A Model for Estimating the Economic Impact of Secondhand Smoke Exposure: A Study in Indiana

Healthcare costs attributable to secondhand smoke exposure among Indian adults

INTRODUCTION

This paper estimates the direct economic costs of diseases attributable to secondhand smoking (SHS) in India for persons aged 15 years and above.

METHODS

Nationally representative data on health care expenditures, healthcare utilization, and SHS prevalence were used to estimate economic costs attributable to SHS. A prevalence-based attributable risk approach was used for estimating the attributable direct costs. To estimate the SHS-attributable fraction, the excess utilization of healthcare among SHS exposed non-smokers compared to unexposed non-smokers was estimated using a method of propensity score matching.

RESULTS

The annual direct economic costs attributable to SHS from all diseases in India in the year 2017 for persons aged 15+ years amounted to INR 566.7 billion (USD 8.7 billion). This amounted to INR 705 per adult non-smoker. The SHS attributable costs were higher among the youngest age group 20-24, and women bear 71% of the direct medical costs attributable to SHS.

CONCLUSIONS

The annual direct economic costs of SHS amount to approximately 0.33% of India's GDP, or 8.1% of total healthcare expenditures in India. It is also much larger than the total excise tax revenue from cigarettes and bidis. As bidi smoking is the most popular form of smoking in India and bidis are mostly consumed by the poor, a disproportionate burden of SHS is likely borne by poor households in India.

IMPLICATIONS

In India, 38.7% of adults are exposed to secondhand smoking (SHS) at home and 30.2% at work. However, there is no estimate of the economic burden of any kind from SHS exposure in India. This study used a prevalence-based attributable risk approach combined with a propensity score matching technique to estimate excess healthcare utilization for SHS exposed non-smokers and the annual direct economic costs of SHS in India. Annual direct SHS-attributable costs in India is INR 566.7 billion (USD 8.7 billion) SHS costs constituted 0.33% of GDP and 8.1% of healthcare expenditures in India.

Healthcare resources attributable to child tobacco smoke exposure

Background

Tobacco smoke exposure (TSE) places an economic toll on the U.S. healthcare system. There is a gap in the literature on pediatric emergency department (ED) and urgent care related healthcare costs and utilization specific to tobacco smoke-exposed patients. The objectives were to assess pediatric ED visits, urgent care visits and hospital admissions longitudinally, and baseline visit costs among tobacco smoke-exposed children (TSE group) relative to unexposed children (non-TSE group).

Methods and findings

We conducted a retrospective study using electronic medical records of 380 children ages 0–17 years in the TSE group compared to 1,140 in the non-TSE group propensity score matched via nearest neighbor search by child age, sex, race, and ethnicity. Linear and Poisson regression models were used. Overall, children had a mean of 0.19 (SE = 0.01) repeat visits within 30-days, and 0.69 (SE = 0.04) pediatric ED visits and 0.87 (SE = 0.03) urgent care visits over 12-months following their baseline visit. The percent of children with ≥ 1 urgent care visit was higher among the TSE group (52.4%) than the non-TSE group (45.1%, p = 0.01). Children in the TSE group (M = $1,136.97, SE = 76.44) had higher baseline pediatric ED visit costs than the non-TSE group (M = $1,018.96, SE = 125.51, p = 0.01). Overall, children had 0.08 (SE = 0.01) hospital admissions over 12-months, and the TSE group (M = 0.12, SE = 0.02) had higher mean admissions than the non-TSE group (M = 0.06, SE = 0.01, p = 0.02). The child TSE group was at 1.85 times increased risk of having hospital admissions (95% CI = 1.23, 2.79, p = 0.003) than the non-TSE group.

Conclusions

Tobacco smoke-exposed children had higher urgent care utilization and hospital admissions over 12-months, and higher pediatric ED costs at baseline. Pediatric ED visits, urgent care visits, and hospitalizations may be opportune times for initiating tobacco control interventions, which may result in reductions of preventable acute care visits.

Burden of disease attributable to second-hand smoke exposure: A systematic review

Our aim was to provide a systematic review of studies on the burden of disease due to second-hand smoke (SHS) exposure, reviewing methods, exposure assessment, diseases causally linked to SHS, health outcomes, and estimates available to date. A literature review of studies on the burden of disease from SHS exposure, available in PubMed and SCOPUS, published 2007-2018 in English language, was carried out following the PRISMA recommendations. Overall, 588 studies were first identified, and 94 were eligible. Seventy-two studies were included in the systematic review. Most of them were based on the comparative risk assessment approach, assessing SHS exposure using mainly surveys on exposure at home/workplaces. Diseases more frequently studied were: lung cancer, ischemic heart disease, stroke, chronic obstructive pulmonary disease, asthma and breast cancer in adults; lower respiratory tract infection, otitis media, asthma, sudden infant death syndrome and low birth weight in children. The SHS exposure assessment and the reported population attributable fractions (PAF) were largely heterogeneous. As an example, the PAF from lung cancer varied between 0.6% and 20.5%. Moreover, PAF were estimated applying relative risks and SHS exposures with no consistent definitions or with different age classes. The research gap on the SHS exposure burden is shrinking. However, estimates are not yet available for a number of countries, particularly the Middle Eastern and African countries, and not all diseases with the strongest evidence of causation, such as sudden infant death syndrome, have been explored. Moreover, in some cases the applied methodology revealed relatively low quality of data.

Healthcare costs attributable to secondhand smoke exposure at home for U.S. adults

OBJECTIVE

To estimate healthcare costs attributable to secondhand smoke (SHS) exposure at home among nonsmoking adults (18+) in the U.S.

METHODS

We analyzed data on nonsmoking adults (N=67,735) from the 2000, 2005, and 2010 (the latest available data on SHS exposure at home) U.S. National Health Interview Surveys. This study was conducted from 2015 to 2017. We examined hospital nights, home care visits, doctor visits, and emergency room (ER) visits. For each, we analyzed the association of SHS exposure at home with healthcare utilization with a Zero-Inflated Poisson regression model controlling for socio-demographic and other risk characteristics. Excess healthcare utilization attributable to SHS exposure at home was determined and multiplied by unit costs derived from the 2014 Medical Expenditures Panel Survey to determine annual SHS-attributable healthcare costs.

RESULTS

SHS exposure at home was positively associated with hospital nights and ER visits, but was not statistically associated with home care visits and doctor visits. Exposed adults had 1.28 times more hospital nights and 1.16 times more ER visits than non-exposed adults. Annual SHS-attributable healthcare costs totaled $4.6 billion (including $3.8 billion for hospital nights and $0.8 billion for ER visits, 2014 dollars) in 2000, $2.1 billion (including $1.8 billion for hospital nights and $0.3 billion for ER visits) in 2005, and $1.9 billion (including $1.6 billion for hospital nights and $0.4 billion for ER visits) in 2010.

CONCLUSIONS

SHS-attributable costs remain high, but have fallen over time. Tobacco control efforts are needed to further reduce SHS exposure at home and associated healthcare costs.

The Economic Impact of Smoke-Free Policies on Restaurants, Cafés, and Bars: Panel Data Estimates From European Countries

In this paper, we investigate the extent to which the economic outcomes of restaurants, bars, and cafés have been affected by the introduction of anti-smoking regulations in Europe. We use an unexploited panel database to collect a comprehensive set of information on financial indicators regarding the balance sheets of private and public companies in various economic sectors. The results show that smoke-free policies did not significantly affect the firms' economic performance, irrespective of the balance sheet indicators analyzed. Moreover, the results are robust to various econometric specifications and suggest that the recent enforcement of anti-smoking legislation in Europe has improved public health without a corresponding negative impact on revenues and employment in the hospitality industry.

How can dental public health competencies be addressed at the undergraduate level?

OBJECTIVES

To discuss the extent to which an undergraduate dental module addresses dental public health competencies via its different learning pedagogies and to explore the relevance of students' written reflections on these dental public health competencies.

METHODS

This article uses a literature review to situate the extent to which dental public health competencies are addressed by the University of British Columbia undergraduate dental module entitled "Professionalism and Community Services" (PACS). It also uses students' written individual self-reflections (between 100 and 500 words) on community service learning activities to critically illustrate how dental public health competencies support their learning.

RESULTS

The PACS dental module is delivered to undergraduate students in all 4 years, more than 190 in total, and addresses six dental public health competencies, including oral health promotion, ethics, and evidence-based practice. The multifaceted pedagogical approach employed to discuss aspects of dentistry related to dental public health includes guest lectures, community activities, small group activities, self-reflection, and reports.

CONCLUSIONS

Given the falling number of dental public health professionals in North America, the discussed undergraduate pedagogy aims to sensitize future dentists to a career focused on dental public health. Through reflections, students pondered ideas related to dental public health; they also engaged in developing meaningful activities in various underserved communities. Further studies are needed to evaluate the influence of this community-based curriculum upon students' practice choice.