title: Changes in ambulance calls after implementation of a smoke-free law and its extension to casinos.
abstract: BACKGROUND
  Casinos are often exempted from legislation mandating smoke-free environments, potentially putting employees and patrons at risk for adverse events triggered by secondhand smoke exposure.
  
  
  RESULTS
  We used an interrupted time series analysis of ambulance calls not originating and originating from casinos in Gilpin County, Colorado, a rural Colorado county with a large casino presence, from January 2000 through December 2012 to determine whether there was a change in ambulance calls originating from casinos when a state smoke-free law was extended to include them. Initial implementation of the smoke-free law (which exempted casinos) was followed by a significant 22.8% drop in ambulance calls (incidence rate ratio, 0.772; 95% confidence interval, 0.685-0.871; P<0.001) from locations other than casinos but no significant change in calls from casinos (P>0.9). The law requiring smoke-free casinos taking effect was followed by a 19.1% (incidence rate ratio, 0.809; 95% confidence interval, 0.724-0.905; P<0.001) drop in ambulance calls from casinos but no change in calls originating outside casinos (P>0.1).
  
  
  CONCLUSIONS
  The observation that ambulance calls not coming from casinos dropped when the smoke-free law was initially implemented (excluding casinos) with no change in calls from casinos, followed by a comparable drop in calls originating from casinos (but not calls from elsewhere) when the law was extended to casinos, suggests that the important effects of secondhand smoke exposure occur acutely. These results also suggest that exempting casinos from smoke-free laws means that more people will suffer medical emergencies.
authors.affiliation: Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA 94143, USA. glantz@medicine.ucsf.edu
authors.forename: Stanton A
authors.initials: SA
authors.lastname: Glantz
authors.forename: Erin
authors.initials: E
authors.lastname: Gibbs
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003120:Colorado / Q000453:epidemiology; D005715:Gambling; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D061845:Smoke-Free Policy; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D017132:Workplace
chemical_list: D014028:Tobacco Smoke Pollution
keywords: cardiovascular diseases; emergency medical services; public policy; risk factors; smoking; tobacco smoke pollution; utilization
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