Estimating the economic burden of second hand smoke exposure

This study estimates the cost of exposure to second hand smoke (SHS) in the U.S. We estimate exposure using both self-reports and measured cotinine. Models are developed to estimate the resulting healthcare costs and lost productivity from premature death. SHS exposure is estimated for nonsmokers including children and adolescents exposed at home, and adults exposed at home and at work. Estimates are disaggregated by race/ethnicity, gender, place of exposure, education, poverty income ratio, health insurance status, and marital status based on analyses of the 1999-2006 National Health and Nutrition Examination Survey. Self-reported exposure rates are found to be highest for children, followed by adolescents and adults. Important differences in exposure are found by socioeconomic characteristics. Blacks had the highest self-reported rates at home and at work and the highest cotinine levels among adults. Mexican Americans had the lowest exposure rates and the lowest cotinine levels among those exposed at home or work and in all age groups. Second hand smoke-attributable fractions (SAFs) are calculated for a number of diseases that have been shown to be associated with SHS exposure, including lower respiratory illness and otitis media in children, and lung cancer and CHD in adults. These SAFs are then applied to expenditures for the particular disease for nonsmokers. We also report greater rates of ADD/ADHD, stammering and stuttering, and headaches among children exposed to SHS compared to those not exposed. SHS exposure is found to lead to substantial illness and cost.