Monday, November 14, 2011

Data from Oregon Show No Change in Rate of Decline in Heart Attack Admissions Following Statewide Bar and Restaurant Smoking Ban

Last week, I revealed that a new report out of North Carolina concluded that the statewide smoking ban resulted in a 21% decline in heart attack admissions, although the actual data showed a 21% increase in heart attack admissions among women and a slowing of the overall rate of decline in heart attacks in the state.

Today, I share data first reported by Jacob Grier over at Liquidity Preference which demonstrated that the statewide smoking ban in Oregon was not associated with any significant increase in the rate of decline in heart attack admission rates in that state.

The following data and graph are copied directly from Jacob Grier's blog Liquidity Preference. Credit goes to Jacob Grier for obtaining these data from the Oregon state health department and for producing the figure.

The data below show age-adjusted rates of heart attack admissions for the state of Oregon. The percentage change from year-to-year is shown in parentheses:

2003 198.4
2004 181.2 (8.67)
2005 166.8 (7.95)
2006 166.6 (0.12)
2007 163.4 (1.92)
2008 152.5 (6.67)
2009 141.5 (7.21)
2010 137.1 (3.11)

Here is the same data in graph form (note that the statewide ban on smoking in bars and restaurants went into effect on January 1, 2009, so the data points for 2009 and 2010 reflect the implementation of the statewide smoking ban):


Source: Jacob Grier. Whatever Happened to Oregon's Heart Miracle. Liquidity Preference blog. November 2, 2011 [link].

As you can see from the figure, there was no change in the rate of decline in heart attacks in Oregon during the first year of the implementation of the smoking ban. If anything, the rate of decline in heart attacks slowed during the second year of the smoking ban. The heart attack admission rate fell by about 7% in the year prior to the smoking ban and by about 7% in the first year following the smoking ban's implementation. However, the rate of decline slowed to just above 3% in the second year following the smoking ban's implementation.

The Rest of the Story

Jacob Grier summarizes this analysis in a commentary published at

Grier writes: "When Oregon's smoking ban took effect in 2009, we were promised that it would usher in drastic reductions in heart attacks. A January 2009 story in this paper reported that even brief exposure to secondhand smoke could set the stage for heart attacks and cited research claiming that banning smoking in bars and restaurants could reduce them by 41 percent over three years. Later in 2009 cardiologist Ty Gluckman suggested in The Oregonian Commentary section that we might see a drop in heart attacks of 17 percent in the first year, saving the state $40 million. So, how's that working out for us?"

"I contacted the Oregon Public Health Division to ask for the latest data. The good news is that heart attack rates in Oregon have been in steady decline since 2003, the earliest year for which I have data. The bad news for smoking ban advocates is that the ban hasn't noticeably affected this rate and certainly hasn't resulted in the large declines that they predicted. The heart attack rate fell by 7.21 percent in 2009, the first year of the smoking ban. That sounds impressive, but it's in line with drops in recent years. 2004 and 2005 saw greater declines -- 8.67 percent and 7.95 percent, respectively -- and 2008, 6.67 percent. Given this existing trend, it would be spurious to credit the ban for the similar drop in 2009. The ban doesn't fare any better if you include data from 2010. In the two years since the ban took effect, rates have dropped only 10 percent, a much smaller decline than we were told to expect in just one year."

In response, a representative of the Greater Portland and Vancouver American Heart and Stroke Association acknowledges that the data presented by Grier are accurate but argues that heart attack rates wouldn't have been expected to decline in Oregon because many cities in the state had already enacted smoking bans. As he writes: "Most published studies of heart attack rates following smoking bans have looked at communities that went smoke-free nearly overnight. This is not Oregon's story."

The truth, however, is that according to Americans for Nonsmokers' Rights, there were only 4 communities in Oregon that enacted smoke-free bar or restaurant laws prior to the statewide smoking ban: Corvallis, Eugene, Independence, and Philomath. This is clearly not enough of the state's population to explain why the smoking ban would not lead to an immediate decrease in heart attacks if that is indeed the expected effect of a statewide ban on smoking in all bars and restaurants.

The rest of the story is that the data from Oregon do not support the conclusion that the statewide smoking ban led to an immediate and significant decline in heart attacks, as claimed by anti-smoking researchers and groups. This does not mean that the ban is unjustified, because it will eventually reduce cardiovascular disease. But remember, it takes many years for secondhand smoke exposure to result in heart disease. It does not happen overnight. Moreover, the ban has immediate effects on respiratory symptoms of nonsmokers, especially those with asthma or other respiratory conditions.

By continuing to rely upon shoddy science to support its conclusions that smoking bans immediately and dramatically reduce heart attacks, the anti-smoking movement is risking losing its scientific credibility. Once that is lost, it will be much more difficult to enact smoking bans. Any short-term gains to be had by touting these Helena-like studies will, in my opinion, be overshadowed by the long-term damage to the scientific credibility of the tobacco control movement.

No comments: