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Published: Thursday, 8/19/2004

Study looks at smoking ban's effect on health


The heart-attack study done by public health researchers at the Medical College of Ohio and funded by the Ohio Tobacco Use Prevention and Control Foundation did not analyze heart attack rates in Toledo because its ban has been fully enforced only since January and 2004 health data are not yet available.

The Bowling Green heart-attack study, spearheaded by Sadik Khuder, associate professor of public health and medicine at MCO, found that heart attacks in the Wood County city fell by 45 percent in the first half of 2003 from the second half of 2002 after the city s smoking ban was fully implemented. Voters passed the smoking ban in 2001.

The study used Kent, Ohio a city in northeast Ohio without a smoking ban but with similar demographics to Bowling Green as a control model.

Heart attacks in the same period also fell in Kent, but by only 26 percent.

The findings are preliminary, but they do indicate a major change in heart attacks, said James Price, a public health professor at the University of Toledo who was the principal investigator in the overall study. The question is, is it due to the Clean Indoor Air Act? We think it may be.

One of the leaders of a group of bar owners opposed to Toledo s smoking ban was not impressed last night when told about the study s conclusions.

I don t think they look at all the facts, said Arnie Elzey, owner of Arnie s Eating & Drinking Saloon on West Central Avenue and a leader of the Citizens for Common Sense, the group opposed to Toledo s smoking ban. These studies should be done by neutral people.

Some scientists who were involved in the study remain cautious about the findings.

There s definitely a [decrease], but it s only for six months. We don t know if it will continue, said Sheryl Milz, an assistant professor of public health at MCO, who helped conduct the Bowling Green research. It might have nothing to do with the clean indoor air ordinance.

One of the area s leading health officials, however, said he s sure the ban is improving public health.

The decrease doesn t surprise me. I have little doubt, there s a relationship between the ban and reduced heart attack cases, said Dr. David Grossman, health commissioner for the Toledo-Lucas County health department and an early supporter of Toledo s smoking ban.

The study which also looked at air quality in bars and restaurants with smoking lounges and the economic impact of smoking bans on bars and restaurants was coordinated by the Northwest Ohio Strategic Alliance for Tobacco Control.

The group received a $400,000 grant to pay for the study from the Ohio Tobacco Use Prevention and Control Foundation, which was established by the Ohio General Assembly in 2000 and funded by money received by Ohio and 45 other states from tobacco companies to settle a massive public-health lawsuit.

Bowling Green voters passed a ban on smoking in most bars and restaurants in November, 2002.

In the study, Ms. Milz and her colleagues examined patient records for Bowling Green residents who were treated for heart attacks at area hospitals before and after the passage of the ban.

Some of the data show what researchers refer to as a statistically significant drop in the number of heart attacks after the ban, meaning the decrease is unlikely to be due to chance.

For example, from July, 2002, to December, 2002, there were 33 heart attack patients. From January, 2003, to June, 2003, there were 18, translating into a 45 percent drop.

However, the rest of the data show why it s difficult at this point to draw any strong conclusions, Ms. Milz said.

One unusual finding: The number of heart attacks went from 30 in the first six months of 2002 [the ban was implemented in February, 2002] to 33 in the second six months. In addition, in some of the previous years of Bowling Green data, there were relatively sharp drops for short periods of time, though not as much as last year.

Ms. Milz said it may take another year or more of data to see if the decrease in heart attacks among Bowling Green residents is a consistent, downward trend.

Smoking ban supporters say the findings suggest smoking bans can reduce the harmful effects of secondhand smoke.

And, they say, the Bowling Green study parallels the findings of a similar survey from Helena, Mont., published in April in the British Medical Journal.

In June, 2002, the city of Helena banned smoking inside all public places, including bars and restaurants. The ban was suspended in a court case in December of that year.

Curious whether heart attacks dropped the brief time the ban was in effect, Dr. Richard Sargent, a family physician in Helena, conducted a study.

Dr. Sargent found that the number of heart attacks in Helena dropped more than 40 percent during the last half of 2002 when the smoking ban was in effect. When the ban was overturned and smoking returned, the number of heart attacks jumped back up to their preban levels.

I was pretty amazed, he said of the drop and then subsequent rise. This was short-term exposure, literally going in for a beer or a sandwich.

Though smoking and secondhand smoke have long been shown to cause lung cancer, the link to heart disease the No. 1 killer of men and women is more recent. In the last 15 years, a growing body of evidence has shown that exposure to secondhand smoke can trigger changes in the body that might cause a heart attack.

Numerous health authorities, including the American Heart Association and U.S. Centers for Disease Control and Prevention, warn about risks of secondhand smoke and its links to heart problems.

Dr. Gopinath Upamaka, a cardiologist and director of coronary care at Toledo Hospital, said there s little doubt secondhand smoke is linked to heart problems, and he tells his patients to avoid secondhand smoke.

He said carbon monoxide in smoke can prevent enough oxygen from getting to the heart, and smoke can make arteries more prone to rupturing.

MCO researchers also found that contaminants from secondhand smoke are still showing up in nonsmoking areas adjacent to enclosed smoking lounges in bars and restaurants they tested in Bowling Green and Toledo.

The levels are low, but MCO researchers said there isn t a known safe level of tobacco smoke exposure, so it s possible even the small levels could be harmful.

Farhang Akbar-Khanzadeh, a public health professor at MCO who did that portion of the study, said his findings parallel those done elsewhere, as well as some of his own previous research.

He said the problem appears to be that the entrances to the separate lounges are frequently opened and closed, allowing secondhand smoke to escape into nonsmoking areas.

The study also looked at the economic impact of smoking bans on area bars, restaurants, and bowling alleys.

Mr. Price, the University of Toledo public health professor who headed the economic portion of the study, said he used information from Dun & Bradstreet a Short Hills, N.J.,-based consulting firm that compiles financial data on both large and small businesses to conclude that there was nearly no difference in the financial health of restaurants in Toledo and Bowling Green after the smoking ban took effect compared to other similar-sized cities in Ohio without bans and compared to the suburban cities of Maumee, Perrysburg, and Sylvania.

He also concluded that bars in Toledo showed a slight financial downturn in the period after the enactment of the city s smoking ban, which wasn t fully enforced until January.

Several bar owners dispute that view, saying the city s smoking ban has definitely hurt them, with many of their patrons heading to the suburbs to smoke.

I think [the study] is a clear and obvious misrepresentation of what s happening in Toledo today, said James Avolt, owner of The Distillery and member of Citizens for Common Sense.

I hope people take a close look at the study to find the errors.

Mr. Price said he resorted to Dun & Bradstreet because he had no luck finding economic data from local sources, and that he did not attempt to contact area bar owners himself.

Dun & Bradstreet did not return calls for comment.

Mr. Avolt said he was not aware of any bar owners who were contacted by the firm for financial information, and was critical of Mr. Price s reliance on financial data he said nobody including Dun & Bradstreet could have found from public sources.

It comes as no surprise to me that this group sees everything in Toledo as being great, and business is booming, said Mr. Avolt. This fella didn t talk to any taverns in town, yet he claims they re all doing well.

Contact Tad Vezner at:tvezner@theblade.comor 419-724-6050.

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