The impact of a smoking ban on hospital admissions for coronary heart disease

https://doi.org/10.1016/j.ypmed.2007.03.011Get rights and content

Abstract

Objective.

In March 2002, the city of Bowling Green, Ohio, implemented a clean indoor air ordinance banning smoking in workplaces and public places. This study evaluates the effect of this ordinance on hospital admissions for smoking-related diseases.

Methods.

A quasi-experimental design with interrupted time-series was used including a matched control city (Kent, Ohio) with no clean indoor air ordinance. Data on hospital admissions during the period of January 1999 to June 2005 were analyzed using Autoregressive Integrated Moving Average (ARIMA) models.

Results.

A reduction in admission rates for smoking-related diseases was achieved in Bowling Green compared to the control city. The largest reduction was for coronary heart disease, where rates were decreased significantly by 39% after 1 year and by 47% after 3 years following the implementation of the ordinance. ARIMA models revealed a statistically significant downward trend in monthly admission rates for coronary heart disease (Bowling Green, ω =  1.69, p = 0.036 vs. Kent, ω =  1.14, p = 0.183) and support the hypothesis that the ordinance had a significant impact on admission rates for coronary heart disease.

Conclusion.

The findings of this study suggest that clean indoor air ordinances lead to a reduction in hospital admissions for coronary heart disease, thus reducing health care costs.

Introduction

Secondhand smoke (SHS) is as a major threat to public health. Exposure to SHS is associated with a number of serious diseases and is a leading cause of death in the United States. An estimated 50,000 deaths per year in the U.S. are attributed to SHS (Centers for Disease Control (CDC), 2005a).

In terms of risk factors for coronary heart disease (CHD), the effect of exposure to SHS may be nearly as large as active smoking (Barnoya and Glantz, 2005). The U.S. Surgeon General concluded that even brief exposure to SHS has immediate adverse effects on the cardiovascular system and increases risks for heart disease (USDHHS, 2006). Exposure to SHS among non-smokers is associated with a 30% to 60% excess risk of coronary heart disease (U.S. Department of Health and Human Services, 2004, He et al., 1999, Whincup et al., 2004).

The greater the number of smokers in a population, the greater the likelihood that more people will be exposed to SHS and the greater the intensity of the exposure. In 2004, Ohio had the fifth highest rate of smoking prevalence (25.9%) of all the states (Centers for Disease Control, 2005b). Smoking induced illnesses in Ohio contributed almost 5% of all hospital costs in 1999 (Miller et al., 1999). Due to the CHD risks associated with SHS, health care practitioners should advise all patients with known coronary heart disease and those at increased risk for CHD to avoid exposure to SHS (Pechacek and Babb, 2004).

Nearly half of the population of the United States is at risk of exposure to SHS (Williams et al., 2005). However, health risks from SHS are completely preventable (USDHHS, 2000). Exposure to SHS can be reduced by over 80% through the elimination of smoking in public places (CDC, 2004). In the past decade, exposure to SHS in the U.S. has decreased considerably, largely as a result indoor smoking bans.

Clean indoor air ordinances (CIA) that ban smoking in public places may lead to significant reductions in the prevalence of smoking and cigarette consumption (Fichtenberg and Glantz, 2002) and therefore may reduce the prevalence of exposure to SHS. Reducing exposure to SHS may lead to a reduction in smoking-related diseases. For this and other reasons, many jurisdictions are implementing laws banning smoking in public places.

Bowling Green Ohio implemented a CIA ordinance in March 2002. Smoking was prohibited in all public places within the city, except for bars and restaurants with bars, provided that the bar area was isolated within a separate smoking room. Smoking was allowed in bars and bowling alleys at the discretion of the owners. The purpose of this study was to evaluate whether this ordinance significantly impacted the rate of hospital admissions for coronary heart diseases.

Section snippets

Methods

To test the impact of the indoor smoking ban on CHD-related hospital admissions, we employed a quasi-experimental design with an intervention city (Bowling Green, Ohio) and a matched control city (Kent, Ohio). Using information from the Health Resources and Services Administration (HRSA), the authors selected the city of Kent to serve as the matched control city. The cities of Bowling Green and Kent were 150 miles apart yet very similar with regard to population size, age and gender

Results

Standardized admission rates for adults in Bowling Green and Kent from 1999 to first half of 2005 are presented in Table 1. Admission rates for CHD-related diseases showed a significant downward trend reduction in the intervention city starting in 2003. Admission rates for CHD in Bowling Green were statistically significantly reduced from 36 per 10,000 populations in 2002 to 22 per 10,000 populations in 2003 (39% decrease; 95% CI, 33% to 45%) and to 19 per 10,000 populations in the first half

Discussion

Our findings suggest that the implementation of a CIA ordinance in Bowling Green Ohio led to a reduction in hospital admissions for CHD. We repeated the analysis for other admissions to assess whether the change in admission rate for smoking-related diseases could have resulted from systematic differences in admissions. Non-smoking-related admissions did not decrease during the study period.

Our results are corroborated by findings from three other research studies. Sargent et al. (2004)

Conclusion

A CIA ordinance in Bowling Green Ohio was associated with a statistically significant reduction in hospital admission rates for CHD. These findings provide further support for the effectiveness of CIA ordinances in reducing hospital admission rates for CHD. The findings of the current study should encourage civic and public health leaders at the local and state levels to continue to promote clean indoor air ordinances as an effective method of protecting and promoting the health of the American

Acknowledgments

The authors would like to thank Jan Ruma, Hospital Council of Northwest Ohio for her administrative leadership. We would also like to thank the Ohio Tobacco Prevention Foundation for providing funding in 2004 for the original pilot study that led to this follow up study. The authors have no conflicts of interest to report. This study was initiated and analyzed by the authors.

References (38)

  • Centers for Disease Control (CDC)

    Indoor air quality in hospitality venues before and after implementation of a clean indoor air law—Western New York, 2003

    Morb. Mortal. Wkly. Rep.

    (2004)
  • Centers for Disease Control (CDC)

    Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 1997–2001

    Morb. Mortal. Wkly. Rep.

    (2005)
  • Centers for Disease Control (CDC)

    State-specific prevalence of cigarette smoking and quitting among adults—United States, 2004

    Morb. Mortal. Wkly. Rep.

    (2005)
  • P. Cullen et al.

    Smoking, lipoproteins and coronary heart disease risk. Data from the Münster Heart Study (PROCAM)

    Eur. Heart J.

    (1998)
  • B. Eliasson et al.

    Effect of smoking reduction and cessation on cardiovascular risk factors

    Nicotine Tob. Res.

    (2001)
  • M.C. Farrelly et al.

    The impact of workplace smoking bans: results from a national survey

    Tob. Control

    (1999)
  • C.M. Fichtenberg et al.

    Effect of smoke-free workplaces on smoking behavior: systematic review

    Br. Med. J.

    (2002)
  • E.A. Gilpin et al.

    The California Tobacco Control Program and potential harm reduction through reduced cigarette consumption in continuing smokers

    Nicotine Tob. Res.

    (2002)
  • S.A. Glantz et al.

    Even a little secondhand smoke is dangerous

    JAMA

    (2001)
  • Cited by (0)

    View full text