Effect of Smoke-Free Air Laws (SFA) on Healthcare Utilization and Cost of Asthma and Stroke

Objective: To assess the impact of smoke-free air (SFA) laws established between 1998-2003 on healthcare utilization and cost of asthma and stroke.

Methods: SFA laws were obtained from the Americans for Nonsmokers' Rights Foundation, State Tobacco Activities Tracking and Evaluation System, and the ImpacTeen Smokeless States Database. Healthcare costs were obtained from MarketScan. Three categories were used to examine the effect of SFA laws: total ban, qualified ban, and no ban. Healthcare utilization and cost (previous two years) for asthma and stroke were calculated. Multivariate logistic regressions were used to estimate the effect of ban on healthcare utilization for adults with asthma or stroke, controlling for age and sex. Cost reduction estimates were also obtained.

Results: The number of smoking bans increased over the 5-years assessed. Cost reductions on healthcare utilization among respondents with asthma and those who had suffered a stroke were significant (p<0.05) among respondents living in counties with SFA laws compared to those living in a county without a SFA law (OR=0.71; 95%CI: 0.51-1.00 and OR=0.72; 95%CI: 0.53-0.93) respectively. Based on SFA in place by 1998, the average cost reduction per county for asthma and stroke were approximately $2.5 million and $1.8 million, respectively.

Conclusions: SFA laws were associated with reductions in healthcare utilization and costs for asthma and stroke. Respondents living under qualified SFA ban were less likely to have seen a healthcare provider than those living under no SFA ban. State and local governments should develop SFA laws to protect the public's health.