Just beyond access: Exploring the affect statewide smoke-free legislation had on reducing emergency department visits among the adult asthma population

Approximately, 19.3% of asthmatics smoke and portions of nonsmoking asthmatics continue to be exposed to secondhand smoke (SHS) in public places. Complexities of asthma coupled with SHS increases the risk of emergency department (ED) use. However, implementing statewide smoking bans may deter ED use among the asthma population. Objective: To determine whether there are variations in asthma-related ED use among the adult asthma population by types of statewide smoke-free legislation between the years of 2000-2010. Methods: Using data from the Behavioral Risk Factor Surveillance Survey 2000-2010, we examined the association between asthma-related ED use and types of statewide smoke-free legislation. Results: Asthmatics residing in states with comprehensive and partial statewide smoking bans reported fewer ED visits over a short period. The relative risk of reporting asthma-related ED visits during that time was 2.14 (95%, CI 1.64 to 2.23) times higher in non-policy states compared to partial policy states and 1.67 (95%, CI 1.25 to 1.71) times higher in non-policy states compared to comprehensive policy states. The findings also showed that statewide policy had a short-term net policy effect on reducing ED visits while controlling for certain socio-demographic factors and specific health characteristics. Conclusion: Statewide smoking bans had a 12-48 month impact on arresting asthma-related ED use among adult asthmatics. The variation in the length of policy effect between partial and comprehensive policy may be due to individual behaviors, tobacco prevention spending, and the need for systematic renewal of preventive health partnerships.