Clean Indoor Air Acts reduce the burden of adverse cardiovascular outcomes

Public Health. 2012 Apr;126(4):279-85. doi: 10.1016/j.puhe.2012.01.005. Epub 2012 Feb 17.


Objectives: Second-hand smoke is associated with an increased risk of adverse health outcomes, such as acute myocardial infarction (AMI) and coronary heart disease (CHD). At present, 38 US states/territories have enacted Clean Indoor Air Acts (CIAAs). The purpose of the current study was to compare the prevalence of self-reported health outcomes on a state/territory-wide level 1 year prior to CIAA implementation and at least 1 year after CIAA implementation for each respective state/territory.

Study design: Pre-test, post-test study.

Methods: Seventeen states/territories with pre- and post-CIAA data were included in the current study. All data (AMI, CHD/angina, former and current smoker rates) were collected from the Behavioral Risk Factor Surveillance System (BRFSS) in the year prior to each state/territory's respective CIAA implementation (baseline) and 2009 (most recent year with BRFSS data).

Results: Between baseline and 2009, 10 states/territories (58.8%) had a significant decrease in the prevalence of CHD/angina or AMI, 11 states/territories (64.7%) had a significant decrease in the prevalence of current smokers, and three states/territories (17.7%) had a significant decrease in the prevalence of both current and former smokers. Six states/territories (35.3%) had a significant increase in the prevalence of former smokers.

Conclusions: State/territory-wide CIAAs are beneficial in reducing adverse cardiovascular health outcomes in the short term. The prevalence of AMI, CHD/angina, and former and current smokers decreased significantly following CIAA implementation. The current study adds further support for the passage and implementation of CIAAs on a state/territory-wide level. However, further studies need to be conducted to assess the long-term outcomes of CIAAs.

MeSH terms

  • Adult
  • Aged
  • Air Pollution, Indoor / legislation & jurisprudence
  • Air Pollution, Indoor / prevention & control
  • Behavioral Risk Factor Surveillance System
  • Coronary Disease / epidemiology*
  • Coronary Disease / prevention & control
  • Humans
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / prevention & control
  • Outcome Assessment, Health Care
  • Prevalence
  • Public Policy / legislation & jurisprudence*
  • Tobacco Smoke Pollution / adverse effects*
  • Tobacco Smoke Pollution / legislation & jurisprudence*
  • United States
  • Young Adult


  • Tobacco Smoke Pollution