Comprehensive Smoke-Free Laws and Cardiovascular Disease Mortality in US Counties.

Area of Science:

• Public Health
• Epidemiology
• Cardiovascular Disease Research

Background:

• Active smoking and secondhand smoke (SHS) exposure are significant risk factors for cardiovascular disease (CVD).
• Comprehensive smoke-free laws are a key tobacco control measure, but long-term impacts on CVD mortality and demographic variations are not well understood.

Purpose of the Study:

• To evaluate the long-term association between comprehensive smoke-free laws and county-level CVD mortality.
• To assess if these associations differ across age, sex, and racial/ethnic groups.

Main Methods:

• A comparative effectiveness study using longitudinal county-level panel data (2000-2018).
• Employed the generalized synthetic control method to analyze staggered adoption of 100% smoke-free laws in 38 treated counties versus 103 control counties.
• Analyzed annual age-adjusted CVD mortality rates, stratified by demographics.

Main Results:

• Implementation of comprehensive smoke-free laws was linked to an average annual reduction of 12.0 CVD deaths per 100,000 population over 12 years.
• Greater reductions were observed in older adults (≥65 years), males, and non-Hispanic White populations.
• Smaller, less precise reductions were noted in younger adults, females, and non-Hispanic Black populations.

Conclusions:

• Comprehensive smoke-free laws are associated with sustained reductions in cardiovascular disease mortality.
• The effectiveness of these laws varies across demographic groups, highlighting potential disparities.
• Additional targeted strategies may be necessary to achieve equitable improvements in cardiovascular health outcomes for all subpopulations.