The proposed ordinance will be presented to the board March 21, 2006
Study that Reported a 27% Decline in Heart Attacks in Starkville Due to Smoking Ban Wasn't Actually a Study; Analysis Hasn't Yet Been Conducted
11/25/2009
Remember the study reported widely in the news two weeks ago which purportedly showed that the smoking ban in Starkville, Mississippi resulted in a 27% decline in heart attacks? Well, it turns out that the so-called "study" wasn't a study at all. As I report today, the study has not yet been conducted! Instead, what happened is that the researchers disseminated a pre-determined conclusion about the effect of the smoking ban, without having the patience to wait for the actual data and conduct the analysis. This commentary, which exposes the bias that is unfortunately rampant for some reason in the smoking ban/heart attack studies, appears today on my tobacco policy blog, at: Read. Study that Reported a 27% Decline in Heart Attacks in Starkville Due to Smoking Ban Wasn't Actually a Study; Analysis Hasn't Yet Been Conducted On November 10, I reported on a press release issued by Mississippi State University which claimed that a new study demonstrated that a local smoking ban in Starkville resulted in a 27% decline in heart attacks. According to the press release: "A Mississippi State study released Monday [Nov. 9] shows a 27 percent decrease in heart attacks among Starkville residents since the city passed a smoking ban in 2006. Researchers associated with the university report also are recommending a statewide public ban on smoking. The study by Robert McMillen and Dr. Robert Collins shows fewer heart attacks being treated at the Oktibbeha County Hospital. It focused on Starkville residents in the three-year span after the ban became law, compared to three years prior." The Starkville smoking ban went into effect in May 2006. The researchers found that the rate of heart attack admissions among Starkville residents at the Oktibbeha County Hospital decreased by 27% from the three -year period proceeding the ban (2003 through 2005) to the three-year period following the ban (2006 through 2008). They attribute this decline to the smoking ban. The conclusions in the press release were widely disseminated through the media (example 1; example 2; example 3; example 4). Headlines boasted that: "Study Links Decline in Heart Attacks to Smoking Bans." A summary of the study appeared on the internet, but the actual study itself did not (at least I could not find it). One of the study authors was quoted in the Starkville Daily News as quantifying the precise effect of the smoking ban on reduced heart attacks: "We have saved $750,000." This calculation assumes that all of the 27% decline in heart attacks during the period 2006-2008 was attributable to the smoking ban. The Rest of the Story As it turns out, it appears that there was no study. These were simply preliminary data on hospital admissions in one community. There is a study ongoing in which acute myocardial infarction (heart attack) rates will be compared between communities with and without smoking bans, but those data have not yet been collected. Jacob Grier over at Coffee, Cocktails, and Commentary has discovered, through a communication with one of the authors of the so-called study, that there is no study written up. There is only the 2-page summary, which explains why my attempt to locate the study on the internet was futile. According to Grier, when he asked the "study" authors for a copy of the actual study, all he received was an email from one of the study authors which stated: "The results that we released in our 2 page report are preliminary results from a larger study. The study examine[s] AMI admissions from several communities that have passed smoke-free ordinances, as well as communities that have not. The latter will serve as controls for the purpose of comparison. The hospital in Starkville was the first to provide us with AMI admission data. When we have received data from the other communities in our study we will prepare a manuscript that compares AMI admissions before and after the smoke-free laws were enacted in communities with and without smoke-free laws." In other words, the study has not yet been conducted! As the author admits, the study consists of the following methodology: compare trends in heart attack rates between communities with and without smoking bans. That is an appropriate methodology, as it will control for secular changes that are occurring in heart attack rates. Well, if the study has not yet been conducted, then how can the "authors" issue a press release with the study's conclusion? If ever there was an example of researchers coming to a pre-determined conclusion about their research hypothesis, this is it. Anti-smoking researchers are apparently so eager to communicate favorable findings to the public that they can't even wait to conduct their studies any more. In this case, data from the intervention group was obtained and immediately released, before the data from the control communities could be examined for comparison purposes. As Grier correctly points out, the 27% decline in heart attacks in Starkville doesn't mean anything in the absence of knowledge of what happened in communities without smoking bans. If there were also large declines in heart attacks in those localities, then the observed decline in Starkville was not attributable to the smoking ban. Fortunately, the researchers appear to be aware that they cannot draw such a conclusion without having a comparison group. This is presumably why they are collecting data from a number of communities that did and did not implement smoking bans. However, the researchers did draw such a causal conclusion and they disseminated it widely through a press release. Moreover, they attributed the entire 27% reduction in heart attacks to the smoking ban, and went as far as calculating the cost savings associated with the reduction in heart attacks, concluding that the smoking ban resulted in a $750,000 savings. What exactly is the point of doing the study at this point? The conclusion has already been widely disseminated. If the study is done and the conclusion turns out to have been wrong, are the investigators going to frantically issue press releases urging newspapers to blast headlines on their front pages saying "Never Mind"? It's too late. The conclusion has already been communicated to the public. Anti-smoking groups are already disseminated the results of this "study" themselves and touting it as evidence that smoking bans produce immediate reductions in heart attacks. Although I am myself a strong anti-smoking advocate who supports smoking bans, I have to agree with Jacob Grier when he concludes that: "to go public with results now, before the data is even collected, is a corruption of science for the pursuit of political ends and unfortunately all too typical for today's anti-smoking movement." There is a great deal of bias apparent in these smoking ban/heart attack studies. Perhaps that's why the objective data from all the large population-based analyses do not support the conclusions from the individual studies conducted in small communities. The Institute of Medicine committee wasn't even interested in examining the data from these population-based analyses. The rest of the story is that the anti-smoking researchers down in Mississippi have already come to a pre-determined conclusion about the effects of smoking bans on heart attacks. The study itself is not needed. This is why it's apparently viewed as reasonable to disseminate the conclusions before the study has been conducted. This loss of scientific integrity is becoming all too common in the tobacco control movement these days. Michael Siegel, MD, MPH Professor Department of Community Health Sciences Boston University School of Public Health 801 Massachusetts Avenue, 3rd Floor Boston, MA 02118 617-638-5167 FAX 617-638-4483 Email: mbsiegel@bu.edu
Smoking ban is senseless law Starkville smokers will be standing outside of their favorite restaurants and bars for a long time. Through governmental means better explained in the news article in Tuesday's Reflector, the Starkville Board of Aldermen made the smoking ban ordinance a more permanent law. Usually, this type of lawmaking bothers me.
However, based on my personal observation, it seems clear that the board only wants to represent the views of Starkville citizens on this particular issue. So yes, democracy is working to a certain extent in Starkville, even though that's not necessarily a good thing (for a historical example, see the decision to elect Hitler). Regardless, this article isn't about democracy. A more interesting aspect of this event is the lack of debate from Starkville citizens. I was present at the meeting in which the board first passed the smoking ordinance. Although the anti-smoking crowd was better organized, other citizens still stood up and shared their concerns about the downsides to smoking bans. Apparently, this debate was absent from the recent board meeting. Starkville Mayor Dan Camp specifically offered the opportunity for dissent, yet no one spoke. This could be a hasty estimation. At the same time, it wouldn't be an overstatement to say that negative opinions on smoking bans have lost common ground and sheer presence in Starkville. Strangely enough, the traditional conservatism of the Mississippi populace is slowly eroding. After all, Starkville set the trend. A few other Mississippi cities have adopted similar smoking policies, and Columbus could possibly be next. These reiterations of the Starkville law show that this phenomenon isn't limited to a liberal college atmosphere. The current ban on Sunday alcohol sales shows that maybe Starkville isn't as liberal as some might suggest. The very foundation of the smoking ban is in opposition to traditional conservative views on both property rights and personal rights.
From a legal and ethical standpoint, I can identify with the argument against smoking bans. People performing or allowing legal activities on their private property should be acceptable. Of course, the counterargument would involve public health concerns, despite the fact that we haven't exactly confirmed the absolute toxicity of secondhand smoke. People are exposed to a variety of unhealthy atmospheres during their lives in America; therefore, only an experiment with proper control and treatment groups could make the definite link. Such an experiment would be practically difficult and ethically questionable, however. But let's ignore the lack of methodological means to indicate whether secondhand smoke undoubtedly causes cancer. The fact is that no one forces people to enter or work at the private establishments of other citizens. They willingly choose to enter or work at the establishments, and it should be quite obvious to them whether they will inhale secondhand smoke. With that knowledge of the legal activity of smoking, the customer or worker cannot claim foul play by the owner, even if secondhand smoke is actually harmful. Bottom line, smoking is legal despite its disregard for public and individual health, and you are voluntarily on the private property of a taxpaying citizen. More counterarguments may follow. For instance, perhaps one could argue that government has the right to step in and protect its citizens from property owners. OK, that's fine, so why not ban drinking at restaurants and bars? An honest and logical person cannot claim that offering alcohol at such establishments doesn't possibly foster more drunken driving accidents, public fights, poisoning and a myriad of other negative consequences from alcohol consumption. Another counterargument is that allowing cigarettes in your establishment pre-selects customers. But many businesses pre-select customers. Movie theaters pre-select those who can see, adult entertainment stores pre-select those who enjoy pornography, and children's theme parks pre-select the younger audience (and their suffering parents). Those who are not pre-selected may still visit those places, but their lack of satisfaction in the venues is a ridiculous aspect to legislate. In conclusion, the most notable aspect about this legislation is not that a certain group is right or wrong. The traditional conservative mold of Mississippi has been cracked, and politicians are touting this law as "progressive." Progressive, eh? Tautological rhetoric at its finest. The Reflector - The online student newspaper of Mississippi State University Read
No smoking: Starkville ban takes effect
5/21/2006
ROBBIE WARD
STARKVILLE - Johnny Joorfetz and Kristin Lofton sat outside Dave's Dark Horse Tavern Saturday, munching on pepperoni pizza, drinking beer and smoking cigarettes.
They sat outside a new patio area designated for smokers. This was their first time to hang outside the bar; it was also the first full day the city's smoking ban was enforced.
"It's going to be weird not being able to watch the band," Lofton said of staying outside when she smokes.
Throughout Starkville, cigarette smoke and tobacco smells became less pungent at area restaurants that had smoking sections.
Some people said smoke-filled restaurants and bars won't be the same. For instance, places like Dave's were known for their smoky atmospheres.
David Hart, the doorman at Dave's and a smoker for years, said he's switched to chewing gum while standing at the door instead of smoking a pack of cigarettes during his shift. But he didn't mind the change.
"It's probably better for all of our health," Hart said.
New patrons
Dave's had its regulars listening to the band Saturday, but it also had customers return who hadn't visited in years.
Robert McMillen sat with a group of friends listening to the band play. McMillen helped organize the grass-roots effort in the city to convince local leaders to vote to make public businesses, including restaurants and bars, smoke-free. Users are required to smoke outside - away from entrances and exits of businesses.
McMillen predicted Starkville will start a healthy trend in Mississippi by being the state's largest city with a strong no-smoking ordinance. People caught smoking inside businesses can be fined $50 for the first offense and $250 afterward. Businesses where smokers are cited for smoking indoors three times within a 12-month period risk losing their business license.
"I have no doubt that a year from now several (cities) will have followed our leadership," said McMillen, a research professor with the Social Science Research Center at Mississippi State University.
Citizens or elected leaders in Tupelo, Meridian and Hattiesburg have already discussed adopting an ordinance similar to Starkville's.
Stephanie Atkins-Arnett dined with her husband and two children Saturday at BIN 612, an Italian eatery on University Drive. She welcomed the new ordinance and remembered the last time she and her husband attended an indoor concert.
"We didn't even stay for the main show because my eyes watered so bad and it was stinky," Atkins-Arnett said.
She said she looked forward to attending more concerts without worrying about the effects of cigarette in enclosed areas.
Minimal impact now
Jamie Dickey, general manager of the Cotton District Grill, said so far the smoking ordinance had a minimal impact at his restaurant. The restaurant's bar had ashtrays conspicuously missing and the entrance had a "no smoking sign" posted.
Dickey said one customer lit a cigarette but put it out when informed the restaurant was smoke free. He said sales at the restaurant were good, but he attributed the increased customers to the MSU-Ole Miss baseball game.
"Anytime the Bulldogs are playing we're busy," he said.
Dickey said the real test of whether the smoking ban affects business will be in late August, when MSU begins its fall semester. "It's going to be kind of neat to see when the students come back," he said.
Ward 5 Alderman Matt Cox, who supported the smoking ban, visited several restaurants Friday and Saturday, distributing "no smoking" stickers required to be posted at businesses. He said many people greeted him with appreciation.
"It's been overwhelmingly positive," Cox said.
Tupelo watches Starkville smoking ban impact
5/21/2006
Andy Kanengiser
TUPELO - Tupelo wants to see how a smoking ban works in Starkville before considering one here, Mayor Ed Neelly says.
The mayor discussed the possible ban during a visit last week with the Tupelo Kiwanis Club. Starkville's ban at restaurants and other public places began Saturday.
Neelly said the idea will be considered in Tupelo, but he didn't specify a date. "It will be brought up," he said.
Councilman Thomas Bonds of Ward 2 said he doesn't expect the council to act until citizens take the issue to City Hall.
Supporters of a smoking ban will meet at the Lee County Library at noon Tuesday. They will hear discussions on the dangers of secondhand smoke. Speakers will include a physician, members of the Partnership for a Healthy Mississippi and the American Cancer Society. The meeting is open to the public.
The smoking-ban issue was brought up briefly at a retreat of Tupelo city officials in Olive Branch weeks ago and continues to be a topic, although it is not on their formal agenda.
"I have been getting a lot of phone calls in support of the ban," said Councilman Mike Bryan of Ward 6. People are concerned about the dangers of secondhand smoke and smoke drifting into non-smoking areas at restaurants, he said.
Bryan said the issue could be one to study for a proposed city committee on the quality of life.
Board Adopts Smoke-Free ordinance (Smoking Ban in Starkville)
March 22, 2006
BRIAN HAWKINS
Cheers erupted from the standing-room-only crowd in the City Hall courtroom Tuesday night after members of the Starkville Board of Aldermen voted unanimously to adopt an ordinance prohibiting smoking in public places and in places of employment.
The ordinance, adopted after a brief public hearing during Tuesday night's Board of Aldermen meeting, takes effect 60 days from Tuesday and specifically defines where smoking is prohibited in the city, requirements for posting “no smoking” signs, responsibilities of business owners, enforcement and violations.
The ordinance was developed by an appointed committee that included three members of the Board of Aldermen, two local restaurateurs, a representative from the Mississippi State University Student Association and two community health advocates working with the Citizens for a Breathe-Free Starkville group.
“We put together a group of stakeholders who had different opinions on the issue and developed an ordinance from scratch for Starkville,” said Ward 5 Alderman Matt Cox, one of the three aldermen on the committee. “We came together with a job to do and we got it done well.”
Robert McMillen, a researcher at MSU and one of the two leaders of Citizens for a Breathe-Free Starkville on the ordinance committee, said the board's adoption of the ordinance makes Starkville the first major municipality in Mississippi to go smoke-free.
“We're very happy with the final ordinance. It showed leadership and that Starkville is a leader in the state in demonstrating that we as a community deem the health of our people as important,” McMillen said.
Members of Mississippi State fraternities expressed concern Tuesday night over a provision within the ordinance prohibiting smoking in common areas of the Greek houses, the majority of which on Fraternity Row and Sorority Row are located within the city limits.
Presidents of at least three fraternities - Kappa Alpha Order, Sigma Alpha Epsilon and Lambda Chi Alpha - requested that the board not act on the ordinance to allow MSU Greek organizations to determine their position on the issue, especially since most had only learned of plans to regulate fraternity and sorority houses in the last several days.
Ultimately, the provision regarding Greek organization houses was removed after it was determined that a later clause in the ordinance eliminated the need for their inclusion since the clause in question stated that rules of other governmental jurisdictions regarding smoking - including those at the University, would supercede the ordinance regulations.
Multiple residents smoke in favor of implementing the ordinance.
Among the indoor public places where smoking will be prohibited when the ordinance takes effect are:
€ Childccare facilities.
€ City buildings.
€ Common areas in bed and breakfast establishments, hotels and motels.
€ Elevators and enclosed stairwells.
€ Health care facilities.
€ Indoor shopping malls.
€ Places of employment.
€ Polling places.
€ Public forms of transportation, including but not limited to motor buses, taxicabs, or other public passenger vehicles.
€ Public bus and transfer point shelters.
€ Retail stores.
€ Enclosed, indoor areas of restaurants and bars.
€ Self-service laundry facilities.
€ Service lobbies, waiting areas, and the common areas open to the public of financial institutions, businesses and professional offices, and multi-unit commercial facilities.
€ Indoor sports arenas and venues.
€ Waiting rooms, hallways, rooms in offices of any physician, dentist, psychologist, chiropractor, optometrist or optician, or other medical services provider.
Exemptions to the ordinance include allowing smoking include:
€ Bed and breakfast, hotel and motel rooms that are rented to guests and are designated as smoking rooms.
€ Private clubs.
The ordinance also includes regulations prohibiting smoking in certain outdoor areas, including:
€ Areas immediately preceding or blocking the entrance and/or exit of an area where smoking is prohibited.
€ Attached areas of restaurants that are covered or partially covered with more than 50 percent of the perimeter of the outside area walled or otherwise closed to the outside.
€ Seating areas of outdoor sports arenas and venues.
Penalties for violations of the ordinance include a fine of no more than $50 for the first offense and no more than t$250 for the second and subsequent offenses.
Another provision within the ordinance allows the Board of Aldermen to suspend or revoke any business license or permit issued by the city for three or more violations of the ordinance by a specific business within a 12-month period.
The ordinance also contains a clause allowing for its repeal in the summer of 2008 if city officials evaluate its effectiveness and deem it necessary to repeal the law.
Editor's note: This is the first in a series of stories dealing with Tuesday's meeting of the Board of Aldermen. Subsequent stories related to Tuesday's board meeting will be published over the next few days. Read
Dear elected officials of Starkville,
It is with concern that I read on the Internet that you are considering enacting a public smoking ban ordinance. I understand that smoking bans are popular right now (much like Prohibition was popular in 1918). I do not smoke myself but am greatly opposed to government-mandated smoking bans. I oppose them on the basis that they go against the rights of property owners, attack personal freedom, cost businesses lost revenue, and are based upon questionable evidence.
Smoking bans are an attack on property rights in much the same way that the Supreme Court attacked property rights in its ruling in the Connecticut "Eminent Domain" case last year. Business owners should legally have the right to allow the use of a legal product on their premises.
As far as lost revenues are concerned, smoking bans have damaged the hospitality industry virtually everywhere they have been passed. Below is a link that lists hundreds of businesses in various parts of the world that have been devastated by mandatory smoking bans. One thing that is particularly scary about the list is that many of the establishments are located in states that have smoking bans that allegedly provide "level playing fields." Read: http://www.smokersclubinc.com/banloss3.htm
Health danger from second hand smoke is highly debatable. Most of the studies on second hand smoke have found no significant health risk. One World Health Organization (WHO) study even found that children exposed to second hand smoke may have a slight immunity to lung cancer. This finding is particularly interesting since the WHO is extremely antismoking.
I have attached two files to this e-mail, one of which deals with information from second hand smoke studies.
Another problem with government-imposed smoking bans is that they create a "smokeasie" atmosphere as some business find ways to sneak around the law in order to keep customers and stay in business. The laws turn law-abiding businessmen and women into criminals. A "smokeasie" culture has developed in California and other states that have passed bans.
In conclusion, it would be a serious mistake for Starkville's elected officials to pass a public smoking ban.
Dr. Jeremy Richards Ph.D.
Barnesville, GA
March 19, 2006
Committee works toward Starkville smoking ban
3/7/2006
ROBBIE WARD
STARKVILLE - A city committee dealt with details Monday to inch closer to a ban on smoking in city workplaces, including restaurants.
The committee - three aldermen, two health advocates, a Mississippi State University student and two restaurant owners - spent nearly four hours in City Hall hammering out details that could make Starkville the largest city in Mississippi to ban smoking in restaurants and other indoor areas.
After hours of discussion, the committee reached consensus on all but a few issues. They agreed on a definition of an enclosed building, and that people can't smoke "immediately proceeding the entrance and exit" of businesses.
The proposed ordinance will be presented to the board March 21.
The committee couldn't decide whether it should take effect 30 days after it's passed or 120 days, as recommended by the Starkville Restaurant Association. The restaurant group says it needs more time build outdoor facilities to their eateries.
The group also didn't agree on whether smoking would be allowed after 10 p.m. in city restaurants, another position supported by the restaurant association. Health advocates say allowing smoking anytime in restaurants would weaken the law. The aldermen on the committee - Sumner Davis of Ward 1, Richard Corey of Ward 4 and Matt Cox of Ward 5 - will decide its recommendations on the two issues later and make a report to the Board of Aldermen.
This meeting was the second time the committee met to piece together a smoking ordinance.
"Last time was a little more fun because we got to talk big picture and not get tangled up in all of the legal issues," said Ward 5 Alderman Matt Cox, chairman of the committee.
For months a grassroots community effort has led to letters, e-mails and phone calls to Mayor Dan Camp and the aldermen in support of a smoking ban.
Restaurant owners and employees have been alone in their opposition to the ban, citing possible loss of sales.
The committee agreed to recommend the Board of Aldermen review the ordinance in two years to decide whether to renew it.
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