The World Health Organization (WHO) reports that nonsmokers experience disease and death due to secondhand smoke (SHS) exposure in the home. We estimated the total excess burden and costs to society due to SHS exposure in U.S. public housing.
Methods.
We quantified the public health burden for outcomes causally related to SHS exposure for nationally representative never-smoking residents in U.S. public housing using (1) WHO-recommended health outcomes and methodology, (2) publicly available and other large databases, and (3) published estimates of morbidity and mortality rates. We used published estimates of direct medical and nonmedical care costs and the value of productivity losses to estimate SHS-related societal costs for disease and death. We estimated the public health and economic burden for two serum cotinine limits of detection (LODs): 0.05 nanograms per milliliter (ng/mL) and 0.015 ng/mL.
Results.
In 2011, an estimated 37,791 never-smoking child and adult U.S. public housing residents experienced illness and death due to SHS exposure at home based on an LOD=0.05 ng/mL (50,967 residents at LOD=0.015 ng/mL). Costs incurred by society for these illnesses and deaths totaled $183 million (LOD=0.05 ng/mL) and $267 million (LOD=0.015 ng/mL) annually. Of the total costs, direct costs (medical and nonmedical) accounted for $128 million and $176 million for LOD=0.05 ng/mL and LOD=0.015 ng/mL, respectively. Medical care accounted for the majority of direct costs—$110 million at LOD=0.05 ng/mL and $153 million at LOD=0.015 ng/mL. Adverse respiratory health outcomes accounted for approximately one-half (56% at LOD=0.05 ng/mL and 52% at LOD=0.015 ng/mL) of total societal costs.
Conclusion.
Implementing smoke-free policies in all U.S. public housing could save lives and decrease SHS-related morbidity and mortality in never-smoking residents, resulting in annual societal savings of $183 million at LOD=0.05 ng/mL and $267 million at LOD=0.015 ng/mL.
References
1.
Centers for Disease Control and Prevention (US). The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta: Department of Health and Human Services (US), Centers for Disease Control and Prevention, National Center for Chronic Disease, Prevention and Health Promotion, Office on Smoking and Health; 2006. Also available from: URL: http://www.ncbi.nlm.nih.gov/books/NBK44324/pdf/toc.pdf [cited 2012 May 12].
2.
ÖbergMJaakkolaMSPrüss-ÜstünASchweizerCWoodwardA.Second-hand smoke: Assessing the burden of disease at national and local levels. Geneva: World Health Organization; 2010. WHO Environmental Burden of Disease Series No. 18. Also available from: URL: http://www.who.int/quantifying_ehimpacts/publications/SHS.pdf [cited 2011 Jul 11].
HallAGSchumacherJRCannellMBBerryJBSchiaffinoMParkS.Tobacco use in Florida: Comparisons between adults living with and without disabilities. Disabil Health J2013;6:213–9.
7.
KraevTAAdamkiewiczGHammondSKSpenglerJD, Indoor concentrations of nicotine in low-income, multi-unit housing: Associations with smoking behaviours and housing characteristics. Tob Control2009;18:438–44.
8.
Department of Housing and Urban Development (US). Characteristics of HUD-assisted renters and their units in 2003. Washington: HUD, Office of Policy Development and Research; 2008. Also available from: URL: http://www.huduser.org/portal/publications/pubasst/hud_asst_rent.html [cited 2011 Aug 1].
9.
HermanPMWalshME, Hospital admissions for acute myocardial infarction, angina, stroke, and asthma after implementation of Arizona/s comprehensive statewide smoking ban. Am J Public Health2011;101:491–6.
10.
MeyersDGNeubergerJSHeJ.Cardiovascular effect of bans on smoking in public places: A systematic review and meta-analysis [published erratum appears in J Am Coll Cardiol2009;54:1902]. J Am Coll Cardiol2009;54:1249–55.
11.
HahnEJYorkNLRayensMK, Smoke-free legislation in Appalachian counties. Am J Public Health2010;100:2012–3.
12.
KabirZClarkeVConroyRMcNameeEDalySClancyL.Low birthweight and preterm birth rates 1 year before and after the Irish workplace smoking ban. BJOG2009;116:1782–7.
13.
MarkowitzS.The effectiveness of cigarette regulations in reducing cases of Sudden Infant Death Syndrome. J Health Econ2008;27:106–33.
14.
Department of Housing and Urban Development (US). Nonsmoking policies in public housing. Washington: HUD, Office of Healthy Homes and Lead Hazard Control; 2009. Also available from: URL: http://www.hud.gov/offices/pih/publications/notices/09/pih2009–21.pdf [cited 2011 Sep 12].
15.
Department of Housing and Urban Development (US). Smoke-free policies in public housing. Washington: HUD, Office of Healthy Homes and Lead Hazard Control; 2012. Also available from: URL: http://portal.hud.gov/hudportal/documents/huddoc?id512–25pihn.pdf [cited 2011 Sep 12].
16.
DrachLLPizacaniBARohdeKLSchubertS.The acceptability of comprehensive smoke-free policies to low-income tenants in subsidized housing. Prev Chronic Dis2010;7:A66.
17.
PizacaniBAMaherJERohdeKDrachLStarkMJ, Implementation of a smoke-free policy in subsidized multiunit housing: Effects on smoking cessation and secondhand smoke exposure. Nicotine Tob Res2012;14:1027–34.
18.
American Nonsmokers' Rights Foundation. U.S. laws and policies restricting or prohibiting smoking in private units of multi-unit housing. 2014 [cited 2012 May 23]. Available from: URL: http://www.no-smoke.org/pdf/smokefreemuh.pdf.
19.
The Center for Social Gerontology. Housing authorities/commissions which have adopted smoke-free policies; 2011 [cited 2012 Oct 12]. Available from: URL: http://www.tcsg.org/sfelp/SFHousingAuthorities.pdf.
20.
AligneCAStoddardJJ, Tobacco and children. An economic evaluation of the medical effects of parental smoking [published erratum appears in Arch Pediatr Adolesc Med1997;151:988]. Arch Pediatr Adolesc Med 1997;151:648–53.
21.
CookDGStrachanDP, Health effects of passive smoking: Summary of effects of parental smoking on the respiratory health of children and implications for research. Thorax1999;54:357–66.
22.
DiFranzaJRAligneCAWeitzmanM.Prenatal and postnatal environmental tobacco smoke exposure and children/s health. Pediatrics2004;113(4 Suppl):1007–15.
23.
FlorenceCSAdamsEKAyadiMF, Pediatric health care costs attributable to exposure to second-hand smoke: An exploratory analysis. J Health Care Finance2007;34:36–43.
24.
LeungGMHoLMLamTH, The economic burden of environmental tobacco smoke in the first year of life. Arch Dis Child2003;88:767–71.
25.
LevyDERigottiNAWinickoffJP, Medicaid expenditures for children living with smokers. BMC Health Serv Res2011;11:125.
26.
LevyDEWinickoffJPRigottiNA, School absenteeism among children living with smokers. Pediatrics2011;128:650–6.
27.
MillerTRauhVAGliedSAHattisDRundleAAndrewsH, The economic impact of early life environmental tobacco smoke exposure: Early intervention for developmental delay. Environ Health Perspect2006;114:1585–8.
28.
OhSSTcheurekdjianHRothLANguyenEASenSGalanterJM, Effect of secondhand smoke on asthma control among black and Latino children. J Allergy Clin Immunol2012;129:1478–83.
29.
LightwoodJ.The economics of smoking and cardiovascular disease. Prog Cardiovasc Dis2003;46:39–78.
30.
LightwoodJMGlantzSA, Declines in acute myocardial infarction after smoke-free laws and individual risk attributable to secondhand smoke. Circulation2009;120:1373–9.
31.
PopeCA3rdBurnettRTTurnerMCCohenAKrewskiDJerrettM, Lung cancer and cardiovascular disease mortality associated with ambient air pollution and cigarette smoke: Shape of the exposure-response relationships. Environ Health Perspect2011;119:1616–21.
32.
PlesciaMWansinkDWatersHRHerndonS.Medical costs of secondhand-smoke exposure in North Carolina. NC Med J2011;72:7–12.
33.
WatersH.The economic impact of secondhand smoke in Maryland. Report submitted to the American Cancer Society. Baltimore: Johns Hopkins Bloomberg School of Public Health; 2006.
34.
WatersHRFoldesSSAlesciNLSametJ.The economic impact of exposure to secondhand smoke in Minnesota. Am J Public Health2009;99:754–9.
35.
ZollingerTWSaywellRMJrMueggeCMPrzybylskiMJ, Estimating the economic impact of secondhand smoke on Indiana in 2007. Indianapolis: Bowen Research Center–Indiana University School of Medicine; 2008.
36.
BehanDFEriksenMPLinY.Economic effects of environmental tobacco smoke. Schaumburg (IL): Society of Actuaries; 2005.
37.
KingBAPeckRMBabbSD, Cost savings associated with prohibiting smoking in U.S. subsidized housing. Am J Prev Med2013;44:631–4.
38.
LewitEMBakerLSCormanHShionoPH, The direct cost of low birth weight. Future Child1995;5:35–56.
39.
TrasandeLLandriganPJSchechterC.Public health and economic consequences of methyl mercury toxicity to the developing brain. Environ Health Perspect2005;113:590–6.
40.
Department of Housing and Urban Development (US). Improving housing subsidy surveys: Data collection techniques for identifying the housing subsidy status of survey respondents. Washington: HUD, Office of Policy Development and Research; 2005. Also available from: URL: http://www.huduser.org/publications/pdf/datacollect.pdf [cited 2012 Dec 1].
41.
Centers for Disease Control and Prevention (US). Fourth national report on human exposure to environmental chemicals, 2009. Atlanta: CDC; 2009.
42.
SAS Institute, Inc.SAS$: Version 9.3. Cary (NC): SAS Institute, Inc.; 2011.
43.
Research Triangle Institute. SUDAAN$: Release 10.0. Research Triangle Park (NC): Research Triangle Institute; 2008.
44.
HaddixACTeutschSMCorsoPS, Prevention effectiveness: A guide to decision analysis and economic evaluation. 2nd ed. New York: Oxford University Press; 2003.
45.
Wolleswinkel-Van denBosch JHStolkEAFrancoisMGaspariniRBrosaM.The health care burden and societal impact of acute otitis media in seven European countries: Results of an Internet survey. Vaccine2010;28Suppl 6:G39–52.
46.
GrosseSDKruegerKVMvunduraM.Economic productivity by age and sex: 2007 estimates for the United States. Med Care2009;47(7 Suppl 1):S94–103.
47.
BarnettSBNurmagambetovTA, Costs of asthma in the United States: 2002–2007. J Allergy Clin Immunol2011;127:145–52.
48.
HarrisJ.Double jeopardy and the veil of ignorance—a reply. J Med Ethics1995;21:151–7.
49.
TrogdonJGFinkelsteinEANwaiseIATangkaFKOrensteinD.The economic burden of chronic cardiovascular disease for major insurers. Health Promot Pract2007;8:234–42.
50.
ChangSLongSRKutikovaLBowmanLFinleyDCrownWH, Estimating the cost of cancer: Results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during1999 to 2000. J Clin Oncol2004;22:3524–30.
51.
BradleyCJYabroffKRDahmanBFeuerEJMariottoABrownML, Productivity costs of cancer mortality in the United States: 2000–2020. J Natl Cancer Inst2008;100:1763–70.
52.
National Center for Healthy Housing. Reasons to explore smoke-free housing. Columbia (MD): National Center for Healthy Housing; 2009.
LevyDERigottiNAWinickoffJP, Tobacco smoke exposure in a sample of Boston public housing residents. Am J Prev Med2013;44:63–6.
55.
MaxWSungHYShiY.Deaths from secondhand smoke exposure in the United States: Economic implications. Am J Public Health2012;102:2173–80.
56.
MaxWSungHYShiY.Who is exposed to secondhand smoke? Self-reported and serum cotinine measured exposure in the U.S., 1999–2006. Int J Environ Res Public Health2009;6:1633–48.
57.
Department of Housing and Urban Development (US). HUD resident characteristics report. Washington: HUD; 2011.
58.
Census Bureau (US). Statistical abstract of the United States: 2012 (131st edition). Washington: Census Bureau; 2011. Also available from: URL: http://www.census.gov/compendia/statab [cited 2012 May 17].
59.
BrownsonRCHopkinsDPWakefieldMA, Effects of smoking restrictions in the workplace. Annu Rev Public Health2002;23:333–48.
60.
WilsonKMKleinJDBlumkinAKGottliebMWinickoffJP, Tobacco-smoke exposure in children who live in multiunit housing. Pediatrics2011;127:85–92.
61.
WilsonKMTorokMMcMillenRTanskiSKleinJDWinickoffJP, Tobacco smoke incursions in multiunit housing. Am J Public Health2014;104:1445–53.
62.
AkobunduEJuJBlattLMullinsCD, Cost-of-illness studies: A review of current methods. Pharmacoeconomics2006;24:869–90.
63.
FosterTSMillerJDMartonJPCaloyerasJPRussellMWMenzinJ.Assessment of the economic burden of COPD in the U.S.: A review and synthesis of the literature. COPD2006;3:211–8.
64.
Bryant-StephensT.Asthma disparities in urban environments. J Allergy Clin Immunol2009;123:1199–206.
ShiNPalmerLChuBCKatkinJPHallCBMasaquelAS, Association of RSV lower respiratory tract infection and subsequent healthcare use and costs: A Medicaid claims analysis in early-preterm, late-preterm, and full-term infants. J Med Econ2011;14:335–40.
