Richmond's Ear, Nose and Throat Specialists

Secondhand Smoke

Secondhand smoke is a combination of the smoke from a burning cigarette and the smoke exhaled by a smoker. Also known as environmental tobacco smoke (ETS), it can be recognized easily by its distinctive odor. ETS contaminates the air and is retained in clothing, curtains and furniture. Many people find ETS unpleasant, annoying, and irritating to the eyes and nose. More importantly, it represents a dangerous health hazard. Over 4,000 different chemicals have been identified in ETS, and at least 43 of these chemicals cause cancer.

Is exposure to ETS common?

Approximately 26 percent of adults in the United States currently smoke cigarettes, and 50 to 67 percent of children under five years of age live in homes with at least one adult smoker.

Access to quality healthcare for children is forwarded by the availability of good healthcare information. With this year’s release of a new surgeon general’s report on secondhand smoke, the following information should be shared with patients.

New Warning on Secondhand Smoke

In July 2006, the Surgeon General released evidence supporting the fact that secondhand smoke, smoke from a burning cigarette and the smoke exhaled by the smoker, represents a dangerous health hazard.

The new report states that there is no risk-free level of secondhand smoke exposure. Although secondhand smoke is dangerous to everyone, fetuses, infants, and children are at most risk. Even brief exposures can be harmful to children. This is because secondhand smoke can damage developing organs, such as the lungs and brain.

Infants and Children Effects and Exposure:

  • Babies of mothers who smoked and those exposed to smoke are more likely to die from Sudden Infant Death Syndrome (SIDS) than babies who are not exposed to smoke.
  • Babies of mothers who smoked and those exposed to smoke after birth have weaker lungs and thereby increased risk of more health problems.
  • Children with asthma exposed to secondhand smoke experience more frequent and severe attacks.
  • Children exposed to secondhand smoke are at increased risk for ear infections and are more likely to need an operation to insert ear tubes for drainage.

Youth and Teens Effects and Exposure:

  • Secondhand smoke exposure causes respiratory symptoms, including cough, phlegm, wheeze, and breathlessness, among school-aged children.
  • On average, children are exposed to more secondhand smoke than nonsmoking adults.


  • More than 4,000 different chemicals have been identified in secondhand smoke and at least 43 of these chemicals cause cancer.
  • On average, children are exposed to more secondhand smoke than nonsmoking adults.
  • Approximately 26 percent of adults in the United States currently smoke cigarettes, and 50 to 67 percent of children less than five years of age live in homes with at least one adult smoker.
  • 28 percent of high schoolers are exposed to secondhand smoke in their own homes.
  • A recent study found that 34 percent of teens begin smoking as a result of tobacco company promotional activities.
  • Among middle school students who were current smokers, 71 percent reported never being asked to show proof of age when buying cigarettes in a store, and 66 percent were not refused purchase because of their age.

Checklist for Protection Against Secondhand Smoke

Young children:

  • Remember that you are a powerful role model. If you don’t smoke, your children are less likely to smoke.
  • Make your home and car smoke-free spaces. Put up no-smoking stickers and signs in your home.
  • Make sure you and your kids aren’t exposed to second-hand smoke at daycare, school, or friends’ homes.
  • Support businesses and activities that are smoke-free. Let other businesses owners know that you can’t support their businesses until they become 100 percent smoke-free too.
  • If you can’t find a smoke-free restaurant and must go to one that allows some smoking, ask to sit in the nonsmoking section.
  • If your asthma or COPD is triggered by smoke, don’t risk it—stay away from any place that allows smoking.
  • Support laws that restrict smoking.

Youth and Teens:


  • Talk to your children about smoking; they’ll be less likely to smoke than if you ignore the problem.
  • Support tobacco education in the schools and ban all smoking on school grounds, on school buses, and at schoolsponsored events for students, school personnel, and visitors.
  • Ask that schools enforce the policy and consistently administer penalties for violations and that this is communicated in written and oral form to students, staff, and visitors.
  • Vote for public smoking restrictions as an important component of the social environment that supports healthy behavior, reducing the number of opportunities to smoke, and making smoking less socially acceptable.
  • Support tax increases on tobacco products so young people cannot afford them.


  • If your friends smoke, ask them in a caring way to quit or at least not to smoke around you.
  • Peers, siblings, and friends are powerful influences on you and others. Understand that the most common situation for first trying a cigarette is with a friend who already smokes.


  • Work together to uphold restrictions on tobacco advertising and promotions.

Most people know that smoking causes cancer, breathing problems, heart attacks, and stroke. Secondhand smoke causes asthma, allergies, breathing problems, and has been shown to cause ear infections in children. There is also a direct link between cancer of the head and neck and smoking. Though quitting can be very difficult, you can get help quitting smoking from support groups, nicotine replacement therapy, and other medications.

There are many excellent resources available both online and from your local health department, church or community organization. Here are just a few:

Smoke’s effect on…

The fetus and newborn: 

Maternal, fetal, and placental blood flow change when pregnant women smoke, although the long-term health effects of these changes are not known. Some studies suggest that smoking during pregnancy causes birth defects such as cleft lip or palate. Smoking mothers produce less milk, and their babies have a lower birth weight. Maternal smoking also is associated with neonatal death from Sudden Infant Death Syndrome, the major cause of death in infants between one month and one year of age.

Children’s lungs and respiratory tracts:

Exposure to ETS decreases lung efficiency and impairs lung function in children of all ages. It increases both the frequency and severity of childhood asthma. Secondhand smoke can aggravate sinusitis, rhinitis, cystic fibrosis, and chronic respiratory problems such as cough and postnasal drip. It also increases the number of children’s colds and sore throats. In children under two years of age, ETS exposure increases the likelihood of bronchitis and pneumonia. In fact, a 1992 study by the Environmental Protection Agency says ETS causes 150 – 300 thousand lower respiratory tract infections each year in infants and children under 18 months of age. These illnesses result in as many as 15 thousand hospitalizations. Children of parents who smoke half a pack a day or more are at nearly double the risk of hospitalization for a respiratory illness.

The ears:

Exposure to ETS increases both the number of ear infections a child will experience, and the duration of the illness. Inhaled smoke irritates the eustachian tube, which connects the back of the nose with the middle ear. This causes swelling and obstruction which interferes with pressure equalization in the middle ear, leading to pain, fluid and infection. Ear infections are the most common cause of children’s hearing loss. When they do not respond to medical treatment, the surgical insertion of tubes into the ears is often required.

The brain:

Children of mothers who smoked during pregnancy are more likely to suffer behavioral problems such as hyperactivity than children of non-smoking mothers. Modest impairment in school performance and intellectual achievement have also been demonstrated.

Who is at risk?

Although ETS is dangerous to everyone, fetuses, infants and children are at most risk. This is because ETS can damage developing organs, such as the lungs and brain.

Secondhand smoke causes cancer

You have just read how ETS harms the development of your child, but did you know that your risk of developing cancer from ETS is about 100 times greater than from outdoor cancer-causing pollutants? Did you know that ETS causes more than 3,000 non-smokers to die of lung cancer each year? While these facts are quite alarming for everyone, you can stop your child’s exposure to secondhand smoke right now.

What can you do?

  • Stop smoking, if you do smoke. Consult your physician for help, if needed. There are many new pharmaceutical products available to help you quit.
  • If you have household members who smoke, help them stop. If it is not possible to stop their smoking, ask them, and visitors, to smoke outside of your home.
  • Do not allow smoking in your car.
  • Be certain that your children’s schools and day care facilities are smoke free.

Text adapted from the American Academy of Otolaryngology – Head and Neck Surgery . Used with permission.