The devastating effects of secondhand smoke

A new study has concluded that children exposed to tobacco smoke at home miss more time in school than those who live in smoke-free environments.

The study was conducted by researchers at Massachusetts General Hospital (MGH) who determined that smoke exposed children suffer from higher rates of respiratory illnesses. The MGH team also detailed the possible economic cost of the children’s elevated school absences; it’s all been released in the online edition of the journal Pediatrics.


“Among children ages 6 to 11 who live with smokers, one quarter to one third of school absences are due to household smoking,” says Douglas Levy, PhD, of the Mongan Institute for Health Policy at MGH, the paper’s lead author. “On a national basis these absences result in $227 million in lost wages and time for caregivers or their employers.”


The authors point out that one-third of U.S. children live with a smoker, and over half of those aged 3 to 11 have measurable levels of a blood marker for tobacco exposure.

Second hand smoke has been proven to increase cases of ear infections and many respiratory conditions, and missing school is an easy way to measure illness in children.


Previous studies tended to ignore the link between secondhand smoke and children who miss school. However, the MGH group analyzed data from the 2005 National Health Interview Study, which is a yearly in-person survey of representative households across the nation.


Adults that had homes with schoolchildren ages 6 to 11 were asked to judge each child’s overall health and were given the following questions:

•    How many people smoked inside the home.

•    How many school days the child missed due to illness or injury during the previous year.

•    Whether the child had three or more ear infections during the previous year.

•    Whether the child had a chest cold or gastrointestinal illness during the preceding two weeks.

•    Whether the child had been disgnosed with asthma, and if so, whether the child had any recent asthma attacks.

Among the 3,087 children whose information was reviewed for this study, over 14 percent lived in a home with at least one individual who smoked in the house. Eight percent lived with one smoker and six percent lived with two or more. The study represents 2.6 million children across the nation.

Kids who lived with one smoker had an average of 1.06 more missed days, and those living with two or more had 1.54 more days missing than children living in houses where no one smokes indoors.

Ailments linked with exposure to tobacco smoke, like ear infections and chest colds, made up 24 percent of absences in kids living in homes where one person smoked indoors and 34 percent for the ones living in places with at least two in-home smokers. Interestingly enough, smoking in the home did not lead to more gastrointestinal illness, and while there was no clear association with an asthma diagnosis or asthma attacks, the study sample might have not had included enough children with the ailment to represent smoke exposure’s known role as a trigger for asthma.

The researchers also determined the potential costs associated with missing school due to smoke related illnesses, including lost income for parents without paid time off, the costs to employers, and the inability of caregivers to complete normal household chores.

“The total impact nationwide was $227 million in lost wages and household work for the families of the 2.6 million children living with smokers and for their employers. Since almost half of the smoking households in our study had low incomes, that impact may be strongest on households least able to afford it,” Levy explains.

“The health impact of living with a smoker is probably more extensive than our study shows, since the survey only asked about three conditions associated with smoke exposure and we know there are several more. And since the absentee levels we report are averages, there are probably are kids who miss much more school because they live with smokers than our study found. More research is needed to help understand the long-term health, developmental and economic consequence of growing up in a home where people smoke.”

Levy is an assistant professor of Medicine at Harvard Medical School.