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Passive smoking is a major health hazard to children, says the RCP

Passive smoking in the home is a major hazard to the health of the millions of children in the UK who live with smokers. Passive smoking and children, a major new report launched today from the Tobacco Advisory Group of the Royal College of Physicians says that children are particularly vulnerable to passive smoke exposure, most of which occurs in the home. About 2 million children currently live in a household where they are exposed to cigarette smoke, and many more are exposed outside the home.

Summary findings

Using evidence-based studies and additional analysis, funded by Cancer Research UK and carried out by the UK Centre for Tobacco Control Studies, partly based at Nottingham University, the report contains alarming new estimates for key measures of health damage attributable to passive smoking, which for children each year causes:

  • over 20,000 cases of lower respiratory tract infection
  • 120,000 cases of middle ear disease
  • at least 22,000 new cases of wheeze and asthma
  • 200 cases of bacterial meningitis
  • 40 sudden infant deaths – one in five of all SIDs.

Each year, these cases generate over 300,000 UK GP consultations and about 9,500 hospital admissions, and cost the NHS about £23.3 million.

The report highlights the most important factors governing exposure to children, which are whether their parents or carers smoke, and whether smoking is allowed in the home. Relative to children in non-smoking families, passive smoke exposure is around three times higher if the father smokes, over six times higher if the mother smokes, and nearly nine times higher if both parents smoke. Smoking by other carers is also a significant source of passive smoke exposure. Children growing up with parents or siblings who smoke are also 90% more likely to become smokers themselves.

In addition to the burden of disease, passive smoking also places a large financial burden on the NHS – at least £9.7 million each year in UK primary care visits and asthma treatment costs, £13.6 million in UK hospital admissions, and £4 million on asthma drugs for children up to the age of 16. The future treatment costs of smokers who take up smoking as a consequence of exposure to smoking by parents could be as high as £5.7 million each year.

The report also covers the ethics of children and passive smoking, and public opinion on smoke-free policy. It makes a series of strong policy recommendations to reduce the burden of passive smoking on children, a burden which is entirely avoidable:

  • The most effective means of protecting children from passive smoking is to reduce the prevalence of smoking in adults, and particularly parents and other carers.
  • So far, reductions in smoking prevalence have been much less marked in younger than older adults
  • Tobacco control initiatives at population and individual level therefore need to be adapted and improved to target younger adults more effectively.
  • This will require a comprehensive strategy including: sustained increases in the real price of tobacco; further reduction in smuggling and illicit trade; investment in new and innovative mass media campaigns targeting smoking in younger adults; more effective health warnings; prohibition of point-of-sale display; generic standardised packaging; tailored cessation services; and a range of other policies.
  • Specific measures to prevent uptake of smoking, by preventing exposure of children to smoking in public and in the media; reducing the number and accessibility of tobacco retailers to children, imposing strict penalties on those who sell to children, and promoting peer-led and other school-based interventions are also needed.
  • It is important to promote smoke-free homes through mass media campaigns, advice and support from health professionals to smokers, and new approaches such as substituting cigarettes with medicinal nicotine
  • Smoke-free legislation should be extended much more widely, to include public places frequented by children and young people, and to prohibit all smoking in cars and other vehicles; media campaigns are needed to explain the need to avoid exposing children to smoking as well as to smoke.
  • Governments and individuals have a duty to protect children from exposure to smoke and to smoking.
  • There is public support for more comprehensive tobacco control policies, and a strong ethical justification for these measures.


The Chief Medical Officer for England, Professor Sir Liam Donaldson, who wrote the Foreword to the report, said:

I very much welcome this report which clearly sets out the danger to children from exposure to secondhand smoke. This is a serious public health concern. In my 2002 Annual Report I highlighted children's special vulnerability to secondhand smoke.

The report’s recommendations align very well with the Government's ten year vision for tobacco control set out in its new strategy for England, A Smokefree Future. Among the many commitments in that report are plans to do more to reduce smoking in homes and cars in which children are present. The report is a very valuable addition to the evidence base which will be considered as part of the Department of Health's review of the existing smokefree legislation in England three years after it came into force, to be carried out later this year.

Professor John Britton, Chair of the RCP Tobacco Advisory Group said:

This report isn’t just about protecting children from passive smoking, it’s about taking smoking completely out of children’s lives.

Professor Terence Stephenson, President of the Royal College of Paediatrics and Child Health (RCPCH), said:

The Royal College of Paediatrics and Child Health has recently led on the call to ban smoking in cars with children travelling in them. We should be making cars totally smoke-free if there are children travelling in them. Second-hand smoke has been found to be strongly linked to chest infections in children, asthma, ear problems and sudden infant death syndrome, or cot death. We strongly support the policy recommendations in this new report and repeat the call for new approaches to address this problem so that we protect the health of children and young people.


For further information, please contact Linda Cuthbertson, head of PR, on +44 (0)203 075 1254 / 0774 877 7919, or email Linda.Cuthbertson@rcplondon.ac.uk