Smoking on your balcony? You're still endangering your children - study

Contrary to Health Ministry advice a few months ago that it’s better for parents who smoke to light up on their balconies rather than anywhere inside, new Tel Aviv University (TAU) research has found that even outside, six out of 10 of children are at risk for being harmed by tobacco smoke. 

The unique Israeli study, led by Prof. Leah (Laura) Rosen from the School of Public Health in TAU’s Sackler Faculty of Medicine, said that many parents mistakenly think that they are protecting their children by restricting their smoking to the porch/window or designated smoking areas inside their homes. In fact, unknowingly, many are exposing their children to health risks.

The research team tested for the presence of nicotine in the hair of children whose parents smoke; this provides an estimate of the amount of exposure to tobacco smoke over the past months. Among parents who restrict smoking to the porch or outside the house, the findings are extremely worrisome. An analysis of the data showed that among smoking families who restricted smoking to the porch or outdoors, and did not smoke inside the house, 62% of the children were exposed to tobacco smoke. 

It was noted that in the first stage of the study (which was published about two years ago), the research team tested for the presence of hair nicotine among children of smoking parents – and then it was found that 70% of the children of smoking parents had measurable hair nicotine. Now, as described above, the researchers examined the data by location of parental smoking. 

Examining the data by location of parental smoking

“Smoking should be avoided within a range of at least 10 meters from the house – and in open areas, smoking should be kept to a distance of at least 10 meters away from children,” the team wrote in the International Journal of Environmental Research and Public Health under the title “Tobacco smoke exposure according to location of home smoking in Israel: Findings from the project zero exposure study.” 

The researchers stressed that in Israel, home balconies should be regarded as part of the environment of the home. “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 10 meters from the house. Likewise, in open areas, smokers should maintain a distance of at least 10 meters from the children.” 

It is known that smoking outside the house, even when the doors and windows are fully closed, does not completely protect children from exposure to tobacco smoke, Rosen said. “The Israeli situation is of great concern because in many cases, porches in Israel are directly adjacent to the 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. The parents mistakenly believe that the porch offers a ‘safe’ place to smoke. In fact, the 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, for example, into the furniture or walls or rugs, 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 and on their clothing, so it is recommended to brush teeth, wash hands and change clothes after smoking before making contact with children.” 

The team wrote that tobacco use continues to be the leading preventable cause of premature illness and death in the world, as it kills up to half of those who use it, resulting in over seven million global deaths each year. An additional 1.2 million people die from diseases caused by exposure to secondhand smoke. Infants and young children exposed to tobacco smoke are at an increased risk of a range of diseases, including low birth weight, sudden infant death syndrome, ear infections, asthma, pneumonia and inflammatory effects leading to metabolic syndrome, insulin resistance, impaired cardiac autonomic function, and premature atherosclerotic heart disease. At least 500 million children worldwide are exposed to secondhand smoke at home.”

Rosen noted that this new information is directly relevant to Case 1416/21 on neighbor smoking, which is currently being heard in the Supreme Court. The appeal against the Health, Interior and Environmental Quality Ministries discusses 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,” Rosen declared. “Therefore, 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 in addition, it can cause substantial harm to neighbors and the children of neighbors.

“We ask the Health Ministry to reconsider its stand in light of these findings. Israel must make the reduction of parental smoking a national goal and invest the appropriate resources in this issue. Unfortunately, there are many misconceptions regarding when and how the exposure occurs. Eighty-five percent of tobacco smoke is invisible, and our sense of smell is not reliable, so many parents mistakenly believe that they are protecting their children while in fact they are exposing them to substantial health risks. As a society, we must safeguard citizens and distance everyone from the risks of tobacco smoke exposure, especially infants and children, pregnant women, and all vulnerable populations.” 

Also participating in the study: Prof. David Zucker from the Hebrew University’s statistics and data science department; Dr. Shannon Gravely from the psychology department of Waterloo University in Canada; Dr. Michal Bitan from the computer science department of the College of Management; Dr. Anna Rule from the Health and Environmental Engineering department at the Johns Hopkins Bloomberg School of Public Health in Baltimore; and Dr. Vicki Meyers from the Gertner Institute for Epidemiology and Public Policy Research at Sheba Medical Center at Tel Hashomer.