cardiovascular disease compared to those in areas without smoke-free policies (HR: 0.75, 95% CI: 0.49, 1.15; HR: 0.76, 95% CI: 0.47, 1.24; HR: 0.54, 95% CI: 0.34, 0.86, respectively; HR 0.58, 95% CI: 0.33, 1.00 for living in an area with all 3 types of policies compared to none). The estimated preventive fraction was 25% for restaurant policies, 24% for bar ...