A Critical Review of an Interdisciplinary Solution Authored by: Samantha Cochran

An analytical review of the article “National and State Cost Savings Associated With

Prohibiting Smoking in Subsidized and Public Housing in the United States” by Brian A.

King, PhD, MPH; Richard M. Peck, PhD; and Stephen D. Babb, MPH.

November 30, 2014

1 | P a g e

Introduction

The Problem

The effects of tobacco on the body have been studied extensively by independent

and government scientists. The CDC has defined secondhand smoke as any smoke from a

burning tobacco product or any smoke that has been exhaled by a person smoking a

tobacco product (2)(6). Smoking is estimated to cause 440,000 deaths per year in the US

(3). Secondhand smoke is estimated to cause 7,330 deaths from lung cancer and 33,950

deaths from heart disease among US adult nonsmokers (1). A separate source from the CDC

states that since 1964, 2.5 million nonsmokers have died from the effects of secondhand

smoke (2). In the article, “National and State Cost Savings Associated With Prohibiting

Smoking in Subsidized and Public Housing in the United States,” the authors cite the US

Surgeon General’s assessment that there is no risk-free level of secondhand smoke

exposure (1)(6). A separate study concluded the overall cost of health care and premature

loss of life attributed to secondhand smoke for the US was estimated to be $53.9 million in

2000(7). In the US, smoking tobacco products is legal, and thus the personal choice of

smokers. However, this choice does not only affect the smoker, but rather affects the people

around the secondhand smoke the smoker produces.

In the US there have been measures undertaken to reduce the public presence of

secondhand smoke, such as prohibiting smoking in all indoor public places and worksites

(1). However, these measures have not extended into the homes of smokers. The article,

“National and State Cost Savings Associated With Prohibiting Smoking in Subsidized and

Public Housing in the United States” has identified a portion of the American people that

are at risk of developing health problems from exposure to secondhand smoke. The article

2 | P a g e

states that people in multiunit housing are particularly vulnerable to secondhand smoke

because the smoke can permeate into adjacent units of non-smokers (1). These multiunit

houses will be the focus of the potential first step towards reducing the cost of secondhand

smoke in America.

The Solution

In America, there are approximately 80 million multiunit housing residents that could

be at an increased risk of secondhand smoke exposure. Of the 80 million residents of

multiunit housing, 7 million live in subsidized or public housing (1)(7). The article by King,

Peck, and Babb states a possible first step towards reducing the health impact of

secondhand smoke. By prohibiting smoking in subsidized housing, the authors propose “an

annual cost savings of $496.82 million (range, $258.96–$843.50 million), including $310.48

million ($154.14–$552.34 million) in secondhand smoke-related health care, $133.77

million ($75.24–$209.01 million) in renovation expenses, and $52.57 million ($29.57–

$82.15 million) in smoking-attributable fire losses (1).” Statistical analysis instructs that if

the range includes the number “0”, the results are not statistically significant. Because the

range includes only positive numbers, the results are statistically significant and provide a

numerical representation of the cost benefit of prohibiting smoking in subsidized housing.

Research

Key Aspects of Article

The article by King, Peck, and Babb considers the topic of implementing a "smoke-

free" environment in subsidized and public housing for both a cost and health benefit using

an interdisciplinary approach. The threats of second hand smoke and national debt seem

3 | P a g e

unrelated, but the authors believe they can be tackled together with an interdisciplinary

approach. Through analytical research of data collected on smoke-related costs, the article

determines correlation between allowing smoking in subsidized housing and $496.82

million (range, $258.96–$843.50 million) in economic impact on the US. The authors Brian

A. King, PhD, MPH; Richard M. Peck, PhD; and Stephen D. Babb, MPH are all highly educated

key thinkers in their field.

The authors make the assumption that the impact of secondhand smoke-related

healthcare costs could be reduced with the decrease in secondhand smoke exposure. This,

however, would not immediately reduce all of the secondhand smoke-related health costs

of the people currently exposed in multiunit subsidized housing. There are already health

problems in the people exposed that will cause them to need health care throughout their

lives, thus reducing the initial impact of their solution. The authors do try to limit the

assumptions made in order to reduce the bias and error of their study.

Key Elements of Interdisciplinary Research

Augsburg states that an interdisciplinary approach must include a broad interest

and competence in one’s field (4). The authors displays competency in their respective

fields and uses their information to create a solution that covers a broad selection of

disciplines. Although the authors include multiple disciplines in their approach, Augsburg

defines interdisciplinary as, “combining or involving two or more disciplines or fields of

study (4).” To be truly interdisciplinary, one must successfully combine the discipline, not

just refer to them separately.

Identifying the key elements of interdisciplinary research as stated by Augsburg in

Becoming Interdisciplinary provides a framework for which to analyze an article’s

4 | P a g e

interdisciplinary approach. A few of the most important items to identify are the discipline

subject matter, research method, and key concept (4). The value of identifying these

characteristics allows the reader to justify the interdisciplinarity of the article. Multiple

disciplines must be identified by the author and successfully integrated into a cohesive

argument for change.

Disciplines in Article Conclusion

These sources of this article come from multiple disciplines, including economic

policy, statistical analysis, physics, public policy, behavioral studies, architecture,

economics, housing and urban development, and medicine. Each discipline plays an

integral role in determining the factors that affect the possibly solution presented in the

article. The authors integrate the statistical analysis and economic impacts to determine

the quality of their potential results. While determining the fields the solution would affect,

and the fields that are involved in the problem itself, they include fire safety, architecture,

air flow, air quality, and medicine. To determine a solution, they bridge the disciplines of

public policy, behavioral studies, and economic policy. Each step of their research and

conclusions has a specific set of disciplines that combine to form their integrated approach

to a complex problem facing America. Additional disciplines could be considered as the

solution is carried out, such as communication (to enact the plans) and law (to successfully

write the federal documents that would enact the new policy).

5 | P a g e

Discussion

Integrity of Sources in the Article

In the article, “National and State Cost Savings Associated With Prohibiting Smoking

in Subsidized and Public Housing in the United States,” the author uses thirty sources for

supporting his thesis. These sources come from multiple areas of study, including economic

policy and impact of smoking on Americans, the CDC analysis of health impact of smoking,

air quality studies on secondhand smoke transfer in multiunit housing, public policy of

non-smoking in public housing, behavioral studies of tenants, home structure fire analysis,

the economic impact of fire in the US, housing and urban development, analysis of human

activity patterns, and medical research of smoking and treatments (1). These varied

sources, combined with the reputable nature of the sources, give the article’s research

integrity and value.

Rebuttal

Despite the overall validity of the article’s findings, there is another perspective that

could influence how the findings are carried out. The American people are strongly against

the illegalization of smoking. When asked if smoking should be made totally illegal, 79%

said “no” in 2014. However, 56% said “yes” to the question of whether smoking should be

made illegal in public places (5). While American support still favors the idea of smoking

being permitted, it will be hard to implement new policies of smoking bans.

Additionally, it is important to mention that, as the author of this paper, I am subject to my

history, allowing for bias. While my mother was pregnant with my brother and myself she

decided to continue smoking. Her choice caused my brother to be born with Asthma and

6 | P a g e

me to be born with an allergy to smoke. Every time I inhale smoke I become dizzy,

nauseous, and find it difficult to breathe. I live in an apartment unit that is frequently

permeated by tobacco and cannabis smoke from neighbors. Their blatant disrespect for the

health of others forces me to be exposed to secondhand smoke daily, despite choosing to

inhabit a smoke-free household. The topic of reducing secondhand smoke exposure to

people who choose to live smoke-free is important to me, but also makes me biased. My

bias could have an effect on my position taken throughout this analysis. However, I

endeavored to use my disciplines of Computational Sciences, Biological Sciences, and

Health Sciences alongside reputable sources and logic to form an impartial analysis of the

research and assertions made by the authors of "National and State Cost Savings Associated

With Prohibiting Smoking in Subsidized and Public Housing in the United States."

Conclusion

Based on the interdisciplinary text we have been reading in this class, I believe the

article’s solution is an interdisciplinary approach. The authors use data and studies from

multiple disciplines to develop their thesis, then further integrate multiple disciplines into

a solution that would require professionals in many different fields to work together. In

order to draft the bill that would make their proposal a reality, people from the fields of

law, medicine, public policy, physics, architecture, behavioral studies, and housing and

urban development would have to work together to determine the best way to successfully

solve the problem established in the article. The US is currently becoming more educated

and health conscious, giving way to a new era where this article could actually have a

chance to become a reality. The people of the US want less health costs and more clean air.

Even the University of Central Florida recognized the trend and went “smoke-free” in 2012.

7 | P a g e

With help from multiple disciplines working together, this interdisciplinary approach could

save millions of dollars, and more importantly millions of lives.

8 | P a g e

Annotated Bibliography

1. King, Brian A., Richard M. Peck, and Stephen D. Babb. "National and State Cost

Savings Associated With Prohibiting Smoking in Subsidized and Public Housing in

the United States." Preventing Chronic Disease 11.E171 (2014): n. pag. Centers for

Disease Control and Prevention, Oct. 2014. Web. 25 Oct. 2014.

<http://www.cdc.gov/pcd/issues/2014/14_0222.htm>.

This article details a potential interdisciplinary approach to alleviating the negative

role smoking plays in the American healthcare system. The article will be analyzed

based on its sources, ideas, assumptions, and interdisciplinarity.

2. "Secondhand Smoke (SHS) Facts." Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention, 11 Apr. 2014. Web. 15 Nov. 2014.

<cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/ind

ex.htm?mobile=nocontent>.

This article will be as a sources for reliable information concerning secondhand

smoke and its health impacts on the human body. It is used to define secondhand

smoke and examine the negative effect secondhand smoke has on the human body.

It is published by the Center for Disease Control and cites reliable government and

medical sources.

9 | P a g e

3. "Toll of Tobacco in the United States." Centers for Disease Control and Prevention.

Penn State University, 18 Mar. 2009. Web. 17 Nov. 2014.

<http://www.med.upenn.edu/cirna/pdf/USA_Figures.pdf>.

This source is a compilation of facts to verify the validity of the figures presented in

the article I am analyzing. This source provided the data of how many deaths were

recorded concerning smoking as a whole. The article is published by the Penn State

University, with sources from the CDC and SAMHSA. It is a reliable source of data.

4. Augsburg, Tanya. Becoming Interdisciplinary: An Introduction to Interdisciplinary

Studies. Dubuque, IA: Kendall/Hunt Pub., 2006. Print.

This text provided the key aspects of interdisciplinary research. Additionally, it was

used to define the term “interdisciplinary”. It is the text assigned to this class and is

therefore a reliable source of information.

5. Riffkin, Rebecca. "Americans Favor Ban on Smoking in Public, but Not Total Ban."

Americans Favor Ban on Smoking in Public, but Not Total Ban. GALLUP, 30 July

2014. Web. 21 Nov. 2014. <http://www.gallup.com/poll/174203/americans-favor-

ban-smoking-public-not-total-ban.aspx>

This website displays the graphical representation of the polls given to Americans

concerning their opinion on the illegalization of smoking. The source conducted the

10 | P a g e

GALLUP poll, which is used by many reputable scholarly journal articles as evidence.

This website is the source of the figures at the end of this paper.

6. "Secondhand Smoke and Cancer." National Institute of Health. National Cancer

Institute, Jan. 2011. Web. 29 Oct. 2014.

<http://www.cancer.gov/cancertopics/factsheet/Tobacco/ETS>.

This source details a fact sheet about secondhand smoke and its effect on cancer. It

is published by the National Cancer Institute at the National Institute of Health. This

is a credible source of information on public health. The article is an informative list

of facts about secondhand smoke. It is the authority on the effects of secondhand

smoke. This source will provide valuable background knowledge on a main topic in

my analysis of the article I have chosen. It will provide detailed information about

secondhand smoke from the discipline of Biological Health.

7. Zollinger, T. W., R. M. Saywell, Jr., A. D. Overgaard, S. J. Jay, A. M. Holloway, and S. F.

Cummings. "Estimating the Economic Impact of Secondhand Smoke on the Health of

a Community." American Journal of Health Promotion 18.3 (2004): 232-38. National

Center for Biotechnology Information. U.S. National Library of Medicine, Jan. 2004.

Web. 1 Nov. 2014. <http://www.ncbi.nlm.nih.gov/pubmed/14748313>.

This journal article details an analysis of the economic impact of secondhand smoke

on the health community. It is published in the American Journal of Health

11 | P a g e

Promotion, a reliable source of scholarly articles. Additionally, it is electronically

accessible through the U.S. National Library of Medicine. The information provided

supports the main argument in the article I have chosen to analyze. There is use of

statistical analysis and detailed demographic studies. The information is based in

economic analysis from the discipline of Statistics and Public Policy. I will use this

source to support the arguments made in the article I have chosen to analyze.

12 | P a g e

Figures

Figure 1

Figure 2

13 | P a g e

Interdisciplinary Statement

While progressing through my degree in Biological Sciences, I realized that my approach to

Public Health had become one-sided and biased. My degree in Interdisciplinary Studies

allowed me the opportunity to learn how to approach problems from multiple

perspectives, integrating all of the pertinent information for a fair and effective solution.

This analysis of a large scale problem with a focus of Interdisciplinary intervention

enlightened me in the true path I want to take in life. Until now, I couldn't verbalize what I

felt I needed to contribute to our society's public health system. I would like to apply my

new tools of analysis to the large scale problems facing the healthcare system in the CDC. I

hope to use this project as a justification of my abilities for admission to Graduate School

and as a basis for my skills. It will allow my future advisors to focus on areas where I need

improvement and help me to become a contribution to the field.