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Impact of public smoking bans on children’s exposure to tobacco smoke at home: a systematic review and meta-analysis
Open accessAbstract
BACKROUND: Meta-analysis of the impact of public smoking bans on children's exposure to secondhand smoke (SHS) exposure at home. METHODS: The electronic databases of PubMed, Web of Science, PsycINFo, ASSIA, CINAHL were searched. German public health journals not captured by these databases and grey literature were considered in addition. Studies were included when they reported children's SHS exposure at home in relation to smoke-free legislation by measuring exposure before and after the introduction of a public smoking ban. Studies had to provide results on exposure prevalences of children aged below 18 years. Language of publications was restricted to German and English. Details of the included studies (n = 15) were extracted by one author and checked for accuracy by a second author. Given the exposure prevalences before and after the introduction of a smoke-free legislation, a random-effects meta-analysis of relative risks (RR) was conducted. Results were presented in a forest plot. RESULTS: Meta-analysis showed that the overall effect was a decreased exposure to SHS in the children's homes after introduction of a public smoking ban (RR = 0.72; 95% CI = 0.62-0.83). Only two of the 15 studies indicated an increased exposure. Sensitivity analyses considering the type of smoke-free legislation, children's age group and study quality did not substantially alter the result. CONCLUSION: The assumption of a displacement of smoking into homes with children due to smoke-free legislation in public places could not be confirmed. Additional research is needed to analyse long-term trends.
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“Despite fears that these would result in displacement of smoking to the home, most studies have found that they either have a neutral effect or, more often, reduce SHS exposure in homes (107).”
From Review of the Impact of Housing Quality on Inequalities in Health and Well-Being (2023) · cites this paper as [107]
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Citations
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Cited by
Sorted by citations
Review of the Impact of Housing Quality on Inequalities in Health and Well-Being
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Radó, M. K., Mölenberg, F. J. M., Westenberg, L. E. H., Sheikh, A., Millett, C. J., Alex Burdorf, A., van Lenthe, F. J., & Been, J. V. (2021) · The Lancet Public Health · doi:10.1016/s2468-2667(21)00097-9 · Cited by 40
Faber, T., Mizani, M. A., Sheikh, A., Mackenbach, J. P., Reiss, I. K. M., & Been, J. V. (2019) · The Lancet Public Health · doi:10.1016/s2468-2667(19)30175-6 · Cited by 28
Living with parents who smoke predicts levels of toxicant exposure in children
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Hone, T., Szklo, A. S., Filippidis, F. T., Laverty, A. A., Sattamini, I. F., Been, J. V., Vianna, C. G. F., de Souza, M. C., de Almeida, L. M., & Millett, C. J. (2019) · Tobacco Control · doi:10.1136/tobaccocontrol-2019-054923 · Cited by 23
Merianos, A. L., Stone, T. M., Jandarov, R., Mahabee‐Gittens, E. M., & Choi, K. (2022) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntac293 · Cited by 14
Partial Smoking Ban and Secondhand Smoke Exposure in Japan
Zeng, S., Noguchi, H., & Shimokawa, S. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16152804 · Cited by 12
“Although a meta-analysis indicated that most studies have confirmed that a public smoking ban reduced exposure to SHS in childrens’ homes [22], our results may still be suggestive because the partial smoking ban in Japan exempted workplace and numerous restaurants.”
ResultHuang, L., Cao, Y., Zhang, Z., Zhang, Y., Kuang, M., Luo, Y., & Zhang, L. (2023) · Tobacco Induced Diseases · doi:10.18332/tid/159802 · Cited by 10
Dai, S., & Chan, K. C. C. (2020) · PLoS ONE · doi:10.1371/journal.pone.0227733 · Cited by 9
“According to a recent meta-analysis of the impact of public smoking bans on children’s household ETS exposure, majority of the included studies reported a decrease in the post-legislation exposure prevalence, while two studies including one Hong Kong study reported an increase.[8] Ho S.”
ResultKang, S. Y., Lim, M. K., & Cho, H. (2021) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntab051 · Cited by 10
Trends of secondhand smoke exposure among children: A scientometric analysis
Lu, H. Z., Qi, S., Chen, W. W., & Gu, D. (2025) · Tobacco Induced Diseases · doi:10.18332/tid/202017 · Cited by 7
“Over the past two decades, the enforcement of smoking bans in public places has indirectly led to a higher prevalence of voluntary smoking bans in homes, which has contributed to a reduction in SHS-related diseases among children and infants 9 .”
Titus, A. R., Mijanovich, T., Terlizzi, K., Ellen, I. G., Anastasiou, E., Shelley, D., Wyka, K., Elbel, B. D., & Thorpe, L. E. (2022) · American Journal of Epidemiology · doi:10.1093/aje/kwac089 · Cited by 7
Effects of Involuntary Smoking and Vaping on the Cardiovascular System
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“A meta-analysis came to the conclusion that public smoking bans (workplaces including the hospitality industry) reduced children’s exposure to SHS at home by 28% [48].”
BackgroundRadó, M. K., van Lenthe, F. J., Sheikh, A., & Been, J. V. (2020) · EClinicalMedicine · doi:10.1016/j.eclinm.2020.100560 · Cited by 7
“Decreased exposure to tobacco smoke exposure in the home via norm spreading is likely to be an important contributor to reducing overall second-hand smoke exposure among infants and pregnant women, hence benefiting neonatal and infant survival [48,49].”
BackgroundRadó, M. K., Mölenberg, F. J. M., Sheikh, A., Millett, C. J., Bramer, W. M., Alex Burdorf, A., van Lenthe, F. J., & Been, J. V. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-038234 · Cited by 7
A breath of fresh air: The effect of public smoking bans on Indigenous youth
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Hallingberg, B., Angel, L., BROWN, R. M. A., Copeland, L., Gray, L., Godwin, J. V., & Moore, G. F. (2021) · BMC Public Health · doi:10.1186/s12889-021-12004-z · Cited by 5
Gad, M. M., Saad, A. M., Al‐Husseini, M. J., Abdel-Gawad, Y. M., Alsalhani, O. M., Alhaddad, R., Mohamad, B., Saleh, M. A., & Simons-Linares, C. R. (2019) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2019.07.001 · Cited by 6
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Gupta, A., Bansal, A., Dixit, P., & Kumar, K. (2024) · BMC Public Health · doi:10.1186/s12889-024-18658-9 · Cited by 6
“Studies have shown that the restriction on smoking at the work-place has resulted in a ripple effect at home, resulting in the reduction of SHS exposure [20, 26, 28–32].”
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“However, there are concerns that comprehensive smoke-free legislation without strong support for cessation could displace smoking into homes, increasing children’s passive smoke exposure (12, 13).”
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Daley, A., Rahman, M., & Watson, B. (2020) · Population Health Management · doi:10.1089/pop.2020.0048 · Cited by 4
Smoking ban in cars protects children, but is vaping ‘The Elephant in the Car’?
Ng, C., & Smyth, A. R. (2020) · Thorax · doi:10.1136/thoraxjnl-2020-214660 · Cited by 3
“[1] However, a systematic review of studies analysing the effects, on children’s ETS exposure, of banning smoking in public places concluded that exposure is considerably reduced.[2] This included data from children in Scotland where ETS exposure was confirmed using salivary cotinine.”
BackgroundModifying urban planning to promote child health: A scoping review of reviews
Wallerich, L., Simos, J., & Cambon, L. (2024) · Health Promotion Perspectives · doi:10.34172/hpp.42995 · Cited by 1
“These results were corroborated to some extent by the meta-analysis conducted by Nanninga et al. 46 In addition, Mlinarić et al 96 clarify the mechanisms that influence the implementation of smoke-free measures at local level, including building trust, reinforcing priorities, and limiting divergent…”
Local tobacco control policy intensity and cigarette smoking behaviours in California
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Sharma, K., Jha, S. K., & Swain, S. (2026) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20261048 · Cited by 1
Fromme, H. (2023) · Springer eBooks · doi:10.1007/978-3-031-40078-0_9 · Cited by 1
Kim, H., Kang, H., & Cho, S. (2023) · Epidemiology and Health · doi:10.4178/epih.e2024009 · Cited by 1
“Household SHS exposure among children decreased after a smoking ban was introduced in public places [33].”
BackgroundLim, K. H., Cheong, Y. L., Kuay, L. K., Riyadzi, M. R., Hamid, H. A. A., Lim, J. H., Kee, C. C., Ghazali, S. M., & Lim, H. L. (2024) · Tobacco Induced Diseases · doi:10.18332/tid/192002 · Cited by 1
“The findings are contradicted by the results of a systematic review and meta-analysis by Nanning et al. 28 on SHS home exposure and Yao et al. 29 among youth in the USA.”
ResultLaila Shahzad, E. H. Q. (2021) · International Journal of Biosciences (IJB) · doi:10.12692/ijb/18.3.30-38 · Cited by 1
The Impact of Tobacco Smoke in the Home
Dai, S., & Chan, K. C. C. (2021) · Springer eBooks · doi:10.1007/978-3-030-67928-6_37-1
The Impact of Tobacco Smoke in the Home
Dai, S., & Chan, K. C. C. (2022) · Springer eBooks · doi:10.1007/978-3-030-92392-1_37
Eisenberg‐Guyot, J., Baker, M., Titus, A. R., Anastasiou, E., Kim, B., Ghassabian, A., & Thorpe, L. E. (2025) · Tobacco Control · doi:10.1136/tc-2025-059422
“53 Nonetheless, given that most NYCHA residents supported the SFH policy pre-implementation, these stakeholder concerns and the ambiguous initial effects of the policy suggest the need for ongoing trust-building and stakeholder engagement to develop effective and sustainable implementation…”
Hallingberg, B., Angel, L., Brown, R., Copeland, L., Gray, L., Godwin, J. V., & Moore, G. (2021) · Figshare · doi:10.6084/m9.figshare.16863732
Chung‐Hall, J., Fong, G. T., Meng, G., Craig, L. V., Indome, E. O., for the ITC Project Collaborators, Kress, A. C., Shi, J., & Ahluwalia, I. B. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-107667
Metadata
- Authors
- Nanninga, S., Lhachimi, S. K., & Bolte, G.
- Affiliations
- University of Bremen (DE)
- Corresponding author
- Nanninga, Sarah
- Venue
- BMC Public Health
- Published
- 2018-06-21
- Volume
- 18
- Issue
- 1
- Pages
- 749-749
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC6011268
- OpenAlex
- W2809374480
- Cited by
- 37
- References
- 50
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 8 · 2020: 7 · 2019: 5
- FWCI
- 0.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
- Keywords
- public smoking bans, passive smoking, children, household smoke exposure, smoking bans, smoke-free public places, tobacco control
- MeSH terms
- Child, Housing, Humans, Tobacco Smoke Pollution, Air Pollution, Indoor, Smoke-Free Policy
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