title: Indoor tobacco legislation is associated with fewer emergency department visits for asthma exacerbation in children.
abstract: 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.
  
  
  
  To determine whether the implementation of indoor smoking legislation is associated with a decrease in emergency department visits for asthma in children.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Pediatrics at Children's Mercy, University of Missouri-Kansas City, Kansas City, Missouri; Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas; Department of Pediatrics, University of Chicago, Chicago, Illinois. Electronic address: cciaccio@peds.bsd.uchicago.edu.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Ciaccio
authors.affiliation: Department of Health Policy and Management, University of Kansas School of Medicine, Kansas City, Kansas.
authors.forename: Tami
authors.initials: T
authors.lastname: Gurley-Calvez
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
authors.forename: Theresa I
authors.initials: TI
authors.lastname: Shireman
mesh_terms: D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D062486:Public Health Surveillance; D012189:Retrospective Studies; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000331:legislation & jurisprudence*; D014481:United States / Q000453:epidemiology; D014026:Nicotiana
chemical_list: D014028:Tobacco Smoke Pollution