Public health advocates have lobbied hard in recent years to clear restaurants, bars and other workplaces of tobacco smoke, and the winds seem to be at their back.
Already, 36 states and the District of Columbia have enacted some version of an indoor smoking ban to protect the health of workers and patrons, and many local communities in other states have followed suit.
But state-regulated casinos are often exempted from such restrictions (as are, of course, the casinos on tribal lands).
"It's politics," says the University of California, San Francisco's Stanton Glantz, who has spent decades tracing the damaging effects of secondhand smoke to the heart and lungs. "Tobacco and gaming interests really fight for these exemptions," he tells Shots.
To get a rough measure of whether those exemptions for casinos actually hurt health, Glantz and a colleague scrutinized 13 years' worth of ambulance call data from Colorado. In particular, they focused on Gilpin County — the high-country home to more than two dozen casinos within about three square miles. The researchers compared the number of calls for ambulances in the county before and after Colorado extended its workplace smoking bans to include casinos in 2008.
The effect seemed "surprisingly strong," Glantz says of his finding published online this week in the journal Circulation. After the smoking ban in restaurants, bars and most other workplaces was initially enacted in 2006, the number of ambulance-summoning phone calls that were made from any location but casinos dropped by 22.8 percent.
But the number of such calls made from casinos stayed as high as it had been the year before. Then, two years later — after casinos banned smoking, too — the number of such emergency calls made from the grounds of a casino dropped by a little over 19 percent. Such calls from all locations have continued to stay down, years after the implementation of the smoking ban.
Considered in isolation the findings confirm only a correlation, not a causal link, Glantz says. Other factors, such as high gas prices, for example, or tough economic times could have slightly reduced the number of patrons who visited casinos during some of the years studied. Fewer patrons might need fewer emergency calls.
Plus, the database Glantz looked at didn't reveal the nature of each emergency. Surely some childbirths, dizzy spells and panic attacks were mixed in with the heart attacks, asthma attacks and strokes.
But a study of nine other states, published last week and covering much the same time period, suggests that, contrary to the fears of some business owners, "smoke-free laws did not have an adverse economic impact on restaurants or bars in any of the states studied," according to the authors.
And in the context of what's known about how smoke affects physiology, the way the number of calls decreased after each ban makes it "very likely," Glantz says, that curtailing smoking inside the casinos was what reduced the phone calls about health emergencies.
"All the pieces fit together," he says.
Many other studies have shown that, in addition to aggravating lung conditions, inhaled smoke can very quickly make platelets stickier and irritate the lining of blood vessels in ways that can lead to the sudden formation of artery-clogging clots that can cause strokes or heart attacks, Glantz says. Last fall two other studies showed that once smoking was banned in bars and workplaces, the number of deaths from heart attacks dropped within months.