Issue: December 2012
November 02, 2012
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Smoke-free laws linked to declines in hospitalization, MI

Issue: December 2012
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Results from two new studies provide evidence that smoke-free laws decreased hospitalizations and the incidence of MI.

According to research published in Circulation, comprehensive smoke-free laws were associated with a rapid 15% decrease in MI hospitalizations, 16% decrease in stroke hospitalizations and 24% decrease in respiratory disease hospitalizations, including asthma and chronic obstructive pulmonary disease.

Stanton Glantz, PhD 

Stanton Glantz

The most comprehensive laws, including those covering workplaces, restaurants and bars, resulted in the highest health benefits.

“Stronger legislation means immediate reductions in secondhand smoke-related health problems as a byproduct of reductions in secondhand smoke exposure and increases in smoking cessation that accompany these laws,” Stanton Glantz, PhD, director of the Center for Tobacco Control Research and Education at University of California, San Francisco, said in a press release. “Passage of these laws formalizes and accelerates social change and the associated immediate health benefits.”

The data come from a meta-analysis of 45 studies covering 33 smoke-free laws at the local and state levels around the United States and from countries as varied as Uruguay, New Zealand and Germany.

Findings from this analysis are consistent with other studies that have found smoke-free laws were followed by significant decreases in acute MI and other cardiac-related hospital admissions, the researchers said.

Laws improved incidence of MI

A decline in the incidence of MI in one Minnesota county appears to be associated with the implementation of smoke-free workplace laws, according to a study published in Archives of Internal Medicine.

Richard D. Hurt, MD, and colleagues at Mayo Clinic, Rochester, Minn., evaluated the incidence of MI and sudden cardiac death in Olmsted County, Minn., during the 18-month period before and after implementation of smoke-free ordinances. In 2002, a smoke-free restaurant ordinance was implemented and, in 2007, all workplaces, including bars, became smoke free, according to a press release.

When comparing the 18 months before implementation of the smoke-free restaurant ordinance with the 18 months after implementation of the smoke-free workplace law, the incidence of MI declined by 33%, from 150.8 to 100.7 per 100,000 people, and the incidence of sudden cardiac death declined by 17%, from about 109.1 to 92 per 100,000 people, according to the release.

During the study period, the prevalence of smoking declined, as did the incidence of hypertension, diabetes and hypercholesterolemia. Obesity remained constant or increased, the researchers said.

Extending health benefits 

In an invited commentary published in Archives of Internal Medicine, Sara Kalkhoran, MD, and Pamela M. Ling, MD, MPH, of the University of California, San Francisco, said these data highlight some of the potential benefits of 100% smoke-free policies in workplaces and businesses.

“Moving forward, we should prioritize the enforcement of smoke-free policies, eliminating loopholes in existing policies as well as encouraging expansion of smoke-free policies to include multiunit housing, motor vehicles, casinos and outdoor locations.

“Exposure to secondhand smoke should not be a condition of employment, and all works, including those of lower income and those in the service and hospitality industries should have equal protection from secondhand smoke exposure,” Kalkhoran and Ling wrote.

For more information:

Hurt RD. Arch Intern Med. 2012;doi:10.1001/2013.jamainternmed.46.

Kalkhoran S. Arch Intern Med. 2012;doi:10.1001/2013.jamainternmed.269.

Tan CE. Circulation. 2012;126:2177-2183.

Disclosure: The National Cancer Institute funded the Circulation study. ClearWay Minnesota, the National Heart, Lung and Blood Institute and the National Institute on Aging funded the Archives of Internal Medicine study. Glantz, Hurt, Ling and Kalkhoran report no relevant financial disclosures.