Smoke Free

By Christine Gorman

Anyone who wants to see the health benefits of municipal smoke-free ordinances need look no further than Pueblo, Colo. After much political back-and-forth, the city banned smoking in restaurants, offices and other indoor spaces in the summer of 2003 and started seeing results within months. In the year and a half before the ban, the city recorded 399 heart attacks; in the 18 months after the change, there were 108 fewer heart attacks. That 27% decrease alone, according to a study presented last week at the annual American Heart Association meeting, resulted in a savings of $1 million to $2 million in direct medical costs.

Because this was the longest, most rigorously conducted study of an antismoking ordinance to date--a smaller study from Helena, Mont., was criticized because it lasted just six months--the findings are worth examining in detail. Pueblo turned out to be an ideal spot for this sort of investigation, says Dr. Christine Nevin-Woods, a public-health physician and one of the study's authors. Located 110 miles south of Denver, Pueblo (pop. 104,000) is geographically isolated, so many confounding factors--such as the movement of large populations--that you'd find in a big place like New York City, which has had a smoking ban since 2003, are eliminated. Gathering data was also relatively straightforward, since almost all heart attacks in Pueblo are treated in one of two hospitals, both of which maintain electronic medical records.

The statistical analysis was complicated, however, and required help from researchers at the Colorado Prevention Center and the University of Colorado. Investigators chose for comparison two areas that don't have smoke-free laws: the part of Pueblo county outside the city and an adjacent county. Although the number of heart attacks fell in both of those areas, the drop was small and not statistically significant.

So how did tiny Pueblo become a leader in the antismoking movement? "We did a lot of education on the issue for four years before we even tried to get an ordinance," says Nevin-Woods. The hard work paid off. Voters affirmed the new rule twice. And while others may quibble that 27% doesn't seem like much of a benefit, it makes a world of difference if you're one of the city's 108 citizens who didn't suffer a heart attack.