Environmental tobacco smoke has been shown to reduce pulmonary function in both children and adults , and has been implicated in a wide range of respiratory illnesses including croup; bronchiolitis; bronchitis; pneumonia; asthma (in children and adults); and lung cancer. Recent studies have attempted to incorporate genetic factors linking ETS and pulmonary diseases. Although more research is needed in this area, the studies indicate that the genetic predisposition for the development of an IgE-mediated response to common allergens is the strongest identifiable predisposing factor in developing asthma. ETS exposure can also be linked to gene mutations, especially the p53 and GSTM1, both linked to an increased risk of developing lung cancer. Future studies, especially those involving genetic-environmental interactions, would benefit from more accurately defining the phenotype by documenting ETS exposure with personal monitors or biomarkers. Based on a growing body of evidence, the American Academy of Pediatrics and the American Academy of Family Physicians have made clear recommendations regarding the importance of screening and counseling ETS exposure at every child visit. Despite these recommendations, a recent study by Winickoff et al  demonstrated that nationally, the rates of screening, education, and counseling provided to smoking parents by health care professionals in pediatrics and family practice were extremely low. Only half of all parents were questioned about the presence of household smokers and only one third of parental smokers were counseled about the dangers of child ETS exposure or the risks associated with modeling smoking behavior. Only about one third (35%) of parents prohibited smoking inside the home and only 22% prohibited smoking in cars . Parents need to be aware that ETS is classified by the US Environmental Protection Agency as a class A carcinogen  and that exposing their children to ETS increases the risk of asthma, sudden infant death syndrome, middle ear disease, pneumonia, cough, upper respiratory infection, reduced high-density lipoprotein levels, and coronary artery disease [8,89-95]. Although small improvements in adult attitudes and practices regarding children's ETS exposure occurred from 2000 to 2001, a significant number of adults in the United States still report ignorance of the harmful effects of ETS [96,97]. For the workplace, population-based data do show a declining ETS exposure, but ETS exposure remains a common public health hazard that is entirely preventable. Two national health objectives for Healthy People 2010 are to reduce cigarette smoking among adults to 12% and the proportion of nonsmokers to 45% . Smoking bans are the most effective method for reducing ETS exposure. Most state and local laws for clean indoor air reduce but do not eliminate nonsmokers' exposure to ETS. A noteworthy exception is the City of New York's recent smoking ban in all public locations including bars and restaurants. Efforts to prevent ETS exposure continue, however, to face formidable obstacles. The tobacco industry and their supporters continue to lobby to repeal or weaken existing antismoking legislation despite overwhelming evidence of the adverse health effects from both active and passive tobacco smoke exposure. To ensure the success of future efforts to reduce ETS, all available strategies (educational, clinical, and regulatory) must be used in a creative, comprehensive, and consistent manner [99,100].
ASJC Scopus subject areas