Publication Date: 
Wednesday, February 2, 2011

The Problem: Tobacco use is a source of chronic and fatal illnesses for users and persons with secondary exposure. In the United States, cigarette smoking contributes to one in five deaths and costs more than $193 billion annually in lost productivity and healthcare expenditures. CDC: Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004.  Nearly 25 percent of annual deaths related to cardiovascular disease in the United States can be attributed to smoking and cigarette smokers are 2 to 3 times more likely to die from cardiovascular disease than non-smokers. CDC: The Health Consequences of Smoking. Complete Report. 2004

The Law: Smoking bans and restrictions prohibit smoking in specified areas. These restrictions aim to eliminate or reduce exposure to secondhand smoke.  Smoking bans and restrictions are found in state and local laws as well as regulations governing workplace safety. For examples of state smoking bans, see ARS 36-601.01 (Arizona), Utah Health Code § 26.83.3 (Utah), VT Health Code § 1742 (Vermont), and RI Health & Safety Code § 23-20.10-3 (Rhode Island).

The Evidence: Meyers et al. performed a systematic review and meta-analysis of 11 studies that assessed the impact of public smoking bans (including workplaces) on the incidence of acute myocardial infarction (AMI) on the general population. Meyers et al. Cardiovascular effect of bans on smoking in public places: A systematic review and meta-analysis. J Am Coll Cardiol, 2009; 54:1249-1255. Studies were drawn from the United States, Canada, Italy, and Scotland. The authors used a random effects meta-analysis to control for differences in study population size and duration of observations. The meta-analysis found that public smoking bans reduce the risk of AMI by 17 percent, and this risk continues to decrease each year after ban implementation. Meyers et al. suggest that the duration of the post-ban effect may be explained by greater compliance to bans, decreased prevalence of smoking, improved air quality, and reduced environmental exposure to tobacco.

The Bottom Line: According to a peer-reviewed systematic review and meta-analysis, substantial evidence suggests that public smoking bans effectively reduce the risk of acute myocardial infarction.

Impact: Effective