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 smoke-free.”

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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