Smoke-free laws and adult smoking prevalence
Introduction
Smokers in communities with comprehensive smoke-free workplace ordinances are more likely to quit than those who live in communities with no smoke-free workplace laws (Moskowitz et al., 2000). However, few studies have examined population smoking prevalence and smoking cessation rates (Levy et al., 2004b) as outcomes of smoke-free legislation. Voluntary restrictions on smoking in public places and private workplaces reduce both smoking prevalence and average daily cigarette consumption (Heloma and Jaakkola, 2003, Farrelly et al., 1999, Brownson et al., 2002, Levy et al., 2004a, Longo et al., 2001, Evans et al., 1999, Chaloupka and Saffer, 1992, Chaloupka and Wechsler, 1997, Townsend, 1998) and increase cessation attempts (Hopkins et al., 2001, Farkas et al., 1999, Hammond et al., 2004). Smoke-free workplaces are associated with a 29% drop in cigarette consumption (Glasgow et al., 1997). Restrictions on smoking may alter the perceived norms related to smoking by changing attitudes concerning the social acceptability of smoking (U.S. Department of Health and Human Services, 1994) and increase public awareness about the dangers of cigarette smoking (Evans et al., 1999).
On April 27, 2004, Lexington-Fayette County, Kentucky, implemented a smoke-free ordinance prohibiting smoking in all public buildings including restaurants, bars, bingo parlors, pool halls, public areas of hotels/motels, and all other buildings open to the public. Kentucky leads the U.S. in smoking prevalence, with 28.6% of adults who smoke cigarettes, compared to 20.2% nationally (Centers for Disease Control and Prevention, 2007). In the United States, from 1997–2001, smoking cigarettes and exposure to secondhand smoke were estimated to result in 438,000 premature deaths and 5.5 million years of potential life lost (Centers for Disease Control and Prevention, 2005). In 1998, smoking-attributable health care costs were estimated at $75.5 billion, accounting for 6 to 14% of personal health expenditures (Max, 2001, Warner et al., 1999).
This study determined whether there was a change in the rate of adult smoking in Lexington-Fayette County following implementation of a smoke-free public places ordinance and evaluated how the smoking rates pre- and post-law in Fayette compared to smoking prevalence in a group of Control counties with similar demographics, but without smoke-free laws.
Section snippets
Methods
The study was a quasi-experimental, two-group design. Behavioral Risk Factor Surveillance Survey (BRFSS) data from 2001–05 were used to test whether adult smoking rates changed significantly in Fayette County from pre- to post-law, relative to the degree of change during the same timeframe in the Kentucky counties that were most similar in education, income and smoking prevalence but that did not have smoke-free laws. To form the Control group, Fayette County and its contiguous counties were
Results
The weighted smoking rate and 95% confidence interval (CI) for Fayette County pre-law, on average, was 25.7% (CI: 21.2–30.1), and this declined to 17.5% (CI: 11.8–23.1) post-law, a decrease of 31.9%. In the 30 counties without a law (Control group), the rates in the pre-law and post-law periods were 28.4% (CI: 26.8–30.0) and 27.6% (CI: 25.2–30.0), respectively. As shown in Fig. 1, Fayette County had smoking rates similar to the group of Control counties for the 40 months before the smoke-free
Discussion
Adult smoking prevalence declined by nearly one-third during the 20 months after implementation of a smoke-free public places ordinance in Lexington-Fayette County, Kentucky. The fact that adult smoking did not decline in Kentucky counties without smoke-free laws and with similar educational attainment, income and smoking rates pre-law indicates that the smoke-free law was associated with a significant decline in adult smoking rates. During the 20-month post-law period, there was no change in
Conclusions
Previous studies have focused primarily on the effect of voluntary smoke-free workplace policies on smoking prevalence (Levy et al., 2004b). This study focuses on the impact of a municipal smoke-free ordinance on a population measure of adult smoking prevalence. While smoke-free legislation is typically enacted to protect nonsmokers from secondhand smoke, this study provides evidence that smoke-free laws may also positively affect the health of both current smokers and those at risk of
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