to secondhand smoke or the smoking status of individuals; thus, they were designed to evaluate the association between smoking bans and acute MIs, not the effects of secondhand-smoke exposure. The publications on the smoking bans in Monroe County, Indiana, and Scotland, however, contain data on smoking status and results of analyses only in nonsmokers; these two studies were designed to assess the association between secondhand-smoke exposure and acute MIs.

The committee discusses the studies below, including information on the smoking bans and restriction in the different locations, available information on secondhand-smoke exposure, study designs, and study results. Publications that examine the effect of the same smoking ban are discussed together; the most comprehensive or recent publication is discussed first. The different smoking bans are discussed in order by earliest publication date. Details of the smoking bans and restriction in the different regions are presented in Table 6-1; available information on the effect of the bans on potential secondhand smoke exposure—including data on enforcement and compliance, air monitoring, and biomonitoring—is presented in Table 6-2; and details of the study designs and published results are presented in Table 6-3.


Smoking Ban and Exposure Information

Helena, Montana, enacted and enforced legislation requiring smoke-free workplaces and public places for the period June 5–December 3, 2002. The legislation banned smoking in restaurants, bars, and other workplaces and protected an estimated population of 28,726 (ANRF, 2009).

One publication examined the relationship between the Helena smoking ban and acute coronary events (Sargent et al., 2004). The committee did not identify any studies reporting air monitoring or biomonitoring for potential secondhand-smoke exposure in Helena before and after the ban compared with during the ban. Regarding compliance, Sargent et al. (2004) state that “the city–county health department reported that all but two businesses complied” with the ordinance, citing a letter to the editor of the Helena Independent Review. The study provided information directly related to the association between smoking bans and acute coronary events.

Published Results on Acute Coronary Events

Sargent et al. (2004) studied the effect of the smoking-ban legislation on hospital admissions for acute MI in Helena, Montana. The study

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