Stanton A. Glantz

Effect of smoke-free workplaces on smoking behaviour: systematic review

Abstract Objective: To quantify the effects of smoke-free workplaces on smoking in employees and compare these effects to those achieved through tax increases. Design: Systematic review with a random effects meta-analysis. Study selection: 26 studies on the effects of smoke-free workplaces Setting: Workplaces in the United States, Australia, Canada, and Germany Participants: Employees in unrestricted and totally smoke-free workplaces Main outcome measures: Daily cigarette consumption (per smoker and per employee) and smoking prevalence Results: Totally smoke-free workplaces are associated with reductions in prevalence of smoking of 3.8% (95% confidence interval 2.8% to 4.7%) and 3.1 (2.4 to 3.8) fewer cigarettes smoked per day per continuing smoker. Combination of the effects of reduced prevalence and lower consumption per continuing smoker yields a mean reduction of 1.3 cigarettes per day per employee, which corresponds to a relative reduction of 29%. To achieve similar reductions the tax on a pack of cigarettes would have to increase from

Cardiovascular Effects of Secondhand Smoke Nearly as Large as Smoking

0.76 to

E-Cigarettes A Scientific Review

3.05 (€0.78 to €3.14) in the United States and from £3.44 to £6.59 (€5.32 to €10.20) in the United Kingdom. If all workplacesbecame smoke-free, consumption per capita in the entire population would drop by 4.5% in the United States and 7.6% in the United Kingdom, costing the tobacco industry

Determinants of left ventricular filling and of the diastolic pressure-volume relation.

1.7 billion and £310 million annually in lost sales. To achieve similar reductions tax per pack would have to increase to

Volume loading slows left ventricular isovolumic relaxation rate. Evidence of load-dependent relaxation in the intact dog heart.

1.11 and £4.26 Conclusions: Smoke-free workplaces not only protect non-smokers from the dangers of passive smoking, they also encourage smokers to quit or to reduce consumption

Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry

Background—Secondhand smoke increases the risk of coronary heart disease by ≈30%. This effect is larger than one would expect on the basis of the risks associated with active smoking and the relative doses of tobacco smoke delivered to smokers and nonsmokers. Methods and Results—We conducted a literature review of the research describing the mechanistic effects of secondhand smoke on the cardiovascular system, emphasizing research published since 1995, and compared the effects of secondhand smoke with the effects of active smoking. Evidence is rapidly accumulating that the cardiovascular system—platelet and endothelial function, arterial stiffness, atherosclerosis, oxidative stress, inflammation, heart rate variability, energy metabolism, and increased infarct size—is exquisitely sensitive to the toxins in secondhand smoke. The effects of even brief (minutes to hours) passive smoking are often nearly as large (averaging 80% to 90%) as chronic active smoking. Conclusions—The effects of secondhand smoke are substantial and rapid, explaining the relatively large risks that have been reported in epidemiological studies.

Short-term Economic and Health Benefits of Smoking Cessation Myocardial Infarction and Stroke

Electronic cigarettes (e-cigarettes) are products that deliver a nicotine-containing aerosol (commonly called vapor) to users by heating a solution typically made up of propylene glycol or glycerol (glycerin), nicotine, and flavoring agents (Figure 1) invented in their current form by Chinese pharmacist Hon Lik in the early 2000s.1 The US patent application describes the e-cigarette device as “an electronic atomization cigarette that functions as substitutes [sic] for quitting smoking and cigarette substitutes ” (patent No. 8,490,628 B2). By 2013, the major multinational tobacco companies had entered the e-cigarette market. E-cigarettes are marketed via television, the Internet, and print advertisements (that often feature celebrities)2 as healthier alternatives to tobacco smoking, as useful for quitting smoking and reducing cigarette consumption, and as a way to circumvent smoke-free laws by enabling users to “smoke anywhere.”3 Figure 1. Examples of different electronic cigarette (e-cigarette) products. Reproduced from Grana et al.1 There has been rapid market penetration of e-cigarettes despite many unanswered questions about their safety, efficacy for harm reduction and cessation, and total impact on public health. E-cigarette products are changing quickly, and many of the findings from studies of older products may not be relevant to the assessment of newer products that could be safer and more effective as nicotine delivery devices. In addition, marketing and other environmental influences may vary from country to country, so patterns of use and the ultimate impact on public health may differ. The individual risks and benefits and the total impact of these products occur in the context of the widespread and continuing availability of conventional cigarettes and other tobacco products, with high levels of dual use of e-cigarettes and conventional cigarettes at the same time among adults4–8 and youth.9–11 It is important to assess e-cigarette toxicant exposure and …

Association of the California Tobacco Control Program with Declines in Cigarette Consumption and Mortality from Heart Disease

Until the 1970s, the left ventricle was considered an isolated shell in which the left ventricular diastolic pressure-volume relation depended on the myocardiums material properties and the left ventricles wall thickness and geometry. According to this view, the relation between diastolic pressure and volume could change only in response to chronic changes in the cardiac muscles material properties, such as scarring due to infarction, or changes in cardiac geometry due to hypertrophy. As a consequence, the diastolic pressure-volume relation was considered unique over the short term. A practical application of this assumed uniqueness was that left ventricular diastolic pressure was used as a surrogate for volume in evaluating systolic function. However, in the early 1970s, studies of patients with coronary artery disease contradicted this simplistic view of the diastolic pressure-volume relation.In these patients, the left ventricular diastolic pressure-volume curve shifted upward temporarily immediately after cardiac pacing-induced angina and then returned to prepacing values. Later, other investigatorsobserved that vasodilator and vasoconstrictor drugs, which change the vascular loading conditions of the left ventricle, also produced acute reversible shifts in the left ventricular diastolic pressure-volume curve. In the process of explaining these clinical observations, we have learned that many factors can affect left ventricular filling and the diastolic pressure-volume relation acutely. The original concept that the pressure within the left ventricle is determined by the balance between the forces due to pressures within the ventricular cavity that expand the ventricle and forces due to elasticity of the myocardium that resist this expan-

The pericardium substantially affects the left ventricular diastolic pressure-volume relationship in the dog.

We studied the effects of volume loading on left ventricular isovolumic relaxation rate in 16 intact anesthetized dogs. End-diastolic pressure, mean aortic systolic pressure, dp/dtmnx, and heart rate were measured at end expiration and end inspiration. Volume loading to approximately 5, 10, 15, and 20 mm Hg above initial end-diastolic pressure was performed. In nine dogs, simultaneous ventricular dimensions were measured with previously implanted tantalum screws using biplane cineangiography. Similar volume loading was done in open-chest and open-pericardium states. Relaxation rate was measured in 3413 beats using T, the time constant of exponential isovolumic pressure fall. T was calculated as reported previously by others and also from a linear regression of dp/dt against p, to eliminate the effects of extracavity pressure changes. T always increased significantly with volume loading, indicating slower relaxation. (For example, with the chest intact, mean T increased from 26 ± 2 (SEM) msec before volume loading to 41.5 ± 4 msec after volume loading.) Using multiple linear regression analysis, we found, in agreement with previous reports, that T decreased significantly as dp/dtMAX, and heart rate increased. In contrast to previous reports, we also found that T increased significantly as end-diastolic and mean aortic systolic pressure increased. These four variables taken together accurately predicted T [SEE (standard error of estimate) = 3.2 msec, R = 0.94, P < 0.001]. Geometric variables, including ventricular dimensions and ejection fraction, did not have a statistically significant effect on T independent of the hemodynamic variables. Opening the chest or pericardium did not have a consistent effect on T. Volume loading slows isovolumic relaxation rate in the intact canine heart. This effect appears to be a reflection of the dependence of relaxation on both end-diastolic and mean aortic systolic pressures.

E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis

Objective: To compare the quality and funding source of studies concluding a negative economic impact of smoke-free policies in the hospitality industry to studies concluding no such negative impact. Data sources: Researchers sought all studies produced before 31 August 2002. Articles published in scientific journals were located with Medline, Science Citation Index, Social Sciences Citation Index, Current Contents, PsychInfo, Econlit, and Healthstar. Unpublished studies were located from tobacco company websites and through internet searches. Study selection: 97 studies that made statements about economic impact were included. 93% of the studies located met the selection criteria as determined by consensus between multiple reviewers. Data extraction: Findings and characteristics of studies (apart from funding source) were classified independently by two researchers. A third assessor blind to both the objective of the present study and to funding source also classified each study. Data synthesis: In studies concluding a negative impact, the odds of using a subjective outcome measure was 4.0 times (95% confidence interval (CI) 1.4 to 9.6; p = 0.007) and the odds of not being peer reviewed was 20 times (95% CI 2.6 to 166.7; p = 0.004) that of studies concluding no such negative impact. All of the studies concluding a negative impact were supported by the tobacco industry. 94% of the tobacco industry supported studies concluded a negative economic impact compared to none of the non-industry supported studies. Conclusion: All of the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment. Policymakers can act to protect workers and patrons from the toxins in secondhand smoke confident in rejecting industry claims that there will be an adverse economic impact.