Association between Florida's smoke-free policy and acute myocardial infarction by race: A time series analysis, 2000-2013.
Racial disparities in acute myocardial infarctions (AMIs) are increasing over time. Previous studies have shown that the implementation of smoke-free policies is associated with reduced AMI rates. The objective of this study was to determine the association between smoke-free policy and AMI hospitalization rates and smoking by race.



Healthcare Cost and Utilization Project data from Florida from 2000-2013 were analyzed using interrupted time series analysis to determine the relationship between Florida's smoke-free restaurant and workplace laws and AMI among the total adult population (aged ≥18years), by age, race, and gender. Behavioral Risk Factor Surveillance System data from Florida from 2000 to 2010 were analyzed using logistic regression to determine the association between policy and the adult smoking prevalence.



After implementation of the smoke-free policy, no statistically significant associations between AMI hospitalization rates or smoking prevalence were detected in the total population. In the subgroup analysis, the policy was associated with declines in AMI hospitalization rates among non-Hispanic white adults aged 18-44years (β=-0.001 per 10,000, p-value=0.0083). No other relationships with AMI hospitalization rates and smoking prevalence were found in the subgroup analysis.



More comprehensive smoke-free and tobacco control policies are needed to further reduce AMI hospitalization rates, particularly among minority populations. Further research is needed to understand and address how the implementation of smoke-free policies affects secondhand smoke exposure among racial and ethnic minorities.
School of Public Health, Department of Behavioral and Community Health, University of Maryland at College Park, 4200 Valley Drive, College Park, MD 20742, USA. Electronic address: emead1@umd.edu.
Erin L
EL
Mead
School of Public Health, Department of Epidemiology and Biostatistics, University of Maryland at College Park, 4200 Valley Drive, College Park, MD 20742, USA. Electronic address: raulcruz@umd.edu.
Raul
R
Cruz-Cano
School of Public Health, Department of Behavioral and Community Health, University of Maryland at College Park, 4200 Valley Drive, College Park, MD 20742, USA. Electronic address: dbernat@umd.edu.
Debra
D
Bernat
American Heart Association, 1150 Connecticut Avenue NW, Suite 300, Washington, D.C. 20036, USA. Electronic address: laurie.whitsel@heart.org.
Laurie
L
Whitsel
Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL 60608, USA. Electronic address: jhuang12@uic.edu.
Jidong
J
Huang
American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231, USA. Electronic address: chris.sherwin@heart.org.
Chris
C
Sherwin
American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231, USA. Electronic address: rosemarie.robertson@heart.org.
Rose Marie
RM
Robertson
D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D005260:Female; D005431:Florida / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D054525:Minority Health / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000453:epidemiology / Q000208:ethnology*; D044469:Racial Groups; D012147:Restaurants / Q000331:legislation & jurisprudence; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000453:epidemiology*; D017132:Workplace / Q000331:legislation & jurisprudence
Adult; Behavioral risk factor surveillance system; Hospitalization/statistics and numerical data; Minority health; Myocardial infarction; Smoke-free policy; Smoking