It’s been a while since we debated smoking bans in the workplace, restaurants, and bars.
A study just released in the Canadian Medical Association Journal examined the rates of hospitalization before, during and after a smoking ban was introduced in Toronto.
In summary, the study found that hospitalizations for cardiac and respiratory problems are down 39 and 32 percent respectively from before the smoking ban to after.
The smoking ban in Toronto was implemented in 3 stages, starting with the workplace, then restaurants, then in bars.
Obviously not all of the decrease can be attributed directly to workplace and restaurant smoking; the study noted that the decline was very slight before/after the ban in bars. Increases in cigarette taxes are also a factor.
So what do you think? Ready to just dismiss this as insignificant and reject a direct link? Feel like using this to show how UHC causes the government to restrict individual freedoms?
I’ve always been in favour of smoking-bans, so I see this as justifying my position.
I guess that 39% could have come from having the personal responsibility to avoid smoke filled restaurants.
I suspect that the result is correct, but it’s not a scientifically foregone conclusion yet. It’s very difficult to control for other factors, with something complicated like a city. Do similar studies in other cities, in different circumstances and at different times, and then we’ll talk.
Okay, just so I don’t come running back too soon, exactly how many cities does this have to be replicated in before you’ll talk?
Were you aware that they compared their results with two other cities that did not implement a smoking ban? From what I can tell, they had a hard time finding “control cities” because during the time frame most municipalities were implementing some form of anti-smoking legislation.
And they also compared their results against diseases not known to be associated with smoking? As a way to show that it wasn’t a situation where hospital admissions of all diseases were dropping over the time frame.
I’m also not sure you could replicate this study in the US because of the complexity of the US health care system. How would you correct for factors such as changes in health insurance policies, changes in jobless rates, changes in median income, all factors in determining when and how someone will receive health care in the US. And all factors that could change dramatically over the course of 7 years.
Sounds like what the climate control people did too, did you really expect that they would post widely different results of the various citys that banned smoking, if it contradicted what they say.
Yes, that’s exactly what I would expect they would do, since this was published research. They did not “hide” data from cities that contradicted their results.
I grew up in Toronto, in my twenties when the smoking ban came into effect. The result was devastation across the social scene, with some bars doing okay and others fading away due to lack of customers. Toronto itself, was not really a smoking city. By the time the second ban had come into effect, only night clubs , bars and eateries were the last bastions of when you could go out and enjoy a smoke over a pool table or meet up with the women, or have a beer on a patio on a summer night.
You would think, that with the studies that had been done and published at the time, that given a year at most , the scene would have recovered with the “non-smoker” who would finally be able to “breathe easier”. That did not happen, the people that went to bars before the ban, still went to the bars, we just could not smoke without some bouncer giving us the evil eye, non smoking patrons , pre ban , just never became a presence in the same way.
Today might be a different scene, but its not my Toronto.
How do you control for other events that occurred during that time? For example, I read somewhere that heart disease has decreased a full 40% in the last ten years due to new technologies that pre-screen for certain conditions and a doctor can get you on meds to treat the condition before having a heart attack.
Also, more people are cutting out the carbs and trans-fats, and giving up smoking altogether.
It’s hard to pinpoint and say that this smoking ban in these areas are what caused the decline.
Well doesn’t he say that they look at other cities that didn’t ban smoking and compared the decline? Surely they’ll have the same impact from better healthcare.
In England and Wales heart disease apparently dropped by 10% the year afterwards, I think its up to you to show another medical advancement that had the same affect.
11% in Italy after smoking bans were enacted there - in a different year to the UK. So you would need something else that explains the drops in both these countries at separate times. I admit correlation is not causation but sometimes its a pretty big hint.
The positive health effects recorded after institution of public smoking bans are suggestive if not conclusive.
The quality of that evidence is better, however than the anecdotal reports cited by anti-smoking ban advocates claiming that such bans have caused lots of bars/restaurants to shut down. What evidence we have on that score suggests that public smoking bans have had a neutral or mildly positive impact on business. For example:
*"When Ohio adopted its ban in 2006, “there was a lot of concern that [bar and restaurant owners] would lose business, but none of our members have said that the ban has impacted them negatively,” said Jarrod Claybaugh of the Ohio Restaurant Association.
Instead, the smoking cessation has encouraged nonsmokers, once fearful of smoke’s effect on their health and dry-cleaning budgets, to enjoy nightlife and visit bars and restaurants more often, he said.
Businesses in cities and states around the country – Michigan’s will become the 38th state ban – have noticed a similar effect."*
And I’ve seen similar data for bar patronage in Boston following institution of its smoking ban.
Maybe Toronto was radically different :dubious:, but I’d have to see something better than anecdotes to demonstrate that.
I know of one bar closing blamed on Houston’s smoking ban. It was a fine place offering live music & food better than the average bar. But I think the cook’s sudden death also contributed. Restaurants & bars tend to have shortish survival curves anyway. Houston’s still got several thriving bar scenes & a ton of good restaurants. (Smoking is still allowed on patios; due to Houston’s climate, they are usable most of the year.)
The bar scene is definitely different from the one I remember from my twenties. Scenes change & people change. At least those young whippersnappers are getting wasted on Washington Avenue–& not on my lawn!
How sad for you that your social life was somewhat curtailed. I guess that’s why you’re upset at a study that shows that the ban reduced serious hospitalizations, and want to deny that it is accurate.
Do you have any actual studies that show that “the scene” is measurably poorer, or is it simply all about you?
My anecdote to add to the discussion is that if they had banned smoking in nightclubs, bars, and pubs back in my drinking days, I would have been ecstatic. I can imagine that there is a bit of a rebound period, in which the non-smoking majority realizes that it’s safe to go back to bars, but after that, I can’t imagine that business suffers from smoking bans.
OK, I don’t have enough experience in epidemiology to say for sure, but this combined with the studies in Italy and the UK does seem significant. Like I said, I’m not surprised, I just care enough about scientific rigor to not jump to conclusions too hastily.
To add my own opinion, I would have enjoyed my trip to Ireland much more had it been a couple of years later, since all the best entertainment was in smoke-filled pubs.
Not to answer for Ruken but “smokers smoking less” was the first thing that popped into my head as well. I smoked when Connecticut introduced a ban in bars. Before the ban, when I went out to drink/play pool I smoked about 20 - 30 cigarettes over the course of the evening. After the ban, I maybe smoked 5 in that same time period.
My anecdotal observations support the notion that most smokers were affected by bans in the same way - they simply smoke less. I imagine smoking less has a great benefit on one’s health. I also wonder if less smoking contributes to less drinking and overeating while at a bar as well.
One of the reasons I didn’t think it was entirely relevant was that there are factors that more directly contribute to cigarette sales. Changes to prices and taxation are the main ones. But Canada also has a huge problem with imported and smuggled cigarettes. So it’s entirely possible that sales could drop over a time frame, but simply means that more people are getting them from the US. A much more difficult factor to directly target. The comparative example within the study would be to suggest that more people from Toronto are opting to go to the US for treatment. Driving/flying/boating to the US for smokes is a lot easier.
I haven’t seen the actual data yet, and the only thing online was this graph from one of the appendices, comparing the Toronto results with the control cities: http://www.cmaj.ca/cgi/data/cmaj.091130/DC1/3
I get a very different read from this graph.
The Tuscany study, which I believe came out this past winter (January?) concluded there was no statistically significant difference in AMI rates before and after a smoking ban was introduced, and the Tuscany study used both linear and non-linear trends to arrive at their conclusions. [There was a 1 percent increase in AMIs the year following the ban, but that percentage is so small that one cannot draw any conclusions from that. It’s just natural variance.]
We’ve been finding these issues with the various analyses; in some places, rates of specific heart disease cases fall after a smoking ban is implemented. In other places they go up despite the implementation of a ban. Short term meta analysis have their weaknesses. Within any given population, rates will rise and fall from year to year.
Then there’s the question of how much of the reduction in various heart disease is due to better/different diagnostic techniques over time. And, certainly, the increasing use of statins has had a dramatic impact as well. Just sayin’.
I’ve heard that smoking actually decreases hospitalization in a population, because fewer smokers spend enough years as geriatric patients to populate hospitals. Of course, this would take a long time to show up.
I read about a study on the health care cost effects of something else, I think drinking, that included some other studies on the side to evaluate some of the methodology. One of these was smoking. The idea was that obviously health care would cost more when there was more smoking. But the study found the opposite, throwing into question the methodology they meant to confirm. They had to dig deeper into this question, and found that most people spend a giant share of their lifetime health care money in the last years of old age, but smokers made it there less often. Of the different ways of dying, the ones enhanced by smoking tend not to be very expensive ones. Maybe you drop dead of a heart attack in your 60s or 70s, or maybe its a few months of chemo and maybe a lung removal, but you don’t usually spend years in bed.
