Introduction: Implementation of smokefree laws is followed by drops in hospital admissions for
cardiovascular diseases and asthma. The impact of smokefree laws on use of non-hospital medical
services has not been assessed. The purpose of this study is to evaluate the impact of Uruguay’s
national 100% smokefree legislation on non-hospital emergency care visits, hospitalizations for
bronchospasm, and bronchodilator use.
Methods: The monthly number of non-hospital emergency care visits and hospitalizations for
bronchospasm, as well as monthly puffs of bronchodilators (total and per person), from 3 years prior
to the adoption of the 100% smokefree policy on March 1, 2006, through 5 years after the policy were
assessed using interrupted time series negative binomial regression. Data analysis was conducted
Results: The incidence of non-hospital emergency visits for bronchospasm decreased by 15%
(incidence rate ratio [IRR]¼0.85, 95% CI¼0.76, 0.94) following implementation of the law.
Hospitalizations for bronchospasm did not change significantly (IRR¼0.89, 95% CI¼0.66, 1.21).
Total monthly puffs of salbutamol and ipratropium administered in the non-hospital emergency
setting decreased by 224 (95% CI¼–372, –76) and 179 (95% CI¼–340, –18.6), respectively, from
means of 1,222 and 1,007 before the law.
Conclusions: Uruguay’s 100% smokefree law was followed by fewer emergency visits for
bronchospasm and less need for treatment, supporting adoption of such policies in low- and
middle-income countries to reduce the disease burden and healthcare costs associated with smoking.
(Am J Prev Med 2014;](]):]]]–]]]) & 2014 American Journal of Preventive Medicine
Sara Kalkhoran, MD, Ernesto M. Sebrié, MD, MPH, Edgardo Sandoya, MD, Stanton A. Glantz, PhD
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