Wednesday, November 5, 2014

Colorado State Smoking Ban: No Impact on Heart Attacks

As early as 2004, various medical journals published articles claiming that small-community smoking bans resulted in nearly immediate reductions in heart disease.  For example, the high-profile BMJ reported that hospital admissions for acute myocardial infarction (AMI) declined 40%, from 40 to 24, in Helena, Montana, after implementation of a smoke-free ordinance (here).  Circulation, the journal of the American Heart Association, reported that AMI admissions dropped 27% “within months” in Pueblo, Colorado (here). Similar reports came from Bowling Green, Ohio (here), Monroe County, Indiana (here) and beyond. 

The striking implication was: Eliminating second-hand smoke saves lives by reducing heart disease.

There were two problems with these claims.  First, the declines, based on small numbers of observations, were actually consistent with random variation (here).  Second, none of the reports accounted for the long-term downward trend in heart disease in the U.S.; they credited no-smoking intervention with the lower number of AMIs at a time when rates were declining nationwide.

In 2011, I documented that state-wide smoking bans in California, Utah, Delaware, South Dakota, New York and Florida had little or no immediate measurable effect on AMI deaths. The study, published in the Journal of Community Health (here), eliminated the “tiny-number” problem and factored in the national downward trend in AMI deaths.

I discussed these findings in my blog (here), but the work was largely ignored, until now.

Recently, researchers from three Colorado institutions reported AMI rates before and after a statewide smoking ban there; their work appears in the American Journal of Medicine (here).  (Thanks to Chris Snowdon, who also blogged about it here).

Paul Basel and colleagues found that “No significant reduction in [AMI] rates was observed” after the Colorado ban was implemented.  They also referred to our study:

“[The Rodu et al.] study compared the decline in [AMI] mortality in 6 states with smoke-free ordinances, with the average decline among 44 states unaffected by smoke-free policy.  No state with a smoke-free ordinance had a significantly lower observed [AMI] mortality compared with that expected by the nationwide secular decrease in states without the ordinance.  This emerging evidence highlights the importance of accounting for secular trends in [AMI] incidence before definitive attribution to smoke-free ordinances can be made.” 

It is comforting to see unfounded second-hand smoke claims corrected, particularly in the pages of a prestigious journal.


Bill Godshall said...

Thanks for posting this Brad.

The junk scientists who claimed that heart attack rates sharply declined after comprehensive smoking bans were implemented (and who implied that the smoking bans caused the heart attack rate to decline) failed to acknowledge (in any of their studies) that the overwhelming majority (typically about 90%)of workplaces and public places had already voluntarily implemented smokefree policies before the comprehensive smoking bans were enacted in most cities, counties and states.

By claiming that comprehensive smokefree laws caused the heart attack rate to decline, Stan Glantz et al were also falsely insinuating that the smokefree policies voluntarily implemented by 90% of employers and public place managements (during the decades prior to the laws) had no impact on heart attack rates).

While it appears that the implementation of smokefree policies in workplaces and public places has helped reduce the heart attack rate during the past three decades (because those policies have helped to reduce cigarette consumption and smoking rates), it is absurd to claim that heart attacks were reduced because an elected official signed a piece of paper (that required the remaining 10% of workplaces to ban smoking).

Bill Godshall

Anonymous said...

Stanton Glantz, of UCSF, currently has a $4 million dollar grant from NIH to study, in part, "biomarkers" of cardiovascular risk from second-hand smoke. Millions down a rat hole to characterize something that doesn't exist. Our tax dollars a work.