Many parents who smoke think that they are protecting their children by restricting their smoking to a porch or next to a nearby window. However, a new study from Tel Aviv University (TAU) finds that these strategies do not protect most children from exposure to tobacco smoke.

In a study unique to Israel, the research team tested for the presence of nicotine in the hair of children whose parents smoke. Among parents who restrict smoking to a porch or outside the house, the findings are extremely worrisome: Nicotine was still found in the hair of six out of ten children tested.

“In Israel, home porches should be regarded as part of the environment of the home,” the researchers say. “Smoking next to a window or in another specific place in the home does not protect most children from exposure.

“Our recommendations are unequivocal:  To reduce children’s exposure to tobacco smoke, smoking should be entirely avoided within a range of ten meters [thirty feet] from the house. Likewise, in open areas, smokers should maintain a distance of at least ten meters from the children.”

The study was led by Professor Leah (Laura) Rosen of the School of Public Health in TAU’s Sackler Faculty of Medicine. The study was published on February 16, 2023, in the International Journal of Environmental Research and Public Health.

In the study, the team tested children’s level of tobacco smoke exposure by testing hair samples of children for the presence of nicotine. This provides an estimate of the amount of exposure to tobacco smoke over a time period of several months. Analysis of the data showed that among smoking families who restricted smoking to a porch or outdoors and did not smoke inside the house, 62% of the children were exposed to tobacco smoke.

“Smoking outside the house, even when the doors and windows are fully closed, does not completely protect children from exposure to tobacco smoke,” Professor Rosen says. “The Israeli situation is of great concern because in many cases, porches in Israel are directly adjacent to living areas and may even be partially open some of the time; the proximity allows smoke to drift from those areas to the interior of the house.

“Parents mistakenly believe that a porch offers a ‘safe’ place to smoke. In fact, children are likely to be directly exposed when they come out to the porch and someone is smoking, or when smoke drifts into the house. Once in the home, the smoke is absorbed into the environment, into the furniture or walls or rugs for example, and is then gradually discharged into the air over weeks or months.

“Further, this residual smoke, known as third-hand smoke, can be absorbed into the body from the environment via swallowing or through the skin, especially among infants and small children. In addition, smoking parents transmit the toxins from the tobacco smoke on their skin, on their hands, in their hair, on their clothing. Therefore it is recommended to brush teeth, wash hands, and change clothes after smoking, before contact with children.”

Professor Rosen notes that this new information is directly relevant to a case currently being heard in Israel’s Supreme Court. An appeal against the Ministries of the Environment, Health, and Interior concerns the tobacco smoke that penetrates apartments as an environmental hazard, a claim that is supported by the definition of an environmental hazard in the Clean Air Law, the Hazard Prevention Law, and the Penal Code.

“The results of this study show that among smoking families, restricting smoking to the porch does not protect most children from exposure to tobacco smoke,” Professor Rosen says. “The Health Ministry’s approach, which opposes protection for individuals from smoke incursion into their own homes in order to protect the smokers’ children, does not protect the children of smokers, and it can also cause substantial harm to neighbors and the children of neighbors.  We are asking the Health Ministry to reconsider its stand in light of these findings.”

Other participants in the study included Professor David Zucker of Hebrew University; Dr. Shannon Gravely of Waterloo University; Dr. Michal Bitan of TAU; Dr. Anna Rule of Johns Hopkins Bloomberg School of Public Health; and Dr. Vicki Meyers of the Sheba Medical Center.