events that are not acute MIs inasmuch as troponin can also be increased in some systemic diseases and in nonthrombotic cardiac disease (Inbar and Shoenfeld, 2009) and small changes can occur in clinically stable populations (Eggers et al., 2009).


Smoking Ban and Exposure Information

The city of Pueblo, Colorado, implemented a smoking ordinance, effective July 1, 2003, that prohibited smoking in workplaces and all public buildings (including restaurants, bars, bowling alleys, and other business establishments). The committee did not identify any air or biomonitoring studies in Pueblo. The ordinance was implemented after a vote that indicated public support for the ban, and Bartecchi et al. (2006) reported that “Pueblo law enforcement officials strongly supported the ordinance and imposed significant fines on violators and on facility owners who allowed smoking on their premises.”

Two publications report on acute coronary events after implementation of the smoking ban: Bartecchi et al. (2006) and Centers for Disease Control and Prevention (CDC, 2009). Both provide information directly related to the association between smoking bans and acute coronary events. The CDC study included 3 years of followup after implementation of the ban; the earlier publication reported data after 1.5 years of followup.

Published Results on Acute Coronary Events

CDC (2009) studied the effect of the citywide smoking ordinance on the incidence of acute MI–related hospitalizations in the city. The authors assessed patients who had a primary diagnosis of acute MI (ICD-9 410.xx) and were admitted to Parkview Medical Center or St. Mary-Corwin Medical Center in 2002–2004; cases were not confirmed clinically. Cases in three periods were assessed: the 1.5 years before implementation of the ban on July 1, 2003 (January 2002–June 2003); the 1.5 years after July 1, 2003 (July 2003–December 2004; phase I post-implementation data previously published in Bartecchi et al. [2006]; and the 1.5 years after that (January 2005–June 30, 2006; phase II post-implementation data). Information on admission date, primary diagnosis, sex, age, ICD code, and hospital name was collected; no information on individual smoking status was available. The authors classified patients in Pueblo County as residing either inside or outside the city limits on the basis of administrative data, including ZIP codes. To allow comparison, the authors also assessed rates of hospitalization for acute MI in a geographically isolated community, El Paso County,

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