Objective. To evaluate the impact of adult tobacco use on the health of children.

Design. A literature review identified relevant research reports. Meta-analysis was used to compute a pooled risk ratio for each condition studied. The risk ratios were combined with data on exposure rates to produce estimates of the population-attributable risk.

Results. Each year, among American children, tobacco is associated with an estimated 284 to 360 deaths from lower respiratory tract illnesses and fires initiated by smoking materials, more than 300 fire-related injuries, 354 000 to 2.2 million episodes of otitis media, 5200 to 165 000 tympanostomies, 14 000 to 21 000 tonsillectomies and/or adenoidectomies, 529 000 physician visits for asthma, 1.3 to 2 million visits for coughs, and in children younger than 5 years of age, 260 000 to 436 000 episodes of bronchitis and 115 000 to 190 000 episodes of pneumonia.

Conclusions. The use of tobacco products by adults has an enormous adverse impact on the health of children. Although more research is needed in several areas, action to reduce the morbidity and mortality among childdren should not be delayed. New laws and policies are needed to grant children protection from bodily injury and death attributable to the use of tobacco products by others.

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