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Second Thoughts on Second-Hand Smoke

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“We find no evidence that legislated U.S. smoking bans were associated with short term reductions in hospital admissions for [heart attack] acute myocardial infarction or other diseases in the elderly, children or working-age adults.”

This startling conclusion comes from four authors in the Congressional Budget Office, RAND Corporation, Center for Primary Care – Stanford University, and University of Wisconsin. These conclusions come from the National Bureau of Economic Research and the disclaimer declares the conclusions of the study are solely of those of the authors.

We know state and local governments have virtually banned smoking in public places including workplaces, restaurants and bars. Smoking bans have been implemented in every U.S. community, and we have all been bombarded with studies in medical literature claiming smoking bans lead to healthier communities, affect hospitalization and impact mortality rates.

This study, undertaken in 2009, reviewed how environmental tobacco smoke (also known as second-hand smoke) is related to health outcomes, the history and effects of smoking bans in the U.S. and around the world. The study does not conclude smoking is good for a person or that secondhand smoke is helpful but it offers a useful perspective and facts.

Many studies suggest that smoking bans lead to decreases in heart attacks. A heart attack occurs due to the sudden deprivation of circulating blood in the heart.

The authors claim that previous published studies on health effects of smoking bans in public places only compared outcomes in a single community that had passed a smoking ban with nearby communities which had not passed smoking bans in public places. We have all read and heard from the U.S. Surgeon General that numerous epidemiologic and laboratory studies have linked second-hand smoke to increased rates of cardiovascular disease, respiratory illness, and lung cancer.  In fact, the studies’ authors declare “A smoking ban could plausibly reduce AMI (heart attack) incidents and mortality as early as the first year after a ban if it eliminates even relatively minor exposure.”

Note the word “plausibly.”

Some states, such as California, have banned smoking in workplaces, restaurants and bars because the bans were politically popular. Studies have suggested heart attack rates decreased approximately 40% in Helena, MT and 27% in Pueblo, CO following the ban of second-hand smoke. This study, interestingly, points out studies finding increased rates of vehicular deaths following the enactment of smoking bans. The theory being that drivers were smoking more in their vehicles and it is a distraction to their driving. It is believed that bans on second-hand smoke have led to “impressive public health gains” and that “public smoking bans would demonstrably improve U.S. public health.”

The authors criticized these conclusions and prior U.S. studies, which they claim were small in scale, examined only a few U.S. regions, and the regions were not representative of typical U.S. communities. The study indicates “It is unknown whether public [smoking] bans effectively reduce exposure to second-hand smoke and whether the reduced exposure leads to clinically significant cardiovascular risk reduction.” The authors also conclude it is “…unclear whether government restrictions affect public health substantially, or simply codify existing workplace practice.”

The paper details the data sets and sources for health outcomes. It also looked at impact of workplace smoking bans might have on the elderly and children although it was assumed these two data sets would primarily be exposed to workplace second-hand smoke as customers. The study also looked at the effects of private restrictions businesses enacted or enforced prior to government bans and accordingly were excluded from the final conclusions.  

The conclusions of this study were interesting: “Workplace smoking restrictions are unrelated to changes in all-cause mortality or mortality due to other AMI in all age groups.” This study also found “We similarly find no evidence of reduction in [hospital] admissions for other diseases in any age group, though smoking restrictions of all sorts are associated with statistically insignificant increases in asthma…among children.”

The study also claims that workplace smoking bans “…on heart attack admissions is close to zero…” Studies like this never make the evening news.

(This article first ran in Farm Futures on November 17, 2015)

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