Indoor smoking bans reduce the number of emergency department (ED) visits in children with asthma, according to a new study.
Pediatric asthma is the most common serious chronic disease in infants and children, according to the American Academy of Allergy, Asthma & Immunology. Secondhand smoke is a well-known trigger for asthma, and a severe asthma attack can lead to a visit to the emergency room.
About 6.3 million children in the United States suffer from this chronic respiratory condition, according to the Centers for Disease Control and Prevention (CDC), which is 8.6 percent of the pediatric population. Asthma exacerbation accounts for more than 1.8 million visits to the ED each year.
Aspen, Colorado, was the first city in the United States to restrict smoking in restaurants back in 1985. California became the first state to enact a smoking ban in nearly every workplace statewide in 1995. Several more states followed suit. According to October 2016 statistics presented by Americans for Nonsmokers Rights (ANR), 1,320 municipalities across 41 states and the District of Columbia now have local smoke-free laws.
The intent of these policies is largely to protect nonsmokers from the adverse health effects of secondhand smoke. This new study suggests smoking bans are helping, at least when it comes to exacerbation of pediatric asthma.
Assistant professor of pediatrics at the University of Chicago and pediatric allergy expert Christina Ciaccio, M.D., led a team of researchers from Brown University and Kansas University in this study. Its objective was to determine whether implementing indoor smoking legislation lowers the number of emergency department visits for exacerbation of asthma in children.
To perform this retrospective analysis, the researchers used data obtained from the Pediatric Health Information System (PHIS), a pediatric database that includes patient encounter data for emergency departments, inpatient facilities, ambulatory surgery centers, and observation units for more than 45 children's hospitals. For this study, the researchers used data from 335,588 patient encounters captured from 20 hospitals in 14 states plus the District of Columbia from July 2000 to January 2014.
The researchers counted the number of visits to each hospital during the three-year period before the indoor smoking bans, and again during the three-year period after the bans took effect. The researchers then used Poisson regression analyses and controlled for age, gender, race, seasonality, payer source and secular trends.
The scientists compared this data with information about indoor smoking legislation from all cities, and found an association between smoking bans and a decreased rate of severe asthma exacerbation. Specifically, emergency department visits by children fell by 8 percent the first year after the ban, 13 percent after two years and 17 percent after three years. Furthermore, the researchers found no general nationwide decline in pediatric asthma-related emergency room visits in areas without smoking bans.
The scientists acknowledge that the results of the study suggests only an association and do not offer concrete proof that the legislation caused the decrease in emergency department visits, but Shireman said the evidence strongly suggests it.
"Combined with other studies, our results make it clear that clean indoor air legislation improves public health," said Shireman in a press release.
The researchers concluded their study by suggesting the consideration of legislation in localities without such laws to protect the respiratory health of children in those communities.
"We should all breathe easier when our children do," said the paper's third author, Tami Gurley-Calvez, PhD, associate professor of health policy and management at Kansas University.
