Health outcomes and health care spending among residents of smoke-free public housing

摘要 在美国，烟草是主要的可预防的死亡原因，对吸烟者和 暴露在二手烟和三手烟中。低收入、多单元住房的居民尤其 容易受到烟草烟雾的影响。低收入的人更有可能吸烟，这反过来又会 增加共享环境的人的烟草烟雾暴露。2015年11月，美国 住房和城市发展部(HUD)提出了一项规则，要求由联邦政府资助的公共 住房管理局(PHA)为他们的住宅制定无烟政策，可能会减少 与吸烟和烟草烟雾暴露相关的发病率。马萨诸塞州的PHA一直在 无烟住房政策的前沿及其经验提供了一个早期评估 住房和城市发展部提议的无烟政策以及其他低收入人群无烟政策的健康益处 住房。首席调查员及同事表示，有黑烟的公共房屋发展项目- 免费政策中空气中的烟草烟雾污染水平(细颗粒物[PM2.5]，尼古丁)低于 那些没有无烟政策的人。此外，他们发现，在波士顿住房管理局推出其 无烟政策在2012年，居民公寓里空气中的尼古丁含量下降了70%。虽然有证据表明 现有的研究表明，无烟住房政策减少PHA的烟草烟雾污染是有希望的 有明显的局限性。此外，还没有研究检查居民健康结果的变化。 在引入无烟住房政策之后。吸烟者和不吸烟者都应该 受益于多单元住宅的禁烟规定。我们建议评估潜在的健康影响 关于烟草治疗使用、不良临床事件信号和医疗保健的无烟公共住房政策 马萨诸塞州所有公共住房居民的支出。我们的研究将采用强有力的准实验 设计以评估交错引入无烟所产生的一系列自然实验 ≥的保单占该州241个PHA的27%。PHA中不采取无烟政策的居民将为 作为并发控制。我们将使用2008-2018年的数据来衡量PHA居民的结果 马萨诸塞州所有付款人索赔数据库(APCD)，这是一个独特的综合资源，包括健康 从该州几乎所有的健康保险公司获得所有参保居民的护理索赔。此外，我们还将包括数据 来自马萨诸塞州戒烟热线的烟草治疗使用。这项研究的结果将有政策- 对国家资助的PHA无烟住房的相关影响(不在住房和城市发展部的政策范围内)，其他 补贴住房和低收入住房，以及全国私人住房市场。

ABSTRACT Tobacco is the leading preventable cause of death in the United States, affecting both tobacco users and those exposed to second- and third hand smoke. Residents of low-income, multiunit housing are particularly vulnerable to tobacco smoke exposure. Low-income individuals are more likely to smoke, which in turn increases the tobacco smoke exposure of people sharing their environments. In November of 2015, the U.S. Department of Housing and Urban Development (HUD) proposed a rule requiring federally-funded public housing authorities (PHAs) to establish smoke-free policies for their residences, potentially reducing the morbidity associated with smoking and tobacco smoke exposure. Massachusetts PHAs have been at the forefront of smoke-free housing policies and their experience provides an early opportunity to assess the health benefits of HUD's proposed smoke-free policy, as well as smoke-free policies in other low-income housing. The principal investigator and colleagues have shown that public housing developments with smoke- free policies have lower levels of tobacco smoke pollution in the air (fine particle matter [PM2.5], nicotine) than those without smoke-free policies. In addition, they found that after the Boston Housing Authority introduced its smoke-free policy in 2012, airborne nicotine in residents' apartments went down by 70%. While the evidence that smoke-free housing policies reduce tobacco smoke pollution in PHAs is promising, the existing research has notable limitations. Furthermore, no studies have yet examined changes in health outcomes for residents following the introduction of smoke-free housing policies. Smokers and non-smokers alike are expected to benefit from the prohibition of smoking in multiunit housing. We propose assessing the potential health impact of smoke-free public housing policies on tobacco treatment use, signal adverse clinical events, and health care spending for all public housing residents in Massachusetts. Our study will use a strong quasi-experimental design to evaluate a series of natural experiments arising from the staggered introduction of smoke-free policies in ≥27% of the state's 241 PHAs. Residents in PHAs that do not adopt smoke-free policies will serve as concurrent controls. We will measure outcomes for PHA residents using 2008-2018 data from the Massachusetts All Payer Claims Database (APCD), a uniquely comprehensive resource that includes health care claims for all insured residents from nearly all health insurers in the state. In addition, we will include data on tobacco treatment use from the Massachusetts state quit line. Findings from this study will have policy- relevant implications for smoke-free housing in state-funded PHAs (not covered by HUD's policy), other subsidized and low-income housing, and private housing markets nationally.