Research has linked secondhand smoke to a host of health conditions in kids, including asthma and respiratory infections, ear infections, low test scores and sudden infant death syndrome. In this latest study, researchers drew upon a national survey of parents and children ages 6 through 18 that took place from 2001 to 2006. In addition to reviewing responses to survey questions about smoking in the home, they also performed tests to check the levels of a contaminant called cotinine, a chemical which is present in the blood of children who have been exposed to the nicotine in tobacco smoke. Only children who lived in homes in which no one smoked indoors were included in the analysis.
The research showed that children who lived in apartments generally had higher levels of tobacco smoke contaminants in their blood than to children who lived in houses. They also found that tobacco contaminant levels were highest in children under 12, those who were black, and those living below the federal poverty level.
One of the study authors, Dr. Jonathon Winickoff at Massachusetts General Hospital in Boston, said he believes his findings will help create the social and political will to push people toward establishing smoke-free housing policies.
"This [study] is the last link in the chain demonstrating the need for smoke-free buildings," he said. "People will shake their heads in disbelief that we ever allowed smoking in buildings where children live."
The study authors suggest that children in apartment-style housing are exposed to higher levels of tobacco smoke because of shared walls, ventilation systems and ductwork. Secondhand smoke can seep through these shared structures and into apartments in which no one smokes inside the home. Once the secondhand smoke is no longer visible to the eye, it can still be absorbed by furniture, carpets, curtains, clothing, toys, and other items that children come into contact with and even put in their mouths.
Most experts and doctors said they support the findings, which add to evidence that smoking affects not only the smoker and those in close contact, but also everyone in the smoker's vicinity. Dr. Nanci Yuan, associate clinical professor at Lucile Packard Children's Hospital at Stanford University in California, said she has concerns not only about smoking's impact on smokers themselves, but also on others like children and pregnant women.
"This article highlights the far reaching negative impact of smoking not only on the smoker themselves and their close contacts, but also impacts and burdens the health of their neighbors and the community as a whole," she said.
Some doctors said the new research should be viewed as a call to action for regulations that would limit secondhand smoke exposure in homes.
"There have been some very significant house standards changed based on lead paint in old homes and apartments," said Dr. Stephen Cook, assistant professor of pediatrics at the University of Rochester Medical Center's Golisano Children's Hospital in Rochester, N.Y.
Such measures, Cook said, might be comparable to efforts that have already been implemented in public places such as bars and restaurants. He added that regulations for the home could be especially beneficial to children living in poorer households, who are disproportionately affected and "have a higher likelihood of living in rental housing."
But while most experts support the findings, a few had concerns that instituting a smoking ban to deal with the issue could create more problems than solutions. Ron Borland of the VicHealth Center for Tobacco Control in Australia said he worries that some low-income tenants may face eviction if smoking bans are instituted.
"Arguments about expelling smoking tenants and even making it a child abuse offense have the potential to do much more harm and should not be part of the discourse," he said. "Disadvantaged people need help, not being put down by ill-meaning but naive good-doers."
Still, many doctors see the opportunity to use this research to for social good. "I would hope it would have significant long-term impact on making changes to protect children," said Dr. Wesley Burks, professor and chief of pediatric allergy and immunology at Duke University Medical Center in Durham, N.C.
Winickoff agreed. "A child with asthma has no choice and is forced to breathe contaminated air in multi-unit homes. Interestingly, children are a protected under the law [on other issues] because they can't vote or speak for themselves."
What this could mean for landlords and property owners is yet to be seen. According to Winickoff, approximately 5 percent of public housing is already smoke-free.