Public Smoking Bans Are Driving Down Hospitalization Rates For Heart Attack

Lawrence LeBlond for – Your Universe Online

Despite a rise in ER visits due to obesity, diabetes and other common health issues, the ban on smoking in restaurants and other public establishments have led to a sharp decline in hospitalizations for heart attacks, strokes and respiratory illnesses such as asthma and emphysema, according to new analysis of several studies.

The analysis, published in the American Heart Association journal Circulation, covers 45 studies from more than 30 smoke-free laws at local and state levels in the US and from a number of countries including New Zealand and Germany.

The data show that comprehensive smoke-free laws were associated with a 15 percent decline in heart attack hospitalizations and a 16 percent decrease in stroke hospitalizations following the adoption of public smoking bans. The adopted laws were also rapidly followed by a 24 percent drop in hospitalizations for respiratory diseases. In fact, the regions with the most comprehensive smoke-free laws resulted in the highest health benefits.

Senior study author Stanton Glantz, Ph.D., director of the Center for Tobacco Control Research and Education at the University of California, San Francisco (UCSF), said: “The public, health professionals and policy makers need to understand that including exemptions and loopholes in legislation — such as exempting casinos — condemns more people to end up in emergency rooms. These unnecessary hospitalizations are the real cost of failing to enact comprehensive smoke-free legislation.”

Findings of this analysis support the AHA´s stance that smoke-free laws must be comprehensive and apply to all workplaces and public environments. The analysis is also consistent with other studies that have found that smoke-free laws were followed by significant decreases in acute heart attack and other cardiac-related hospitalizations.

One such study stems from a 2002 law banning smoking in restaurants only in Olmsted County, Minnesota. The study, published Monday in the Archives of Internal Medicine found that the law had no affect on heart attack hospitalization outcomes, until the law was extended in 2007 to include all workplaces and public environments. After the comprehensive law was put into effect, heart attacks fell by 33 percent, according to information gleaned from Minnesota´s Mayo Clinic.

That drop was impressive, given that people in Minnesota were getting less healthy in the same time frame, with higher rates of diabetes and obesity. The study found rates of high blood pressure and unhealthy cholesterol levels stayed the same.

Raising taxes on tobacco and more smoking-cessation campaigns caused many in Minnesota to quit smoking during the study period, which lasted from 2002 to 2007, according to the authors of that study. But the trends did not fully explain the drop in heart attacks and sudden cardiac deaths (which fell by 17 percent).

While the Olmsted researchers said smoking bans in public environments may have helped lower the hospitalization rates, an accompanying editorial in the journal said people who continued to smoke did not smoke more at home to compensate for the public smoking restriction. In fact, a widespread establishment of no-smoking zones in homes have seemed to follow the public smoking bans, suggesting that many smokers are smoking less than they once did.

In another study examining data from an Indiana Adult Tobacco Survey, researchers found nearly 73 percent of Hoosiers support a statewide workplace smoking ban.

The results of this study could be important in increasing focused public awareness strategies aimed at reducing exposure to secondhand smoke, said study leader Terrell Zollinger, professor of epidemiology at the Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis (IUPUI).

In the study, Zollinger found three variables that were the most important predictors of garnering support: People who never or formerly smoked were more supportive, as were females and those who were more aware of the health hazards of secondhand smoke.

About 32 percent of respondents to the survey who are current smokers support indoor workplace smoking bans; 68 former smokers did so; and 85 percent of those who had never smoked said they support indoor workplace bans on smoking.

Zollinger said the results of his study suggest that efforts to gain additional support for smoke-free-air laws should focus on men, people unaware of the health hazards from secondhand smoke, smokers and former smokers.

Zollinger will present the findings of his study at 3:30 p.m. EDT today (Oct. 30)

Raymond Gibbons, a cardiologist and past president of AHA, said smoking bans are meant to protect non-smokers. Secondhand smoke can trigger heart attacks in non-smokers with underlying heart disease, he noted.

Secondhand smoke affects a non-smoker´s blood vessels in as little as five minutes, causing changes that increase the risk of heart attack, according to the Mayo Clinic.

About 46,000 non-smoking Americans die from secondhand smoke exposure each year, according to the National Cancer Institute.

Smoking bans also reduce health care costs  for individuals, health plans and government payers, Glantz said. Total savings ranged from $302,000 in all health care costs in Starkville, Miss., to nearly $7 million just in heart attack-related hospitalizations in Germany, according to information in the Circulation study.

“If politicians are serious about cutting medical costs, they need to look at this,” Glantz said. “The best way to keep health care costs down is to not get sick. … There is nothing else you can do to have these big an effect on hospital admissions.”

Glantz said lawmakers should also consider the findings from past studies when voting to exempt certain facilities from smoke-free laws. “The politicians who put those exemptions in are condemning people to be put into the emergency room,” Glantz warned.

David Sutton, a spokesman for Philip Morris USA, the top cigarette maker in the country, noted that his company agrees that secondhand smoke is dangerous, but said smoking bans are not always necessary, and that businesses such as restaurants can accommodate non-smokers through separate rooms or ventilation.

“Reasonable ways exist to respect the comfort and choices of both non-smoking and smoking adults,” Sutton said. “Business owners — particularly owners of restaurants and bars — are most familiar with how to accommodate the needs of their patrons and should have the opportunity and flexibility to determine their own smoking policy. The public can then choose whether or not to frequent places where smoking is permitted.”

In conclusion, Glantz said: “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. Passage of these laws formalize and accelerate social change and the associated immediate health benefits.”

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