The issues raised in this chapter are relevant to the interpretation of the major studies that are the subject of this report. Recommendations for future studies are in Chapter 6.
All the epidemiologic studies being reviewed should be evaluated in light of the amount of contextual data that are taken into account, including measurements both before and after bans and measurements comparing locales with and without bans.
When study results are compared, it may be impossible to separate contextual factors associated with a ban—such as public comment periods, information announcing the ban, and notices about the impending changes—from the effect of the ban itself.
The time from onset of a ban and concurrent activities to manifestation of disease can vary with the timing (and nature) of enforcement, and latency periods for cardiovascular incidents in people with different magnitudes of risk. Those factors, therefore, need to be considered in examining epidemiologic evidence.
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