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.”

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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.

Read more about Resources for Quitting Tobacco Use ; Smoking and Cardiovascular Disease; and American Heart Association efforts to reduce exposure to secondhand smoke by reducing tobacco use.

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Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content.

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Darcy Spitz
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American Heart Association