From
The Wall Street Journal:
A new study from Scotland provides what public-health experts in the U.S. say is the strongest evidence yet that public bans on smoking -- being debated in several locales -- improve health by reducing exposure to secondhand smoke.
According to the study, which appears in Thursday's edition of the New England Journal of Medicine, hospital admissions for heart attacks and acute coronary problems fell 17% overall, and even more for nonsmokers, in the year after Scotland banned smoking in public places.
"There has long been a claim from smokers that they are affecting their own bodies, and why should the public care?" said David Cohen, director of cardiovascular research at Saint Luke's Mid America Heart Institute in Kansas City, Mo., who wasn't involved in the study. "This shows that the public should absolutely care ... that is an incredibly powerful finding."
The study found that nonsmokers accounted for 67% of the overall reduction in heart-disease hospitalizations, said Jill Pell, the University of Glasgow professor who led the study. Nonsmokers saw a 20% reduction in their hospital admissions following the ban. Smokers' admissions were down 14%.
This isn't the first study published on the health impact of smoking bans -- the 17% decrease in hospitalizations among Scots was comparable to rates recorded in previous research. But these findings "should add considerable oomph to the pressure for smoking bans" elsewhere, because of the study's rigor and use of blood tests, said Edith Balbach, director of the Community Health Program at Tufts University and president of Americans for Nonsmokers' Rights.
Unlike past studies, researchers took blood and saliva samples from patients as they were admitted to the hospital. Then they searched for a molecule that's the product of
nicotine metabolism --
cotinine. The presence of cotinine can definitively classify patients as smokers or nonsmokers instead of relying on self-reporting by patients.
Researchers found that nonsmokers with heart disease had higher levels of cotinine than the general population but lower levels than before the ban, a sign that their exposure to secondhand smoke had decreased but was still a factor in their heart damage.
Inhaled smoke makes blood platelets stickier, thus more likely to clot and clog arteries -- after even brief exposure to low levels of smoke. But the increased stickiness can wear off after just a few days. These effects make heart disease the most immediate health risk of tobacco smoke, and reducing these effects provides the most immediate benefit of smoking bans, according to public-health experts.
Support for state and local smoke-free laws has grown in recent years; still, such bans face strong opposition in many areas, especially in the Midwest and South. Opponents typically include small-business and restaurant owners, who say bans reduce their revenues, and libertarian groups.
There has been little action at the federal level since an executive order signed by President Bill Clinton ended smoking in federal buildings in 1997. Antismoking groups prefer to target local and state governments.
More than 60% of the U.S. population is covered by some type of smoking ban at the state or local level, usually restricting smoking in either public areas or workplaces, according to Americans for Nonsmokers' Rights. More comprehensive bans like Scotland's -- which prohibited smoking in all enclosed public areas and workplaces after March 2006 -- are now law in 14 states, up from three in 2005, according to the Centers for Disease Control and Prevention.
The economic impact of smoking bans is still hotly debated in state and local governments. But academic researchers are less divided. On the basis of numerous peer-reviewed studies, the Surgeon General's Office issued a report in 2006 concluding that "smoke-free policies and regulations do not have an adverse economic impact on the hospitality industry" -- a conclusion the tobacco industry disputes.
"We think that people should be able to avoid being around second-hand smoke, especially in places they must go, such as government buildings and public transportation," said Bill Phelps, a spokesman for Altria Group Inc., which owns cigarette maker Philip Morris USA. But he added that "business owners, particularly those who own restaurants and bars, should be able determine smoking policy for their own businesses."
There are about one million hospitalizations for acute coronary syndrome in the U.S. every year, Dr. Cohen said. Each episode generally costs between $10,000-$20,000 to treat, pegging the cost of this care at $10 billion per year or more, he said.