Smoking in the home and children's health

Background: Almost one in three children lives in households with at least one adult smoker, and about one in four children are exposed to secondhand smoke at home.

Objectives: We estimate for young children the annual excess health service use, health care expenditures, and disability bed days for respiratory conditions associated with exposure to smoking in the home.

Methods: Health service use, health care expenditures, and disability bed days data come from the 1999 and 2001 Medical Expenditure Panel Survey (MEPS). Reported smoking in the home comes from the linked National Health Interview Survey, from which the MEPS sample is drawn. Multivariate statistical analysis controls for potentially confounding factors. The sample is 2,759 children age 0 to 4.

Results: Smoking in the home is associated with an increase in the probability of emergency room visits for respiratory conditions by 5 percentage points and the probability of inpatient use for these conditions by 3 percentage points. Overall, indoor smoking is associated with $116 in additional health care expenditures for respiratory conditions for exposed children. Indoor smoking is also associated with a 9 percentage-point increase in the probability of having a bed day due to respiratory illness for children.

Conclusions: Smoking is associated with acute respiratory exacerbations, including worse health and reductions in children's activities. Substantial proportions of hospital stays and emergency department visits by children are related to respiratory conditions. Reducing smoking inside the home would likely reduce the use of these expensive services and improve children's health.