After Arizona enacted a statewide ban on smoking in most indoor public places. including workspaces, restaurants, and bars, there was a 14% reduction in strokes in counties that had not previously had a ban in place.352 A study of New York State did not find a reduction in strokes despite a decrease in risk of MI when it enacted a comprehensive smoking ban in enclosed work- spaces, restaurants, and construction sites.353 Smoking likely contributes to increased stroke risk through both short-term effects on the risk of thrombus generation in ath- erosclerotic arteries and long-term effects related to increased Smoking as little as a single cigarette increases heart rate, mean BP, and cardiac index and decreases arterial dis- Beyond the immediate effects of smoking, both active and passive exposure to cigarette smoke is associated with the development of atherosclerosis.357 In addition to placing indi- viduals at increased risk for both thrombotic and embolic stroke, cigarette smoking approximately triples the risk of cryptogenic stroke among individuals with a low atherosclerotic burden and no evidence of a cardiac source of emboli.358,359 Although the most effective preventive measures are to never smoke and to minimize exposure to environmental tobacco smoke, risk is reduced with smoking cessation. 