• Decline in smoking leads to drop in coronary heart disease deaths

    May 2008

    How effective are tobacco-free initiatives? To find out, a group of Harvard researchers recently analyzed data over a 10-year period following the implementation of the Massachusetts Tobacco Control Program (MTCP). The sweeping statewide anti-tobacco program was authorized by a 1992 ballot initiative and funded by a special cigarette tax.


    The U.S. Public Health Service’s “Healthy People 2010” initiative has set a goal of reducing smoking prevalence among adults to less than 12 percent. Currently, according to the health service, 23 to 26 percent of Americans smoke.  


    The researchers found that between 1993 and 2003 a 29 percent decline in smokers in Massachusetts coincided with a 31 percent drop in coronary heart disease(CHD) deaths in persons age 25 to 84. In an article published in the August 2008 issue of the American Journal of Public Health, Zabubair Kabir, MD, PhD, and his colleagues report that 425 fewer CHD deaths in 2003 can be attributed to this reduction in smoking. The smoking rate dropped from 20.5 percent in 1993 to 14.5 percent in 2003, and if the trend continues, they predict it will be 12 percent by 2010.

    The U.S. Public Health Service’s “Healthy People 2010” initiative has set a goal of reducing smoking prevalence among adults to less than 12 percent. Currently, according to the health service, 23 to 26 percent of Americans smoke.

    Conducting the study

    The researchers used a validated CHD mortality model called IMPACT to determine the effect of reduction in smoking on heart disease deaths. Smoking prevalence in Massachusetts was obtained from state health data and the U.S. census. Only regular smokers who smoked every day were included in the analysis.

    Using 1993 as a baseline, they found approximately 3,030 fewer CHD deaths than expected occurred in 2003 and 14 percent of that number was the result of a decline in smoking prevalence. They note that previous studies have shown that more than half the decline in CHD deaths can be attributed to improvements in three major risk factors: cholesterol, smoking and blood pressure.

    However, the researchers warn that “gross budgetary cuts” in the Massachusetts program could reverse the decline in CHD deaths and result in 100 more deaths between 2005 and 2010. They also recommend that other states implement comprehensive tobacco control programs similar to that of Massachusetts.

    Effectiveness of tobacco control programs

    According to a February 2008 report by the Centers for Disease Control and Prevention (CDC), tobacco control programs are directly related to a decline in smoking. The study, published in the American Journal of Public Health, found that declines in adult smoking prevalence were directly related to increases in state per-person investments in tobacco control programs. Nevertheless, overall funding for state tobacco control programs declined by 28 percent between 2002 and 2005.

    Help for quitting smoking

    According to the 2006 U.S. Surgeon General’s Report, secondhand smoke contains at least 250 chemicals that are known to be toxic. There is no safe level of exposure to second-hand smoke. It is the third leading cause of preventable death in the United States and causes heart disease and lung cancer in nonsmoking adults. An estimated 3,000 nonsmokers die from lung cancer annually and more than 46,000 nonsmokers die from heart disease every year in the United States due to secondhand smoke exposure.

    Currently in Kentucky, 19 communities, including Lexington-Fayette County, have enacted smoke-free laws or regulations. The most comprehensive ordinances/regulations include smoke-free workplace and smoke free enclosed public place laws.


    Secondhand smoke contains at least 250 chemicals that are known to be toxic.  


    Along with legislating smoking bans, effective tobacco control programs also provide support for smoking cessation. The American Lung Association’s Freedom from Smoking program addresses psychological and behavioral addictions to smoking and strategies for coping with urges to smoke. Such behavior-change programs can be combined with nicotine replacement products and non-nicotine pills such as Zyban® and Chantix® to help smokers quit.

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Page last updated: 5/22/2014 3:26:43 PM
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    What the news means for you

    Smoking bans do lead to declines in usage rates

    Joseph Conigliaro, MD, MPH, FACP
    Internal Medicine

    Wright, Heather, MDThe results of the Massachusetts Tobacco Control program are just what I would have predicted. This study is important because it proves you can implement population-based interventions such as tobacco control. Changing the price of cigarettes, for example, has had an impact on smoking.

    I’m confident that because of the smoking bans put in place in Fayette County and other communities, in five to 10 years we will see a measurable difference in the rate of smoking and its outcomes in Central Kentucky.


    “One of the major obstacles I find to getting people to quit smoking is that many don’t believe it’s important enough.” 


    As of November 20, 2008, smoking and other forms of tobacco use are not allowed in any UK HealthCare facilities or on the grounds. We have joined the Kentucky Hospital Association’s Tobacco-free Healthcare Collaborative, a group of health care providers in Lexington and surrounding counties that have committed to being tobacco free.

    In the past, people have been allowed to smoke in certain outdoor areas of UK HealthCare grounds. We have also given permission for patients to go outside and smoke in shelters. This is a double standard. It flies in the face of what we are trying to do. Tobacco is a health hazard and it affects the health of others. Based on the mission of UK HealthCare, it’s our right to ban tobacco.

    What we are doing is in line with the way the rest of the country is going. It is inconvenient and uncomfortable for some people, but we do whatever we can to minimize that discomfort and inconvenience.


    “One excellent resource that is free to callers is the toll-free number – 1-800-QUIT-NOW. You can talk to a real person, not a recording, and get help to quit smoking.” 


    While we are aggressive in enforcing the tobacco ban, we make every effort to balance discipline and be compassionate and understanding about why people need to smoke. That is why the policy is coupled with resources to help people.

    Support for smokers

    We have a lot of concern for the families of patients. If someone is a heavy smoker and his or her child is in the Kentucky Children’s Hospital, that person wants to stay with their child and is under a lot of stress. We will work on ways and means to get such people through their ordeal while they are here.

    Nicotine patches and gum are available at a reduced rate for family members. Patients already have access to nicotine patches to help them through their hospital stay without nicotine withdrawal. It’s a necessary intervention.

    All of our staff is trained on this new policy. The medical staff knows to ask patients about their tobacco use and assess how much the patient smokes. We provide staff with the tools to make sure they recognize people who are in need.

    One of the major obstacles I face in getting people to quit smoking is that many don’t believe it’s important enough. Patient education is the key here. Another dimension is confidence. People realize smoking is bad for them but they just cannot quit. In these cases, help can be provided to increase the person’s confidence and motivation.

    One excellent resource that is free to callers is the toll-free number – 1-800-QUITNOW. You can talk to a real person, not a recording, and get help to quit smoking. You also get a follow-up call. As a physician taking care of patients who don’t have the money to go to a counselor, I find this is a tremendous service.

    Dr. Conigliaro is associate chief medical officer at UK HealthCare and director of the Center for Enterprise Quality and Safety. He is also a professor in the UK College of Medicine.

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