Pueblo smoking ban leads to drop in heart attacks, study finds

Heart attacks fell sharply in Pueblo in the years after a city smoking ban took effect, according to a report released Wednesday, and researchers say it's the strongest link yet between such laws and improved health.

The southern Colorado city saw a 41 percent drop in heart attack hospitalization rates among city residents in the three years after a smoking ban took effect July 1, 2003, according to the report by the U.S. Centers for Disease Control and Prevention. The size of the drop surprised researchers, said the study's lead researcher, Terry Pechacek, associate director for science at the CDC's Office on Smoking and Health.

"The significant continued decline was not predicted," he said.
Several studies have shown that heart attacks decrease significantly when smoke-free laws are in place, but this was the first to show that such declines seem to continue over time.

Pechacek said it suggests that the risk of secondhand smoke might be underestimated, and that Colorado's smoking ban, which took effect July 1, 2006, can only go so far in protecting people.

"Even with the statewide law, people need to recognize that they need to pay attention to secondhand smoke in homes, vehicles and everywhere else," he said.

Researchers looked at how many Pueblo residents were admitted to the hospital with heart attacks in the 18 months before the ban, and continued to monitor the data for three years after, through June 30, 2006.

Initially, the CDC found a 27 percent decline in the rate of such hospitalizations 18 months after the ban. When those results were published, critics questioned whether that number was abnormally high, Pechacek said. His team decided to extend their research another 18 months, and found that the rate of heart attack hospitalizations dropped an additional 19 percent. Bottom line: The rate of heart attacks dropped from 257 per 100,000 people before the ban to 152 per 100,000 in the three years afterward.

Researchers compared the city of Pueblo to El Paso County and unincorporated areas of Pueblo County, because neither were under a smoking ban at the time. Both control groups saw no significant change in heart attack hospitalizations over the same four years, and the study found no other environmental, political or population changes that could have skewed results in that time frame.

The Pueblo study is one of at least nine studies that tied declines in heart attack hospitalizations with smoke-free laws. But experts say this one establishes one of the strongest links between the two.

The study did not look at patients' smoking status or possible health complications such as obesity or diabetes, and it did not measure whether there was reduced secondhand smoke in buildings, so there was no way to conclude exactly how much of the decline was from reduced exposure to secondhand smoke.

Pechacek also noted that the law itself likely led to social changes that further limited exposure to secondhand smoke, such as people's rules about smoking at home, as well as prompting people to quit.

An analysis of all related studies has shown about a 19 percent decrease in heart attack hospitalizations associated with such laws, he said. Given that, he said he believes additional smoking bans could put a major dent in more than 1 million heart attack hospital admissions each year.

"This study is very dramatic," said Dr. Michael Thun, a researcher with the American Cancer Society who was not involved in the CDC study. "This is now the ninth study, so it is clear that smoke-free laws are one of the most effective and cost-effective to reduce heart attacks."

Smoking bans have become increasingly prevalent in recent years as research on secondhand smoke collects, but they remain controversial.

"I have never seen any proof at all that secondhand smoke is hazardous to anybody's health," said Bruce Hicks, owner of Murray Street Darts, who has been fighting the ban in court after being cited for openly defying it. "And besides that, I still think it's a business rights issue rather than a health issue."

Businesses have gotten creative in their efforts to keep patrons puffing by exploiting loopholes. In Minnesota this year, bar owners allowed customers to dress up in costume.

The reason? The law exempts performers in theatrical productions.

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Contact the writer: 636-0198 or brian.newsome@gazette.com.

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The Associated Press contributed to this report.

Read the CDC study here.