VA study adds to evidence on health benefits of smoking bans

A study by VA researchers has linked public-smoking bans to lower hospitalization rates for heart and lung disease.

Where there's smoke—A study by VA researchers has linked public-smoking bans to lower hospitalization rates for heart and lung disease. (Photo: iStock)

Americans take it for granted nowadays that someone sitting nearby in a bar, restaurant or office won't blow smoke in their faces. Smoking bans in public places are common today in the U.S.

A new study by VA researchers shows the bans do more than avoid annoyances for non-smokers: They prevent illnesses linked to secondhand smoke.

The study, published in the December issue of the journal Health Affairs, is one of the most extensive looks yet at the health effects of smoking bans.

"Most studies to date examined a single location, or a small number of locations," said lead author Mark Vander Weg, PhD. "We looked at more than 3,100 counties across the country with and without smoking bans."

Vander Weg, a psychologist, is an investigator with the Center for Comprehensive Access and Delivery Research and Evaluation, part of the Iowa City Veterans Affairs Health Care System. He is also an associate professor of psychology and internal medicine at the University of Iowa.

Focus on heart attacks, lung disease

The researchers tracked hospital admissions in counties where smoking bans had been put in place between 1991 and 2008, as well as in counties where no such clean-air laws had been enacted.

The team zeroed in on two illnesses known to be worsened by exposure to secondhand smoke. One was lung diseases such as emphysema and bronchitis, known collectively as chronic obstructive pulmonary disease, or COPD. The other was heart attack. Several studies have already drawn a strong link between heart attack and smoking bans, although the studies have varied in size and methodology.

For comparison, the VA team also tracked hospitalizations for two other conditions thought to be far less affected by secondhand smoke: gastrointestinal bleeding and hip fractures.

The study relied on Medicare data to track hospital admissions, so it included only people age 65 and older.

Overall, admission rates for heart attack, hip fracture, and GI bleeding went down during the 18-year study period. COPD admission rates went up. But the researchers were concerned mainly with how the trends in ban locales compared with those in non-ban locales.

Sharp differences in admission rates

Among the study's findings:

• On average, within the first three months after bans had been enacted, heart attack admission rates went down 6 percent more in ban locales than in non-ban locales. Three years post-ban, the relative difference jumped to 20 percent.
• Within the first three months, the increase in COPD admission rates in ban locales was 5 percent lower than in non-ban locales. After three years, the difference had grown to 17 percent.
• In counties that banned smoking in all three types of locations�bars, restaurants, and offices�greater relative reductions were seen than in counties that banned smoking only in one setting.
• Little difference was seen between ban and non-ban counties when it came to the two diseases not linked to secondhand smoke.

The researchers note limitations to their study. First, they didn't measure actual exposure to secondhand smoke. So they can't rule out that the differences in hospitalization rates may have stemmed from other factors. Second, they didn't distinguish between hospitalizations of smokers and nonsmokers, or of people with and without histories of the diseases they examined. So there's no way to trace how the bans' impact differed among the various groups. Another limitation: In areas where bans were enacted, smoking rates in the general population may have declined, thus resulting in fewer people overall getting hospitalized for heart attack or lung disease.

On the whole, though, Vander Weg says the findings "provide further support for the public health benefits of laws that limit exposure to tobacco smoke."

His coauthors on the study included Gary Rosenthal, MD, and Mary Vaughan Sarrazin, PhD. Funding was provided by VA and the Agency for Healthcare Research and Quality.