Smoking policy blogger questions study on Kanawha ban

CHARLESTON, W.Va. — The conclusions drawn by the authors of a recent study conducted by the Kanawha-Charleston Health Department that links indoor smoking bans to a decrease in hospital admissions for heart attacks “flies in the face of logic,” said a Boston University professor and smoking policy blogger.

“The most interesting thing is that the study doesn’t conclude what it actually finds,” said Dr. Michael Siegel, professor of Community Health Sciences at Boston University School of Public Health.

Siegel, author of the blog “The Rest of the Story: Tobacco News Analysis and Commentary,” posted a review earlier this month of the Kanawha County study.

In June, researchers with the Health Department and the West Virginia University Prevention Research Center linked a 37 percent decline in the heart attack hospitalization rate from 2000 to 2008 to a countywide smoking ban in the study, “Clean Indoor Air Regulation and Incidence of Hospital Admissions for Acute Coronary Syndrome in Kanawha County, West Virginia.”

The study was published in the online medical journal Preventing Chronic Disease and also was posted to the U.S. Centers for Disease Control and Prevention, Preventing Chronic Disease Public Health Research, Practice and Policy website.

The only major change that took place during the study’s time period from 2000 to 2008 was the county’s revision of its smoking ban in 2004 to remove smoking sections in all restaurants and most work places, Siegel said in an interview with the Gazette last week.

“The study and the results show there was a consistent decline in heart attacks during that entire period,” Siegel said. “It was gradually going down, and it just continued going down at the same rate [after the start of the 2004 smoking ban].

“What I would have to conclude from this data is that the smoking ban would seem to have no effect in the rate of heart attack admissions in the county.”

Siegel instead attributes the steady decline to improvements in preventive care, medication and technology to treat heart disease.

“If you look almost anywhere in the United States during this time period, heart disease is declining,” Siegel said. “If they would have found anything other than a decline, I would have been shocked, because that’s the general trend everywhere.”

The authors of the study — Dr. Rahul Gupta, head of the Kanawha-Charleston Health Department, Anita Ray of county Health Department and Robert Anderson and Juhua Luo of WVU’s Mary Babb Randolph Cancer Center — were unavailable for comment Friday.

The aim of the study, as stated by the authors’ published report, was to monitor the rate of heart attack admissions during an eight-year period in a community with existing clean indoor air regulations.

Kanawha County in 1995 implemented its clean indoor air regulation that banned smoking in most public places, including retail stores, elevators, restrooms, public transportation systems, waiting areas and public meeting areas, such as school buildings.

The ordinance exempted bars and allowed restaurants to designate up to half of their seating as smoking sections.

In 2000, the ordinance was modified to increase penalties for violations, and revised again in 2004 to remove smoking sections in restaurants and other public indoor areas.

Siegel argues the 1995 ordinance that allowed designated smoking sections was not strong enough to protect the public from the hazards of secondhand smoke.

“Even if someone was to make the argument that this 50 percent smoking ordinance had an effect on heart attacks, [you would] have to go back to data before 1995 to see the rate before the ordinance was put in effect,” Siegel said.

“If heart disease from 1990 to 1995 had been going up, and then from 1995 to 2008 it was going down, that might be a different story. But they don’t go back to 1990, so how can they possibly draw a conclusion from the effect of the ordinance?” he said.

The authors of the study do state in their findings that no significant changes were recorded “between, before and after the removal of smoking areas in restaurants,” in 2004.

The heart attack admission rate steadily dropped by about 6 percent a year among women, nonsmokers and people without diabetes, according to the study.

“Although this decline may not be conclusively linked directly to the [Clean Indoor Air Regulation], a significant benefit in the rate of [Acute Coronary Syndrome] admissions for male smokers occurred after the regulations were strengthened in 2004 to remove all smoking areas from restaurants,” the authors of the study state in the report.

Following the 2004 changes, heart attack admissions among male smokers decreased by about 7 percent a year, from 842 patients admitted to Kanawha County hospitals in 2004 to 664 reported in 2000. Prior to 2004, no changes over time were recorded in this population segment, the report states.

“I do want to emphasize that the rationale for passing smoking bans doesn’t hinge on whether or not it decreases the rate of heart disease,” Siegel said. “Even if there is no immediate decline in heart attacks, that doesn’t mean they should repeal the whole thing.”

Siegel does not question that secondhand smoke increases a person’s risk of developing heart disease by up to 30 percent but said the Kanawha County report tries to draw a conclusion too soon.

It can take decades for a smoker or a person exposed to secondhand smoke to develop heart disease, he said.

“Do I think smoking bans will eventually result in a decline in heart attacks? Absolutely,” Siegel said. “If you reduce that exposure over time, you are going to reduce the number of heart attacks. But are you going to see it over four years?”

Heart disease is the No. 1 cause of death in West Virginia, according to the American Heart Association.

West Virginia is tied with Kentucky for the nation’s highest smoking rate, at about 26.5 percent, according to data from the U.S. Centers for Disease Control and Prevention. Charleston was ranked first and Huntington third on the Gallup-Healthways Well-Being Index’s list of cities with the highest proportion of smokers.

By Veronica Nett
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