Tobacco and children. An economic evaluation of the medical effects of parental smoking

Arch Pediatr Adolesc Med. 1997 Jul;151(7):648-53. doi: 10.1001/archpedi.1997.02170440010002.


Objective: To determine the economic influence of pediatric disease attributable to parental smoking.

Data sources: Computerized bibliographic databases were searched. Subject headings included asthma, burn, cost, low birth weight, otitis media, respiratory syncytial virus bronchiolitis, sudden infant death syndrome, and tobacco smoke pollution. The following constraints were applied to the published articles we studied: publication time, January 1980 through May 1996; age range of children studied, neonate to 18 years; and written in English. Articles used specifically as references for cost issues were limited to studies performed in the United States.

Data extraction: This study is a literature synthesis, which uses as its primary source the results of previously published best estimates. This is not a meta-analysis of studies analyzing the relationships between childhood disease and smoking.

Results: Using data for relative risk, prevalence, and cost of illness and death, we calculated the attributable risk fraction and corresponding direct medical expenditures and costs for loss of life. Costs are adjusted to 1993 dollars. Estimated annual excess cases of childhood illness and death attributable to parental smoking include low birth weight (46,000 cases, 2800 perinatal deaths), sudden infant death syndrome (2000 deaths), respiratory syncytial virus bronchiolitis (22,000 hospitalizations, 1100 deaths), acute otitis media (3.4 million outpatient visits), otitis media with effusion (110,000 tympanostomies), asthma (1.8 million outpatient visits, 14 deaths), and fire-related injuries (10,000 outpatient visits, 590 hospitalizations, and 250 deaths).

Conclusions: Parental smoking is an important preventable cause of morbidity and mortality among American children; it results in annual direct medical expenditures of $4.6 billion and loss of life costs of $8.2 billion. Additional efforts to reduce children's exposure to tobacco smoke are warranted.

MeSH terms

  • Burns / economics
  • Health Care Costs*
  • Humans
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Otitis Media / economics
  • Parents*
  • Pediatrics / economics*
  • Respiratory Syncytial Virus Infections / economics
  • Sudden Infant Death
  • Tobacco Smoke Pollution / economics*


  • Tobacco Smoke Pollution