Stubbing out smoking in all American workplaces would save more than 2,420 lives and $280 million

Stubbing out smoking in all American workplaces would prevent hundreds of deaths – primarily among those exposed to secondhand smoke – and save tens of millions of dollars in health-care costs each year, a Stanford University School of Medicine researcher has found in a new study.

Making workplaces smoke-free would prevent an estimated 610 stroke and heart attack deaths in the first year alone, mostly among non-smokers. Over seven years, the study projects that more than 2,420 lives and $280 million would be saved – not including the costs associated with other smoking-related illnesses or lost productivity.

“The most surprising finding was that the majority of the effects would occur in people who are passively exposed to secondhand smoke,” said Michael Ong, MD, PhD, a fellow at Stanford’s Center for Primary Care and Outcomes Research and at the Veterans Affairs Palo Alto Health Care System. He collaborated on the study with Stanton Glantz, PhD, professor of medicine at UC-San Francisco and director of its Center for Tobacco Control Research and Education.

Non-smokers accounted for 60 percent of the reduction in heart attacks, even though the relative risks of such occurrences are much lower for those exposed to secondhand smoke than for smokers. “Because there are so many more people who are still being exposed to secondhand smoke in their workplaces, all those little benefits add up to a large number,” Ong explained.

For the study, Ong ran a computer simulation based on survey data from 1999 and 2000 showing the number of Americans working indoors in non-smoke-free workplaces (about 31 percent), and smoking prevalence. They also drew on previous findings about the percentage of smokers who will quit if their workplace goes smoke-free. Combining this with information about the relative risks of heart attack and stroke for smokers, non-smokers and those exposed to secondhand smoke, the researchers were able to estimate the nationwide health toll of smoking in the workplace for the first time. The results appear in the July 1 issue of the American Journal of Medicine.

Smoking causes one out of every six deaths from cardiovascular disease and is the leading preventable risk factor for such disease.

The simulation showed a national smoke-free workplace policy would cause 1.3 million smokers to quit (previous studies have shown that nearly 15 percent of smokers will quit if they can’t smoke at work). These quitters would have 360 fewer strokes and 630 fewer heart attacks in the first year, preventing 320 deaths. Those who continue to smoke would average 1.3 fewer cigarettes per day, adding up to 401 million fewer packs nationwide per year. Among those currently exposed to secondhand smoke, a smoke-free policy would prevent 910 heart attacks, 210 of them fatal.

The study probably underestimates the benefits of smoke-free workplaces for several reasons, Ong said. First, it does not account for the reduced number of strokes among those exposed to secondhand smoke.

The pair also did not model the effects of a smoke-free workplace policy on rates of lung disease, although they plan to do so in the future. “Lung cancer and chronic obstructive pulmonary disease take a long time to develop – over 10 years – and the long timeline complicates any analysis,” Ong explained. Also not included were the health effects on those who continue to smoke, or potential savings from increased productivity.

Another reason the study probably underestimates the benefits of smoke-free workplaces is that the 15 percent quitting rate was drawn from studies of white-collar workers. Previous studies have shown that blue-collar workers are more likely to be smokers and more apt to quit when they can’t smoke at work.

Although the potential health-care savings from a smoke-free workplace are impressive – $49 million from the reduction in heart attacks and $12 million from fewer strokes in the first year – they pale in comparison to the $2.3 billion in pretax revenue that the tobacco companies would lose because of decreased cigarette consumption. For this reason, Ong believes it is unlikely that all workplaces would go smoke-free at once.

“Action at the state or national level is least likely to provide strong smoke-free legislation due to the massive ability of the tobacco industry to make campaign contributions and hire well-connected lobbyists,” he wrote in the study. “Such legislation is generally best done at the local level, where public health forces are relatively strong and the tobacco industry’s influence is relatively weak.”