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Secondhand smoke exposure: Effects in children

Jonathan M Samet, MD, MS
Marianna Sockrider, MD, DrPH
Section Editors
George B Mallory, MD
Teresa K Duryea, MD
Deputy Editor
Alison G Hoppin, MD


Few epidemics have been as devastating and preventable as that caused by tobacco consumption. Cigarette smoking became highly prevalent in most developed countries through the 20th century; with a lag of several decades, the rise of smoking was followed by epidemic increases in smoking-related diseases, including lung and other cancers, heart disease, and chronic lung disease. Despite mounting epidemiologic evidence and authoritative syntheses in the reports of the United States Surgeon General, smoking and smoking-related diseases are still major public health concerns. There has been some success with tobacco control in developed countries; however, tobacco smoking is on the rise in developing countries.

The issue of exposure to secondhand smoke (SHS) and health has a much briefer history, although the irritating nature of tobacco smoke to the nonsmoker has long been chronicled. Some of the first epidemiological studies on SHS exposure and health were reported in the late 1960s [1-3]. Initial investigations focused upon parental smoking and lower respiratory illnesses in infants; studies of lung function and respiratory symptoms in children soon followed [4,5]. The first major studies on SHS and lung cancer in nonsmokers were reported in 1981 [6,7], and by 1986, the evidence supported the conclusion that SHS was a cause of lung cancer in nonsmokers, a conclusion reached by the International Agency for Research on Cancer (IARC), the United States Surgeon General, and the United States National Research Council [4,8,9].

A substantial body of evidence has continued to identify new diseases and other adverse effects, including increased risk for coronary heart disease and stroke associated with SHS [10]. The comprehensive review in the 2014 report of the Surgeon General, The Health Consequences of Smoking—50 Years of Progress leaves no doubt that involuntary exposure to tobacco smoke is harmful to nonsmokers [10]. The findings on SHS and disease have been the foundation of the drive for smoke-free indoor environments and for educating parents concerning the effects of their smoking on their children's health.

The effects of SHS on the health of children will be reviewed here. The health effects of SHS in adults and approaches to limit exposure to SHS are discussed separately. (See "Secondhand smoke exposure: Effects in adults" and "Control of secondhand smoke exposure".)


Secondhand smoke (SHS) is one of several terms used for the involuntary exposure of nonsmokers to tobacco smoke from the smoking of others. The smoke inhaled by nonsmokers has also been referred to as environmental tobacco smoke (ETS), but this term has fallen out of use. More than one billion adults worldwide are smokers [11], implying that some SHS exposure is almost unavoidable for children and for the two-thirds of adults who do not smoke.

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Literature review current through: Nov 2017. | This topic last updated: Nov 07, 2017.
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