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The Impact of the Danish National Smoking Ban From 2007 on the Incidence of Eight Smoking-related Diseases: A Nationwide Register-based Interrupted Time Series Analysis.
Nicotine Tob Res. 2023 03 22; 25(4):648-656.NT

Abstract

BACKGROUND

Previous research has documented the effect of comprehensive smoking bans on preventing various adverse health outcomes in the years post-ban. In 2007, Denmark implemented a national smoking ban that prohibited indoor smoking in workplaces and public settings, although only partial restrictions applied in specific premises such as small bars, one-person offices, and in psychiatric units. We tested the hypothesis that the implementation of the national smoking ban was associated with a decrease in incidence of smoking-related morbidity in the Danish population compared to the pre-ban period.

METHODS

Interrupted time series analyses including the entire Danish population (≥30 years) was conducted. Information of hospitalizations and cause-specific mortality due to acute myocardial infarction, heart failure, hemorrhagic stroke, ischemic stroke, chronic obstructive pulmonary disease, cancer in bronchus and lung, cancer in lip, mouth, oral cavity, and pharynx, and bladder cancer were obtained from population-based registers. Poisson regression models accounting for seasonal variations and secular trends quantified immediate changes in incidence rates occurring at the time of the smoking ban as well as changes in the post-ban trend compared to pre-ban levels.

RESULTS

Overall, we observed no consistent declines in incidence of cardiovascular diseases, chronic obstructive pulmonary disease, or the specific types of cancer in the post-ban period compared with the pre-ban period.

CONCLUSION

No consistent reduction in incidence of smoking-related diseases was observed after the smoking ban was introduced in Denmark. This probably reflects that the Danish smoking ban included several exemptions, resulting in a less comprehensive ban compared to those introduced in other countries.

IMPLICATIONS

In this study, we found that the Danish national smoking ban from 2007 did not consistently reduced the incidence of eight smoking-related outcomes in the post-ban period compared to pre-ban levels. We argue that due to the exemptions in the smoking ban, which for example allowed smoking in specific premises of the care and nursing sector, in one-person offices, and small bars, the ban was not sufficiently comprehensive to influence smoking behavior and thereof the incidence of smoking-related morbidity. Our findings highlight the importance of introducing comprehensive legislative measures to yield largest health benefits at a population level.

Authors+Show Affiliations

National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.Steno Diabetes Center Copenhagen, The Capital Region of Denmark, Gentofte, Denmark.National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

36367774

Citation

Jarlstrup, Nanna Schneekloth, et al. "The Impact of the Danish National Smoking Ban From 2007 On the Incidence of Eight Smoking-related Diseases: a Nationwide Register-based Interrupted Time Series Analysis." Nicotine & Tobacco Research : Official Journal of the Society for Research On Nicotine and Tobacco, vol. 25, no. 4, 2023, pp. 648-656.
Jarlstrup NS, Thygesen LC, Grønbæk MK, et al. The Impact of the Danish National Smoking Ban From 2007 on the Incidence of Eight Smoking-related Diseases: A Nationwide Register-based Interrupted Time Series Analysis. Nicotine Tob Res. 2023;25(4):648-656.
Jarlstrup, N. S., Thygesen, L. C., Grønbæk, M. K., Rod, M. H., & Tolstrup, J. S. (2023). The Impact of the Danish National Smoking Ban From 2007 on the Incidence of Eight Smoking-related Diseases: A Nationwide Register-based Interrupted Time Series Analysis. Nicotine & Tobacco Research : Official Journal of the Society for Research On Nicotine and Tobacco, 25(4), 648-656. https://doi.org/10.1093/ntr/ntac257
Jarlstrup NS, et al. The Impact of the Danish National Smoking Ban From 2007 On the Incidence of Eight Smoking-related Diseases: a Nationwide Register-based Interrupted Time Series Analysis. Nicotine Tob Res. 2023 03 22;25(4):648-656. PubMed PMID: 36367774.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Impact of the Danish National Smoking Ban From 2007 on the Incidence of Eight Smoking-related Diseases: A Nationwide Register-based Interrupted Time Series Analysis. AU - Jarlstrup,Nanna Schneekloth, AU - Thygesen,Lau Caspar, AU - Grønbæk,Morten Klöcker, AU - Rod,Morten Hulvej, AU - Tolstrup,Janne Schurmann, PY - 2021/10/27/received PY - 2022/09/16/revised PY - 2022/11/09/accepted PY - 2022/11/12/pubmed PY - 2023/3/25/medline PY - 2022/11/11/entrez SP - 648 EP - 656 JF - Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco JO - Nicotine Tob Res VL - 25 IS - 4 N2 - BACKGROUND: Previous research has documented the effect of comprehensive smoking bans on preventing various adverse health outcomes in the years post-ban. In 2007, Denmark implemented a national smoking ban that prohibited indoor smoking in workplaces and public settings, although only partial restrictions applied in specific premises such as small bars, one-person offices, and in psychiatric units. We tested the hypothesis that the implementation of the national smoking ban was associated with a decrease in incidence of smoking-related morbidity in the Danish population compared to the pre-ban period. METHODS: Interrupted time series analyses including the entire Danish population (≥30 years) was conducted. Information of hospitalizations and cause-specific mortality due to acute myocardial infarction, heart failure, hemorrhagic stroke, ischemic stroke, chronic obstructive pulmonary disease, cancer in bronchus and lung, cancer in lip, mouth, oral cavity, and pharynx, and bladder cancer were obtained from population-based registers. Poisson regression models accounting for seasonal variations and secular trends quantified immediate changes in incidence rates occurring at the time of the smoking ban as well as changes in the post-ban trend compared to pre-ban levels. RESULTS: Overall, we observed no consistent declines in incidence of cardiovascular diseases, chronic obstructive pulmonary disease, or the specific types of cancer in the post-ban period compared with the pre-ban period. CONCLUSION: No consistent reduction in incidence of smoking-related diseases was observed after the smoking ban was introduced in Denmark. This probably reflects that the Danish smoking ban included several exemptions, resulting in a less comprehensive ban compared to those introduced in other countries. IMPLICATIONS: In this study, we found that the Danish national smoking ban from 2007 did not consistently reduced the incidence of eight smoking-related outcomes in the post-ban period compared to pre-ban levels. We argue that due to the exemptions in the smoking ban, which for example allowed smoking in specific premises of the care and nursing sector, in one-person offices, and small bars, the ban was not sufficiently comprehensive to influence smoking behavior and thereof the incidence of smoking-related morbidity. Our findings highlight the importance of introducing comprehensive legislative measures to yield largest health benefits at a population level. SN - 1469-994X UR - https://www.unboundmedicine.com/medline/citation/36367774/The_Impact_of_the_Danish_National_Smoking_Ban_From_2007_on_the_Incidence_of_Eight_Smoking_related_Diseases:_A_Nationwide_Register_based_Interrupted_Time_Series_Analysis_ DB - PRIME DP - Unbound Medicine ER -