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Your Environment. Your Health.

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

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost analysis (CA)
Mason J, Wheeler W, and Brown MJ
Public Health Rep
This cost-analysis used large-scale databases and biomarker data to estimate the public health and economic burden of secondhand smoke (SHS) exposure for child and adult non-smokers living in U.S. public housing. The authors estimated that the total annual economic burden of SHS-attributable illness and death of non-smokers in public housing ranged from $183 million to $267 million, depending on serum cotinine limit of detection. They concluded that implementing smoke-free policies in all U.S. public housing can improve the health of residents and reduce societal costs.
Adult and child never smokers residing in public housing

Health Outcomes

  • Morbidity and mortality associated with: cancer outcomes (lung cancer)
  • cardiovascular outcomes (ischemic heart disease)
  • respiratory outcomes (asthma, lower respiratory infection – syncytial virus, pneumonia, bronchitis/bronchiolitis)
  • birth outcomes (low birth weight)
  • sudden infant death syndrome
  • otitis media

Environmental Agents

List of Environmental Agents:

  • Air pollutants (secondhand smoke)

Source of Environmental Agents:

  • Secondhand smoke

Economic Evaluation / Methods and Source


  • Cost analysis (CA)

Cost Measured:

  • Costs considered in source studies, including direct medical costs (e.g., hospitalizations, physician’s visits, medications)
  • costs of productivity loss (e.g., caregiver time lost from work or school due to illness)
  • nonmedical direct costs

Potential Cost Measures:

  • SHS-attributable fire-related and apartment renovation costs
  • implementation costs of smoke-free policies
  • costs borne by society (e.g., long-term care, copayments, other nonmedical direct expenses)
  • intangible cost of SHS-exposure related health effects (e.g., pain and suffering)

Benefits Measures: (Not available)

Potential Benefits:

  • Lower out-of-pocket expenditures for medical care
  • lower apartment clean-up costs
  • fewer productivity losses for employers and society


  • United States

Models Used: (Not available)

Methods Used:

  • The authors estimated the public health and economic burden of secondhand smoke (SHS) exposure for child and adult never smokers living in U.S. public housing using large-scale databases, including biomarker data. The authors — 1) estimated the public health burden attributable to SHS for health outcomes by calculating a population-attributable fraction using WHO estimates of relative risk; 2) estimated annual societal economic burdens for each health outcome using published estimates for direct medical costs, nonmedical care costs, and the value of lost productivity; and 3) estimated the public health and economic burden for two serum cotinine limits of detection.

Sources Used:

  • 2009 National Youth Tobacco Survey; 2010 National Health Interview Survey; National Health and Nutrition Examination Survey (2007-2008, 2009-2010); Second-hand smoke: assessing the burden of disease at national and local levels (Öberg et al./WHO, 2010); additional sources cited in publication

Economic Evaluation / Methods and Source


  • Mason J, Wheeler W, and Brown MJ. 2015. The economic burden of exposure to secondhand smoke for child and adult never smokers residing in U.S. public housing. Public Health Rep.
  • Pubmed
  • DOI: (Not available)

NIEHS Funding: (Not available)

Other Funding: (Not available)

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