The economic burden of exposure to secondhand smoke for child and adult never smokers residing in U.S. public housing.

OBJECTIVE: 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.

Estimates of costs for housing-related interventions to prevent specific illnesses and deaths.

Public health is embracing economic analyses in an effort to use limited resources in the most efficient manner. However, users of economic analyses in the public health arena should recognize the inherent strengths and weaknesses of different types of analysis, as well as understand how the inclusion or omission of certain costs or benefits might influence study results. For example, asthma is a chronic condition that can result in health care costs that accrue well beyond the duration of a housing intervention. Thus, an economic analysis that omits long-term health care costs can underestimate the total economic benefit of the housing intervention. This article contains reviews of economic articles on housing interventions published in PubMed, examines salient differences between studies, and discusses pertinent gaps in the literature. In addition, this article attempts to provide an overview of key economic evaluation methods in relation to housing interventions to a target audience of local and state public health practitioners. Specific housing-related health issues discussed include asthma, lead, and carbon monoxide poisoning and radon-related lung cancer.