Child asthma emergency visits drop after indoor smoking bans

December 30, 2016 by David Orenstein  , Brown University
Child asthma emergency visits drop after indoor smoking bans
Where cities have restricted indoor smoking in public places, children have been less likely to go to the emergency room with asthma problems. Credit: Brown University

A new study helps to answer the burning question of whether recently enacted indoor smoking bans in public areas have improved health. The research finds the bans are associated with a 17 percent overall reduction in the number of children visiting emergency departments with asthma complaints.

"Across 20 metropolitan areas that introduced clean regulations during the 2000s, fewer children were seen in the emergency rooms for ," said study senior author Theresa Shireman, a professor at the Brown University School of Public Health. "Clean indoor air laws not only reduce expensive health care use, but they also help parents and their children avoid time-consuming, stressful events."

Shireman and co-authors Dr. Christina Ciaccio of the University of Chicago and Tami Gurley-Calvez of the University of Kansas argue that more cities should pass restrictions that prevent smoking in indoor public spaces such as restaurants. The three researchers performed the study while colleagues at Kansas.

"Children are in a very unique situation in that they have very little control over their environment," Ciaccio said. "This study shows that even those short exposures to secondhand smoke in public spaces like restaurants can have a significant impact on exacerbations."

Before and after

The study in the journal Annals of Allergy, Asthma & Immunology examined emergency asthma visits at 20 pediatric hospitals in 14 states and Washington, D.C. For each hospital, the researchers counted the number of visits in the three years before and the three years after indoor smoking bans took effect.

In total, they counted 335,588 visits between 2000 and 2014. When making pre-ban and post-ban comparisons, they controlled for a variety of possible confounding factors including season and other temporal variations; patient gender, age and race; and Medicaid enrollment as a proxy for socioeconomic status.

In each area the numbers varied, with some showing declines, most remaining barely changed, and some showing increases—but in the preponderance of locales, rates declined. In the aggregate across all 20 hospitals, the reduction in visits became deeper with every year after bans went into effect: 8 percent one year after, 13 percent two years after and finally 17 percent after three years.

To see if they all they were measuring was a long-term decline that had nothing to do with smoking policy, the researchers ran a test where they arbitrarily picked Jan. 1, 2007, as a date to make their six-year before-and-after comparison for every hospital. That test yielded no significant decline in visits, meaning that there is no general nationwide decline in asthma emergencies.

The researchers acknowledged that the study only shows an association and doesn't prove that the bans caused the drop in , but Shireman said the evidence strongly suggests it. Secondhand smoke, after all, is known to be an asthma trigger, the researchers noted.

"Combined with other studies, our results make it clear that clean indoor air legislation improves ," Shireman said.

Explore further: New federal rule bans smoking in public housing

More information: Christina E. Ciaccio et al. Indoor tobacco legislation is associated with fewer emergency department visits for asthma exacerbation in children, Annals of Allergy, Asthma & Immunology (2016). DOI: 10.1016/j.anai.2016.10.005

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2.4 / 5 (5) Dec 30, 2016
This is another "no brainer". A reduction of poison and particulate, in a closed space, reduces asthma incidents. Yeah, there's money well spent.
1.2 / 5 (5) Dec 31, 2016
There was a huge increase in asthma cases in the early 2000's after dramatic reductions in smoking during the 90's and no one had a clue why. And now you are going to tie a 10% reduction to indoor smoking bans?.. Give me a break!
2.8 / 5 (6) Dec 31, 2016
Sam, seems to be another doubter without proof. His feelings are no substitute for the actual studies.
1 / 5 (3) Jan 01, 2017
Cigarettes are technically determined to be "drug delivery devices". Same as joints.

Neither should be imposed on others.
5 / 5 (1) Jan 01, 2017
gkam is correct to point out the need for proof in SamB's comment, which illustrates the need for studies to give evidence to EVERY claim. pntaylor doesn't think we should spend money on research that returns "obvious conclusions". Well, SamB doubts this seemingly obvious conclusion, even with the above evidence. Knowledge, even seemingly "no brainer" knowledge, is derived through evidence. It's what allows us to scoff at those who seek to trick us with falsehoods(e.g. the cigarette companies) or flat earthers who refuse to accept evidence for what it is (e.g. SamB, seemingly).
not rated yet Jan 02, 2017
Could the fact that cars are also putting out a lot less pollution and many residences now heat with electricity or gas versus oil or coal? I would think that would also have some effect to prevent kids with asthma problems. Yea, I know the article was talking about inside spaces but the air gets mixed anyway and very few heating or AC systems filter out much more than large dust.
not rated yet Jan 06, 2017
There was a huge increase in asthma cases in the early 2000's after dramatic reductions in smoking during the 90's and no one had a clue why.

Not true. Look up "Hygiene hypothesis." There's a great deal of evidence to suggest that our attempts to provide clean, sterile environments for our children to grow up in produce immune systems that react aggressively to anything and everything foreign. Pre-, peri-, and post-natal life are an important time period for a young immune system to learn not just self vs. non-self but also harmful vs. harmless. Take the recent news about peanuts. While it's taken the conservative medical community a long time to come around, it's not surprising to immunologists that the key to preventing peanut allergies is to feed peanuts or peanut products to babies as soon as possible.

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