title: Impact of a comprehensive smoke-free law following a partial smoke-free law on incidence of heart attacks at a rural community hospital.
abstract: BACKGROUND
  Secondhand smoking (passive smoking) is associated with many negative health effects, primarily respiratory and cardiovascular diseases. Approximately, 46,000 deaths from cardiovascular disease are associated with secondhand smoke exposure annually in the United States, which is roughly 150 deaths in North Dakota. Studies show that passage of smoke-free laws at the community level can reduce the incidence of heart attack.
  
  
  METHODS
  We conducted a retrospective review of electronic medical records of patients admitted for heart attacks 4 months prior (April 15, 2010 through August 14, 2010) to implementation of the smoke-free ordinance and 4 months following (August 15, 2010 through December 14, 2010) implementation of the comprehensive smoke-free ordinance in Grand Forks, ND, United States.
  
  
  RESULTS
  We found an association between the heart attack rate and implementation of the comprehensive smoke-free law. The heart attack rate prior to the ban was 0.5% (83/16,702) compared with 0.3% (63/18,513) after the ban (p = .023). Thus, the rate of heart attacks decreased 30.6% and number of heart attack admissions decreased 24.1%, from 83 to 63, after implementation of a comprehensive smoke-free law.
  
  
  CONCLUSIONS
  We found an implementation of the comprehensive smoke-free law was associated with a decrease in the heart attack rate. The heart attack rate decreased 30.6%. Our finding was similar to previous community level smoke-free law implementation studies and notable for the change going from a partial smoke-free law to a comprehensive smoke-free law.
authors.affiliation: Department Family and Community Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202-9037, USA. eric.l.johnson@med.und.edu
authors.forename: Eric L
authors.initials: EL
authors.lastname: Johnson
authors.forename: James R
authors.initials: JR
authors.lastname: Beal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006764:Hospitals, Community; D006780:Hospitals, Rural; D006801:Humans; D015994:Incidence; D009111:Local Government; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D009658:North Dakota / Q000453:epidemiology; D012189:Retrospective Studies; D012424:Rural Population; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000331:legislation & jurisprudence*
chemical_list: D014028:Tobacco Smoke Pollution