health care

Smoking ban reduced hospital admissions, costs

Posted 2/20/12

PROVIDENCE – A new study offered clinical evidence that Rhode Island’s 2005 ban on smoking in public places and workplaces has been effective in cutting hospitalization rates for heart attacks.

Between 2003 and 2009, the study findings showed that there was a 28.4 percent drop in admissions at Rhode Island’s 11 acute care hospitals for acute myocardial infarctions (heart attacks) and a 14.6 percent reduction in medical costs, representing a savings of more than $6 million, based on projected reimbursable costs.

The study, “The Impact of Rhode Island’s Statewide Smoke-Free Ordinance on Hospital Admissions and Costs for Acute Myocardial Infarction and Asthma,” compared the rates of admissions for two conditions, heart attacks and asthma, against a control group that measured the rates of hospitalization for appendicitis. Patients under the age of 18 and out-of-state residents were excluded.

The study demonstrated the value of investing in preventive measures to reduce health costs and improve health outcomes, according to Dr. Michael Fine, director of the R.I. Department of Health.

“The results contribute to the growing number of studies showing the significant health benefits and cost savings gained by having a statewide ban on indoor smoking in place,” Fine said.

Under Fine’s leadership, tobacco-free living, the top priority under the National Prevention Strategy for public health, has set continuing aggressive goals to further reduce tobacco use, including preventing initial tobacco use among young people, eliminating nonsmokers exposure to second-hand smoke, and promotion of quitting among young adults.

In a separate matter on the tobacco front, major tobacco companies – including R.J. Reynolds Tobacco Co., Philip Morris USA Inc., the U.S. Smokeless Tobacco Manufacturing Co., American Snuff Company, and the Lorillard Tobacco Co. – filed a lawsuit in U.S. District Court seeking to block the city of Providence’s new ordinances set to take effect March 1. The ordinances ban sales of non-cigarette tobacco products marketed as having candy or fruit flavors.

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sswenson@aegistg.com

First let me say that I have no desire to die on the “smoking ban” hill. However, I may be one of the few left who believe people are actually capable of making their own decisions no matter how stupid those decisions might be. On the other hand, I really want the press to do their job and not to simply pander to a popular (even righteous) lobby. Did Mr. Asinof even read the study? First, according to the study, asthma INCREASED by 55% from the start of the smoking ban (2003) to 2009: “There was a significant increase in hospitalization rates for asthma between 2003 (11.3; 95% CI 10.6 – 12.1 and 2009 (13.5; 95% CI 12.8 – 14.3)…” This would appear to refute any conclusion drawn from this grossly limited study about the relationship between the smoking ban and improvement to public health. But the authors of the study dodge this bullet by admitting other contributing causes (e.g., poverty, poor housing). However, the authors admit no scientific, socio-economic or environmental factors that may have contributed to a likewise decrease in AMI (e.g., generally improving diets, shifts in Rhode Island demographics and advancements in cardio-vascular health practice). The study authors further suggest the asthma data be discounted because of the relatively smaller sample size; however, the 95% confidence intervals are narrower for the asthma data set thereby indicating slightly stronger correlation (sorry Mr. Asinof, you’ll need to go back to those high school statistics books for an explanation of that one). Second, the study authors confess that Rhode Island Hospital does not collect data for second-hand smoke biomarkers. The Rhode Island Smoking Ban is part of the “Public Health and Workplace Safety Act” and, while I was not privy to the debate on the floor of legislature, I think it’s safe to assume that second-hand smoke was a major technical driver behind the bill thus its inclusion under the workplace safety rubric. Smoking in public spaces may indeed be a bad thing; but, being engaged in a holy war does not mean you’re exempt from doing the hard work of good science. And shame on Mr. Asinof and the Providence Business News for reading this tripe with uncritical eyes, for not doing the hard work of journalism and publishing this story under an irresponsible headline.

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