What is environmental tobacco smoke (ETS), or second-hand smoke?
Environmental tobacco smoke (also called ETS or secondhand smoke) is the smoke you breathe that comes from other people, whether they exhale it or get it from the tobacco burning near you, like the end of a cigarette (sidestream smoke).
ETS or secondhand smoke has over 250 dangerous chemicals in it. These dangerous chemicals include toxins (poisons) and carcinogens (cancer-causing chemicals). Some of these harmful chemicals are:
- vinyl chloride
- hydrogen cyanide
How does secondhand smoke affect babies? Infants and toddlers have tiny bodies, tiny lungs, and breathe rapidly. All of these things increase how smoke can affect them. "The EPA estimates that passive smoking is responsible for between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age annually, resulting in between 7,500 and 15,000 hospitalizations each year."
Some major risks for babies from ETS are:
- Sudden Infant Death Syndrome (SIDS)
- Decreased lung function
- Pneumonia and bronchitis
- Sinus problems that can lead to fluid in the middle ear, which can then lead to ear infections, doctor’s visits, operations and childhood hearing loss.
How does secondhand smoke affect kids?
Exposure to environmental tobacco smoke (ETS) puts children at risk for serious health problems. Breathing in second-hand smoke is also called “involuntary smoking” or “passive smoking”). Can you imagine giving a cigarette to your two-year-old? The exposures to secondhand smoke can affect children in very similar ways.
There are many ways in which children are hurt by secondhand smoke. Smoking around kids puts them at risk for:
- Ear infections (which can lead to hearing problems)
- Upper respiratory infections
- Reduced lung function
Exposure to environmental smoke increases kids’ risk later in life of:
- Lung cancer
- Heart disease
- Cataracts (of the eyes)
How can I protect my children from secondhand smoke?
Many people believe that ETS won’t be too bad for their kids if they smoke with the window cracked open at home or in the car, or use an air filter or fan. This is not correct. In fact, the Surgeon General says there is no amount of contact with secondhand smoke that is risk-free. Many of the harmful substances in secondhand smoke stay in your clothes and the air and in furniture, carpets and curtains of your house or car long after you’ve put out the cigarette, cigar or pipe.
- If you smoke, don’t smoke around your children.
- Don’t let other people smoke around your kids. (Video)
- Avoid bringing your kids to places where people smoke.
- Take the smoke-free homes pledge!
- Haga la promesa de mantener su hogar libre de humo!
For more information on protecting kids from secondhand smoke:
- Raisesmokefreekids.com debunks the myths about secondhand smoke, and has videos about these myths (click on “watch the videos” in the left hand column).
- How to protect yourself and your loved ones from secondhand smoke
- Proteja a Su Familia del Humo de Segunda Mano
- Health effects of exposure to secondhand smoke
What if my child has asthma?
Kids with asthma especially need clean air to breathe. They can stay healthier if the air around them doesn’t increase their risk for asthma attacks. Secondhand smoke can trigger asthma attacks.
What are the dangers for kids with sickle cell disease?
Kids with sickle cell disease who are exposed to ETS at home have more than twice as many episodes of pain (known as "crises") as sickle cell patients who were not exposed. Sickle cell crises involve serious symptoms, and often require hospitalization. Researchers in one study estimate that ETS exposure increases the risk of crisis by 90% among children with sickle cell disease. 
How can I prevent my kids from smoking if I smoke?
Parents can be the biggest influence in their kids’ lives when they stay involved. Ideally, you would quit using tobacco to send your kids the right message. If that’s not an option for you right now, then make sure you talk to your kids honestly and often about tobacco use. Start talking around age 5 or 6, and keep it up. Many kids are addicted by age 14. Don’t use tobacco around your kids, don’t offer it to them, and don’t leave it where they can easily get it. It is possible to help keep your kids tobacco-free even if you smoke .
- For more information and resources on preventing youth tobacco use, see YourChild: Tobacco and Kids.
- Low birth weight infants (smoking nearly doubles the risk)
- Pregnancy complications
- Higher rate of infant morbidity and mortality
Cigarette smoking delivers thousands of chemicals to an unborn baby, some of which are well-documented reproductive toxins—like lead, for example. Other chemicals that can affect a developing fetus are nicotine and carbon monoxide. Nicotine narrows blood vessels and crosses the placenta. It reduces blood flow to the uterus and placenta. Carbon monoxide prevents the blood from being able to carry oxygen, and can lead to the fetus not getting enough oxygen.
Researchers have found many different abnormalities at the microscopic level in placentas, fetuses, and newborns of women who smoked while pregnant.Smoking during pregnancy has been linked to 10 percent of all infant deaths . It is the main risk factor contributing to Sudden Infant Death Syndrome (SIDS)  . Being exposed to mom’s cigarette smoking during pregnancy is a risk factor after birth for wheezing and asthma in children up to two years old . Smoking during pregnancy may also be a risk factor for preterm birth.
In a review of the research evidence on prenatal tobacco exposure and development problems  , the author says that prenatal exposure to tobacco seems to affect newborn neurological development and behavior. In studies of animals exposed in utero to carbon monoxide and nicotine, these toxins harmed thinking and behavior. Smoking during pregnancy may also cause the brain and nervous system of the human fetus to develop abnormally.
Smoking early on and through pregnancy is linked to worse pregnancy outcomes. You can avoid some of the harmful effects by cutting back on smoking, but not smoking at all is even better for your baby. 
Talk to your doctor about quitting smoking or cutting back while pregnant. Nicotine replacement therapy may be an option .
- Smoke-free Families is a national program that works to help pregnant women quit smoking. Help and support can be as easy as a phone call away. 1-800-QUIT-NOW (1-800-784-8669), offers free one-on-one cessation counseling for pregnant smokers 24 hours a day. Callers can also request additional free quit smoking materials.
For information on prenatal services in your community, call 1-800-311-BABY or your State or local Health Department. For information in Spanish, call 1-800-504-7081.
Get their booklet Need Help Putting Out That Cigarette?
- If you live in the Ann Arbor area, you can take quit smoking classes at the University of Michigan.
- In Michigan, you can call the State of Michigan Quit Line at 1-800-480-QUIT (7848).
- ex is an online quitting program with lots of helpful multimedia tools and a research-based strategy.
- Lots of groups offer stop-smoking classes—so find your local chapter of the American Lung Association (212-315-8700), American Heart Association (800-AHA-USA1), and the American Cancer Society (800-ACS-2345) to see what they have to offer.
- The American Lung Association offers a free online smoking cessation program, called Freedom From Smoking Online.
- Smokefree.gov has quit-smoking guidance, and offers expert help by instant messaging, and by phone in English and Spanish. Call 1-877-44U-QUIT.
- How to quit smoking from UMHS.
- Usted puede dejar de fumar from UMHS.
- Help for Cravings and Tough Situations.
- Complete Guide to Quitting from the American Cancer Society (available in Spanish by calling the American Cancer Society (ACS) toll free at 1-800-ACS-2345).
- There are medications that can help you quit. Find out more about how to use your nicotine replacement product.
- Order a free “You Can Quit Smoking Kit” from the U.S. Agency for Healthcare Research and Quality (AHRQ) by calling 1-800-358-9295.
- Read the American Academy of Pediatrics policy statement on environmental tobacco smoke.
- University of Michigan lung expert Dr. Steven Gay offers 10 reasons to kick the habit.
- YourChild: Tobacco and Kids
- The Campaign for Tobacco Free Kids works to reduce tobacco use and its devastating consequences in the United States and around the world. By changing public attitudes and public policies on tobacco, they aim to prevent kids from smoking, help smokers quit and protect everyone from secondhand smoke.
- American Cancer Society: What’s so bad about tobacco?
- American Lung Association: Tobacco Control
- National Cancer Institute: Smoking and Cancer
- Environmental Protection Agency (EPA): Smoke-Free Homes and Cars, includes information in Spanish.
- Centers for Disease Control and Prevention (CDC): Smoking and Tobacco Use
- CDC en Español: Tabaquismo
Written and compiled by Kyla Boyse, R.N. Reviewed by Steven E. Gay, MD, MS.
Updated October 2008
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