WASHINGTON — A major report confirms what health officials long have believed: Bans on smoking in restaurants, bars and other gathering spots — like the ones enacted in several Kentucky cities, including Lexington — reduce the risk of heart attacks among non-smokers.
"If you have heart disease, you really need to stay away from secondhand smoke. It's an immediate threat to your life," said Dr. Neal Benowitz of the University of California, San Francisco, who co-wrote Thursday's report from the prestigious Institute of Medicine.
More than 126 million non-smoking people in the United States are regularly exposed to someone else's tobacco smoke. The surgeon general in 2006 cited "overwhelming scientific evidence" that tens of thousands die each year as a result, from heart disease, lung cancer and a list of other illnesses.
Since Lexington approved the first indoor smoking ban in Kentucky in 2003, 25 other Kentucky cities, counties and health departments have passed rules to limit indoor smoking in public places.
The report "really is a confirmation of what we've known for quite a while. The information of secondhand smoke and heart attack has been growing," said Ellen Hahn, director of the Kentucky Center for Smoke-Free Policy at the University of Kentucky. Smoking bans, she said, "are really a public health vaccine." In Kentucky, she said, about $1.2 billion is spent annually on people who are sick from smoking.
Joey Maggard, executive director of the Central Kentucky Chapter of the America Heart Association, said, "Cardiovascular disease is our No. 1 killer. We lose 35 Kentuckians a day to heart disease or stroke." The report, he said, "just helps us to build our case for prevention. That's why it is important to us here locally."
Yet smoking bans have remained a hard sell, as lawmakers and business owners debate whether such prohibitions are worth the anger of smoking customers or employees.
Hahn said a recent study showed a large percentage of Kentucky adults still don't consider secondhand smoke harmful. And, she said, while the state has made progress, it's very difficult to convince people, especially those in small, rural towns, that smoking bans are necessary. Many times, she said, arguments become less about the health benefits of limiting indoor smoking and more focused on the issue as a matter of personal liberty.
Plus, she said, the state has not committed enough resources to educating the public about smoking or helping people quit. "We are behind the curve," she said. "Some other states have really put their money where their mouth is."
Thursday's hard-hitting report promises to influence that debate here and abroad.
"The evidence is clear," said Dr. Thomas Frieden, head of the U.S. Centers for Disease Control and Prevention, which requested the study. "Smoke-free laws don't hurt business ... but they prevent heart attacks in nonsmokers."
Among the report's conclusions: While heavier exposure to secondhand smoke is worse, there's no safe level. It also cited "compelling" if circumstantial evidence that even less than an hour's exposure might be enough to push someone already at risk of a heart attack over the edge.
That's because within minutes, the smoke's small particles and other substances can start constricting blood vessels and increasing blood's propensity to clot — key heart attack factors. Yet many people don't know they have heart disease until their first heart attack, making it important for everyone to avoid secondhand smoke, Ben owitz said.
"Even if you think you're perfectly healthy, secondhand smoke could be a potential threat to you," he said.
Many of the IOM committee members initially were skeptical they'd find much benefit from the bans, said statistician Stephen Feinberg of Carnegie Mellon University. He proclaimed himself "the resident skeptic" who changed his mind. "There was a clear and consistent effect of smoking bans," he said.
Since New York led the way in 2003, 21 states plus the District of Columbia now have what the CDC calls comprehensive laws banning smoking in public and private workplaces, restaurants and bars — with no exception for ventilated smoking areas. Some other states have less restrictive laws. Hahn said about 30 percent of the population of Kentucky is covered by comprehensive laws.
All together some 41 percent of people in the country are as protected in public from secondhand smoke as possible, Frieden said. The report found just 5 percent of the world's population was covered by comprehensive smoke-free laws.
While the public mostly connects smoking with lung cancer, heart disease is a more immediate consequence. About a third of all heart attacks in the United States are related to smoking, Frieden said.
How much do bans help? That depends on how existing bans were studied and how much secondhand smoke exposure different populations have. Some heavily exposed non-smokers have the same risk of heart damage as people who smoke up to nine cigarettes a day, said Dr. Lynn Goldman, an environmental health specialist at Johns Hopkins University who led the Institute of Medicine committee.
Her team reviewed 11 key studies of smoking bans in parts of the United States, Canada, Italy and Scotland. Those studies found drops in the number of heart attacks that ranged from 6 percent to 47 percent.
Some of the benefit might be to smokers who at least cut back because of public or workplace smoking bans, and might even quit at home, too. But two studies — one in Monroe, Ind., and another in Scotland — as well as a 52-country study of secondhand smoke's heart effects focused particularly on non-smokers, to reassure that the bans do help them, Goldman said.
The impact can be quick.
Helena, Mont., for example, recorded 16 percent fewer heart attack hospitalizations in the six months after its ban went into effect than in the same months during previous years, while nearby areas that had no smoking bans saw heart attacks rise. More dramatically, heart attack hospitalizations dropped 41 percent in the three years after Pueblo, Colo., banned workplace smoking.