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Smoke-Free Workplace Laws Provide Blueprint for Prevention

 |  By John Commins  
   October 31, 2012

The dangers and costs of cigarette smoking have been widely known for decades. It would be difficult to find any credible source that would defend smoking in the workplace or in other public areas. The only question left unresolved is the quantifiable effectiveness of workplace smoking bans.

The answer may be better than expected.

New studies suggest that workplace smoking bans are proving to be remarkably effective tools for reducing a number of smoking-related illnesses, both among smokers and those affected by second-hand smoke. 

A study out this month in the Journal of the American Medical Association provides impressive findings. Researchers in Olmsted County Minnesota, home of the Mayo Clinic, examined public health data in the county in the 18 months immediately before and after a smoke-free workplace law ordinance was passed by the Olmsted County Board of Commissioners in 2007.

The JAMA study found that myocardial infarction fell by 33%—from 150.8 to 100.7 per 100,000 population, and sudden cardiac death fell by 17%,  from 109.1 to 92.0 per 100 000 population.

The study concluded that the extent of the decline could not be explained by "community cointerventions or changes in cardiovascular risk factors with the exception of smoking prevalence. As trends in other risk factors do not appear explanatory, smoke-free workplace laws seem to be ecologically related to these favorable trends. Secondhand smoke exposure should be considered a modifiable risk factor for MI. All people should avoid secondhand smoke to the extent possible, and people with coronary heart disease should have no exposure to secondhand smoke."

Also this month, a separate study in the American Heart Association's Circulation magazine examines the relationship between smoke-free legislation and hospital admission or death from cardiac, cerebrovascular, and respiratory diseases.

Examining dozens of previous studies and using a dizzying methodology, the Circulation report determined that "smoke-free legislation was associated with a lower risk of smoking-related cardiac, cerebrovascular, and respiratory diseases, with more comprehensive laws associated with greater changes in risk."

Barbara Yawn, MD, a family physician and director of research at the 66-bed Olmsted Medical Center in Rochester, MN, calls the findings, particularly those in JAMA, "really very impressive."

"Most of us thought we'd see a reduction of maybe 10% or 15%, but the studies have been quite remarkable," Yawn told HealthLeaders Media.

Yawn did not take part in the JAMA study but says those findings are consistent with a study she conducted that examines cardiac and respiratory events related to smoking and air pollution. The study will be published in the American Journal of Public Health.

"We looked at air pollution levels before and after the smoking ban in public places and there is a substantial difference," she says. "Even when we have fairly high air pollution levels, all of the cardiac and breathing problems don't go up nearly as high any more. It was the combination of air pollution and these smoking in public places that were giving us a double whammy. Now we have at least taken the one away that we can control."

Minnesota's hospitals have been smoke-free for more than 10 years. That public smoking ban has been extended to restaurants, bars, and retail stores. "You pretty much can't smoke anywhere except outdoors and away from buildings," Yawn says.

As a result, she says "we have seen a decrease in asthmas, asthma exacerbations, asthma visits to the emergency room, asthma hospitalizations, and chronic obstructive pulmonary disease. We have seen a decline in the visits to our offices for acute problems and urgent care and emergency rooms and hospitalizations."

It's intriguing to consider what other public health problems out there might be dramatically reduced with well-crafted legislation. Could we see the same sorts of reductions in medical events with laws or public policies that tackle obesity?

"We would love to cut back on the availability of high-calorie lunches in schools," Yawn says. "There are other ways to get them those fruits and vegetables besides sugary juice and fried foods. We would all like to turn to school lunches because those kids are captive. What can we do to help in that arena because we know that obesity doesn't start when you are 25 or 30 or 40? It starts in school and you eating habits there."

The leaders and medical professionals in the nation's community hospitals, who are among the most trusted and respected people in their communities, are particularly well suited to press for these sorts of public policy changes.

Imagine, for example, the cost savings and the quality of live improvements that millions of Americans would enjoy if we could see a 33% reduction in obesity-related chronic illnesses such as diabetes.

Yawn says anti-smoking ordinances provide the blueprint for cost-effective, preventative public healthcare policy. She believes the lessons learned can be applied elsewhere, the results replicated.    

"Stopping smoking in public places has to be one of the most doable and effective tools that we have," she says. "This is really an important instance of where we need to be going with improving people's health. I can give them medication and I can improve one person at a time but if we do these public health measures we can improve the lives of hundreds and thousands of people over a period of time by something like this public approach to smoking."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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