Connecting Policy Change and Health Outcomes: Smoke-Free Laws and Blood Pressure

Photo of Robert A. Harrington, M.D., FAHA, President-elect, American Heart AssociationRobert A. Harrington, M.D., FAHA, President-elect, American Heart Association

It’s not exactly a news flash that tobacco smoke hurts your health.

But now, a study sheds some light on potential reasons why smoke-free policies in cities, states and counties are associated with benefits such as reduced rates of hospitalization for cardiovascular diseases. The study examined the association of smoke-free policies with blood pressure, a key risk factor for heart disease and stroke.

Researchers, whose findings were published in Journal of the American Heart Association, found that non-smokers who had access to smoke-free restaurants, bars and workplaces had lower systolic blood pressure readings than those who lived in areas without smoke-free laws.

The researchers didn’t find a consistent association between smoke-free policies and diastolic blood pressure, or between smoke-free policies and hypertension. But the study’s results are still meaningful because even small reductions in systolic blood pressure at an individual level may reduce cardiovascular risk across a population. And increases in blood pressure, even below the threshold for hypertension, have been associated with worse CVD outcomes.

The researchers linked data from approximately 2,600 participants in the Coronary Artery Risk Development in Young Adults (or CARDIA) study to state, county and local smoke-free policies. CARDIA enrolled a geographically diverse group of non-smoking black and white adults in the mid-1980s and conducted follow-up exams over 30 years.

Earlier this year, the same group of researchers published findings, also from the CARDIA cohort, that 100% smoke-free policies are associated with lower risk of cardiovascular disease among middle-aged adults. In that study, smoke-free policies in restaurants and bars were associated with about a 25 percent lower risk of having a cardiovascular incident, such as a heart attack or stroke, and such policies in workplaces were linked to a 46 percent lower risk.

The importance of policy changes in improving health

Educating people about the harms of tobacco smoke exposure are important, but it isn’t enough on its own. Policy, systems, and environmental changes are critical supports to individuals’ efforts to avoid second-hand smoke.

The American Heart Association advocates for a 100 percent indoor smoke-free environment and supports comprehensive smoke-free air laws that apply to all indoor workplaces and public environments. But a large part of the U.S. population still isn’t covered by smoke-free policies.

Now that smoke-free policies have been in many places for years, it’s time to study their association with health outcomes. More findings like the ones published today could strengthen our advocacy efforts to cover more of the U.S. with smoke-free policies. I think that we owe it to our hearts.