January 21, 2013

Stanton A. Glantz, PhD

Hospital Admissions for Childhood Asthma Drop After Smoke-Free Legislation in England

Chris Millett and other colleagues at Imperial College London and I just published a paper in Pediatrics, "Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England," that shows that childhood asthma admissions, which had been rising 2% a year before England put a strong smokefree law in place, dropped by 8.9% immediately after the law and continued to fall after that.

This is a particularly important paper because during the long debate before the law tobacco industry allies (including the Minister of Health for some of the time) claimed that if workplaces, including pubs, were made smokefree smokers would smoke more at home, thereby harming their children.  (The same claim pops up from time to time around the world.)  Earlier work by my group showed in the US that smokefree laws are associated with more voluntary smokefree home policies, especially when there are smokers in the house.  This new paper shows there are substantial health benefits for kids.

This paper also builds the case that strong tobacco control policies produce substantial and immediate reductions in health care costs.  Tobacco control should be considered a central element of medical cost containment in the short as well as long run.

The BBC did a nice story on the paper, which is here.

Here is the abstract for the paper:
OBJECTIVE: To assess whether the implementation of English smoke-free legislation in July 2007 was associated with a reduction in hospital admissions for childhood asthma.

METHODS: Interrupted time series study using Hospital Episodes Statistics data from April 2002 to November 2010. Sample consisted of all children (aged ≤14 years) having an emergency hospital admission with a principle diagnosis of asthma.

RESULTS: Before the implementation of the legislation, the admission rate for childhood asthma was increasing by 2.2% per year (adjusted rate ratio 1.02; 95% confidence interval [CI]: 1.02–1.03). After implementation of the legislation, there was a significant immediate change in the admission rate of −8.9% (adjusted rate ratio 0.91; 95% CI: 0.89–0.93) and change in time trend of −3.4% per year (adjusted rate ratio 0.97; 95% CI: 0.96–0.98). This change was equivalent to 6802 fewer hospital admissions in the first 3 years after implementation. There were similar reductions in asthma admission rates among children from different age, gender, and socioeconomic status groups and among those residing in urban and rural locations.

CONCLUSIONS: These findings confirm those from a small number of previous studies suggesting that the well-documented population health benefits of  comprehensive smoke-free legislation appear to extend to reducing hospital admissions for childhood asthma.

The full paper is here.

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