Secondhand Smoke and Asthma in the Bronx: A Public Health Crisis

Bronx Community Health Issue: Asthma

Asthma rates in the Bronx are higher than other boroughs and continue to impact residents, including children ages 0-17 at alarming rates. Emergency room visits for children in the Bronx is approximately 351 per 10,000 compared to 188 per 10,000 for New York City (BronxCare Health System, 2022). The BronxCare Health System Community Health Needs Assessment and Community Service Plan prioritizes asthma as a critical need area for Bronx communities.

The Centers for Disease Control and Prevention (2022) identify asthma as a disease impacting airways to the lungs. Asthma attacks include coughing, wheezing, shortness of breath, and tightness/pain in the chest. Secondhand smoke is a major trigger for these attacks in people with asthma (CDC, 2022). The New York City Housing Authority prohibits smoking in and within 25 ft of NYCHA buildings (NYC, 2018). However, the policy does not seem to deter smokers and lacks consistent enforcement.

While there are several other factors contributing to rising asthma rates in children in the Bronx, policy preventing smoking-cigarettes/ cigars/ vapes/marijuana/ etc.-in all public areas and enforcement of new and existing policy can make a huge impact on improved air quality and public health outcomes, including reduced childhood asthma rates.

Critical Questions

1. Do children living in "smoke-free" NYCHA buildings have fewer asthma attacks than those living in private housing?
2. What impact does the no-smoking policy in NYCHA properties have on asthma attacks in children?

The map above shows asthma-related emergency room visits for children in NYC. Most of the Bronx (the entire South Bronx) is in dark blue, showing extreme and disproportionate rates. The data was collected in 2018, the same year New York City Housing Authority enacted the smoke-free policy. The research seeks to determine impact of the policy on asthma-related emergency room visits for children. Further research on the impact of the NYCHA smoke-free policy may inform additional, smoke-free streets policy in the Bronx.

Background

Mixed-method research is needed to determine impact of smoke-free policy on asthma attacks in children. Quantitative data on frequency, duration, and intensity of asthma-related illness is essential to answer the critical research questions. Qualitative data on residents' perceptions of enforcement and impact level of the smoke-free policy is essential in building a case for smoke-free streets in the Bronx.

Further background study of other heavily populated urban areas where smoke-free streets policy is implemented yielding improved public health outcomes for residents is essential in lobbying for policy change. A great example is the World Health Organization's study of Mecca and Medina in Saudi Arabia (WHO, 2011). The study reports improved air quality in and around the cities following implementation and enforcement of tobacco-free laws.

Setting and Demographics

The Bronx is the Northern-most borough of New York City, bordering Manhattan to the Southwest, Queens to the East, and Westchester County to the North. The United States Census Bureau (2021) reports 1.5 million people living in the 42.1 square miles of the Bronx. Approximately 40% of the 1.5 million reside in the Southwestern corner known as the "South Bronx" (Statistical Atlas, 2023) (Institute for Civil Infrastructure Systems, 2009). The median income for Bronx households is 43K compared to the New York State average of 74K. The New York State reports a 13.9% poverty level. The Bronx county has a reported 26% of residents living at or below poverty level (United States Census Bureau, 2021).

World Population Review (2023) provides the following population by race overview:

Objectivity and Bias: Research Ethics

Data presented are essential in the background of this study. Moving forward with this study involving human subjects, the following ethical guidelines are critical:

• Clear purpose for improved health outcomes
• Voluntary participation-informed consent protocols and community in agreement with study
• Participants informed of all possible dangers associated with study
• Privacy and confidentiality procedures in place
• Participant and community updates at critical points in the research
• Researchers are informed and competent
• Research is fair, honest, impartial, and transparent
• Research is beneficial
• Findings made public
• Researchers take full responsibility for ethical principles and practices

(Avasthi et al., 2013)

Data Collection and Evaluation

Quantitative data are collected from federal, state and local agencies identifying asthma rates pre and post no-smoking policy in New York City Housing Authority buildings. Additional data on enforcement of the no-smoking policy are collected through the NYPD public data reports. Qualitative data are collected through survey and interview.

Attributes aligning to the data collection and study include:

• Current statistics showing disproportionate childhood asthma rates in the Bronx (Montefiore, 2019).
• Centers for Disease Control and Prevention (2022) identifying secondhand smoke as a major asthma attack trigger.
• The link between poverty and smoking rates (NYC Department of Health and Mental Hygiene, 2022).
• Evidence of improved health outcomes in similar, heavily populated areas where street no-smoking laws were enacted, including the World Health Organization study on Mecca and Medina in Saudi Arabia (WHO, 2011).
• Bronx Community Needs Assessment (2018) identifying asthma as a public health threat.

Next Steps

The Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (2016) lists support for efforts of tobacco control programs to reduce smoking and environmental tobacco smoke in NY State. Public health leaders in the Bronx must work together to study existing quantitative , gather qualitative data from the Bronx community, and present findings to government officials who can develop and enforce laws preventing smoking in all public areas (Guerriero, 2023).

Smoke-free streets improves health outcomes for all residents, workers, and visitors. Strategies including high taxes on tobacco products, significant fines and enforcement of no-smoking policies, smoking cessation programs, prohibiting the advertisement and sponsorship of tobacco products are proven effective in reducing tobacco use. Robust public health education campaigning through cultural centers, religious organizations, schools, and health care facilities is the community's best defense in mitigating health risks including asthma, by actively lobbying for smoke-free streets in the Bronx.

Providing the community with ongoing, current research on the impact of secondhand smoke and childhood asthma, and the impact of current NYCHA policies through transparent public health education empowers community members to rally for changes for improved health outcomes.

References

Avasthi, A., Ghosh, A., Sarkar, S. & Grover, S. (2013). Ethics in medical research: General principles with special reference to psychiatry research. Indian Journal of Psychiatry, 55(1), 86-91. https://www.doi.org/10.4103/0019-5545.105525

BronxCare Health System. (2022). Community health needs assessment and community service plan 2022-2024. https://www.bronxcare.org/fileadmin/SiteFiles/Images/1-About_Us/d-Community_Service_Plan/CSP_2022_12.15.22_FINAL.pdf

Centers for Disease Control and Prevention. (2022). Asthma and secondhand smoke. https://www.cdc.gov/tobacco/campaign/tips/diseases/secondhand-smoke-asthma.html

Centers for Disease Control and Prevention. (2016). Behavioral risk factor surveillance system: State by state listing of how data are used. https://www.cdc.gov/brfss/state_info/brfss_use_examples.htm

Guerriero, A. (2023). Data interpretation [unpublished presentation]. School of Public Health, American College of Education.

Institute for Civil Infrastructure Systems. (2009). South bronx environmental study. https://www.icisnyu.org/south_bronx/Demographics_001.html

Montefiore Hospital. (2019). Bronx community health dashboard: Asthma. https://www.montefiore.org/documents/communityservices/OCPH-Dashboard-asthma.pdf

New York City Department of Health and Mental Hygiene. (2015). Community health survey. https://www.nyc.gov/site/doh/data/data-sets/community-health-survey.page

New York City Department of Health and Mental Hygiene. (2018). New york city community health profiles 2018 map atlas. https://www.nyc.gov/assets/doh/downloads/pdf/data/2018-chp-atlas.pdf

New York City Housing Authority. (2018). NYCHA’s smoke-free policy. https://www.nyc.gov/assets/nycha/downloads/pdf/nycha-smoke-free-policy-2018.pdf

New York City Police Department. (2023). Citywide crime statistics. https://www.nyc.gov/site/nypd/stats/crime-statistics/crime-statistics-landing.page

Statistical Atlas. (2023). Population of the south bronx, new york, new york. https://statisticalatlas.com/neighborhood/New-York/New-York/South-Bronx/Population

United States Census Bureau. (2020). Bronx county, new york. https://data.census.gov/profile/Bronx_County,_New_York?g=0500000US36005

World Health Organization. (2011). Tobacco-free cities for smoke-free air: A case study in Mecca and Medina. https://www.emro.who.int/images/stories/tfi/documents/PUB_KOBE_TOBACCO_FREE_CITIES_SAUDI_EN.pdf

World Population review. (2023). Bronx population 2023. https://worldpopulationreview.com/boroughs/bronx-population