The Economic Impact of Early Life Environmental Tobacco Smoke Exposure: Early Intervention for Developmental Delay

Article excerpt

BACKGROUND AND OBJECTIVES: Early-life exposure to environmental tobacco smoke (ETS) can result in developmental delay as well as childhood asthma and increased risk of cancer. The high cost of childhood asthma related to ETS exposure has been widely recognized; however, the economic impact of ETS-related developmental delay has been less well understood.

METHODS AND RESULTS: The Columbia Center for Children's Environmental Health (CCCEH) has reported adverse effects of prenatal ETS exposure on child development in a cohort of minority women and children in New York City (odds ratio of developmental delay = 2.36; 95% confidence interval 1.22-4.58). Using the environmentally attributable fraction (EAF) approach, we estimated the annual cost of one aspect of ETS-related developmental delay: Early Intervention Services. The estimated cost of these services per year due to ETS exposure is > $50 million per year for New York City Medicaid births and $99 million per year for all New York City births.

CONCLUSION: The high annual cost of just one aspect of developmental delay due to prenatal exposure to ETS provides further impetus for increased prevention efforts such as educational programs to promote smoke-free homes, additional cigarette taxes, and subsidizing of smoking cessation programs.

KEY WORDS: asthma, children, developmental delay, environmental tobacco smoke. Environ Health Perspect 114:1585-1588 (2006). doi:10.1289/ehp.9165 available via http://dx.doi.org/ [Online 11 July 2006]

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An estimated 35-80% of inner-city children are exposed to environmental tobacco smoke (ETS) (DiFranza et al. 2004; Gergen et al. 1998; Hopper and Craig 2000; Kum-Nji et al. 2006; Weaver et al. 1996). The health effects associated with early-life ETS exposure include reduced fetal growth, neurodevelopmental problems, respiratory disease including asthma, increased cancer risk, and cardiovascular disease, with some adverse effects manifesting in childhood and others in adulthood (Samet 2005; U.S. Department of Health and Human Services 2006).

In earlier work, we documented an association between ETS and developmental delay (Rauh et al. 2004). Here we present estimates of the cost of Early Intervention Services to remediate these developmental delays attributable to ETS in the New York City Medicaid population and in the total New York City population. In the first step, based on the CCCEH results (Rauh et al. 2004), we calculated the fraction of total delay attributable to mothers' ETS exposure during pregnancy (the environmentally attributable fraction, or EAF). The EAF was then multiplied by the prevalence of delay, the size of the exposed population, and the cost per intervention to give the estimated annual cost of Early Intervention Services among children with ETS-related developmental delay. We find that there are substantial costs for the interventions needed to address ETS-related developmental delay. These costs provide more impetus to efforts on ETS prevention. Finally, we describe feasible approaches to intervention.

Health Effects of ETS Exposure

With respect to developmental effects, there is no evidence of a threshold below which ETS exposure is safe (DiFranza et al. 2004; Samet 2005). For example, Martin and Bracken (1986) reported a doubling in the risk for low-birth-weight babies when the nonsmoking mother was exposed to ETS for [greater than or equal to] 2 hr/day. Based on meta-analysis, Windham et al. (1999) estimated that passive maternal smoking during pregnancy results in an average decrease of 31 g in birth weight. The Ottawa Prenatal Prospective Study reported that the long-term effects of maternal passive smoking during pregnancy were smaller in magnitude but qualitatively similar to those of active maternal smoking and included effects on speech and language skills, intelligence, visual/spatial abilities and mother's rating of behavior (Makin et al. …