Press Release Pediatrics Tobacco Smoke Exposure Study

Children in Multi-Unit Housing at Greater Risk of Tobacco Smoke Exposure

AAP urges smoke-free environments for all children

Washington, DC–Children exposed to secondhand tobacco smoke are at greater risk for a

variety of illnesses, even at very low levels of exposure. A new study from the American

Academy of Pediatrics (AAP) Julius B. Richmond Center, the University of Rochester Medical

Center, and MassGeneral Hospital for Children is the first to show significant evidence of

increased tobacco smoke exposure in the blood of children who live in multi-unit housing, even

if no one smokes in their unit.

The study, “Tobacco Smoke Exposure in Children Who Live in Multiunit Housing,” which will

be published in the January 2011 print issue of Pediatrics and available online today, compared

tobacco-smoke biomarkers in children who live in various types of housing. The study found that

among children who live in households where no one smokes inside, those who live in

apartments have a 45 percent increase in cotinine levels (a common marker of tobacco smoke

exposure) compared with children who live in detached homes. The full study can be found

online at:

“The scope of illnesses in children associated with tobacco smoke exposure is expansive, ranging

from asthma to cognitive impairments to sudden infant death syndrome,” said Karen Wilson,

MD, MPH, FAAP, an assistant professor of pediatrics at the University of Rochester Medical

Center’s Golisano Children’s Hospital and lead author of the paper. “This study shows that the

threat of secondhand smoke can occur even when the child’s immediate home environment is


The study, which was supported by the Flight Attendant Medical Research Institute, analyzed

data from the 2001–2006 National Health and Nutrition Examination Survey. The survey

assessed levels of secondhand smoke exposure for children ages 6 -18 years living in various

types of housing where no one smokes inside—detached houses (including mobile homes),

attached houses, and apartments. Key findings include:

  • Children living in multi-unit homes had a 45 percent increase in cotinine levels compared

    with children who live in detached homes.

  • From the lowest detectable to the highest levels of cotinine tested, a greater proportion of

    children in multi-unit housing were found positive for smoke exposure than children in

    other housing types. This increase could be caused by smoke seeping through walls or

    shared ventilation systems.

  • Smoking bans in multi-unit housing may reduce children’s exposure to tobacco smoke.

“As again confirmed in a U.S. Surgeon General’s report released yesterday, there is no safe level

of tobacco smoke exposure for children,” said AAP President O. Marion Burton, MD, FAAP.

“The AAP calls for smoke-free environments for all children, and this new study makes clear

that multi-unit housing must be completely smoke-free to achieve this goal. The expansion of

smoke-free policies at all levels is essential.

“The U.S. Department of Housing and Urban Development took a positive step in this direction

last year by urging local public housing authorities to establish smoke-free policies, and the next

step is a federal policy that protects children in public housing from tobacco smoke exposure,”

said Dr. Burton. “All children deserve to live in a healthy environment, and this can only be

achieved by eliminating tobacco smoke where they live.”

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The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians,

pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety

and well-being of infants, children, adolescents and young adults.

For AAP resources on secondhand tobacco smoke, visit


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