Intended for healthcare professionals


Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study

BMJ 2004; 328 doi: (Published 22 April 2004) Cite this as: BMJ 2004;328:977
  1. Richard P Sargent, attending physican1,
  2. Robert M Shepard, attending physican1,
  3. Stanton A Glantz (glantz{at}, professor of medicine2
  1. 1HealthCare Quality Performance Council, St Peter's Community Hospital, 2475 Broadway, Helena, Montana 59601, USA
  2. 2Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94143-1390, USA
  1. Correspondence to: S Glantz
  • Accepted 4 February 2004


Objective To determine whether there was a change in hospital admissions for acute myocardial infarction while a local law banning smoking in public and in workplaces was in effect.

Design Analysis of admissions from December 1997 through November 2003 using Poisson analysis.

Setting Helena, Montana, a geographically isolated community with one hospital serving a population of 68 140.

Participants All patients admitted for acute myocardial infarction.

Main outcome measures Number of monthly admissions for acute myocardial infarction for people living in and outside Helena.

Results During the six months the law was enforced the number of admissions fell significantly (− 16 admissions, 95% confidence interval - 31.7 to - 0.3), from an average of 40 admissions during the same months in the years before and after the law to a total of 24 admissions during the six months the law was effect. There was a non-significant increase of 5.6 (− 5.2 to 16.4) in the number of admissions from outside Helena during the same period, from 12.4 in the years before and after the law to 18 while the law was in effect.

Conclusions Laws to enforce smoke-free workplaces and public places may be associated with an effect on morbidity from heart disease.


  • Contributors All three authors made a substantial contribution to the conception, design, analysis and interpretation of data, drafting the article and revising it critically for important intellectual content, and providing final approval of the version to be published. RPS and RMS collected the data, and SAG did the statistical analysis and is guarantor.

  • Funding ProtectMontanaKids, a project of the American Cancer Society, American Heart Association, and American Lung Association of the Northern Rockies, with support from the Robert Wood Johnson Foundation. National Cancer Institute Grant CA-61021 and the American Legacy Foundation.

  • Competing interests None declared.

  • Ethical approval St Peter's Community Hospital Institutional Review Board for Human Research.

  • Accepted 4 February 2004
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