Do smoking bans significantly reduce heart attacks?
An analysis of 13 studies shows that smoking bans result in lower risks of heart attacks.
(Credit: AIGA)It's all over the news. A major analysis published this week of more than a dozen studies in North America, Italy, Scotland, and Ireland designed to determine the effect of smoking bans on heart attack rates shows a 17 percent reduction in heart attacks in places where bans were in effect for one year. That rate more than doubles to 36 percent in places where bans have been in effect for three years.
The impact of smoking bans is "bigger than expected," the BBC reports. The bans are "potent weapons in the battle to prevent heart attacks," claims The Wall Street Journal. Communities that ban smoking get a "big payoff," according to CNN. In the days since the report first came out, scores of articles have added to the chorus that smoking bans significantly reduce heart attacks.
But a closer look at the analysis and a conversation with its author, James Lightwood, suggests that the results should not be considered "iron-clad." (Full disclosure: I do not smoke, and I have been happy about each smoking ban that went into effect in the cities I've lived in, from New York and Boston to San Francisco and Portland. While it would be convenient to take this good news at face value, I feel it would also be irresponsible.)
First, the analysis does not take into account the initial baseline numbers of heart attacks, which would give us the actual scale of this 17 percent reduction (i.e., if the 17 percent reduction results in a million fewer heart attacks, that may be more meaningful than if it results in 100 fewer). Lightwood says he did not set out to investigate how many heart attacks are reduced, but whether the percentage reduction was consistent across different studies, so at least for now the question of scale remains.
"Our goal from the beginning was to do a very careful simulation analysis to compare the community rates in individual risk. Then we got stuck halfway through, because we realized that, to our surprise, there really hadn't been any analysis that pulled everything together. So we did a kind of simple but not really formal meta analysis."
Also, the studies Lightwood analyzed mostly measure simple before-and-after data points, instead of comparing reductions between cities with bans and cities without. It is hard to determine the primary factor of reduction without comparing these numbers to true control groups. (A few of the original studies did use controls by comparing the cities in question to nearby cities that had not imposed smoking bans, but a number of factors might account for differences in heart attack rates from one city to the next.) "One issue is that we don't know what prompted most of these studies," Lightwood says. "If people sat around and said, 'I see people smoking, let's do a study,' that could prove a biased result, because places where people are not smoking wouldn't prompt a study."
It is possible that the meta-analysis is spot on--that 100 studies would show an average 17 percent reduction in heart attacks in one year as well. And if smoking bans generally do result in this kind of reduction, it's time to clink glasses at the nearest smoke-free bar (irony about the effects of drinking on one's health duly noted). But until the studies being analyzed are more uniform, readers should be cautious about possible, ahem, smoke and mirrors.
Elizabeth Armstrong Moore is a freelance journalist based in Portland, Ore. She has contributed to Wired magazine, The Christian Science Monitor, and public radio. Her semi-obscure hobbies include unicycling, slacklining, hula-hooping, scuba diving, billiards, Sudoku, Magic the Gathering, and classical piano. She is a member of the CNET Blog Network and is not an employee of CNET. 
Example: As you may well know, they had been re-paving the west half of I-405 up here in PDX over this past summer, and IIRC there have been fewer accidents (roughly). Does that mean that applying new asphalt every year causes fewer accidents, or was it just the fact that ~1/4 of the I-405 loop was literally closed-off each weekend during the re-paving phase?
cardiovascular damage causes what in atherosclerosis sufferers?
Heart attacks.
Since the causation was already known. The only question was what kind of benefit you get out of the removal of the problem. Apparently more than it was first thought.
True - so has eating too many fatty foods, lack of regular exercise, over-exercising, living in regions of general bad air quality, etc.
...your point?
When they done with smoking they would start prohibiting fatty food and mandating exercise. You, non-smokers, who think it is OK to oppress other people (for their own good) should know that health Nazis will get you too.
Living causes death...with 100% mortality rate!!!
OMG...what's a person to do?!?!?!?
Look...I know smoking is bad for a persons health yada yada yada. Maybe having a smoking ban reduces heart attacks but I'm pretty sure most smokers have just moved from the ban areas. I know when I see the smoking area where I work...it's the same smokers. They are just smoking in a different area cause there is a smoke ban around the business I work for...hmmm...I think this study is flawed.
First: When smoking indoors everyone else in the room is subjected to the effects of the smoke. This multiplier effect means more people at risk. Shift the smokers outside and as a general rule their smoke tends to be affecting only them or at least a smaller number of people because even in a group moving air dissipates the smoke more rapidly.
Second: Smoking bans and other means of showing official disapproval of smoking (including warnings on packets, advertising bans etc) have been shown to lead to significant reductions in the number of people smoking which in turn lowers risks.
Thirdly: Smoking bans empower non-smokers to assert their rights to not have smoking in their vicinity. 40 years ago non-smokers were very meek and while not liking the smoking still provided ashtrays for guests. Now, not only are ashtrays not found in non-smokers homes but smokers are finally starting to consider people around them and are more likely to ask if they can smoke or simply refrain from smoking in places where they do not see others smoking. This social change has seen smokers themselves smoking less in social situations which presumably leads to health benefits for themselves.
It is now decades since smoking was demonstrated to cause severe health issues. Sure, other things also cause just as severe health issues but there is a difference - smoking affect the health of people who do not personally smoke, and smoking is an unnecessary activity. There is no reason to think that there would not be health benefits stemming from smoking bans.
However you do raise an interesting issue - that of smokers moving outside to smoke. It is not unreasonable to consider addressing that issue by extending bans to include people smoking while congregating outside buildings as they do.
Oh I most certainly do get it...
I get that I don't need the government telling me or anyone else what to do. I can make my own informed decisions by logic and reasoning. Thank you very much. Don't get me wrong...I'm not advocating anarchy. This is a personal decision and very much up to the smokers as well as non-smokers. You don't like smoking, then stay away from the smokers. How hard is that. I say this as a non-smoker...just so you know.
What I mean is...I think it should be up to the establishment/person to decide if they want to have a smoking section or allow smoking all together. They then would have to live with the decision themselves...good or bad. I know, I know...what about the employees. I say what about them!!! If they were to work for such an establishment, that would be their own decision.
I'm sorry you don't get it. I moved out of my parents house long ago...I don't need another "mom and dad".
Where should we stop, or should we? Why not pass a law saying the only allowed activities throughout life are sleeping, jogging and biking. Oh, I can see no harm in hugging trees, so maybe we'll allow that too.
My point is not to offend fat people, however, my point is to say that I think we have already given the GOVT much more than an inch, and they are already well past taking a mile.
Please get the F*&^ out of our lives. Who'd have ever thought that lighting something on fire and then drawing the smoke off of that fire into your lungs would be bad for you.
Please. Get a life. If you want to ban something then ban government bans.
I could care less about whether smoking reduces heart attacks. I don't want that carcinogen being blown at me in a public place and having that disgusting smell fouling my clothes.
The reason smoking is banned indoors is because those same smoking blowhards show inconsiderate behavior with their nasty habit. Had they had manners and some kind of self-respect, they would have excused themselves to take care of their bad habit away from individuals that care about their health. But no, common-sense is just too difficult a concept for certain people who claim they can "think for themselves".
By your logic murder would not be a crime (thats just a ban on killing your fellow humans). Theft would not be a crime (after all the crime of theft is just a ban on stealing) etc etc
It is plainly ludicrous not to ban activities that cause harm to others. Smoking endangers my health. I should not be subjected to an increased risk of heart attack just because someone else wants to light up right beside me.
I personally support bans on things like murder, theft, smoking in my face, assault, fraud, drink driving, and so on. I suspect that if you thought about it you too would be a supporter of bans on harmful activities.
Cute strawman, where can I get one?
http://www.jacobgrier.com/blog/archives/2210.html
to see how researchers promise the "right" kind of answers for $ BEFORE doing research and how they juggle numbers to create the promised "right answers" Meanwhile
http://www.velvetgloveironfist.com/wagner_on_pell.php
and
http://tobaccoanalysis.blogspot.com/2009/09/iceland-smoking-banheart-attack-study.html
show how even the most recent "best" studies are worthless. Read the granddad of all these studies, the ?Helena Heart Miracle? & the BMJ's official RR?s at
http://www.bmj.com/cgi/eletters/bmj.38055.715683.55v1#67440
and
http://www.bmj.com/cgi/eletters/bmj.38055.715683.55v1#125618
to see how the evidence of what they did was erased from the net
If the "little studies" are trash, then the "big piled-up study" is also trash. Read those links. You?ll be surprised ... and maybe angered.
Michael J. McFadden
Author of "Dissecting Antismokers' Brains"
http://www.jacobgrier.com/blog/archives/2210.html
to see how researchers promise the "right" kind of answers for $ BEFORE doing research and how they juggle numbers to create the promised "right answers" Meanwhile
http://www.velvetgloveironfist.com/wagner_on_pell.php
and
http://tobaccoanalysis.blogspot.com/2009/09/iceland-smoking-banheart-attack-study.html
show how even the most recent "best" studies are worthless. Read the granddad of all these studies, the ?Helena Heart Miracle? & the BMJ's official RR?s at
http://www.bmj.com/cgi/eletters/bmj.38055.715683.55v1#67440
and
http://www.bmj.com/cgi/eletters/bmj.38055.715683.55v1#125618
to see how the evidence of what they did was erased from the net
If the "little studies" are trash, then the "big piled-up study" is also trash. Read those links. You?ll be surprised
Michael J. McFadden
Author of "Dissecting Antismokers' Brains"
I've now found an excellent short analysis of some of the other recent "micro studies" that this new one is based on. Read "The Myth Of The Smoking Ban Miracle" at:
http://www.spiked-online.com/index.php/site/article/7451/
- MJM
"The government is my father I shall not want..."
- by sumwatt October 2, 2009 8:16 PM PDT
- You're playing a statistical game with numbers and committing a number of flaws in your argument. You are essentially drawing on the conclusion that the risks associated are significant and measurable when there is no such evidence to support such a conclusion other than the potentially mild annoyance many people have. The crux of your argument rests on the assumption that the explicit risks of primary smoke and second hand smoke are essentially equal when in fact they are not (and very very different).
- Like this Reply to this comment
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(27 Comments)The subtle reality that those uncomfortable non-smokers appear to ignore is that when removed from a smoking atmosphere, there is very little evidence that the risk stays the same. What I mean is that your body naturally cleanses itself of these toxins quite quickly. Within an hour or two after exposure, the increased risk is returned back to the same level of risk prior to exposure. The *real* risk of exposure to second-hand smoke is really very low - to the point that the effects can not be fully quantified into an exposure that would threaten one's life.
Your second point is moot. The "official" position of the population, from a natural rights perspective, has no bearing on transactions and association amongst individuals in the private sector. Disapproval of any given subject is not justification in and of itself - especially in regards to private individuals making personal choices.
Thirdly, Your basis on the assumption of rights is overly liberal. Rights in the context you present them (guaranteed rights) are only so between the public and government. Non-smokers who are employed in establishments do so at-will. A society that provides for liberty as the mechanism for enjoying rights do so with the expectation of the assumption of risk is assumed by the individual at all times. Contracting your labor to someone is done on the terms of the employer unless your employment agreement is bargained. The assumption that a person demand an employer act against his own best interest under threat of law is, essentially, extortion.
Your third flaw only supports my initial assertion - you really don't understand the science you put forth as your argument. You attempt to frame the argument that smoking and second hand smoke exposure are the same thing. And sadly you are very, very, very, very wrong. You succumb to the idea that correlation equals causation, a logical assertion that If A = B then B=C - If smoking is bad, then second hand smoke is bad. To paraphrase Dave Hitt's analogy, you are making this kind of argument:
All children drink milk; all heroin users have been children; therefore drinking milk causes heroin addiction.
But for someone to assert that it is also reasonable to accept a ban because it is an "unnecessary" activity is a bit deluded. We can essentially leverage that same logic to support banning just about any activity humans engage in that increase the potential of mortality including riding a bike, running, lifting weights - just to name a few. And before you jump on what I just said, I said it increases your risk of mortality; you have to expose yourself to risks in order to enjoy the end result.