Secondhand smoke was established as a cause of lung disease in nonsmokers in 1986 (1). Subsequently, other diseases and adverse effects of secondhand smoke were established, including increased risk for coronary heart disease (CHD) (2). Specifically, secondhand smoke exposure increases CHD risk by 25% to 30% (3). These risks are attributed to various mechanisms including but not limited to endothelial dysfunction and arterial stiffness, increased oxidative stress, reduced heart rate variability, and increased insulin resistance (4).

All levels of US government have been slow to provide the public with comprehensive clean indoor air policies (5). The greatest obstacle to making fundamental societal changes is not funding but the lack of political will (6). In 2009, West Virginia (along with Kentucky) had the highest rate of adult smokers in the nation, 26% (7). However, because of the autonomous nature of local boards of health in West Virginia, only 18 of its 55 counties currently have comprehensive indoor air regulations. The failure to provide this protection places people at risk.

In the first published study of the effect of a smoking ban on heart disease rates, following legislation in Helena, Montana, that required smoke-free workplaces and public places, a significant drop in acute myocardial infarction (AMI) was observed; this reduction ended after 6 months when the ban was repealed (8). Similarly, AMI reductions were found when smoking prohibitions were implemented in 4 other US jurisdictions (9-12) and in Canada (13), Italy (14-16), and Scotland (17). A meta-analysis of 11 reports from 10 study locations demonstrated a mean AMI decrease of 14% after smoking bans were implemented. The effect was most pronounced for younger adults (18). Researchers projected that 156,400 AMIs would be prevented each year if comprehensive smoking regulations were launched in the United States.

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