Secondhand smoke exposure has been cited as the most common and preventable environmental respiratory irritant for children, resulting in increased risks for acute respiratory infections (bronchitis, pneumonia), otitis media and exacerbations in chronic respiratory conditions (asthma, cystic fibrosis) (IOM, 2000). Economic costs associated with secondhand smoke exposure have been estimated to be over $157 billion annually and over 440,000 premature deaths due to secondhand smoke (CDC, 2002). Household exposure to secondhand smoke is particularly high among children and estimates of exposure in US children's homes range from 11.7 to 34.2% based on number of homes with an adult smoker (CDC, 2000).

Neonatal and health consequences during infancy have been strongly linked to early secondhand smoke exposure, such as SIDS (CDC, 2002), decreases in lung function, and in utero exposure has been associated with a 23 gram decrease in birthweight (Windham, Eaton & Waller, 1995). Secondhand smoke exposure has been clearly linked to asthma exacerbations in preschool children (IOM, 2000), and recovery from acute asthma exacerbations in children can be impaired significantly by secondhand smoke exposure. Annual direct medical expenditures for childhood respiratory illness attributable to maternal smoking have been estimated to total $661 million for children under the age of 6 years (Taggart & Fulwood, 1993). Coupled with the impact of pediatric asthma and secondhand smoke on family budgets, out-of-pocket expenditures result in the largest single indirect cost of childhood asthma, approaching $1 billion in 1990.