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Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence
coronary event? If yes, what is known or suspected about how this risk may vary based upon absence or presence (and extent) of preexisting coronary artery disease?
What is the strength of the evidence for a causal relationship between indoor smoking bans and decreased risk of acute myocardial infarction?
What is a reasonable latency period between a decrease in secondhand smoke exposure and a decrease in risk of an acute myocardial infarction for an individual? What is a reasonable latency period between a decrease in population secondhand smoke exposure and a measurable decrease in acute myocardial infarction rates for a population?
What are the strengths and weaknesses of published population-based studies on the risk of acute myocardial infarction following the institution of comprehensive indoor smoking bans? In light of published studies’ strengths and weaknesses, how much confidence is warranted in reported effect size estimates?
What factors would be expected to influence the effect size? For example, population age distribution, baseline level of secondhand smoke protection among nonsmokers, and level of secondhand smoke protection provided by the smoke-free law.
What are the most critical research gaps that should be addressed to improve our understanding of the impact of indoor air policies on acute coronary events? What studies should be performed to address these gaps?
two publications on the effects of a smoking ban in Pueblo, Colorado—one with 18 months of data (Bartecchi et al., 2006) and one with 3 years of data (CDC, 2009); and one publication each on the effects of smoking bans in Helena, Montana (Sargent et al., 2004), Monroe County, Indiana (Seo and Torabi, 2007), Bowling Green, Ohio (Khuder et al., 2007), New York state (Juster et al., 2007), Saskatoon, Canada (Lemstra et al., 2008), and Scotland (Pell et al., 2008). Those 11 publications, which are observational studies examining changes in heart-attack rates following the implementation of a smoking ban, are not designed to answer questions regarding all three of the associations discussed previously. Most of the studies do not measure individual exposures to secondhand smoke or the smoking status of individuals. Those studies, therefore, are designed to evaluate the association between smoking bans and heart attacks, not the effects of secondhand smoke exposure. The publications on the smoking bans in Monroe County, Indiana (Seo and Torabi, 2007), and Scotland (Pell et al., 2008),