ECONOMIC BURDEN OF ENVIRONMENTAL TOBACCO-SMOKE ON HONG-KONG FAMILIES - SCALE AND IMPACT

Study objective-To examine the financial cost of doctor consultations for cough, phlegm, and wheeze in children living in a home where famil y members smoke compared with those not exposed to environmental tobac co smoke. To model these costs to provide the Territory of Hong Kong w ith estimates of potentially avoidable health care resource use. Desig n-Cross sectional questionnaire survey. Subjects and setting-All child ren (10 615) in classes primary 3 to 6 (aged 8-13 years) attending 27 schools in two districts of Hong Kong in 1992 and their parents. Measu rements and main results-Doctor consultations during the previous thre e months for symptoms of either cough, phlegm or wheeze were higher in younger children, ranging from 22.9% in 8 year olds to 8.4% in those aged 12 or over. For those children living in homes with one, or more than one, smoker category (there were four categories of smokers: fath er, mother, siblings, others), the adjusted odds ratios (95% confidenc e intervals) for a doctor consultation for any of these symptoms were 1.15 (1.01, 1.31) and 1.38 (1.14, 1.67) respectively. Using US$15 as t he minimum cost incurred per consultation, the expected direct cost pe r annum per child of doctor consultations was 14% higher for children Living in a one smoker category home and 25% for two or more compared with exposure to no smokers in the home. Using these values on a terri tory wide basis, the annual avoidable direct cost associated with expo sure to tobacco smoke in children from birth to 12 years of age ranged from US$338 042 to US$991 591. Conclusions-Exposure to environmental tobacco smoke not only provides a respiratory health risk for children but also an avoidable excess cost to the family's financial resources and health service providers.