Data From Seven States Show No Connection Between Smoking Bans and Heart Attack Rates

A few weeks ago, I noted a study of 74 U.S. cities with smoking bans that contradicted the widely repeated claim that such laws lead to immediate, dramatic reductions in heart attacks. A study recently reported in the Journal of Community Health likewise finds no such changes in six states with smoking bans:

Target-year declines in AMI [acute myocardial infarction] mortality in California (2.0%), Utah (7.7%) and Delaware (8.1%) were not significantly different from the expected declines (P = 0.16, 0.43 and 0.89, respectively). In South Dakota AMI mortality increased 8.9% in the target year (P = 0.007). Both a 9% decline in Florida and a 12% decline in New York in the 2004 target year exceeded the expected declines (P = 0.04 and P < 0.0002, respectively) but were not significantly different (P = 0.55 and 0.08, respectively) from the 9.8% decline that year in the 44 states without bans. Smoke-free ordinances provide a healthy indoor environment, but their implementation in six states had little or no immediate measurable effect on AMI mortality.

Similarly, notes tobacco policy blogger Michael Siegel, data from Ohio, where a statewide smoking ban took effect in 2007, show the following declines in hospital discharges for myocardial infarction:

2005-2006 (baseline): -4.7% 

2006-2007 (first year of implementation): -2.7% 

2007-2008 (second year of implementation): -2.2% 

2008-2009 (third year of implementation): -6.3% 

Average annual decline post-implementation: -3.6%

In other words, Siegel writes, "the rate of decline in heart attack discharges in Ohio was greater prior to the smoking ban than it was in the first three years after the smoking ban," which "clearly does not support the conclusion that the smoking ban resulted in a large and immediate decline in heart attack discharges." The Ohio Department of Health nevertheless concludes (PDF) that there was "a sharp decline in heart attack rates immediately following implementation of the law." In fact, it says, there was "a significant change in age‐adjusted rates of AMI discharges within one month [!] after the enactment of the Smoke‐Free Workplace Act." Siegel (who supports smoking bans but opposes unscientific arguments in favor of them) analyzes the statistical trickery behind those conclusions here and here.

The data from these seven states fit the pattern Siegel has noted: While a few small jurisdictions, such as Helena, Montana, and Pueblo, Colorado, have seen big drops in AMI rates after implementing their smoking bans, studies that look at multiple jurisdictions and bigger populations (including analyses of nationwide data) find no such effect. Ban boosters focus on the few places that fit the story they want to tell, ignoring the broader picture. This blatant cherry picking has been blessed by the National Academy of Sciences, whose Institute of Medicine issued a 2009 report endorsing the biologically implausible notion that smoking bans have a noticeable impact on heart attack rates within a year or two. In light of the accumulating evidence to the contrary (much of which was available when the report was written), that embarrassing conclusion should be revisited. 

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  • ||

    I am quite sure the nanny staters behind these laws will show their commitment and respect to science by now supporting their repeal.

  • ||

    That will happen approximately when the government repeals anti-discrimination laws, noting that discrimination was decreasing in the years immediately proceeding them as well.

    The "maybe we need this law to consolidate the gains and continue changing public opinion, attitudes, and behavior" argument is essentially irrefutable.

  • Citizen Nothing||

    My paper swallowed the Ohio Department of Health press release whole, playing it on the front page last week.
    Sigh.

  • Hank||

    ...the widely repeated claim that such laws lead to immediate, dramatic reductions in heart attacks.

    This is the part I'd love a link for. I'm a smoker and I take the obvious libertarian position on bans, but in Lexington KY, I do not remember proponents even pretending AMI mortality was a factor.

  • ||

    "This is the part I'd love a link for."

    Link: http://www.newscientist.com/ar.....tacks.html

  • Hank||

    I know the studies came out, so I think my comment was confusing. What I do not ever remember seeing is any smoking-ban proponents claiming their goal was a reduction in AMI mortality.

    It makes this "new" data of limited use when (if?) proponents were not using it as a major reason for the bans.

  • ||

    I also don't remember the decrease in MI mortality being bandied about in my area as a reason for smoking bans.

    Bans were promoted as a public health and workplace safety issue around here, and everywhere else I remember reading about. Methinks Mr Sullum is cherry-picking a bit hisownself.

  • Fist of Etiquette||

    Well, this sucks. I'm no longer at a decreased risk for heart disease as a non-smoker.

  • Citizen Nothing||

    I'll soon reach the age where taking up smoking no longer cuts my life expectancy. Think I'll buy a pipe.

  • ||

    If you're going to smoke a pipe, you're gonna have to wear a hat, too.

    Be classy, go with a fedora. Hipsters have ruined the porkpie.

  • Angua von Überwald||

    And the bowler is also known as "the one that makes look a bit of a twit".

  • NoVAHockey||

    wouldn't that be hoot. bans remain but the discount for not smoking is eliminated.

  • ||

    In other news raising a child really doesn't take a village.

    http://www.physorg.com/news/20.....llage.html

  • Warty||

    "Children were 52 percent less likely to die if their paternal grandparents were dead. Why? Because in a patrilineal society, the paternal grandparents are likely to live with the child, competing for scarce resources."

    brb going to beat grandpa to death kthxbye

  • ||

    SURGEON GENERAL'S WARNING:

    Go ahead! Light up! Disregard all of the aforementioned propaganda disguised as a health advisory.

  • ?||

    You know I think I'm gonna quit not smoking. Anybody have suggestions on what brand of cigarettes I should start smoking. However I would prefer to stay away from Philip Morris brands, bastards supported the FDA regulating cigarettes.

  • Colonel_Angus||

    Roll your own.

  • Ray||

    Turkish Silver, brother.

  • Concerned Citizen||

    After thirty years spent in smoke filled homes, cars, offices, elevators, bars, etc, I still can't find sympathy for smokers. You've told me "fuck you" for thirty years. Payback's a bitch.

  • Rhywun||

    "Payback's a bitch."

    No kidding. The price of a pack of smokes in my state has quintupled in the last 15 years. Those state budgets don't balance themselves, y'know.

  • ||

    "After thirty years voluntarily spent in smoke filled homes, cars, offices, elevators, bars, etc, I still can't find sympathy for smokers stop being a passive-aggressive little bitch."

    All fixed.

  • Concerned Citizen||

    Wrong. From age 1 to age 18 I had little say in where I was. And in the workforce, smokers still made the rules. I assert my right to work without being exposed to toxic chemicals. Smokers have every right to smoke, just keep their chemicals to themselves. How can not polluting other people's lungs not be a libertarian position? Or do you just want freedom without responsibility?

  • Jordan||

    That, of course, presumes that second hand smoke is a toxic chemical. This has never been substantiated.

  • Concerned Citizen||

    What the hell have you been smoking? Cigarette smoke contains over 4,000 chemicals, including 43 known cancer-causing (carcinogenic) compounds and 400 other toxins. These include nicotine, tar, and carbon monoxide, as well as formaldehyde, ammonia, hydrogen cyanide, arsenic, and DDT.

  • Coeus||

    including 43 known cancer-causing (carcinogenic) compounds.

    Many things are cancer-causing in high enough concentrations. So what? The concentrations available in second hand smoke have been tested by many, including OSHA, who ruled that no amount of second-hand smoke encountered has high enough concentrations to be harmful.

  • ||

    Seems to me that constant exposure to relatively low levels of carcinogens and toxic chemicals is positively correlated w/ health problems.

    Cigarette smoke has also been positively correlated lung cancer.

  • ||

    The poison is in the dose, my friend.

  • Jesus Jones||

    Pretty sure asthma disagrees with you here.

  • ||

    OK, point taken on the home, although I personally know people who got their parents to stop smoking. As to the workplace, you chose to work there, knowing full well smoking was allowed. You chose to expose yourself.

    How can not polluting other people's lungs not be a libertarian position?

    How can violating property owners' right to choose to run their business as they see fit, in order to satisfy a lifestyle choice be a libertarian position?

    Or do you just want freedom without responsibility?

    Responsibility also means that you have to respect the rights of others, even when the practice of those rights is in direct conflict with your moral code.

  • Concerned Citizen||

    Where I grew up, the only place you could breathe was outside. Every place inside was polluted. No respect for anyone else's personal rights, so fuck the smokers. See how they like it.

  • ||

    Ah, I see, choice is an illusion with you. So sad you missed the free will gene, as well as the assertiveness in-person one as well (which goes back to my original conclusion).

    Better luck in the next life.

  • Concerned Citizen||

    Businesses don't have to follow laws? I can power my business with a nuclear reactor? I don't have to have fire exits? It's beginning to seem that the libertarians on this site are all about freedom without responsibility.

  • ||

    I do see, however, that your arm-waving, raving hyperbole gene is dominant.

  • Concerned Citizen||

    Choice is an illusion? I wish I could live and work outside year round like you do, but I'm not as tough as you.

  • Colonel_Angus||

    Businesses shouldn't be allowed to obtain electricity from (presumably their own) nuclear reactor?

  • Concerned Citizen||

    Should or shouldn't, they have a long list of laws and regulations they have to follow.

  • LK||

    Where I grew up, the only place you could breathe was outside.

    Zombie alert. North. One post.

  • ||

    How can not polluting other people's lungs not be a libertarian position?

    How can opposing laws that limit people's freedom to smoke not be a libertarian position?

  • Concerned Citizen||

    You can ingest anything you want. You cannot pollute me with your choices. I cannot pollute you with my choices. It's simple, really.

  • Armchair Lawyer||

    You can ingest anything you want. You cannot pollute me with your choices. I cannot pollute you with my choices. It's simple, really.

    That is fairly accurate. The libertarian solution still does not reside in bans and regulations. Since each of us "owns" our bodies, we are free to make personal choices. If my choice causes damage to your body, then I have committed a tort against you. The solution is to sue me in a private court. You will have to prove (51% threshold) I owed you a duty of care, I breached that duty, I directly caused you injury, you suffered damage, and there was proximate cause. Good luck with that!

  • OrangeCouch||

    Awesomest. Reply. Ever!

    Seriously, how does anyone expect to be taken seriously when they use "common sense" arguments that are unfortunately too common yet display a significantly lack of sense...

    Kudos to you, Armchair Lawyer!

  • Jesus Jones||

    This is why the libertarian solution will never be a reality, though I bet the bar association would love the shit out of it if it ever happened.

  • Armchair Lawyer||

    I did say the suit would be heard in a private court. Plus, there wouldn't be "a bar association" needed. Any person could be a lawyer, no bar exam necessary. Of course you will want to hire the best person you can to represent you. That's how I see it. Check out the link for a good book on libertarian justice.

  • Joe||

    Do you drive an automobile? Well, I don't; and you cannot pollute me with your choices, your carbon-monoxide, your exhaust toxins....

    ... stop whining.

  • sevo||

    "OK, point taken on the home,"

    Nope.
    There are whiny bastards who gripe about the smells from the kitchen (5,000 CHEMICALZ!) or perfume, or...
    Whiny bastards are whiny bastards.

  • Coeus||

    How can not polluting other people's lungs not be a libertarian position?

    I'm guessing this is a troll, but on the off chance it's not, try looking into other claims made about second-hand smoke. They all use statistical cherry-picking, and in several cases (most notably the WHO report) have titles and summaries which are in direct contradiction to the findings in the study.

    So what it boils down to is that some people are offended by smoke, and no libertarian position exists or ever will exist that you have the right to not be offended in public or on another's property.

  • Concerned Citizen||

    Cigarette smoke contains over 4,000 chemicals, including 43 known cancer-causing (carcinogenic) compounds and 400 other toxins. These include nicotine, tar, and carbon monoxide, as well as formaldehyde, ammonia, hydrogen cyanide, arsenic, and DDT.

  • Coeus||

    Again, so what? See my response above.

  • Concerned Citizen||

    I'll share some heroin with you. Consent not necessary.

  • Coeus||

    And what the fuck does that have to do with the price of tea in China?

  • Concerned Citizen||

    Uninvited chemicals in your blood. You don't seem to mind. Now hold still...

  • Coeus||

    You can control the thousands of barely detectable chemicals which enter your bloodstream through the enviroment on a daily basis? You must share your secret.

  • ||

    You must share your secret.

    HEPA-filtered hermitage.

  • Concerned Citizen||

    Eureka!

  • sevo||

    "And then, Obama was all about "change" from W, wasn't he?"

    Pretty sure we have asshole straw-man champion right here!

  • sevo||

    "And then, Obama was all about "change" from W, wasn't he?"
    Pretty sure we have asshole straw-man champion right here!"
    Sorry; ignore. Copied from another subject.

  • ||

    The poison is in the dose, my friend.

  • stonewyrm||

    I don't know about voluntary. When I was growing up in the 70s it was pretty near impossible to avoid cigarette smoke unless you never left the house. This is much less the case today, but I expect that has as much to do with changing attitudes as laws.

  • ||

    I too grew up in the 70's and had no trouble avoiding smoking. When I didn't avoid it, it was because I made a choice to socialize with smokers.

  • Concerned Citizen||

    Then we're not related.

  • ||

    and when it swings back the other way (eventually it will) you'll be back to spending your time in smoke filled homes, cars, offices, elevators, bars, etc. 'round and 'round she goes...

    Sorry.

  • Concerned Citizen||

    Not anymore. I'm big enough to shove their cigarette down their throat. I'm not initiating force, just responding to an assault on my lungs.

  • ||

    Oh, please.

  • Concerned Citizen||

    Like they'd have the lung capacity to fight back.

  • ||

    Am I irritated by walking through a cloud? Sure. "Assaulted"? Um, no. Big difference; but the risk of picking a fight is yours alone.

  • Concerned Citizen||

    Maybe I'm a little sensitive, as my mother smoked during all five of her pregnancies. I was born with 20/400 vision in my left eye. Children of smokers have the toxic chemicals in their bloodstream. That's assault with a deadly weapon. I react accordingly.

  • Coeus||

    Maybe I'm a little sensitive

    a little? You appear to be so sensitive that you're unable (though I think it's more likely unwilling) to read and comprehend the actual content of the studies that have been done.

  • Concerned Citizen||

    You try having smoke blown in your face for 30 years. I don't care what the studies say, cig smoke contains a lot of bad shit that I don't want in my bloodstream.

  • sevo||

    "I don't care what the studies say,.."

    So you admit you're a whiny asshole willing to use guns to enforce what you don't like.
    Not like it wasn't obvious.

  • ||

    Yes. Smoking sucks. It's the one activity that for whatever reason short-circuits common human decency and requires a unique response.

  • Concerned Citizen||

    Where did I say I'd use guns?

  • mike c.||

    Thirty years is a long time. Move out of your mom's house.
    I smoke Bugler. Not in the house, My wife won't let me.

  • mike c.||

    Also, tell her it isn't nice to blow smoke in your face.

  • Hank||

    I don't care what the studies say

    Then we're obviously done here.

  • sevo||

    "....just responding to an assault on my lungs."

    Right. Asshole doesn't like the smell of something, can therefore beat up people.
    Tell you what. I'll get my baseball bat and you walk by me after eating garlic.

  • Concerned Citizen||

    More than the smell, it's the 400 toxic chemicals I object to. You know, property rights and all that.

  • ||

    Smoke is easily identified and thus, avoided. However, I suggest you practice your technique thoroughly at your local biker bar. You don't want to attack pedestrians half-assed.

    Do you plan on assaulting drivers of cars and trucks as they pass by as well?

  • Concerned Citizen||

    Cigarette smoke contains over 4,000 chemicals, including 43 known cancer-causing (carcinogenic) compounds and 400 other toxins. These include nicotine, tar, and carbon monoxide, as well as formaldehyde, ammonia, hydrogen cyanide, arsenic, and DDT.
    I don't go to biker bars. If you don't mind someone forcing these chemicals on you, that's your choice. I choose to resist. You bitch and moan about property rights and pollution, but you don't claim your own body as your property?

  • ||

    You bitch and moan about property rights and pollution, but you don't claim your own body as your property?

    Sure, and I also choose to not move next to the town dump and complain about the smell.

    See, also, airport; noise.

  • Concerned Citizen||

    When smokers ruled every enclosed space, this was not an option.

  • ||

    I choose to resist.

    Sure you do, tuff gai, sure you do. Just not against anyone who can fight back.

    Start with the lifetime smoker pensioners. They're practically dead anyway, right?

  • Concerned Citizen||

    Lucky for them, they're more easily avoided now. I'm legally blind in my left eye, probably because my mother smoked during pregnancy, so I'm open for a right hook.

  • ad hoc, ergo procter hoc?||

    hmmmm

  • sevo||

    "Cigarette smoke contains over 4,000 chemicals, including 43 known cancer-causing (carcinogenic) compounds and 400 other toxins. These include nicotine, tar, and carbon monoxide, as well as formaldehyde, ammonia, hydrogen cyanide, arsenic, and DDT."

    So, fucking what? Did you read the article? For all the claims of 'we're going to die!', none has been found.
    If you'd have been my kid whining about your victimhood, you wouldn't have needed to go outside; you'd have been thrown.
    Whiny assholes are tiresome. Those who use guns to enforce their whines are dangerous.

  • sevo||

    "I'm legally blind in my left eye, probably because my mother smoked during pregnancy,..."

    From an earlier article on stupid:
    "There’s a woman who came up crying to me tonight after the debate. She said her daughter was given that vaccine. She told me her daughter suffered mental retardation as a result of that vaccine."

    So you're a whiny bastard who's stupid on top of it?

  • ||

    I hope Concerned Citizen doesn't drink coffee. There are over 1000 chemicals in coffee and only 28 have been tested with 19 testing positive as rodent carcinogens. Roughly half of all 'natural' chemicals tested are carcinogens. Poor ignorant Concerned Citizen doesn't have a clue.

  • sevo||

    Poor ignorant c-c is a statist asshole willing to outlaw anything c-c doesn't like.
    A true danger to humanity,

  • Concerned Citizen||

    So, Sevo, you'd like to fly on an airliner where smoking is permitted? All I'm saying is smokers have been the rudest fucks I've ever been around, and now they're getting what they asked for. Fuck them and fuck you.

  • Old Mexican||

    Data From Seven States Show No Connection Between Smoking Bans and Heart Attack Rates


    You misunderstand, sir - smoking bans had nothing to do with lowering heart attack rates but with limiting competition. You see, my good man, if some restaurants imposed their own "smoking bans," they would lose customers to those that didn't. Why, we can't have that! Let's instead have the government impose our business model on the rest!

  • ||

    ...which is funny, since the majority of Americans are non-smokers. The poor smoke the most, but are obviously not the most desirable restaurant customers, since they're poor (and apparently they spend their disposable income on cigarettes).

    I have chosen restaurants and bars based on their smoking policies. If they allow smoking indoors, I avoid going there. I am certain that the same is true of many others.

    So, if a place figures that smokers are a good niche market, more power to 'em. Let them be smoke-filled.

    But I really don't buy that non-smoking establishments are chasing away paying customers. Quite the contrary, on the whole.

  • Government||

    I have chosen restaurants and bars based on their smoking policies.

    We prefer when choice is removed from the equation.

  • Old Mexican||

    Re: Barry D,

    But I really don't buy that non-smoking establishments are chasing away paying customers.


    Cui bono, Barry? Follow the money.

    If smoking bans affect only a tiny minority of people, like you say, why impose them?

  • ||

    Because bans that affect a small minority are the most popular and easiest to enforce.

    That's why.

    Its not about the purported benefits or burdens of the ban. Its the banning itself, the thrill of exercising dominance and power.

  • LK||

    21% of American adults smoke (quick lookup from Answers.com, 2008). That's not a small minority. The US population is 13% black.

    Just sayin' there's more to it than that.

  • ||

    I don't get thrilled at the exercising of dominance and power except when it comes to smoking. I enjoy annoying smokers because of their general disregard for everyone else around them. I honk at them when they throw there butts out of their care windows; I mock them when I jog past them with comments like "Suck it up fatty", etc. Smokers should be treated like the thoughtless assholes the generally are.

  • ||

    And those of us who smoke but don't litter think douchebags like you who hurl insults at others to make you feel better about your tiny dick should be run down as you jog.

  • ||

    Public shaming is a good tool.

    Granted, as a smoker you're already announcing to the world that you're a 2-digit IQ clown; and making fun of the mentally challenged is generally terrible, but in this case, for the good of society getting a good mocking is warranted.

  • Pope Jimbo||

    My favorite part of the smoking ban debate is when the local do-gooders insist that if a town would ban smoking, the restaurants and bars would see a huge increase in patronage because all the non-smokers would come piling in once they didn't have to worry about 2nd hand smoke.

    Of course, once the ban gets passed business drops off in bars and restaurants. Why? Because everyone goes to the bars and restaurants in the next town/suburb.

    The solution? Pass a county wide smoking ban. Of course once that is passed all bars restaurants will see an increase in business because non-smokers will come out in droves.

    Repeat at the metro level and state level when businesses don't benefit from the horde of non-smokers showing up.

    Maybe they are worried about getting the shit beat out of them by Concerned Citizen if he smells smoke on their clothes and takes umbrage at their filthy attempt to poison him with 3RD HAND SMOKE!!!!!

  • LK||

    Cops have a big pull on this. A bar with a pool table, a local musician, a waitress with tattoos, a bartender named Snake Eyes, and a bouncer with a Harley, where just about everyone smokes, will attract a diversity crowd come Friday night. With cellular phones in hand the diversity crowd will be dialing 911 every time a cue ball flies of the table or a womanizer follows a gal into the parking lot. The cops just don't want to deal with this.

  • Steve||

    Honestly, I would love it if people were required to register as smokers and only allowed to buy cigarettes from government-run outlets (after showing their registration card of course.) There should be no packaging at all; except for maybe something embarrassing.

  • Paul||

    But what about the intangible, long term benefits to our children?

  • LK||

    Such as employment in convalescent homes changing the soiled bed sheets of smoke-free octogenerains with dementia.

  • ||

    Cigarette makers should be allowed create "Hard" brands with a radical increase in the amount of tar, nicotine and carcinogens. Something that would virtually guarantee rapid addiction - and a much higher incidence of cancer and emphysema. The could be marketed to "Tough Guys". "Think you're a bad-ass? Try 'Black Bone Cigarettes'" I mean, if you're a smoker you've already announced to the world that you're a moron; at least this way you can look like a real man.

  • ||

    It seems like there's a lot of noise in the data - if one had gone may 05-may 06 the pre implementation decline rate would have been much closer to zero. Im curious what the decline rates were in the few years before the 'baseline year' as well

  • ||

    But this study only seems to show that the ban itself does not seem to have a direct affect on heart attack rates. This study does not indicate if there are fewer smokers as a result of the ban. Our office building banned cigarette smoking several years ago, but the number of people that still smoke heavily is still the same. They smoke outside, but they still smoke.

    At least I don't have to smell the stench.

  • Joe||

    As a non-driver, I am sick and tired of breathing in all of the carbon-monoxide and pollutants from your automobiles...

    ... stop whining.

  • Michael J. McFadden||

    Excellent column Mr. Sullum! I would like to point out however that this recent "flurry" of large scale studies, the 2009 NBER/RAND/Stanford, the 74 cities, and the 7 states studies were all presaged by the 2005 study done by Dave Kuneman and myself and turned down for publication by the BMJ on the primary grounds that it contributed "nothing new to what is already known." See the full story on that at:

    http://www.acsh.org/factsfears.....detail.asp

    and you'll get a better idea of the why and how behind all these little cherry-picked Helena clones got published with media spotlights...

    - MJM

  • Old Smokey||

    Smoke, smoke, smoke that cigarette
    Puff, puff, puff and if you smoke yourself to death
    Tell St. Peter at the Golden Gate
    That you hate to make him wait
    But you just gotta have another cigarette.

    I'm just drivin' nails in my coffin
    Every time I drink a bottle of booze
    I'm just drivin' nails in my coffin
    Drivin' those nails over you

    Cigarettes, whiskey and wild, wild women They'll drive you crazy, they'll drive you insane Cigarettes, whiskey and wild wild women They'll drive you crazy, they'll drive you insane

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