Background-Several countries in the world have not yet prohibited smoking in public places. Few studies have been conducted on the effects of smoking bans on cardiac health. We evaluated changes in the frequency of acute coronary events in Rome, Italy, after the introduction of legislation that banned smoking in all indoor public places in January 2005. Methods and Results-We analyzed acute coronary events (out-of-hospital deaths and hospital admissions) between 2000 and 2005 in city residents 35 to 84 years of age. We computed annual standardized rates and estimated rate ratios by comparing the data from prelegislation (2000 -2004) and postlegislation (2005) periods. We took into account several time-related potential confounders, including particulate matter (PM 10 ) air pollution, temperature, influenza epidemics, time trends, and total hospitalization rates. The reduction in acute coronary events was statistically significant in 35-to 64-year-olds (11.2%, 95% CI 6.9% to 15.3%) and in 65-to 74-year-olds (7.9%, 95% CI 3.4% to 12.2%) after the smoking ban. No evidence was found of an effect among the very elderly. The reduction tended to be greater in men and among lower socioeconomic groups. Conclusions-We found a statistically significant reduction in acute coronary events in the adult population after the smoking ban. The size of the effect was consistent with the pollution reduction observed in indoor public places and with the known health effects of passive smoking. The results affirm that public interventions that prohibit smoking can have enormous public health implications.

Background: A smoking ban in all indoor public places was enforced in Italy on 10 January 2005. Methods: We compared indoor air quality before and after the smoking ban by monitoring the indoor concentrations of fine (,2.5 mm diameter, PM 2.5 ) and ultrafine particulate matter (,0.1 mm diameter, UFP). PM 2.5 and ultrafine particles were measured in 40 public places (14 bars, six fast food restaurants, eight restaurants, six game rooms, six pubs) in Rome, before and after the introduction of the law banning smoking (after 3 and 12 months). Measurements were taken using real time particle monitors (DustTRAK Mod. 8520 TSI; Ultra-fine Particles Counter-TRAK Model 8525 TSI). The PM 2.5 data were scaled using a correction equation derived from a comparison with the reference method (gravimetric measurement). The study was completed by measuring urinary cotinine, and pre-law and post-law enforcement among non-smoking employees at these establishments Results: In the post-law period, PM 2.5 decreased significantly from a mean concentration of 119.3 mg/m 3 to 38.2 mg/m 3 after 3 months (p,0.005), and then to 43.3 mg/m 3 a year later (p,0.01). The UFP concentrations also decreased significantly from 76 956 particles/cm 3 to 38 079 particles/cm 3 (p,0.0001) and then to 51 692 particles/cm 3 (p,0.01). Similarly, the concentration of urinary cotinine among nonsmoking workers decreased from 17.8 ng/ml to 5.5 ng/ml (p,0.0001) and then to 3.7 ng/ml (p,0.0001). Conclusion: The application of the smoking ban led to a considerable reduction in the exposure to indoor fine and ultrafine particles in hospitality venues, confirmed by a contemporaneous reduction of urinary cotinine.

The mortality of a cohort of 2310 male workers who obtained a licence to handle pesticides in the period 1973-1979 in the province of Rome was investigated. The cohort contributed 26,846 person-years of exposure. The vital status of the cohort was determined up to the end of 1988. The causes of death of the 207 who had died were ascertained from death certificates. Standardized mortality ratios (SMR) were computed using both the provincial and the national mortality rates. The two methods yielded very similar results. Using the national rates, the SMR for all causes was 56 (95% confidence interval (CI) : 45.3-59.8), for cardiovascular diseases 47 (95% CI : 37.1-59.1), and for all cancers 72 (95% CI : 57.8-89.3). A statistically significant excess was noted for brain cancer (SMR = 270, 95% CI : 108.6-556.9). In addition, the cohort experienced statistically significant lower lung cancer mortality (SMR = 57, 95% CI : 35.6-80.0).

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The mortality of a cohort of 168 pesticide applicators employed in the disinfestation service of the city of Rome for an average of 20 years is examined. Exposure data were abstracted from work records, and causes of death for the 42 workers who had died, were obtained from death certificates. Standardized mortality ratios (SMR) for specific causes of death were computed on the basis of provincial mortality rates. An excess in mortality from cancer of the liver and bile ducts with four cases observed and 0.7 expected (SMR = 571, 95% confidence interval (CI): 154-1463) was found. Increased risk for other cancers was also observed, but the SMR were not statistically different from unity. An increased risk of liver cancer occurs in those exposed to organochlorine pesticides between 1960 and 1965.