What was once a carefree recreational and social pleasure that could be encountered on any corner has now become a known health concern to all who choose to partake.  It is impossible to live in our current society without constant warnings about the detrimental consequences of even one cigarette.  Commercials on our televisions, advertisements on our computers, and warnings on the package from the Surgeon General himself all scream, “CAUTION: Dead End,” as clearly as a street sign . . . but even all that isn’t enough to discourage some people from picking up a pack.

If the threat of these numerous consequences does not prevent one from smoking, perhaps the effects that smoking could have on those around one will.  Though we were not certain about the harmful effects of secondhand smoke in previous decades, we now understand that it can be just as dangerous as smoking itself with high enough exposure.  Secondhand smoke is cigarette smoke that a non-smoking bystander regularly inhales due to another individual smoking in an enclosed space. Understandably, it has been linked to health problems similar to those seen in a primary smoker since someone standing near a smoker is breathing in the same air, the same smoke, and the same toxic chemicals as the smoker.  Interestingly enough, the chemicals in secondhand smoke have been found to be up to 50 times more carcinogenic than those inhaled by the smoker through primary smoking due to “sidestream smoke”, a type of smoke that constantly emanates from the burning end of a cigarette (5).  Certain organic chemicals found in sidestream smoke can persist longer than elements of mainstream smoke, and sidestream smoke has been found to contain three times more toxins than mainstream smoke (4).

Though some people are aware of the common cardiovascular and respiratory effects of smoking and secondhand smoke, most people do not realize that certain negative cognitive effects have been linked to secondhand smoke exposure, as well.  The first concern that comes to mind upon hearing this is the way in which a child’s ability to learn can be affected by exposure to secondhand smoke from a family member or someone that they live with.  In fact, the primary location where children may be exposed to secondhand smoke is in their homes, especially since they have minimal control over their indoor environment, and essentially no means by which to  escape of their own accord (3).  This makes children much more vulnerable to the effects of secondhand smoke than adults are, as do certain physiological differences, such as immunological immaturity and more narrow and short airways when compared to adults (5).  Approximately 40% of school-age children, along with 1 in 3 adolescents, are exposed to secondhand smoke against their will – the equivalent of 24 million children and adolescents (4).  In 2004, 1% of total deaths worldwide were caused by secondhand smoke, and 28% of those were children (6).

Cognitive effects that studies have linked to secondhand smoke exposure in children include lower vocabulary and reasoning skills, higher rates of cognitive and intellectual defects, significantly poorer performances in reading and mathematics, behavioral problems, lower height and weight gain, and inferior visual and spatial abilities when compared to children with no exposure (2).  Additionally, exposed children are more likely to be hospitalized due to asthma, wheezing attacks, rhinitis symptoms, food sensitization, and even complications as significant as atrial fibrillation, cancer, and death (5) (6).  Exposure to secondhand smoke during childhood has also been linked to such cardiometabolic risk factors as obesity, dyslipidemia, and insulin resistance, along with severe effects on arterial function and structure, resulting in premature atherosclerosis, impaired cardiac autonomic function, and changes in heart rate variability (4).  These are all serious medical conditions, demonstrating that children can suffer from the effects of a caretaker’s smoking for the remainder of their lives –  lives that can be noticeably shortened with secondhand smoke exposure.

In an effort to help lower the number of health problems caused by secondhand smoke, especially in children, many cities and even some countries around the world have implemented laws that place restrictions on where cigarette smoking is allowed, mostly affecting enclosed spaces.  These bans are meant to decrease the probability of a non-smoker picking up the habit of smoking from someone around them as well, which is a phenomenon often seen in children who have at least one smoking parent (6).

In 2007, Bavaria implemented such a smoking ban on all enclosed public areas and this legislation has since been amended to encompass total prohibition (6).  Some studies are able to link a decrease in home exposure for children directly to these smoking bans, and in some cases there were even instances of voluntary bans across regions where such legislation exists, lowering even more extensively the exposure of children in affected households (6).  One study in particular showed that the smoking ban lowered the exposure levels to secondhand smoke for non-smokers, as well as the prevalence of several health risks related to secondhand smoke, and changed the way that parents felt about smoking directly around their children (6).

This program and other similar initiatives such as campaigns in the media and increased taxation have been found to be moderately effective in their efforts to reduce smoking and increase awareness of its consequences (4).  One study looked at six previous studies on trends in smoking restrictions within the home before and after the implementation of a public smoking ban (1). All six studies found an overall positive response: either a significant increase in at-home smoking restrictions, or no significant change (1).  Across the board, within 6 months after smoking bans were implemented, the number of homes that were without smoking restrictions was found to decrease significantly (1).  In layman’s terms, smoking bans have not been shown to cause any increase in smoking within the home, so it cannot possibly hurt to try them.

Are these laws actually making concrete progress?  Is there enough of a positive outcome that it is worth passing similar legislation in the United States?  In short, absolutely.  When the first US Surgeon General warning was released, warning all smokers about the detrimental effects that cigarettes can have, there were significant reductions in levels of both smoking and childhood exposure to secondhand smoke (4).  This shows that once the information is disseminated and adults are made aware of the consequences of their behavior and decisions when it comes to smoking, positive changes result.  A study from 2016 found that the majority of parents were unaware of the harm that secondhand smoke was causing their children (5).  A public smoking ban could increase awareness, and education through media can supplement and explain the reasoning behind such legislation. Intermediates, such as healthcare providers, can provide individuals with the knowledge that they need to make informed decisions regarding their smoking habits.  Although certain states do currently have public smoking bans, including Massachusetts, more can always be done in order to spread the word and advocate for or even create or increase regulations in other parts of the country.  Even the smallest change for the better when it comes to the health of the children of our country is worth a try.


  1. Liang, L. A., Weber, A., Herr, C., Hendrowarsito, L., Meyer, N., Bolte, G., . . . Kolb, S. (2016, July 14). Children’s exposure to second-hand smoke before and after the smoking ban in Bavaria-a multiple cross-sectional study | European Journal of Public Health | Oxford Academic. Retrieved September 26, 2017, from https://academic.oup.com/eurpub/article/26/6/969/2616281/Children-s-exposure-to-second-hand-smoke-before
  2. Ling, J., & Heffernan, T. (2016). The Cognitive Deficits Associated with Second-Hand Smoking. Retrieved September 26, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805605/
  3. Mbulo, L., Palipudi, K. M., Andes, L., Morton, J., Bashir, R., Fouad, H., . . . D’Espaignet, E. T. (2016, February 11). Secondhand smoke exposure at home among one billion children in 21 countries: findings from the Global Adult Tobacco Survey (GATS). Retrieved September 26, 2017, from http://tobaccocontrol.bmj.com/content/early/2016/02/11/tobaccocontrol-2015-052693?papetoc
  4. Raghuveer, G., White, D. A., Hayman, L. L., Woo, J. G., Villafane, J., Celermajer, D., . . . Zachariah, J. (2016, October 18). Cardiovascular Consequences of Childhood Secondhand Tobacco Smoke Exposure: Prevailing Evidence, Burden, and Racial and Socioeconomic Disparities: A Scientific Statement From the American Heart Association. Retrieved September 26, 2017, from http://circ.ahajournals.org/content/134/16/e336.short
  5. Sigaud, C. H., Castanheira, A. B., & Costa, P. (n.d.). Association between secondhand smoking in the home and respiratory morbidity in preschool children. Retrieved September 26, 2017, from http://www.scielo.br/scielo.php?pid=S0080-62342016000400562&script=sci_arttext
  6. Trends in exposure to second hand smoke at home among children and nonsmoker adolescents. (2015, October 28). Retrieved September 26, 2017, from http://www.sciencedirect.com/science/article/pii/S0048969715308925

Related Posts