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Association of state tobacco control policies with active smoking at the time of intervention for intermittent claudication.

Authors
  • Levin, Scott R1
  • Hawkins, Summer S2
  • Farber, Alik1
  • Goodney, Philip P3
  • Osborne, Nicholas H4
  • Tan, Tze-Woei5
  • Malas, Mahmoud B6
  • Patel, Virendra I7
  • Siracuse, Jeffrey J8
  • 1 Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass.
  • 2 School of Social Work, Boston College, Chestnut Hill, Mass.
  • 3 Division of Vascular and Endovascular Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH.
  • 4 Division of Vascular and Endovascular Surgery, University of Michigan Medical Center, Ann Arbor, Mich.
  • 5 Division of Vascular and Endovascular Surgery, University of Arizona Medical Center, Tucson, Ariz.
  • 6 Division of Vascular and Endovascular Surgery, University of California San Diego Medical Center, La Jolla, Calif.
  • 7 Division of Vascular Surgery and Endovascular Interventions, New York Presbyterian-Columbia University Irving Medical Center, New York, NY.
  • 8 Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass. Electronic address: [email protected]
Type
Published Article
Journal
Journal of vascular surgery
Publication Date
May 01, 2021
Volume
73
Issue
5
Identifiers
DOI: 10.1016/j.jvs.2020.08.156
PMID: 33098941
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Active smoking among patients undergoing interventions for intermittent claudication (IC) is associated with poor outcomes. Notwithstanding, current levels of active smoking in these patients are high. State-level tobacco control policies have been shown to reduce smoking in the general US population. We evaluated whether state cigarette taxes and 100% smoke-free workplace legislation are associated with active smoking among patients undergoing interventions for IC. We queried the Vascular Quality Initiative database for peripheral endovascular interventions, infrainguinal bypasses, and suprainguinal bypasses for IC. Active smoking at the time of intervention was defined as smoking within one month of intervention. We implemented difference-in-differences analysis to isolate changes in active smoking owing to cigarette taxes (adjusted for inflation) and implementation of smoke-free workplace legislation. The difference-in-differences models estimated the causal effects of tobacco policies by adjusting for concurrent temporal trends in active smoking unrelated to cigarette taxes or smoke-free workplace legislation. The models controlled for age, sex, race/ethnicity, insurance type, diabetes, chronic obstructive pulmonary disease, state, and year. We tested interactions of taxes with age and insurance. Data were available for 59,847 patients undergoing interventions for IC in 25 states from 2011 to 2019. Across the study period, active smoking at the time of intervention decreased from 48% to 40%. Every $1.00 cigarette tax increase was associated with a 6-percentage point decrease in active smoking (95% confidence interval, -10 to -1 percentage points; P = .02), representing an 11% decrease relative to the baseline proportion of patients actively smoking. The effect of cigarettes taxes was greater in older patients and those on Medicare. Among patients aged 60 to 69 and 70 to 79 years, every $1.00 tax increase resulted in 14% and 21% reductions in active smoking relative to baseline subgroup prevalences of 53% and 29%, respectively (P < .05 for both); however, younger age groups were not affected by tax increases. Among insurance groups, only patients on Medicare exhibited a significant change in active smoking with every $1.00 tax increase (an 18% decrease relative to a 33% baseline prevalence; P = .01). The number of states implementing smoke-free workplace legislation increased from 9 to 14 by 2019; however, this policy was not significantly associated with active smoking prevalence. At follow-up (median, 12.9 months), $1.00 tax increases were still associated with decreased smoking prevalence (a 25% decrease relative to a 33% baseline prevalence; P < .001). Cigarette tax increases seem to be an effective strategy to decrease active smoking among patients undergoing interventions for IC. Older patients and Medicare recipients are the most responsive to tax increases. Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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