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Impact on children health professionals. Data from the Global Respiratory illnesses and symptoms. Both Youth Tobacco Survey (GYTSI indicate that SHS maternal and paternal smoking cause lower exposure is common among youth. Surveys of respiratory tract illnesses such as bronchitis children in school, aged 13 -15 years, conducted and pneumonia, particularly during the first between 1999 and 2006 in 132 countries found year of life.15,22,23 Numerous surveys also show that 44% had been exposed at home and 56% a greater frequency of the most common res- in public places during the 7 days prior to the piratory symptoms - cough, phlegm and survey.38AstudyofworkersatMexico'sNational wheeze - in the children of smokers.24.25 The Institute of Health showed that 91% were ` highest levels of risk have been found in house- exposed to some degree to tobacco smoke.39A s holds where both parents smoke. survey of third-year students in health profes- sional schools in 10 countries found exposure ` Asthma. Exposure to SHS exacerbates pre- to SHS at home ranging from 30% in Uganda existing asthma and causes new-onset asthma to 87% in Albania, and exposure in public places among children (as well as adults, as discussed from 53% in Uganda to 98% in Serbia.40 ` above). 11, 2e, 27 Exposure to SHS in the home increases emergency room visits and medication While exposure to tobacco smoke in the United use by asthmatic children. 28.21 States has declined substantially over the past ` several years, studies of cotinine (a by-product Lung growth and development. Since the United of nicotine) reviewed in the 2006 United States States Surgeon General concluded in 1986 that Surgeon General's Report show that more than ` SHS reduces the rate of lung function growth 40% of non-smoking adults and almost 60% during childhood, evidence has continued to of children aged 3 through 11 years are still accumulate to support this conclusion. iL15,30, exposed to SHS.15 ` 31 An effect has been associated both with e, maternal smoking during pregnancy and with Two recent studies of a variety of settings in 39 exposure to SHS after birth. developed and developing countries found SHS ` in the great majority of the locations surveyed.41, Middle-eardisease/otitismedial.SHS exposure 42 In seven Latin American countries SHS causes otitis media, or middle ear disease, a (measured by ambient nicotine levels) was common childhood illness that accounts for a detected in 94% of the locations surveyed, large number of visits to physicians and, if including hospitals, schools and government untreated, can lead to hearing impairment. 13.15.31 buildings.41 A study comparing levels of fine particulate matter in indoor environments, Pre and postnatal effects where smoking was or was not observed, con- Exposure of non-smoking women to SHS during duded that among the 32 countries studied, ` pregnancy causes low birth weight and preterm only the two countries with national compre- delivery.14, 33, 34.35 SHS exposure also causes hensive smoke-free air policies - Ireland and Sudden Infant Death Syndrome (SIDS or cot New Zealand - had acceptable levels of indoor death).15,"Other perinatalhealth effects where airquality.42,43 there may be a link with SHS exposure are intrauterine growth retardation and sponta- Widespread exposure translates into significant neous abortion (miscarriagel.14,31 health consequences at the population level. For example, Cal/EPA estimates that in the Magnitude of exposure to SHS United States SHS causes 3 400 lung cancer Exposure to SHS is widespread in most coun- deaths and between 23 000 and 70 000 heart tries, even in health-care settings and among disease deaths annually. In children, SHS is