The 13th World Conference on Tobacco OR Health

Objective: To evaluate the effects of Lexington, Kentucky's smoke-free ordinance on acute asthma and cardiac events, including the rate of hospital and emergency department (ED) discharges. The smoke-free ordinance, prohibiting smoking in all buildings open to the public, was implemented in April 2004. Lexington, located in the heart of tobacco country, was the first Kentucky community to go smoke-free.

Methods: A time series design was used to examine asthma and cardiac outcomes among Lexington-Fayette County residents 40 months before and 8 months after the law implementation. A statewide database was the source for in-patient discharges from all four hospital systems. Each hospital provided ED data. Poisson regression determined the predictors of incidence of each event type (ED and hospitalizations), with separate asthma and cardiac models. The asthma models included all ages, while cardiac models contained only adults. Regressors in addition to the smoke-free status indicator were sex, age, month and year. The models reflected current census estimates to account for population at risk.

Results: The Poisson model for asthma ED visits determined a significant change from pre- to post-law (p < .0001): the ratio of the incidence for post-law relative to pre-law was 0.69, indicating a 31% decline in asthma events. The change in cardiac ED visits was marginally significant (p = .06): the odds ratio for post-law relative to pre-law was 0.78, corresponding to a 22% decline in cardiac events. The comparisons of hospitalizations between pre- to post-law were not significant for either asthma or cardiac events.