title: The effect of a statewide smoking ordinance on acute myocardial infarction rates.
abstract: BACKGROUND
  Public smoking ordinances may reduce acute myocardial infarction events. Most studies assessed small communities with reported reductions as high as 40%. No reduction or smaller reductions were found in countrywide studies; less is known about the impact of statewide ordinances. We previously demonstrated identical 27% reductions in acute myocardial infarction hospitalizations in 2 Colorado communities after enactment of strict smoking ordinances. Subsequently, on July 1, 2006, a statewide ordinance went into effect. We sought to determine the impact of this legislation on acute myocardial infarction hospitalization rates.
  
  
  METHODS
  Hospital admissions for a primary acute myocardial infarction diagnosis were examined from 2000 to 2008. Poisson regression models were fit to the monthly events from January 1, 2000, to March 31, 2008. The final model included a quadratic trend over time, harmonic terms, and a post-ordinance effect. The model was adjusted temporally for population changes, using population estimates as an offset variable.
  
  
  RESULTS
  A total of 58,399 unique acute myocardial infarctions were recorded during the study period. No significant reduction in acute myocardial infarction rates was observed post-ordinance (relative risk, 1.059; 95% confidence interval, 0.993-1.131). However, a steep decline in acute myocardial infarction rates was noted from 2000 to 2005 just before enactment. There were 11 strict, local smoking ordinances in effect within Colorado before enactment of the statewide ordinance. After excluding these communities, the findings were similar (relative risk, 1.038; 95% confidence interval, 0.971-1.11).
  
  
  CONCLUSIONS
  Although local smoking ordinances in Colorado previously suggested a reduction in acute myocardial infarction hospitalizations, no significant impact of smoke-free legislation was demonstrated at the state level, even after accounting for preexisting ordinances.
authors.affiliation: Department of Medicine, University of Colorado Health Sciences Center, Aurora, Colo.
authors.forename: Paul
authors.initials: P
authors.lastname: Basel
authors.affiliation: Denver Health and the Rocky Mountain Poison and Drug Center, Denver, Colo.
authors.forename: Becki Bucher
authors.initials: BB
authors.lastname: Bartelson
authors.affiliation: Denver Health and the Rocky Mountain Poison and Drug Center, Denver, Colo.
authors.forename: Marie Claire
authors.initials: MC
authors.lastname: Le Lait
authors.affiliation: Department of Medicine, University of Colorado Health Sciences Center, Aurora, Colo; Denver Health and the Rocky Mountain Poison and Drug Center, Denver, Colo; Colorado Prevention Center, Community Health, Aurora, Colo. Electronic address: mkrantz@dhha.org.
authors.forename: Mori J
authors.initials: MJ
authors.lastname: Krantz
mesh_terms: D000368:Aged; D003120:Colorado / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D016017:Odds Ratio; D011640:Public Policy / Q000331:legislation & jurisprudence*; D012107:Research Design; D012306:Risk; D012907:Smoking / Q000453:epidemiology / Q000331:legislation & jurisprudence*; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence*
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Acute myocardial infarction; Secondhand smoke; Smoking ordinance