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Reducing Secondhand Tobacco Smoke: Cardiac and Asthma
Outcomes
Ellen Hahn, D.N.S.,
Principal Investigator;
Debra Moser, D.N.Sc.,
Patricia Burkhart, Ph.D.,
&
Mary Kay Rayens, Ph.D.,
Co-investigators
Funded by the Flight
Attendant Medical Research Institute
(2004-2006)
Abstract
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The broad, long-term objective is to assess the relationship
between reduction in exposure to secondhand tobacco smoke (SHTS)
at the community level and health care outcomes associated
with acute coronary syndromes and asthma. The specific aim
is to evaluate the effects of a community initiative to
reduce exposure to SHTS on cardiac and asthma outcomes
including the rate of hospital and emergency department (ED)
discharges, length of stay, and total hospital costs.
Although many local communities have adopted measures to
reduce exposure to SHTS, the tobacco-growing states lag
behind in protecting workers from SHTS. The
Lexington-Fayette (Kentucky) Urban County Government enacted
a smoke-free law on July 1, 2003, making all public
buildings smoke-free including, but not limited to,
restaurants, bars, bowling alleys, bingo halls, laundromats,
and racetracks. Lexington’s initiative is considered by the
Americans for Nonsmoker’s Rights as one of the strictest
local laws in the U.S. The effective date was September 29,
2003. However, at the time of the grant submission, the
enforcement of the initiative was temporarily delayed due to
a court injunction.
The study will be a time series design using five 6-month
time periods; three time points prior to and two time points
after enforcement of the Smoke-Free Lexington initiative.
The administrative data base (Comp Data) used to summarize
and track all Kentucky hospital billing records will be
accessed for all Lexington hospitals during each of the five
time periods. Comp Data will be queried for hospital
discharge diagnosis by DRGs and ICD-9 codes, length of stay,
total hospital charges, dates of service, gender, age, and
zip code of residence. Since Comp Data does not compile
emergency department (ED) discharge information, each
Fayette County hospital will provide all data fields of
interest above for the ED discharge diagnosis by DRGs and
ICD-9 codes. Based on the enforcement date of the community
intervention in Lexington (projected November 1, 2003), the
data collection time periods will be in 6-month time
intervals from November 1 of a given year to April 30 of the
following year. Multiple linear regression will be used to
determine predictors for length of stay and total costs;
predictors will include year, month, gender, age, and an
indicator variable for whether the observation occurred
before or after the initiative. For the number of events
(hospital and ED discharges) per at-risk population, an
incidence rate, Poisson regression will be used with the
same predictors.
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