A Systematic Review of Health Outcomes Associated with Smoke Free Legislation: Evidence on Reducing Tobacco Related Diseases
DOI:
https://doi.org/10.61194/jrkpk.v2i1.662Keywords:
Smoke-Free Policies, Secondhand Smoke Exposure, Tobacco Control, Public Health Legislation, Smoking Cessation, Respiratory Diseases, Cardiovascular DiseasesAbstract
Smoke-free policies have emerged as a critical strategy in global public health, aimed at reducing smoking prevalence and mitigating the risks associated with secondhand smoke exposure. This study systematically reviews the effectiveness of smoke-free laws in reducing tobacco-related diseases, improving public health outcomes, and influencing smoking behaviors. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science to analyze empirical studies on smoke-free regulations over the past fifteen years. Findings indicate that smoke-free policies significantly reduce hospital admissions for respiratory and cardiovascular diseases, lower tobacco-related mortality, and enhance smoking cessation rates. The benefits are particularly notable among vulnerable populations, including children, pregnant women, and individuals with chronic health conditions. However, challenges in enforcement, compliance, and socio-economic disparities continue to affect policy efficacy. Regional variations demonstrate that cultural norms, economic stability, and community engagement play a critical role in shaping policy effectiveness. To maximize public health benefits, policymakers should focus on strengthening legislative enforcement, increasing public awareness through educational initiatives, and addressing socio-economic barriers to compliance. Future research should explore the long-term effects of these policies and develop targeted interventions that integrate public health advocacy with economic incentives. Implementing comprehensive, well-enforced smoke-free policies is essential for reducing tobacco-related disease burdens and fostering healthier environments globally.
References
Ho JSY, Ho AFW, Jou E, Liu N, Zheng H, Aik J. Association Between the Extension of Smoke-Free Legislation and Incident Acute Myocardial Infarctions in Singapore From 2010 to 2019: An Interrupted Time-Series Analysis. BMJ Glob Health. 2023;8(10):e012339.
Mbulo L, Palipudi K, Andes LJ, Morton J, Bashir R, Fouad H, et al. Secondhand Smoke Exposure at Home Among One Billion Children in 21 Countries: Findings From the Global Adult Tobacco Survey (GATS). Tob Control. 2016;25(e2):e95–100.
Majmundar A, Allem JP, Cruz TB, Unger JB. Where Do People Vape? Insights From Twitter Data. Int J Environ Res Public Health. 2019;16(17):3056.
Agaku IT, Singh T, Rolle I, Olalekan AY, King BA. Prevalence and Determinants of Secondhand Smoke Exposure Among Middle and High School Students. Pediatrics. 2016;137(2).
Ho SH, Lim JT, Ong J, Hapuarachchi HC, Sim S, Ng LC. Singapore’s 5 Decades of Dengue Prevention and Control—Implications for Global Dengue Control. PLoS Negl Trop Dis. 2023;17(6):e0011400.
Shafer P. Impact of US Smoke-Free Air Laws on Restaurants and Bars by Employer Size: A Panel Study. BMJ Open. 2017;7(11):e018137.
Mayne SL, Jacobs DR, Schreiner PJ, Widome R, Gordon‐Larsen P, Kershaw KN. Associations of Smoke‐Free Policies in Restaurants, Bars, and Workplaces With Blood Pressure Changes in the CARDIA Study. J Am Heart Assoc. 2018;7(23).
Radó M, Mölenberg FJM, Westenberg LEH, Sheikh A, Millett C, Burdorf A, et al. Effect of Smoke-Free Policies in Outdoor Areas and Private Places on Children’s Tobacco Smoke Exposure and Respiratory Health: A Systematic Review and Meta-Analysis. Lancet Public Health. 2021;6(8):e566–78.
Martini S, Artanti KD, Hargono A, Widati S, Ahsan A, Prabandari YS. Association Between Percentage of Smokers and Prevalence of Smoking Attributable Morbidity in Indonesia: One Decade After Implementation of Smoke-Free Area Regulation. BMC Public Health. 2022;22(1).
David AM, Mercado S, Klein JD, Kaundan M s. o. K, Koong HN, Garcia EL. Protecting Children and Families From Tobacco and Tobacco‐related NCDs in the Western Pacific: Good Practice Examples From Malaysia, Philippines and Singapore. Child Care Health Dev. 2017;43(5):774–8.
Hahn EJ, Rayens MK, Wiggins AT, Gan WQ, Brown H, Mullett TW. Lung Cancer Incidence and the Strength of Municipal Smoke‐free Ordinances. Cancer. 2017;124(2):374–80.
Skipina T, Upadhya B, Soliman EZ. Secondhand Smoke Exposure Is Associated With Prevalent Heart Failure: Longitudinal Examination of the National Health and Nutrition Examination Survey. Nicotine & Tobacco Research. 2021;23(9):1512–7.
Agaku IT, Vardavas C. Disparities and Trends in Indoor Exposure to Secondhand Smoke Among U.S. Adolescents: 2000-2009. PLoS One. 2013;8(12):e83058.
Young WF, Karp S, Bialick P, Liverance C, Seder A, Berg E, et al. Health, Secondhand Smoke Exposure, and Smoking Behavior Impacts of No-Smoking Policies in Public Housing, Colorado, 2014–2015. Prev Chronic Dis. 2016;13.
García‐Esquinas E, Navas‐Acién A, Rodríguez‐Artalejo F. Exposure to Secondhand Tobacco Smoke and the Frailty Syndrome in US Older Adults. Age (Omaha). 2015;37(2).
Paramita A, Indrawati L, Izza N, Tjandrarini DH, Andarwati P, Nantabah ZK, et al. Passive Smoking Is Strongly Associated With Heart Disease in Hypertensive Workers: Analysis of the 2018 Indonesia Basic Health Research. Asian Journal of Social Health and Behavior. 2024;7(1):37–43.
Omaduvie U, Adisa AO. Exposure to Secondhand Smoke in the Home and Public Areas Among Adolescents in Abuja, Nigeria: Tobacco Control Implications. Tob Prev Cessat. 2015;1(December).
Nahdiyah E, Winarni S, Djuwadi G. Implementation of a No Smoking Area at SMPN 12 Malang in the Janti Health Center Working Area. Media Publikasi Promosi Kesehatan Indonesia (Mppki). 2024;7(9):2377–83.
Guo J, Guo L, Cui S, Zhu T, Dardik A, Gu Y. Autologous Bone Marrow-Derived Mononuclear Cell Therapy in Chinese Patients With Critical Limb Ischemia Due to Thromboangiitis Obliterans: 10-Year Results. Stem Cell Res Ther. 2018;9(1).
Amul GGH, Pang T. The State of Tobacco Control in ASEAN: Framing the Implementation of the FCTC From a Health Systems Perspective. Asia Pac Policy Stud. 2018;5(1):47–64.
Nganabashaka JP, Ntawuyirushintege S, Niyibizi JB, Umwali G, Bavuma C, Byiringiro JC, et al. Population-Level Interventions Targeting Risk Factors for Hypertension and Diabetes in Rwanda: A Situational Analysis. Front Public Health. 2022;10.
Ho V, Ross JS, Steiner C, Mandawat A, Short M, Ku-Goto MH, et al. A Nationwide Assessment of the Association of Smoking Bans and Cigarette Taxes With Hospitalizations for Acute Myocardial Infarction, Heart Failure, and Pneumonia. Medical Care Research and Review. 2016;74(6):687–704.
Acımış NM, Gundogan MB, Barış E, Akın M, Kandemir İ. The Prevalence of Tobacco Product Use Among Students in the Faculty of Medicine at Pamukkale University and Their Views on the Smoke-Free Campus Implementation. TRP. 2024;25(2):82–8.
Schoj V, Alderete M, Ruiz E, Hasdeu S, Linetzky B, Ferrante D. The Impact of a 100% Smoke-Free Law on the Health of Hospitality Workers From the City of Neuquén, Argentina. Tob Control. 2010;19(2):134–7.
Glantz SA, Gibbs E. Changes in Ambulance Calls After Implementation of a Smoke-Free Law and Its Extension to Casinos. Circulation. 2013;128(8):811–3.
Young L, Lindsay D, Ray R. What Do Beginning Students, in a Rurally Focused Medical Course, Think About Rural Practice? BMC Med Educ. 2016;16(1).
Issa JS, Abe TMO, Pereira AC, Megid MC, Shimabukuro CE, Valentin LSO, et al. The Effect of São Paulo’s Smoke-Free Legislation on Carbon Monoxide Concentration in Hospitality Venues and Their Workers. Tob Control. 2010;20(2):156–62.
Robson D, Cole F, Jalasi S, Boojharut B, Smith S, Thompson S, et al. Smoking Cessation and Serious Mental Illness: A Service Evaluation of a Drop‐in Stop Smoking Clinic on an Acute In‐patient Unit. J Clin Nurs. 2012;22(3–4):405–13.
Rojas‐Rueda D, Morales-Zamora E, Alsufyani WA, Herbst CH, Albalawi S, Alsukait RF, et al. Environmental Risk Factors and Health: An Umbrella Review of Meta-Analyses. Int J Environ Res Public Health. 2021;18(2):704.
Mayne SL, Widome R, Carroll AJ, Schreiner PJ, Gordon‐Larsen P, Jacobs DR, et al. Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease. Circulation. 2018;138(6):557–66.
Kayani N, Cowan SR, Homan SG, Wilson JS, Warren VF, Yun S. Economic Effect of Smoke-Free Ordinances on 11 Missouri Cities. Prev Chronic Dis. 2012;
Kristina SA, Permitasari NPAL, Krisnadewi KI, Santoso KA, Puspawati PR, Masrida WO, et al. Cancer Attributable to Tobacco Smoking in Member Countries of Association of Southeast Asian Nations (ASEAN) in Year 2018. Asian Pacific Journal of Cancer Prevention. 2019;20(10):2909–15.
Zhou L, Niu L, Jiang H, Jiang C, Xiao S. Facilitators and Barriers of Smokers’ Compliance With Smoking Bans in Public Places: A Systematic Review of Quantitative and Qualitative Literature. Int J Environ Res Public Health. 2016;13(12):1228.
Liu R, Hammond SK, Hyland A, Travers MJ, Yang Y, Nan Y, et al. Restaurant and Bar Owners’ Exposure to Secondhand Smoke and Attitudes Regarding Smoking Bans in Five Chinese Cities. Int J Environ Res Public Health. 2011;8(5):1520–33.
Brown‐Johnson C, Sanders‐Jackson A, Prochaska JJ. Online Comments on Smoking Bans in Psychiatric Hospitals Units. J Dual Diagn. 2014;10(4):204–11.
Mackay D, Haw S, Ayres JG, Fischbacher C, Pell JP. Smoke-Free Legislation and Hospitalizations for Childhood Asthma. New England Journal of Medicine. 2010;363(12):1139–45.
Snyder BM, Nian H, Miller AM, Ryckman KK, Li Y, Tindle HA, et al. Associations Between Smoking and Smoking Cessation During Pregnancy and Newborn Metabolite Concentrations: Findings From PRAMS and INSPIRE Birth Cohorts. Metabolites. 2023;13(11):1163.
Tin STW, Kubuabola I, Ravuvu A, Snowdon W, Durand A, Vivili P, et al. Baseline Status of Policy and Legislation Actions to Address Non Communicable Diseases Crisis in the Pacific. BMC Public Health. 2020;20(1).
Stallings‐Smith S, Hamadi H, Peterson B, Apatu E, Spaulding A. Smoke-Free Policies and 30-Day Readmission Rates for Chronic Obstructive Pulmonary Disease. Am J Prev Med. 2019;57(5):621–8.
Redmon P, Koplan JP, Eriksen MP, Li S, Wang K an. The Role of Cities in Reducing Smoking in China. Int J Environ Res Public Health. 2014;11(10):10062–75.
King B, Travers MJ, Cummings KM, Mahoney MC, Hyland A. Prevalence and Predictors of Smoke-Free Policy Implementation and Support Among Owners and Managers of Multiunit Housing. Nicotine & Tobacco Research. 2009;12(2):159–63.
Faber T, Coffeng LE, Sheikh A, Reiss I, Mackenbach JP, Been J V. Tobacco Control Policies and Respiratory Conditions Among Children Presenting in Primary Care. NPJ Prim Care Respir Med. 2024;34(1).
Petersen AB, Thompson LM, Dadi GB, Tolcha A, Cataldo JK. An Exploratory Study of Knowledge, Attitudes, and Beliefs Related to Tobacco Use and Secondhand Smoke Among Women in Aleta Wondo, Ethiopia. BMC Women S Health. 2018;18(1).
Allen K, Kypridemos C, Hyseni L, Gilmore A, Diggle PJ, Whitehead M, et al. The Effects of Maximising the UK’s Tobacco Control Score on Inequalities in Smoking Prevalence and Premature Coronary Heart Disease Mortality: A Modelling Study. BMC Public Health. 2016;16(1).
Xia J, Huang XB, Sun L, Zhu H, Lin W, Xiao-Rong D, et al. Epidemiological Characteristics of Malaria From Control to Elimination in Hubei Province, China, 2005–2016. Malar J. 2018;17(1).
Li P, Chen B, Deveaux G, Luo Y, Tao W, Li W, et al. Cross-Verification of COVID-19 Information Obtained From Unofficial Social Media Accounts and Associated Changes in Health Behaviors: Web-Based Questionnaire Study Among Chinese Netizens. JMIR Public Health Surveill. 2022;8(5):e33577.
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