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Using chief complaint data to evaluate the effectiveness of a statewide smoking ban


In November 2006, Ohioans supported a statute that set into law a requirement that all public places, and places of employment in Ohio prohibit smoking.1 The law took effect in December 2006; however, the rules for implementation were not finalized until June 2007. The primary purpose of the law was to protect employees in all workplaces from exposure to environmental tobacco smoke. When determining how best to evaluate the health impact of a smoke-free law as it relates to secondhand smoke exposure, most studies have reviewed the incidence of heart attacks or AMIs. In the 2006 Surgeon General’s Report, ‘The Health Consequences of Involuntary Exposure to Tobacco Smoke,’2 secondhand smoke exposure is causally associated with cardiovascular events, including AMI. The Institute of Medicine also released a report in 2009 from a meta-analysis, ‘Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence,’3 of 11 epidemiologic studies, reviewing the incidence of acute coronary events following the passing of a smoke-free law. Each of the 11 studies showed a decrease in heart attack rates after implementation of smoke-free laws. The purpose of this study was to evaluate this relationship in Ohio.


The objective of this study, after completion of the preliminary analysis, was to evaluate whether or not the smoke-free law in Ohio has made a positive change in reducing the effects of secondhand smoke exposure by comparing syndromic surveillance data (trends for emergency department, and urgent care chief complaint visits), related to heart attack and/or acute myocardial infarction (AMI) before and after the smoking ban.


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