Smoke-Free Laws Linked to Lower CVD Mortality

Comprehensive smoke-free laws were associated with sustained reductions in county-level cardiovascular disease (CVD) mortality in a comparative effectiveness research study published in JAMA Network Open.

The study evaluated whether comprehensive 100% smoke-free laws were associated with long-term changes in CVD mortality in US counties. The authors noted that active smoking and secondhand smoke exposure are major cardiovascular risk factors, while prior evidence on the long-term association between smoke-free policies and CVD mortality has been limited.

Researchers used longitudinal county-level panel data and the generalized synthetic control method to assess staggered policy adoption across 38 treated counties that adopted comprehensive smoke-free laws covering workplaces, restaurants, and bars between 2007 and 2018. The control group included 103 counties that did not implement smoke-free laws at any level during the study period from 2000 to 2018. The main outcome was annual county-level age-adjusted CVD mortality per 100,000 population.

Implementation of comprehensive smoke-free laws was associated with a mean annual reduction of 12.0 CVD deaths per 100,000 population over 12 postpolicy years. In adjusted analyses, the mean annual reduction was 12.6 deaths per 100,000 population. Larger reductions were observed among adults aged 65 years or older, male individuals, and non-Hispanic White populations. Associations among younger adults, female individuals, and non-Hispanic Black populations were smaller or less precise.

The authors noted several limitations, including the ecological design, possible influence from concurrent tobacco-control policies or broader cardiovascular prevention changes, potential exposure misclassification, nonrandom policy adoption, and limited precision in some subgroup analyses. They concluded that comprehensive smoke-free laws were associated with sustained reductions in county-level CVD mortality, while noting that additional strategies may be needed to address residual tobacco exposure and improve outcomes across subpopulations.

Source: Wu C, Habib M, Wong ND, Kuo T, Nianogo RA. Comprehensive smoke-free laws and cardiovascular disease mortality in US counties. JAMA Netw Open. 2026;9(6):e2621170. doi:10.1001/jamanetworkopen.2026.21170