Hindawi Publishing Corporation Journal of Environmental and Public Health Volume 2012, Article ID 589018, 5 pages doi:10.1155/2012/589018 Research Article Association of Indoor Smoke-Free Air Laws with Hospital Admissions for Acute Myocardial Infarction and Stroke in Three States Brett R. Loomis1 and Harlan R. Juster2 1 RTI International, 3040 Cornwallis Road, Research Triangle Park, P.O. Box 12194, NC 27709, USA 2 Bureau of Chronic Disease Evaluation and Research, New York State Department of Health, Corning Tower Room 1084, Empire State Plaza, Albany, NY 12237-0679, USA Correspondence should be addressed to Brett R. Loomis, loomis@rti.org Received 21 December 2011; Accepted 1 May 2012 Academic Editor: Bernard Tanguy Copyright © 2012 B. R. Loomis and H. R. Juster. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To examine whether comprehensive smoke-free air laws enacted in Florida, New York, and Oregon are associated with reductions in hospital admissions for acute myocardial infarction (AMI) and stroke. Methods. Analyzed trends in county-level, age- adjusted, hospital admission rates for AMI and stroke from 1990 to 2006 (quarterly) for Florida, 1995 to 2006 (monthly) for New York, and 1998 to 2006 (monthly) for Oregon to identify any association between admission rates and passage of comprehensive smoke-free air laws. Interrupted time series analysis was used to adjust for the eﬀects of preexisting moderate local-level laws, seasonal variation in hospital admissions, diﬀerences across counties, and a secular time trend. Results. More than 3 years after passage of statewide comprehensive smoke-free air laws, rates of hospitalization for AMI were reduced by 18.4% (95% CI: 8.8– 28.0%) in Florida and 15.5% (95% CI: 11.0–20.1%) in New York. Rates of hospitalization for stroke were reduced by 18.1% (95% CI: 9.3–30.0%) in Florida. The few local comprehensive laws in Oregon were not associated with reductions in AMI or stroke statewide. Conclusion. Comprehensive smoke-free air laws are an eﬀective policy tool for reducing the burden of AMI and stroke. 1. Introduction Substantial evidence has accumulated showing that exposure to secondhand tobacco smoke is a serious and preventable public health hazard [1]. A complex mixture of particles and gases, secondhand smoke is associated with 38,000 deaths per year in the United States from coronary heart disease and lung cancer in nonsmokers [2]. Comprehensive smoke- free air laws successfully reduce secondhand smoke expo- sure among workers in smoke-free establishments [3] and among the general population [4]. A comprehensive review by the Institute of Medicine [5] concluded that there is a causal relationship between secondhand smoke exposure and cardiovascular disease, and smoke-free air laws that ef- fectively reduce exposure to secondhand smoke reduce the likelihood of a cardiovascular event. Three meta-analyses [6– 8] found an average reduction of 11% to 17% in cardiovas- cular hospitalizations or mortality following enactment of a smoke-free air law. This study investigates the impact of smoke-free air laws in three US states—Florida, New York, and Oregon—on county-level rates of hospitalization for acute myocardial infarction (AMI) and stroke. We update a previously pub- lished estimate of reductions in AMI hospitalizations in New York [9] with additional data and provide the ﬁrst estimates of the impact of smoke-free air laws in Florida and Oregon. Florida, New York, and Oregon diﬀer from each other in terms of their population demographics and experiences with smoke-free air laws, providing an opportunity to study the impact of similar laws in diﬀerent settings. Florida