ResearchPublications

Extract: We thank Dr. Widome for her thoughtful commentary (1) on our study evaluating associations between smoke-free 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 health-care 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.