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

Millett, Christopher; Lee, John Tayu; Laverty, Anthony A; Glantz, Stanton A.; Majeed, Azeem

doi:10.1542/peds.2012-2592

Cited by 95 publications

(101 citation statements)

References 22 publications

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“…To prevent overlap, admissions containing both a diagnosis of an upper and a lower acute RTI were counted as a lower RTI only as this was considered the more severe outcome. Furthermore, admissions with a primary diagnosis of asthma were excluded to prevent overlap with a previous study assessing the impact of the English smoke-free legislation on paediatric asthma hospitalisations [16]. Transfers between hospitals following initial admission were not included in order to avoid double-counting.…”

Section: Outcome Definitionsmentioning

confidence: 99%

“…We used negative binomial regression analysis to assess the association between the July 2007 introduction of smoke-free legislation and RTI admission rates [16,23,24]. The method takes into account the underlying time trend in RTI admissions by including a continuous variable for time, and estimates both the immediate ("step") and gradual ("slope") change in RTI admission rate after implementation of smoke-free legislation [14].…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Accumulating evidence now demonstrates the public health benefits of smoke-free legislation, including effects on paediatric respiratory health [14]. Asthma hospitalisations decreased among children following smoke-free legislation in Scotland and England, UK [15,16], as did paediatric emergency department visits for asthma in Lexington-Fayette County in Kentucky, USA [17]. In a recent meta-analysis that included these studies, we demonstrated that implementation of smoke-free legislation was followed by a 10% (95% CI 5-15%, p=0.0001) drop in paediatric hospital attendance for asthma [14].…”

Section: Introductionmentioning

confidence: 99%

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Smoke-free legislation and childhood hospitalisations for respiratory tract infections

et al. 2015

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Second-hand smoke exposure is a major risk factor for respiratory tract infections (RTIs). Although evidence suggests important early-life health benefits of smoke-free public environments, the impact on childhood RTIs is unclear. We investigated the association between England's smoke-free legislation and childhood RTI hospitalisations.We used the Hospital Episode Statistics database to obtain nationwide data on hospital admissions for acute RTIs among children (<15 years of age) from 2001 to 2012. Hospitalisation counts were disaggregated by month, age group, sex and small-area level, and linked to urbanisation, region, deprivation index and corresponding population estimates. Negative binomial regression analyses were adjusted for confounders, seasonal variation, temporal autocorrelation, population-size changes and underlying incidence trends. Models allowed for sudden and gradual changes following the smoke-free legislation. We performed sensitivity and subgroup analyses, and estimated number of events prevented.We analysed 1 651 675 hospital admissions. Introduction of smoke-free legislation was followed by an immediate reduction in RTI admissions (−3.5%, 95% CI −4.7-−2.3%), this mainly being attributable to a decrease in lower RTI admissions (−13.8%, 95% CI −15.6-−12.0%). The reductions in admissions for upper RTI were more incremental.The introduction of national smoke-free legislation in England was associated with ∼11 000 fewer hospital admissions per year for RTIs in children. @ERSpublications Smoke-free legislation in England was associated with a drop in paediatric respiratory infection admissions

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Section: Outcome Definitionsmentioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Smoke-free legislation and childhood hospitalisations for respiratory tract infections

et al. 2015

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“…55 Implementation of smoke-free legislation led to decreases in childhood asthma hospitalizations in England and Scotland. 56,57 9. The effects of tobacco smoke exposure on risk of asthma start in utero.…”

Section: Definitionsmentioning

confidence: 99%

Protecting Children From Tobacco, Nicotine, and Tobacco Smoke

Farber¹,

Groner²,

Walley³

et al. 2015

Pediatrics

209

121

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This technical report serves to provide the evidence base for the American Academy of Pediatrics’ policy statements “Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke” and “Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke.” Tobacco use and involuntary exposure are major preventable causes of morbidity and premature mortality in adults and children. Tobacco dependence almost always starts in childhood or adolescence. Electronic nicotine delivery systems are rapidly gaining popularity among youth, and their significant harms are being documented. In utero tobacco smoke exposure, in addition to increasing the risk of preterm birth, low birth weight, stillbirth, placental abruption, and sudden infant death, has been found to increase the risk of obesity and neurodevelopmental disorders. Actions by pediatricians can help to reduce children’s risk of developing tobacco dependence and reduce children’s involuntary tobacco smoke exposure. Public policy actions to protect children from tobacco are essential to reduce the toll that the tobacco epidemic takes on our children.

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“…Secondhand smoke (SHS) exposure is a significant public health problem with clear negative impacts on children's health, including increased risk of asthma exacerbation, hospitalization, and premature death [1][2][3]. While 17% of US adults smoke cigarettes [4], more than 40% of US children have evidence of SHS exposure [5].…”

Section: Introductionmentioning

confidence: 99%

Clinical Decision Support Tool for Parental Tobacco Treatment in Hospitalized Children

et al. 2016

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SummaryObjectives: To create and evaluate the feasibility, acceptability, and usability of a clinical decision support (CDS) tool within the electronic health record (EHR) to help pediatricians provide smoking cessation counseling and treatment to parents of hospitalized children exposed to secondhand smoke (SHS). Methods: Mixed method study of first-year pediatric residents on one inpatient unit. Residents received training in smoking cessation counseling, nicotine replacement therapy (NRT) prescribing, and use of a CDS tool to aid in this process. The tool, which alerted when a patient was identified as exposed to SHS based on the history taken on admission or during a prior encounter, had the following capabilities: adding SHS exposure to the patient's problem list; referral to Free Quitline through discharge instructions; and linking to a printable NRT prescription form. We measured feasibility by EHR utilization data. We measured acceptability and usability of the tool by administering questionnaires to residents. Results: From June-August 2015, the alert triggered for 106 patients, and the tool was used for 52 (49%) patients. 41 (39%) patients had SHS exposure added to the problem list, 34 (32%) parents were referred to the Quitline through discharge instructions, and 15 (14%) parents were prescribed NRT. 10 out of 15 (67%) eligible pediatricians used the tool. All clinicians surveyed (9 out of 10) found the tool acceptable and rated its usability good to excellent (average System Usability Scale score was 85 out of 100, 95% CI,[76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93]. Conclusions: A non-interruptive CDS tool to help residents provide smoking cessation counseling in the hospital was feasible, acceptable, and usable. Future work will investigate impacts on patient outcomes. BackgroundSecondhand smoke (SHS) exposure is a significant public health problem with clear negative impacts on children's health, including increased risk of asthma exacerbation, hospitalization, and premature death [1][2][3]. While 17% of US adults smoke cigarettes [4], more than 40% of US children have evidence of SHS exposure [5]. Hospital-initiated tobacco control interventions promote smoking cessation in adults, especially when counseling is combined with nicotine replacement therapy (NRT) [6]. Parents who smoke are receptive to receiving smoking cessation interventions when their child is hospitalized [7]. Inpatient pediatric clinicians, however, rarely provide such treatments to parents who smoke [7,8].Pediatric-based smoking cessation interventions in a variety of care settings may be effective in helping parents quit, but barriers have prevented further adoption and sustainability of such practices [8][9][10]. Time, logistical issues, record-keeping challenges, scope of practice concerns, and lack of insurance reimbursement are cited as barriers to counseling and prescribing NRT [11]. To address these concerns, professional organizations have adopted policy statements and clinical guidelines th...

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

Cited by 95 publications

References 22 publications

Smoke-free legislation and childhood hospitalisations for respiratory tract infections

Smoke-free legislation and childhood hospitalisations for respiratory tract infections

Protecting Children From Tobacco, Nicotine, and Tobacco Smoke

Clinical Decision Support Tool for Parental Tobacco Treatment in Hospitalized Children

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