2015/04/29 Council Agenda Packet

PREVENTING CHRONIC DISEASE VOLUME 11, E171 PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY OCTOBER 2014 of lack of data(9). The final value for each state is the estimated Variations in state living costs were accounted for in the sensitiv- health care cost savings for all nonsmoking residents of subsid- ity analysis by using the same approach that was used to calculate ized and public housing. the baseline figures. Renovation costs Results The cost of renovating units where smoking occurred was calcu- All subsidized housing lated by multiplying the state's number of occupied subsidized and public housing units(excluding Alaska and District of Columbia) Prohibiting smoking in all US subsidized housing would yield es- by the average annual turnover rate for subsidized and public timated annual cost savings of $496.82 million (range, housing in each state (9), the estimated prevalence of adult $258.96-$843.50 million), including $310.48 million smoking in subsidized housing (32.7%) (10), and an adjustment ($I54.14-$552.34 million) in secondhand smoke-related health for the percentage of smokers with smoke-free home rules in each care, $133.77 million ($75.24-$209.01 million) in renovation of state (15). The resulting value for each state was then multiplied smoking-permitted units,and$52.57 million($29.57-$82.15 mil- by the state's estimate of the excess cost of renovating a single lion)in smoking-attributable fire losses(Table 1). unit that permits smoking. State estimates of excess renovation costs were obtained by using the average($1,674)of a previously By state,total annual cost savings for subsidized housing ranged published range($770-$2,170)from the Smoke-Free Housing Co- from$0.58 million($0.31-$0.94 million) in Wyoming to$124.68 alition of Maine(18). This excess renovation estimate was adjus- million($63.45-$216.71 million)in New York(Table 1). By cost- ted to 2012 dollars by using the consumer price index ($1,906) type, state annual cost savings for secondhand smoke-related (13), and a price deflator was applied to account for variations in health care ranged from $0.19 million ($0.10-$0.35 million) in living costs across states: the deflator was calculated by dividing Wyoming to $101.15 million ($50.22-$179.9 million) in New each state's 2012 cost of living index by Maine's cost of living in- York. State annual cost savings for renovation of smoking-permit- dex(13). ted units ranged from $0.23 million ($0.13-$0.36 million) in Idaho to$15.70 million($8.83-$24.53 million)in New York;and Smoking-attributable fire costs state annual cost savings for smoking-attributable fire losses The cost associated with smoking-attributable fires was calculated ranged from $0.05 million($0.03-$0.08 million) in Wyoming to by multiplying the state's number of subsidized and public hous- $7.84 million($4.41-$12.24 million)in New York. ing residents by National Fire Protection Association estimates of Public housing the annual per capita loss(including property damage,deaths,and injuries)from all US fires($151)(19),which was adjusted to 2012 Prohibiting smoking in public housing alone would yield estim- dollars using the consumer price index($161),and by the percent- ated annual cost savings of$152.91 million($79.81-$259.28 mil- age of fires caused by cigarettes (5.0%) (20). These national es- lion), including $94.01 million ($46.67-$167.24 million) in timates were applied to each state because of the lack of state-spe- secondhand smoke-related health care, $42.99 million cific data for this indicator. ($24.18-$67.17 million)in renovation of smoking-permitted units, and $15.92 million ($8.95-$24.87 million) in smoking-attribut- Sensitivity analysis able fire losses(Table 2). A sensitivity analysis was performed to develop a range for each By state,total annual cost savings for public housing ranged from cost savings estimate by using an approach described by King and $0.08 million ($0.04-$0.13 million) in Idaho to $57.77 million colleagues (10). For health care costs, we used the range of per- ($29.41-$100.36 million) in New York (Table 2). By cost type, capita secondhand smoke expenditures from Waters and col- state annual cost savings for secondhand smoke-related health care leagues ($56-$121) (12), which was adjusted to 2012 dollars by ranged from $0.04 million ($0.02-$0.07 million) in Idaho to using the consumer price index($60-$129) (13);the assumed av- $46.66 million($23.17-$83.01 million) in New York. State annu- erage percentage of time spent in public housing was 43.8%to al cost savings for renovation of smoking-permitted units ranged 73.0% (14). For renovation costs, it was assumed that per-unit from $0.03 million ($0.01-$0.04 million) in Idaho to $7.49 mil- costs and turnover rates were 75%to 125%of baseline figures for lion ($4.21-$11.70 million) in New York, and state annual cost each state. For smoking-attributable fire costs, it was assumed that savings for smoking-attributable fire losses ranged from $0.01 per-capita losses from all fires and the proportion of smoking-re- million (<$0.01-$0.02 million) in Idaho and Wyoming to $3.61 lated fires were 75%to 125%of baseline figures for each state. million($2.03-$5.65 million)in New York. 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. www.cdc.gov/pcd/issues/2014/14_0222.htm•Centers for Disease Control and Prevention 3