Titus et al. Respond to "Guiding Comprehensive and Equitable Policy".
Titus et al. Respond to "Guiding Comprehensive and Equitable Policy".
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提图斯等人。
DOI：
10.1093/aje/kwac185
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发表时间：
2023
影响因子：
5
通讯作者：
Thorpe,LornaE
中科院分区：
文献类型：
--
作者：
Titus,AndreaR;Anastasiou,Elle;Shelley,Donna;Elbel,Brian;Thorpe,LornaE
我们感谢Widome博士对我们的研究进行了深思熟虑的评论(1)，该研究评估了纽约市住房管理局(NYCHA)开发项目的无烟住房政策与参加医疗补助计划的儿童的呼吸结果之间的关系(2)。Widome博士提出了几个与我们的研究和更广泛的烟草政策评估相关的主题。由于每个主题都对这一领域未来的流行病学研究有重大影响，我们对她的评论提出了我们的其他观点。首先，Widome博士指出了在政策生命周期中参与流行病学的重要性，从政策实施前阶段延伸到包括长期监测。我们完全同意这一点。我们发现，在政策出台后的头17个月里，无烟政策与呼吸道保健就诊次数的减少没有相关性，这与我们之前对空气质量的分析(3)相一致，后者同样未能发现空气动力学直径(PM2)小于或等于2.5PM2的颗粒物显著减少。5)或在政策实施后紧随其后的时期内空气中的尼古丁。然而，政策实施不是一蹴而就的，最近的研究表明，更长的时间范围可能会产生不同的见解。在一项配套研究中，我们发现有证据表明，与政策未涵盖的开发项目的走廊相比，政策实施3年后，NYCHA走廊中的空气尼古丁水平显著降低(4)。同样，要在健康结果方面实现可衡量的变化也需要时间。我们正在继续监测儿童哮喘、出生结局和其他情况的发生率。我们的研究并不是第一次提出无烟政策随时间变化的影响(5)，强调了检验时间异质性的分析技术的重要性。其次，Widome博士指出，虽然流行病学可以探索政策是否能在特定环境下减少二手烟暴露，但定性研究更有能力回答“为什么”的问题，突出了学科之间的重要相互作用。我们自己的定性研究-在实施科学框架的指导下-
We thank Dr. Widome for her thoughtful commentary (1) on our study evaluating associations between smokefree housing policies in New York City Housing Authority (NYCHA) developments and respiratory outcomes among Medicaid-enrolled children (2). Dr. Widome raised several themes pertinent to our study and to tobacco policy evaluations more broadly. Because each theme has significant implications for future epidemiologic research in this area, we offer our additional perspective on her commentary.First, Dr. Widome notes the importance of engaging epidemiology across the policy life cycle, extending from the pre–policy-implementation phase and including long-term surveillance. We fully agree. Our finding that smoke-free policies were not associated with reduced respiratory healthcare visits in the first 17 months following policy introduction mirrored our prior analysis of air quality (3), which similarly failed to find significant reductions in particulate matter less than or equal to 2.5 μm in aerodynamic diameter (PM2. 5) or airborne nicotine in the immediate postpolicy period. However, policy implementation does not happen overnight, and more recent work suggests that a longer time horizon may yield different insights. In a companion study, we found evidence of substantially reduced airborne nicotine levels in NYCHA hallways 3 years after policy implementation, as compared with hallways in developments not covered by the policy (4). To achieve measurable change in health outcomes similarly may take time. We are continuing to monitor rates of childhood asthma, birth outcomes, and other conditions. Our studies are not the first to suggest variable impacts of smoke-free policies over time (5), highlighting the importance of analytical techniques that examine temporal heterogeneity. Second, Dr. Widome notes that while epidemiology can explore whether policies work to reduce secondhand smoke exposure in specific contexts, qualitative research is better equipped to answer “why” questions, highlighting an important interplay between disciplines. Our own qualitative research—guided by implementation science frameworks—