1. Introduction
deaths, death, premature illness
PROLIFERATION, DISEASE, DISEASES
Young children are particularly vulnerable to harms from tobacco smoke exposure (TSE). This study aimed to compare TSE: (1) between children who live in smoking families and those who do not; and (2) among children who live in smoking households with varying smoking locations. The data came from two studies that were conducted concurrently in Israel (2016–2018). Study 1: a randomized controlled trial of smoking families (Tobacco use continues to be the leading preventable cause of premature illness and death in the world. Tobacco kills up to half of those who use it, resulting in over 7 million global deaths each year. An additional 1.2 million people die from diseases caused by exposure to secondhand smoke (SHS) [Scientific evidence showing the causal relationship between tobacco smoke exposure (TSE), which includes both second- and third-hand exposure, and death and disease, has led to a proliferation of smoke-free laws in public places throughout the world, particularly in bars, restaurants, hospitality venues, and workplaces [Restricting smoking to outside of the home has long been thought to help reduce and even eliminate a child’s exposure to tobacco smoke. However, studies have shown that even when parents restrict smoking to areas outside the home, exposure may occur, increasing the risk of disease for children. A study in California by Matt et al. found that young child TSE, based upon cotinine levels, was 5–7 times higher in households of smokers who smoked outdoors than in households of nonsmokers [Smoking rates are high in Israel (1 in 5 adults smoke), and over 60% of children are exposed to TSE [We aimed to (1) assess TSE exposure in study samples of children living in non-smoking and smoking families in Israel and (2) assess whether TSE differed by smoking location (inside, on the balcony/porch, or in the yard, garden, or other place outside of the home). We hypothesized that an unrestricted smoking policy, where smoking is allowed in any room or part of the home, would be associated with the highest levels of TSE; however, based on previous literature, we also anticipated detectable levels of TSE among children whose parents restricted smoking to balconies or yards. 