A 2009 systematic review of 10 studies conducted across the United States, Canada and Europe linked the implementation of smoking bans in public places and workplaces with significant reduction of heart attack incidence. The review was published in the Journal of the American College of Cardiology.
The combined population of all study sites totaled nearly 24 million people. Heart attack risk decreased on average by 17% in all locations, with the greatest effect among younger people and non-smokers. All 10 locations reported decreases in heart attack incidence, with the largest decreases in the United States.
Smoking Bans in the United States and Canada
The city of Helena, Montana, saw a decline of 40% in heart attack incidence after implementing a smoking ban in June 2002. In the surrounding area which had no smoking ban, heart attacks increased by 46%. The smoking ban was suspended in December 2002. Heart attack rates in Helena increased to pre-ban rates six months after the ban was suspended.
Heart attacks decreased by 27% in the city of Pueblo, Colorado, 18 months after enacting a ban on smoking. The surrounding Pueblo County area experienced a 15% decline. Adjacent El Paso County, which had no smoking ban, experienced a four percent decrease in heart attacks. Pueblo City noted a further 19% reduction in heart attacks after an additional 18 months for an overall three-year reduction of 41%. Neither Pueblo County nor El Paso County noted further reductions.
New York State saw an 8% decline in heart attacks a year after its smoking ban. In 2002-2004, smoking prevalence in New York City decreased from 21.5% to 18.5%.
Heart attacks decreased by 50% in Monroe County, Indiana, 18 months after implementing a smoke-free policy. Neighboring Delaware County, which had no smoking ban, experienced a 20% decline in heart attacks. The ban went into effect in 2003 but excluded bars until 2005.
After three years, heart attack incidence decreased by 19% in Bowling Green, Ohio. The neighboring city of Kent, which had no smoking ban, noted a smaller decrease.
The city of Saskatoon, Saskatchewan, saw a 14% decline in heart attacks one year after enacting a smoking ban. Smoking prevalence was 24% in 2003 and 18 percent in 2005.
Smoking Bans in Europe
Five months after the implementation of a smoking ban in Piedmont, Italy, heart attack incidence decreased by 9.8% in those younger than 65 years and increased by 6.2% in those over 65 years. Nicotine vapor in public places, cigarette sales and cigarette consumption all decreased by 90%, 8.9%, and 7.6%, respectively.
One year after banning smoking in Rome, Italy, heart attack incidence declined by 11%in those younger than 65 years and declined by 8% percent in those aged 75-84 years, particularly among men.
Heart attack incidence decreased by 6% two months after enacting a smoke-free policy in Naples/Trieste, Italy. Reduction in heart attacks was limited to men aged 45-54 years, an 8% decrease.
Ten months after Scotland introduced a smoking ban, admissions for acute coronary syndrome declined by 17%. Admissions decreased by 14% in smokers, 19% in former smokers, and 21% in never smokers. England, which did not have a ban, experienced a 4% decline. Non-smokers reporting exposure to secondhand smoke decreased from 43% to 22%. Secondhand smoke in bars decreased 86% within two weeks of ban implementation.
How the Smoking Bans Worked
The beneficial effect of the smoking bans was rapid—declines in heart attack incidence occurred within three months. Association between smoking bans and reduced heart attack incidence was strengthened by high levels of compliance with the bans, decreased smoking prevalence and sales of tobacco, improved air quality and reduced environmental exposure to tobacco smoke.
(Learn more about successful smoking bans in the province of Santa Fe and the city of Neuquén in Argentina, and about the global support for workplace smoking bans.)
Reference:
- Meyers DG, Neuberger JS, He J. Cardiovascular effect of bans on smoking in public place: A systematic review and meta-analysis. J Am Coll Cardiol 2009; 54: 1249-1255.
Juan Ramos - Juan Ramos is a health communication specialist based in Boston, Massachusetts, USA. He has worked in the non-profit sector for more than ...
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