Negative Health Effects of Secondhand Smoking:

Heart DiseaseEric L. Johnson, M.D.

Assistant Professor

Department of Family and Community Medicine

University of North Dakota

School of Medicine and Health Sciences

Assistant Medical Director

Altru Diabetes Center

Smoking Causes Death

Smoking causes approximately• 90% of all lung cancer deaths in men• 80% of all lung cancer deaths in women• 90% of deaths from chronic obstructive lung

disease (COPD)

CDC

Smoking Causes DeathCompared with nonsmokers smoking

increases risk of—• Coronary heart disease by 2 to 4 times• Stroke by 2 to 4 times• Men developing lung cancer by 23 times• Women developing lung cancer by 13 times• Dying from chronic obstructive lung diseases

(COPD) by 12 to 13 times

CDC

Tobacco Use in North Dakota

• ~116,000 ND adults and ~8,000* HS students smoke cigarettes

• ~20,000 ND adults and ~3,800^ HS students use spit tobacco

-HS students:*26% in 2003, 27% in 2005, 22% in 2007

^10% in 2003, 12.7% in 2005, 10.2% in 2007

(BRFSS 2008)(BRFSS 2008)

(YRBS 2005,2007)(YRBS 2005,2007)

However, today our focus on not on negative health effects on the smoker…..

Secondhand Smoke(Passive Smoking)

• Negative effects of smoke on people who aren’t doing the smoking

• No longer speculation that this is dangerous for those exposed to secondhand smoke

Secondhand Smoke DeathsUnited States• Lung cancer – 3,000 deaths annually • Heart Disease – 35,000 deaths annually

North Dakota• 80-140 deaths annually

CDCAmerican Cancer Society

Second Hand Smoke and Cardiovascular Risk (Heart Attack)• Cardiovascular Risk (Heart Attack) is

~80-90% of primary smoking

• Secondhand smoke increases risk of heart attack by 30%

• Well understood phenomenon- no longer speculative concerning harmful effects

Barnoya A, Glantz S Circulation May 24 2005The Health Consequences of Involuntary Exposure to Tobacco Smoke: Report of the Surgeon General 2006

“Smoking Ban”

• “Smoking Ban” is not an adequate description

More descriptive….

• “Comprehensive Smoke Free” legislation

• “Smoke Free” Policy

Smoke Free Legislation

• Typically, legislation that eliminates smoking in public places

• The smoker is NOT the medical focus of this type of legislation

(not protecting the smoker from themselves)

• Focus in on reducing injury inflicted on others

Smoke Free Legislation and Heart Attack

Location PopulationChange in Heart Attack

Hospital Admissions

 Helena 68,140 −40%

 Pueblo 698,229 (2counties) −41%

 New York 18,976,457 −8%

 Indiana 239,332 −50%

 Ohio 29,636 −20%

 Saskatoon 202,340 −13%

Communities Similar to Grand Forks

• Pueblo, CO

• Population 103,648

• College Town

• Decrease in Heart Attacks following “smoking ban” 27%

Communities Similar to Grand Forks

• Bowling Green, OH

• Population 29,636

• College Town

• Reduction in Heart Attacks following “smoking ban” 19%

Communities Similar to Grand Forks

• Helena, MT• Population 47,154 • College Town• Reduction in Heart Attack with “smoking

free” legislation 40%• Increase in Heart Attacks following smoke

free legislation repeal 40%

“Smoke Free Legislation” and Heart Attack

• 11 legitimate studies

• Europe, U.S., Canada

• Approx 17% reduction in Heart Attack across all studies

• Approx 195,000 Heart Attacks would be avoided in U.S. annually

• In an age of health care cost containment, can’t disregard