2015/04/29 Council Agenda Packet

PREVENTING CHRONIC DISEASE VOLUME 11, E171 PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY OCTOBER 2014 for many people, especially children(1). Nearly all nonsmokers approach used to estimate cost savings across each of these 3 who live with someone who smokes inside their home are ex- factors is outlined in the accompanying diagram using New York posed to secondhand smoke(5). as an example; in brief,annual cost savings were calculated using subsidized housing residency estimates,and data were adjusted for Multiunit housing residents are particularly susceptible to involun- inflation and variations in other costs across states(Figure). tary secondhand smoke exposure in the home. Environmental studies indicate that secondhand smoke constituents can infiltrate units where no smoking occurs(eg,units whose residents have ad- Health Caro Renovation opted smoke-free home rules) from units and shared areas where 973.700 421,000 973,300 smoking is permitted (6,7). Additionally, research indicates that , (Sub'etawnouungRaawanta) ( (Subsdiaad Housing unm) S. (Smna,ad Housing Residents) many of the nearly 80 million Americans who live in multiunit 0 0 0 housingexperience secondhand smoke infiltration in their livingSgeeeal `�'u "" PperCap.Cost) (Adjusted R., R.no•a ro� x) (adjusted v.Canna Cost) unit that originated from elsewhere in or around their building(8). x O O 1. Nearly 7 million US multiunit housing residents live in govern- (Health Care Ccu Adjustment) ment subsidized housing, including approximately 2 million in t.611 ` 5 Ea enatad Tumwa RRa) (Eati na ad F. From Smoking) ( veragepublic housing either owned or operated by a government housing "'�"�" "�'•"�� 0 0 authority (9). The potential for secondhand smoke exposure in (Adjusted Per Cava Coat) 0.377 $7.114 Minton (Estimated Smoking gate) Coat Savings public or subsidized housing is of particular concern because a O O large proportion of these units are occupied by people who are 0.474 0.606 particularly sensitive to secondhand smoke, including children , (adjusted Exposure^"ome `(Smokws WRh No Smoke-Free iWie) (45%),the elderly(41%),and the disabled(25%)(9). ® o $101.15 Million ` I $15.70 MiSion In addition to increasing the health burden and health care costs, ""�'""� Cost Savings exposure to secondhand smoke in multiunit housing can also lead Figure.Example of calculations used to estimate cost savings associated with to considerable financial costs for renovation of units in which prohibiting smoking in subsidized housing,New York State. smoking has occurred and smoking-attributable fires(10,11). Re- search suggests that prohibiting smoking in all US subsidized Health care costs housing nationwide would yield cost savings of approximately $521 million per year, including$154 million annually for public Expenditures for health care related to secondhand smoke expos- housing(10). However,the cost savings that could be achieved by ure were based on published cost estimates from a study conduc- prohibiting smoking in these settings at the state level is uncertain. ted among nonsmoking Minnesota residents. The estimates were The objective of our study was to assess the state-specific costs derived from claims data from the state's largest health insurer that could have been averted if smoking were prohibited in US (12). Because Minnesota's overall smoking prevalence is approx- subsidized housing in 2012, including those from secondhand imately half that of subsidized housing residents (3,10),the annu- smoke-related direct health care, renovation of units where al per capita savings reported for Minnesota($44)were adjusted smoking has occurred, and smoking-attributable fires. Estimated to$85 using the smoking prevalence for each of these populations cost savings were calculated for subsidized housing overall (in- (32.7/16.8 multiplied by $44). This value was then adjusted to cluding public housing)and for public housing alone. 2012 dollars ($91) using the consumer price index (13). To ac- count for differences in living costs across states, $85 was multi- Methods plied by a price deflator, which was calculated by dividing each state's 2012 cost of living index by Minnesota's cost of living in- Cost savings estimates were calculated by using the approach of dex(13). This value was multiplied by the number of subsidized King and colleagues(10),which we modified to account for infla- and public housing residents in each state(9)and adjusted for the tion, state variations in health care and living costs, and state dif- approximate percentage of total secondhand smoke exposure oc- ferences in key indicators such as subsidized and public housing curring in the home(58.4%)(14),state variation in the prevalence residency,tenant turnover rates,Medicaid enrollment,and smoke- of smoke-free home rules(15),per capita health care expenditures free home rule prevalence.Costs that could be averted by prohibit- (16), and the proportion of the population enrolled in Medicaid ing smoking in subsidized housing were calculated for 3 factors: (17). Alaska and the District of Columbia were excluded because 1) secondhand smoke-related health care; 2) renovation of smoking-permitted units; and 3) smoking-attributable fires. The The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U S.Department of Health and Human Services, the Public Health Service.the Centers for Disease Control and Prevention,or the authors affiliated institutions. 2 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2014/14_0222.htm