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Open AccessArticle

Reinforcement of Tobacco Control and Reduction in Medical Utilization for Asthma in Taiwan: A Population-Based Study

1
Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 108, Taiwan
2
Center for Quality Management, National Taiwan University Hospital, Taipei 100, Taiwan
3
Department of Business and Management, Ming Chi University of Technology, New Taipei City 243, Taiwan
4
Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(20), 3950; https://doi.org/10.3390/ijerph16203950
Received: 23 July 2019 / Revised: 26 September 2019 / Accepted: 15 October 2019 / Published: 17 October 2019
(This article belongs to the Section Environmental Health)
Environmental air quality can affect asthma control and the development of overt asthmatic manifestations. In this population-based study, we investigated the effect of reinforcing a smoking ban in Taiwan through the enactment of the Tobacco Hazards and Prevention Act (THPA) on healthcare utilization rate by asthmatics. Analysis was performed based on data relevant to non-hospitalized asthmatic patients with insurance claims between 2005 and 2013 from the National Health Insurance Research Database of Taiwan, reported data on Asian dust storms, and penalty rates for violations of the tobacco ban. Poisson regression showed that the risk for outpatient visits for asthma was lower after enactment of the THPA (RR = 0.98, 95% CI = 0.98–0.99), with a yearly trend of a reduced risk (RR = 0.99, 95% CI = 0.99–1.00), also lower in geographic regions with medium (RR = 0.79, 95% CI = 0.79–0.80) and high (RR = 0.91, 95% CI = 0.91–0.92) penalty rates. Subgroup analysis showed that asthma visit rates were reduced in both male and female groups after the enactment of the THPA. The risk of an asthma ER visit was increased after the enactment of the amended THPA (RR = 1.07, 95% CI = 1.05–1.09), although the yearly trend was not significant (RR = 1.00, 95% CI = 1.00–1.00). The risk of emergency room visits for asthma was significantly reduced in regions with medium (RR = 0.68, 95% CI = 0.68–0.69) and high (RR = 0.75, 95% CI = 0.74–0.76) penalty rates. Subgroup analysis showed that the visit rates were similar in both male and female groups. The effectiveness of reinforcing the smoking ban warrants further policies aimed at further reducing passive smoking. View Full-Text
Keywords: tobacco ban; smoking; asthma; healthcare utilization tobacco ban; smoking; asthma; healthcare utilization
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Liang, H.-J.; Wu, M.-J.; Jerng, J.-S.; Yang, C.-H. Reinforcement of Tobacco Control and Reduction in Medical Utilization for Asthma in Taiwan: A Population-Based Study. Int. J. Environ. Res. Public Health 2019, 16, 3950.

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