Although secondhand smoke has been linked to death and illness, a new study suggests that parents around the world do very little to protect their children from "passive smoking" exposure. Heather Wipfli, Ph.D., project director at the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health, and colleagues conducted home surveys in 31 countries. Researchers examined the smoking histories of the adults in the homes, exposures to secondhand smoke inside the house and in the community, and attitudes toward smoking. They used air-sampling technology to gauge nicotine levels in homes and hair samples to measure individual exposure levels of non-smoking women and children. The study appears in the April issue of the American Journal of Public Health. Concentrations of nicotine in the air were 17 times higher in households with smokers compared to those without, and nicotine concentrations were about 12.9 times higher in homes that permitted smoking compared to households that voluntarily banned it. Researchers found nicotine even in homes without smokers, indicating that visitors and others sometimes smoked in the homes. Children had higher levels of nicotine than women did, and among children living with a smoker, those under 5 years old had levels nearly twice as high as children ages 5 and older did. The United States and Western Europe were not included in the study, which comprised seven Eastern European countries, nine countries in North and South America, 12 Asian countries and three in the Middle East. In study countries, nearly all households permitted smoking inside, which represents a major difference from the United States, where surveys by the Centers for Disease Control and Prevention show that more than 80 percent of homes no longer allow smoking inside the living area. This study is among the first to demonstrate that secondhand smoke is a worldwide concern, according to Kenneth Rosenman, M.D., professor of medicine at Michigan State University. Educational programs have helped to achieve the large proportions of U.S. households that do not allow indoor smoking and the results of this study, according to Rosenman, should lead health organizations in other countries to step up education activities aimed at increasing voluntary no-smoking policies. "It is clear from this study that if one is going to continue to smoke, then don't smoke at home and particularly not around your children," Rosenman said. "If my patient is not the smoker, it is important that they insist those that do smoke don't do so in the house or around them." He was not associated with the study. "Our research clearly shows that parents are failing to protect their children from secondhand smoke exposure, perhaps because they are unaware of the risks," Wipfli said. "The results highlight the need to improve public awareness of the importance to go outside to smoke to limit the exposure of women and children living in the home." The Flight Attendant Medical Research Institute funded the study. The American Journal of Public Health is the monthly journal of the American Public Health Association. Visit

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