Smoke-free legislation was associated with substantially fewer hospitalizations and deaths from heart and respiratory diseases, according to research in the American Heart Association journal Circulation.
Researchers reviewed 45 studies covering 33 smoke-free laws at the local and state levels around the United States and from countries as varied as Uruguay, New Zealand and Germany and found:
- Comprehensive smoke-free laws were associated with a rapid 15 percent decrease in heart attack hospitalizations and 16 percent decrease in stroke hospitalizations.
- Smoke-free laws were also rapidly followed by a 24 percent decrease in hospitalizations for respiratory diseases, including asthma and chronic obstructive pulmonary disease.
- The most comprehensive laws -- those covering workplaces, restaurants and bars -- resulted in the highest health benefits.
"The public, health professionals and policy makers need to understand that including exemptions and loopholes in legislation - such as exempting casinos - condemns more people to end up in emergency rooms," said Stanton Glantz, Ph.D., senior study author and director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. "These unnecessary hospitalizations are the real cost of failing to enact comprehensive smoke-free legislation."
The findings support the American Heart Association's position that smoke-free laws should be comprehensive and apply to all workplaces and public environments, including restaurants, bars and casinos. The analysis also is consistent with other studies that have found smoke-free laws were followed by significant decreases in acute heart attack and other cardiac-related hospital admissions.
"Stronger legislation means immediate reductions in secondhand smoke-related health problems as a byproduct of reductions in secondhand smoke exposure and increases in smoking cessation that accompany these laws," Glantz said. "Passage of these laws formalize and accelerate social change and the associated immediate health benefits."
Crystal E. Tan, M.S., a medical student at UCSF, is co-author of the study.
Author disclosures are on the manuscript.
The National Cancer Institute funded the study.
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