Effect of public smoking ban in Helena, Montana: Author's reply

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7452.1380 (Published 03 June 2004) Cite this as: BMJ 2004;328:1380
  1. Stanton A Glantz, professor of medicine (glantz{at}medicine.ucsf.edu)
  1. Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94143-1390, USA

    EDITOR—We present a simple observation: when Helena, Montana, implemented a smoke free law admissions for myocardial infarction dropped significantly, then rebounded when the law was suspended through a lawsuit by tobacco industry allies.

    Kabat makes the usual arguments of scientists who have worked with the tobacco industry.13 Rather than taking our paper at face value, he tells us we should have done a different study. He ignores the evidence (cited in our paper) that exposure to smoke falls when such laws are in effect. He ignores our discussion and the accompanying commentary by Pechacek and Babb, which provided the biological explanation of why the rapid drop we observed would be expected. He also failed to disclose his ties to the tobacco industry.3

    Yes the numbers are small because, as we point out in the paper, the fact that Helena is a small isolated community is what made the study possible. Small numbers make it harder to detect an effect when it exists; the fact that we detected a statistically significant drop in admissions when the law was in effect despite the small numbers is a strength, not a weakness, of the study.

    Surindran raises interesting questions that will require larger studies to answer. As we said in our paper, we believe that the effect we found was due to a combination of much lower exposure to second hand smoke and people stopping smoking because of the smoke free environments.4 We agree with Surindran that our results indicate that smoke free policies would make a difference for non-smokers.


    • Conflict of interests None declared


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