Prevention of Secondhand Smoke Exposure: School/Child Care

All places where children and adolescents learn, live, play and work (eg, schools, universities, child care settings, restaurants, public parks, multi-unit housing, sporting arenas, airports and vehicles) should be smoke-free, in order to discourage smoking initiation, as well as to prevent exposure to secondhand and thirdhand smoke.

Children and adolescents with chronic conditions (eg, asthma) face significant health harms from tobacco use and secondhand smoke exposure. Those who suffer from chronic conditions, which are often not visible, could be at an even greater risk for adverse reactions if environments are not smoke or tobacco free. Smoke-free laws should include electronic nicotine delivery systems (ENDS, or e-cigarettes), as secondhand vapor from these products contains some of the same chemicals as secondhand smoke. 

Early childcare settings; schools; and trade schools, colleges, and universities are also workplaces for teachers, administrators and support staff. These employees should also be protected from the risks posed by secondhand and thirdhand smoke exposure. Smokeless tobacco products should be included in such policies, as they are becoming more popular with youth. 

Warning: The tobacco industry is well-known for its effective marketing schemes and retaliation tactics. The industry battles pending smoke-free or clean air ordinances by contending that such laws will negatively impact business owners, or that the use of proper ventilation will alleviate secondhand smoke exposure. The industry also lobbies for preemption laws that take power from local governments, which is where tobacco control advocates typically are the most successful. Be aware of these tactics when looking to take action on this recommendation. 

Recommended by: 

• AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke 
• AAP policy statement– Electronic Nicotine Delivery Systems 
• AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke 
• Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 6, 50 
• CDC– Health Equity in Tobacco Prevention and Control 
• CDC Morbidity and Mortality Weekly Review, February 25, 1994– Guidelines for School Health Programs to Prevent Tobacco Use and Addiction- Recommendation 1 
• National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 4 
• Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827 
• Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 460 
• Surgeon General report– Reducing Tobacco Use, 2000- page 261 
• U.S. Department of Housing and Urban Development– Smoke Free Housing- A Toolkit for Owners/Management Agents of Federally Assisted Public and Multi-family Housing 
• U.S. Department of Housing and Urban Development– Smoke Free Housing- A Toolkit for Residents of Federally Assisted Public and Multi-family Housing 

For more information: 

• AAP Issue Brief– Tobacco-free Environments 
• American Nonsmokers' Rights Foundation– Smoking Policies in the 35 Busiest US Airports 
• Americans for Nonsmokers’ Rights– Going Smokefree in Your Community 
• Campaign for Tobacco-Free Kids– Smoke-Free Laws 
• ChangeLab Solutions– Model Ordinance: Comprehensive Smokefree Places 
• Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals 
• Public Health Law Center– Vehicles 
• University of Michigan– Smoke-free Campus Supervisor's Toolkit 

For more information about tobacco industry tactics: 

• Americans for Nonsmokers’ Rights– Advice to Business Owners 
• Americans for Nonsmokers’ Rights– Economic Impact 
• Americans for Nonsmokers’ Rights– Tobacco’s Dirty Tricks 
• CDC Morbidity and Mortality Weekly Review, March 18, 2005- Preemptive State Smoke-free Indoor Air Laws--United States, 1999--2004 
• Surgeon General report– The Health Consequences of Involuntary Exposure to Tobacco Smoke- page 11 

Children and adolescents spend much of their day in educational settings. Implementing tobacco-free policies will reduce the dangers of secondhand and thirdhand smoke exposure and the risk of modeling tobacco use by those adults with whom children and adolescents spend much of their day.

Children and adolescents with chronic conditions (eg, asthma) face significant health harms from tobacco use and secondhand smoke exposure. Those who suffer from chronic conditions, which are often not visible, could be at an even greater risk for adverse reactions if environments are not smoke or tobacco free. Hookah, electronic nicotine delivery systems (including e-cigarettes), smokeless tobacco, and flavored tobacco products should be included in such policies, as they are popular with youth. 

Recommended by: 

• AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke 
• AAP policy statement– Electronic Nicotine Delivery Systems 
• AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke 
• Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 6, 50 
• CDC– Health Equity in Tobacco Prevention and Control 
• CDC Morbidity and Mortality Weekly Review, February 25, 1994– Guidelines for School Health Programs to Prevent Tobacco Use and Addiction- Recommendation 1 
• National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 8 and 9 
• Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827 
• Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 460 
• Surgeon General report– Reducing Tobacco Use, 2000- page 261 
• World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention P 

For more information: 

• AAP Issue Brief– Tobacco-free Environments 
• American Lung Association of Oregon– Model Policy for Head Start Programs 
• Americans for Nonsmokers’ Rights– Going Smokefree: Colleges and Universities 
• Campaign for Tobacco-Free Kids– Smoke-Free Laws 
• CDC– School Health Index 
• ChangeLab Solutions– Model Ordinance: Comprehensive Smokefree Places 
• Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals 
• Maryland Department of Health and Mental Hygiene– The Cigar Trap 
• Public Health Law Center– Vehicles 
• Smoking Cessation Leadership Center– Tobacco-Free Toolkit for Community Health Facilities 
• University of Michigan– Smoke-free Campus Supervisor's Toolkit 
• U.S. Department of Health and Human Services– Establishing a Smoke-Free Environment in Head Start Programs: Final Program Instruction 
• U.S. Department of Health and Human Services– Tobacco-Free College Campus Initiative