Cardiovascular health and economic effects of smoke-free workplaces

Am J Med. 2004 Jul 1;117(1):32-8. doi: 10.1016/j.amjmed.2004.02.029.


Purpose: Smoking is the leading controllable risk factor for heart disease. Only about 69% of U.S. indoor workers are currently covered by a smoke-free workplace policy. This analysis projects the cardiovascular health and economic effects of making all U.S. workplaces smoke free after 1 year and at steady state.

Methods: We estimated the number of U.S. indoor workers not covered by smoke-free workplace policies, and the effects of making all workplaces smoke free on smoking behavior and on the relative risks of acute myocardial infarctions and strokes. One-year and steady-state results were calculated using an exponential decline model. A Monte Carlo simulation was performed for a sensitivity analysis.

Results: The first-year effect of making all workplaces smoke free would produce about 1.3 million new quitters and prevent over 950 million cigarette packs from being smoked annually, worth about 2.3 billion dollars in pretax sales to the tobacco industry. In 1 year, making all workplaces smoke free would prevent about 1500 myocardial infarctions and 350 strokes, and result in nearly $60 [corrected] in savings in direct medical costs. At steady state, 6250 myocardial infarctions and 1270 strokes would be prevented, and $279 million [corrected] would be saved in direct medical costs annually. Reductions in passive smoking would account for 60% of effects among acute myocardial infarctions.

Conclusion: Making all U.S. workplaces smoke free would result in considerable health and economic benefits within 1 year. Reductions in passive smoking would account for a majority of these savings. Similar effects would occur with enactment of state or local smoke-free policies.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Cost of Illness
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / economics*
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / prevention & control
  • Public Policy
  • Smoking / adverse effects
  • Smoking / economics*
  • Smoking Cessation / economics*
  • Smoking Prevention
  • Stroke / economics*
  • Stroke / epidemiology
  • Stroke / prevention & control
  • Tobacco Smoke Pollution / adverse effects
  • Tobacco Smoke Pollution / economics
  • United States / epidemiology
  • Workplace* / economics
  • Workplace* / legislation & jurisprudence


  • Tobacco Smoke Pollution