Environmental Tobacco Smoke: Public Perception of Risks of Exposing Children to Second- and Third-Hand Tobacco Smoke

Christopher Roberts, BS; Grace Wagler; Michele M. Carr, DDS, MD, PhD


J Pediatr Health Care. 2017;31(1):e7-e13. 

In This Article

Abstract and Introduction


Introduction: Extensive evidence exists regarding health risks posed by children's exposure to second-hand smoke, and there is increasing evidence concerning the risks of third-hand smoke. This evidence is most meaningful if the public is aware of these risks and can help curb childhood exposure.

Methods: Participants were selected at an academic medical center and asked to complete a survey. Responses were compared based on respondents' smoking status and the presence or absence of children in their homes.

Results: A total of 310 adults responded. Nonsmokers and respondents living with children were more likely to see smoking in the home as affecting all the queried health problems (p < .05). Knowledge of the risks of second-hand smoke exposure is limited, and very few respondents perceived risk from third-hand smoke exposure.

Discussion: The widespread lack of awareness of the risks associated with environmental tobacco smoke must be addressed to curb childhood exposure.


There is an abundance of evidence describing the impact that environmental tobacco smoke (ETS) can have on children's health. Many of the harmful effects of ETS include respiratory symptoms, such as increasing the incidence of coughing, asthma, and both upper and lower respiratory tract infections (American Academy of Pediatrics Committee on Substance Abuse, 1994; American Academy of Pediatrics Committee on Environmental Health, 1997; Cook & Strachan, 1999; U.S. Department of Health and Human Services, 2014; Johansson, Halling, & Hermansson, 2003; Li, Peat, Xuan, & Berry, 1999), as well as increasing the severity of childhood pneumonia (Ahn et al., 2015). Exposure to ETS can also lead to numerous disorders of the ear, nose, and throat such as otitis media ((Adair-Bischoff & Sauve, 1998; U.S. Department of Health and Human Services, 2014; Ilicali, Keles, Deger, & Savas, 1999; Jones, Hassanien, Cook, Britton, & Leonardi-Bee, 2012), sensorineural hearing loss (Lalwani, Liu, & Weitzman, 2011; Talaat, Metwaly, Khafagy, & Abdelraouf, 2014), and tonsillitis (Straight, Patel, Lehman, & Carr, 2015). ETS exposure increases the incidence of childhood obesity (Apfelbacher et al., 2008; Mangrio, Lindstrom, & Rosvall, 2010; Moore et al., 2016; Raum et al., 2011), and it can also lead to poor childhood growth as measured by height (Muraro et al., 2014). ETS exposure can also increase the incidence of sleep-disordered breathing (Jara, Benke, Lin, & Ishman, 2015). This is not meant to be a comprehensive list of the risks of ETS exposure; rather, it is meant to give a sense of the extensive health consequences associated with ETS exposure. Although there is a large body of evidence substantiating the harmful effects of ETS on children's health, this evidence would have a greater impact if the public were aware of these risks. Previous studies have shown that awareness of the risks of ETS exposure can lead to the implementation of smoking bans in cars and homes (Drehmer et al., 2014; Winickoff et al., 2009).

The present study was designed to evaluate the general population's risk perception of the dangers that ETS exposure poses to children, including an analysis of the risk perceptions for exposure to both second-hand tobacco smoke (SHS), which is exposure to smoke because of proximity to a person who is actively smoking, and third-hand tobacco smoke (THS), which is exposure to compounds that remain in the air and on surfaces such as furniture and clothing after someone has finished smoking rather than exposure to the smoke itself. This study was also designed to assess how these risk perceptions differ between cohorts based on present and past smoking habits and the presence or absence of individuals under the age of 18 years living in respondents' homes.