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PMCID: PMC5166981 DOI: 10.1016/j.anai.2016.10.005


BACKGROUND: During the past 3 decades, numerous cities and states have adopted laws that ban smoking in public indoor spaces. The rationale for these policies has been to protect nonsmokers from the adverse health effects of secondhand smoke.

OBJECTIVE: To determine whether the implementation of indoor smoking legislation is associated with a decrease in emergency department visits for asthma in children.

METHODS: This retrospective analysis used a natural experiment to estimate the impact of clean indoor air legislation on the rate of emergency department admissions for asthma exacerbation in children. Data were obtained from the Pediatric Health Information System. A Poisson regression was used for analyses and controlled for age, sex, race, payer source, seasonality, and secular trends.

RESULTS: Asthma emergency department visits were captured from 20 hospitals in 14 different states plus the District of Columbia from July 2000 to January 2014 (n = 335,588). Indoor smoking legislation, pooled across all cities, was associated with a decreased rate of severe asthma exacerbation (adjusted rate ratio 0.83, 95% confidence interval 0.82-0.85, P < .0001).

CONCLUSION: Indoor tobacco legislation is associated with a decrease in emergency department visits for asthma exacerbation. Such legislation should be considered in localities that remain without this legislation to protect the respiratory health of their children.

Journal Title

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology





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MeSH Keywords

Asthma; Child; Child, Preschool; Disease Progression; Emergency Service, Hospital; Female; Health Policy; Humans; Male; Outcome Assessment (Health Care); Public Health Surveillance; Retrospective Studies; Tobacco; Tobacco Smoke Pollution; United States


Asthma; Tabacco; Smoke Pollution