The Problem: Tobacco use is a source of chronic and fatal illnesses for users and persons with secondary exposure. Smoking is responsible for approximately 1 in 5 deaths in the United States, causing 480,000 deaths annually. Smoking increases risk for stroke by 2-4 times, coronary heart disease by 2-4 times, lung cancer by about 25 times, and lowers overall health. Quitting smoking vastly reduces risk; within 2-5 of cessation, risk of stroke drops to that of a non-smoker. CDC: Health Effects of Cigarette Smoke
The Law: Smoking bans and restrictions prohibit smoking in specified areas. These restrictions aim to eliminate or reduce exposure to secondhand smoke. Smoking bans and restrictions are found in state and local laws as well as regulations governing workplace safety. For examples of state smoking bans, see ARS 36-601.01 (Arizona), Utah Health Code § 26.38.2 (Utah), VT Health Code § 1742 (Vermont), and RI Health & Safety Code § 23-20.10-3 (Rhode Island).
The Evidence: Meyers et al. performed a systematic review and meta-analysis of 11 studies that assessed the impact of public smoking bans (including workplaces) on the incidence of acute myocardial infarction (AMI) on the general population. Meyers et al. Cardiovascular effect of bans on smoking in public places: A systematic review and meta-analysis. J Am Coll Cardiol, 2009; 54:1249-1255. Studies were drawn from the United States, Canada, Italy, and Scotland. The authors used a random effects meta-analysis to control for differences in study population size and duration of observations. The meta-analysis found that public smoking bans reduce the risk of AMI by 17 percent, and this risk continues to decrease each year after ban implementation. Meyers et al. suggest that the duration of the post-ban effect may be explained by greater compliance to bans, decreased prevalence of smoking, improved air quality, and reduced environmental exposure to tobacco.
The Evidence: Lupton, Townsend, et. al performed a meta- analysis evaluating the attitudes towards and efficacy of university smoking bans on the health behaviors of their students. A Systematic Review and Meta-analysis of the Acceptability and Effectiveness of University Smoke-Free Policies. Eighteen studies were included from the United States, and 1 was included from the United Kingdom, based on inclusion criterion regarding university setting, study type and outcome measurement. With a 95% CI, 58.94% of students, derived from 12 studies, 68.39% of faculty, derived from 7 studies, and supported smoke-free policies. Additionally, of the 2 studies which analyzed reduction in smoking behaviors, both indicated significant reduction from pre to post enactment periods. 25% of US universities were smoke-free. Authors concluded that community support for smoke-free bans was related to the efficacy of those bans, which may aid in the reduction of smoking behaviors.
The Bottom Line: According to a peer-reviewed systematic review and meta-analysis, substantial evidence suggests that public smoking bans may effectively reduce smoking behaviors
Impact: Effective