Cardiovascular Effect of Bans on Smoking in Public Places
Open accessAbstract
Objectives A systematic review and a meta-analysis were performed to determine the association between public smoking bans and risk for hospital admission for acute myocardial infarction (AMI).Background Secondhand smoke (SHS) is associated with a 30% increase in risk of AMI, which might be reduced by prohibiting smoking in work and public places.Methods PubMed, EMBASE, and Google Scholar databases plus bibliographies of relevant studies and reviews were searched for peer-reviewed original articles published from January 1, 2004, through April 30, 2009, using the search terms "smoking ban" and "heart" or "myocardial infarct." Investigators supplied additional data. All published peer-reviewed original studies identified were included. Incidence rates of AMI per 100,000 person-years before and after implementation of the smoking bans and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated. Random effects meta-analyses estimated the overall effect of the smoking bans. Funnel plot and meta-regression assessed heterogeneity among studies.Results Using 11 reports from 10 study locations, AMI risk decreased by 17% overall (IRR: 0.83, 95% CI: 0.75 to 0.92), with the greatest effect among younger individuals and nonsmokers. The IRR incrementally decreased 26% for each year of observation after ban implementation.Conclusions Smoking bans in public places and workplaces are significantly associated with a reduction in AMI incidence, particularly if enforced over several years.
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The largest relative risk reductions in acute coronary events were seen among younger persons and nonsmokers.
“The largest relative risk reductions were seen among younger persons and nonsmokers.”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [413]
In two separate meta-analyses, the pooled relative reduction in acute coronary events was 17% (95% CI, 8%, 25%).
“In 2 separate meta-analyses of these studies, the pooled relative reduction in acute coronary events was 17% (95% CI, 8%, 25%).”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [413]
Meta-regression suggested that benefits increased over time, with larger reductions in coronary events seen with longer durations of follow-up after the smoking ban was instituted.
“Meta-regression suggested that benefits increased over time, with larger reductions in coronary events seen with longer durations of follow-up after the smoking ban was instituted.”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [413]
The studies reviewed in the IOM report and recent meta-analyses, in combination with several other more recent studies, provide convincing evidence that community smoking bans reduce rates of cardiovascular and smoking-related respiratory events, at least partly through lower exposure to secondhand smoke and possibly other concomitant effects.
“In sum, the studies reviewed in the IOM report401 and recent meta-analyses,412,413 in combination with several other more recent studies, provide convincing evidence that community smoking bans reduce rates of cardiovascular and smoking-related respiratory events, at least partly through lower exposure to secondhand smoke and possibly other concomitant effects (Table 8).”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [413]
Factors associated with indoor smoking bans, such as related media reports or outreach efforts, were difficult or impossible to separate from the impact of the ban itself.
“In all these studies, factors associated with the indoor smoking ban, such as related media reports or outreach efforts, were difficult or impossible to separate from the impact of the ban itself.”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [413]
The pooled analysis suggests a substantial overall pooled effect of smoking bans that increases over time.
“The pooled analysis suggests a substantial overall pooled effect that increases over time.413”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [413]
Several healthcare-level behavioral change strategies have been effective, including individual-oriented sessions, a focus on specific proximal goals, self-monitoring with feedback, group sessions, and trained motivational interviewing.
“Several approaches have been effective, including (1) individual-oriented sessions to assess readiness for behavior change, collaboratively identify goals, and develop plans to achieve these goals; (2) a focus on specific, proximal goals for targeted behaviors; (3) self-monitoring with oral, written, and/or electronic feedback; (4) group sessions for peer support, group problem solving, and skill”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [413]
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- Authors
- Meyers, D. G., Neuberger, J. S., & He, J.
- Affiliations
- University of Kansas (US)
- Corresponding author
- Meyers, David G.
- ORCID
- He, Jianghua
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2009-09
- Volume
- 54
- Issue
- 14
- Pages
- 1249-1255
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1457592498
- Cited by
- 346
- References
- 60
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 7 · 2023: 9 · 2022: 14 · 2021: 8 · 2020: 9 · 2019: 17 · 2018: 11 · 2017: 16 · 2016: 17 · 2015: 26 · 2014: 26 · 2013: 34 · 2012: 53
- FWCI
- 32.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- public smoking bans, passive smoking, acute myocardial infarction, cardiovascular risk, hospitalization, workplace smoking restrictions, non-smokers, young adults
- MeSH terms
- Age Factors, Humans, Myocardial Infarction, Patient Admission, Public Facilities, Smoking, Tobacco Smoke Pollution, Incidence, Prevalence
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