According to a new study, a statewide workplace smoking ban in Massachusetts may be responsible for a steep drop in heart-attack deaths since 2004.
The Massachusetts Department of Public Health, which produced the study, says the biggest health gains came among those people the ban saved from regular exposure to second-hand smoke.
The rate of heart-disease-related deaths has been cut nearly in half in Massachusetts since 1999, and the downward trend began years before the workplace ban went into effect.
But there’s reason to believe that the ban accelerated the decline. For one, the cities and towns that saw health improvements earliest were the ones in which local smoking restrictions were enacted before the statewide ban. Now, two years after the statewide ban was put in place, heart-attack death rates have fallen to almost uniform levels across Massachusetts.
Tobacco companies, meanwhile, are pouring hundreds of millions of dollars into research on how to create a safe cigarette (likely an impossible goal).
Smoking rates in the U.S. have fallen to their lowest levels since 1920, pushed down by the accumulating weight of medical evidence showing the grave health effects of tobacco use.
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That’s particularly encouraging news about the former victims of second-hand smoke. They didn’t get any of the satisfaction, just the heart attacks. But much less now. It’s one case where government intervention seems to have worked.
Good News! Now if we could figure out how to place a similar stigma on alcohol use, another big killer.
This study looks suspect to me. I’m not a smoker, nor have I ever been, but I’m also against anti-smoking laws. I can see the government banning smoking in public buildings, but private owners should be able to set their own rules and employees and patrons can choose to spend their time elsewhere if the rules bother them. It seems like a simple, elegant market solution to me. Why is this solution never satisfactory? Can the Freakonomics team crunch some of the data on this and let me know if the conclusions in the report overreach as much as they appear to?
Even if we posit a connection between the ban and the lower death rate, can we be sure that the ban hasn’t simply stopped many people from smoking? Is there any reason to believe it’s connected to second-hand smoke?
Not a smoker here either, but this smacks of either 2good2Btru syndrome, or people looking around for validation from slim sources in order to get more exposure for their views.
It has obviously worked.
https://www.reason.com/blog/show/130115.html
Last week the Massachusetts Department of Public Health claimed a new study shows the state’s smoking ban has resulted in 577 fewer heart attack deaths per year since it took effect in July 2004. The department, perhaps hoping its spin will be accepted before critics have a chance to examine the basis for it in detail, does not plan to release the study until next year. All we have to go on is a press release, a “fact sheet” (PDF), and a story in The Boston Globe. But several things are clear:
1) Heart attack deaths were already declining before the statewide ban; the researchers claim the trend accelerated after the law took effect.
2) Judging from the graph on the fact sheet, heart attack deaths (as a percentage of all deaths) fell sharply after the ban even in municipalities that were already subject to local smoking bans, including those that had “strong” laws. That’s not what you’d expect if restrictions on smoking caused the decline.
3) The reduction in heart attack deaths reported by the Globe-30 percent over three years-is much smaller than the effects attributed to smoking bans in other studies. The report on Helena, Montana, for example, initially claimed a 60 percent reduction in heart attacks within six months, which was later downgraded to 40 percent.
4) Although Massachusetts Public Health Commissioner John Auerbach says “we believe the single most compelling reason [for the decline in heart attacks after the ban] was reduced exposure to secondhand smoke in workplaces,” it’s not clear what biological mechanism would account for such a quick effect. It can’t be that fewer people are developing heart disease, since that takes years. Presumably what Auerbach has in mind is that less secondhand smoke means heart attacks are less likely to be triggered in people with pre-existing heart disease. Is there any evidence that, prior to the ban, nonsmokers with heart disease were keeling over dead as a result of heart attacks triggered by exposure to secondhand smoke?
Michael Siegel, who seems to have had a look at the raw data, has more (emphasis added):
In the first year after the smoking ban was implemented, there was no significant decline in heart attack deaths in the state. Moreover, there was no decline in heart attack deaths even among just those residents living in towns that did not previously have smoking bans. Thus, this study refutes the conclusions from Helena, Pueblo, Bowling Green, etc. that smoking bans immediately reduce heart attacks by decreasing secondhand smoke exposure.
The study did find a decline in heart attack rates from the first to second year after the statewide smoke-free law was implemented, but it turns out that the magnitude of this decline was not significantly different in towns with or without smoking bans prior to the state law. Thus, the study provides no evidence that the statewide smoking ban was associated with any significant decline in heart attacks, even up to two years after its implementation.
Siegel adds that cities with smoking bans did see significant reductions in heart attack deaths compared to cities without such laws in the seven-year period from 1999 through 2006. They also had lower smoking rates, which suggests they may be seeing the results of improving health in former smokers who quit as a result of the ordinances. Case-control studies indicate that the heart disease rate among former smokers falls by about 50 percent within four years of quitting.
In short, even if secondhand smoke has no measurable impact on death rates, over the long term smoking bans can be expected to reduce the incidence of heart disease (and other smoking-related illnesses) by pressuring smokers to quit. From a “public health” perspective, in fact, that is the main benefit of smoking bans. But whether we’re talking about smokers or nonsmokers, immediate, sharp reductions (within the first six months to a year) are not biologically plausible, and they’re not what the Massachusetts study found.
My mother told me the bars in her small rural town are hurting because people don’t want to go if they can’t smoke. Instead, they stay at home and drink.
If true, that makes me wonder if the biggest life savings aren’t in reduced drunken driving accidents.
Rant time:
Nothing saves lives: experience tells us that 100% of the people who have ever lived either have or will die.
I despise all headlines XXX saves lives, XYZ reduces death. No they don’t, they may delay death- but they do not stop or prevent death.
Everyone who fails to get lung cancer because they stopped or never started smoking will simply die of some other ailment or accident later in their lives, and therefore cause the death rate for these other ailments to increase. Put it this way :If we eliminated all forms of cancer- the death rate from heart disease would sky rocket. Then we would see an article- “Heart Disease rates increasing, deaths rate all all-time high.”