No-smoking laws in Colorado led to a drop in the number of ambulance calls to public locations in Gilpin County, but not to casinos, which were exempt. When no-smoking laws were extended to casinos, ambulance calls to casinos dropped. Researchers say the smoking ban in casinos limited second-hand smoke exposure to nonsmokers and may have encouraged some smokers to quit. American Heart Association CEO Nancy Brown calls on more states and cities to pass strong smoke-free laws that include casinos.
When smoking was banned from casinos in Colorado, ambulance calls to casinos in Gilpin County dropped about 20 percent, according to research reported in the American Heart Association journal Circulation.
The drop in calls from casinos was similar to drops in ambulance calls from elsewhere two years earlier when Colorado banned smoking everywhere but casinos.
How did the smoking ban lead to a reduction in ambulance calls? Partially by eliminating exposure to secondhand smoke, said Stanton Glantz, Ph.D., the study's lead author.
"Inhaling secondhand smoke increases the chances of blood clots than can block arteries and makes it more difficult for arteries to expand properly, changes that can trigger heart attacks," said Glantz, director of the Center for Tobacco Control Research and Education and professor of medicine in the division of cardiology at the University of California, San Francisco. "The calls may also have decreased due to smokers not being able to smoke in the casinos, thus avoiding the immediate toxic effects of smoke on their blood and blood vessels and because some people quit smoking."
For this study, the first to examine the health impact of smoking bans in casinos, researchers focused on the number of ambulance calls in Gilpin County, Colorado, a tourist destination with 26 casinos -- the largest concentration in the state.
Smoking was banned from public locations, including workplaces, restaurants and bars in Colorado in 2006, and ambulance calls to those locations went down 22.8 percent. Casinos, however, were exempt from the ban and their ambulance calls remained about the same.
Then, in 2008, smoking was extinguished at the casinos, too, and ambulance calls there dropped by 19.1 percent, while there was no further change at the other facilities.
"The fact that there were changes only at the time the law changed in both venues is strong evidence that the law is what caused the change in ambulance calls," according to Glantz.
"Casinos are often exempted from legislation mandating smoke-free environments, putting employees and patrons at risk for heart attacks, strokes, asthma attacks and other adverse events triggered by secondhand smoke," Glantz said. "The message to policymakers is clear: stop granting casino exemptions. They lead to a substantial number of people being sent to the hospital, often at taxpayer expense, something that is completely preventable."
As of spring 2013, 20 states have laws that require smoke-free gambling facilities, while another 28 states have state-regulated gambling but only partial or no smoke-free laws, Glantz said. These laws do not cover casinos on American Indian and Alaska native soil; only a few of those are smoke-free, he said.
"For decades the American Heart Association has strongly supported laws that require indoor public places and workplaces to be smoke-free," said Nancy Brown, CEO of the American Heart Association. "We applaud Colorado lawmakers for protecting casino workers and patrons and encourage more states and Native American tribes to follow suit."
The study did not have information on outcomes of the ambulance calls or detailed information on patients, so researchers could not differentiate events related to smoking or secondhand smoke from other emergencies.
"My advice for people with heart disease is to make your home smoke free and don't visit casinos or other venues with secondhand smoke," Glantz said.
- S. A. Glantz, E. Gibbs. Changes in Ambulance Calls After Implementation of a Smoke-Free Law and Its Extension to Casinos. Circulation, 2013; 128 (8): 811 DOI: 10.1161/CIRCULATIONAHA.113.003455
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