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Thaddeus Miller,¹ Virginia A. Rauh,¹ Sherry A.M. Glied,² Dale Hattis,³ Andrew Rundle,¹ Howard Andrews,¹ and Frederica Perera¹

¹Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA; ²Health Policy & Management, Columbia University, New York, New York, USA; ³George Perkins Marsh Institute, Clark University, Worcester, Massachusetts, USA

Abstract
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]

Address correspondence to F.P. Perera, Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 100 Haven Ave., Tower 3, Suite 25F, New York, NY 10032 USA. Telephone: (212) 304-7275. Fax: (212) 544-1943. E-mail: fpp1@columbia.edu

We gratefully acknowledge M. Neidell and S. Viswanathan, Columbia University ; A. Wolaver and T. Kinnaman, Bucknell University ; B. Schiller, New York City Early Intervention Program ; D. Bellinger, Harvard University.

Grant support came from the Bauman Family Foundation, Beldon Fund, John Merck Fund, New York Community Trust, Educational Foundation of America, and Marisla Foundation.

The authors declare they have no competing financial interests.

Received 14 March 2006 ; accepted 11 July 2006.