Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America.
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States of America.
PLoS One. 2021 Apr 16;16(4):e0250285. doi: 10.1371/journal.pone.0250285. eCollection 2021.
Smoke-free ordinances (SFO) have been shown to be effective public health interventions, but there is limited data on the impact SFO on lung cancer outcomes. We explored the effect of county-level SFO strength with smoking prevalence and lung cancer incidence in Indiana.
We obtained county-level lung cancer incidence from the Indiana State Cancer Registry and county-level characteristics from the Indiana Tobacco Prevention and Cessation Commission's policy database between 1995 and 2016. Using generalized estimating equations, we performed multivariable analyses of smoking prevalence and age-adjusted lung cancer rates with respect to the strength of smoke-free ordinances at the county level over time.
Of Indiana's 92 counties, 24 had a SFO by 2011. In 2012, Indiana enacted a state-wide SFO enforcing at least moderate level SFO protection. Mean age-adjusted lung cancer incidence per year was 76.8 per 100,000 population and mean smoking prevalence per year was 25% during the study period. Counties with comprehensive or moderate SFO had a smoking prevalence 1.2% (95% CI [-1.88, -0.52]) lower compared with counties with weak or no SFO. Counties that had comprehensive or moderate SFO also had an 8.4 (95% CI [-11.5, -5.3]) decrease in new lung cancer diagnosis per 100,000 population per year compared with counties that had weak or no SFO.
Counties with stronger smoke-free air ordinances were associated with decreased smoking prevalence and fewer new lung cancer cases per year. Strengthening SFO is paramount to decreasing lung cancer incidence.
无烟条例（SFO）已被证明是有效的公共卫生干预措施，但关于 SFO 对肺癌结果的影响的数据有限。我们探讨了印第安纳州县级 SFO 强度与吸烟流行率和肺癌发病率之间的关系。
我们从印第安纳州癌症登记处获得了县一级的肺癌发病率，并从印第安纳州烟草预防和戒烟委员会的政策数据库获得了县一级的特征数据，时间范围为 1995 年至 2016 年。我们使用广义估计方程，对吸烟流行率和年龄调整后的肺癌率进行了县级 SFO 强度随时间变化的多变量分析。
印第安纳州的 92 个县中，有 24 个县在 2011 年之前就有了 SFO。2012 年，印第安纳州颁布了一项全州范围内的 SFO，强制实施至少是中等水平的 SFO 保护。研究期间，每年的平均年龄调整后肺癌发病率为每 10 万人 76.8 例，每年的平均吸烟流行率为 25%。与 SFO 较弱或不存在的县相比，具有全面或中等 SFO 的县的吸烟流行率低 1.2%（95%CI[-1.88，-0.52]）。与 SFO 较弱或不存在的县相比，具有全面或中等 SFO 的县每年每 10 万人新诊断的肺癌病例减少了 8.4（95%CI[-11.5，-5.3]）。
具有更强的无烟空气条例的县与吸烟流行率降低和每年新肺癌病例减少有关。加强 SFO 对于降低肺癌发病率至关重要。
