Photo Credit: Nati Shohat/Flash90
Cigarettes in an ashtray, April 9, 2021.

First of its kind research in Israel by the Sackler Medical School of Tel Aviv University uncovers concerning data about secondhand smoking by children of smokers: According to the study, 70% of children were found to have nicotine residue in hair samples.

The study was conducted under the leadership of a team of experts from the Tel Aviv University School of Medicine headed by Prof. Leah (Laura) Rosen of the School of Public Health together with researchers Dr. Vicki Myers, Prof. Nurit Guttman, Ms. Nili Brown, Prof. Mati Berkovitch, and Dr. Michal Bitan. Prof. David Zucker of the Hebrew University of Jerusalem and Dr. Anna Rule of Johns Hopkins University in the US also participated in the study. The study was published in the prestigious journal Nicotine & Tobacco Research (Protecting Children From Tobacco Smoke Exposure: A Randomized Controlled Trial of Project Zero Exposure).


In the study, the researchers sought to examine whether raising awareness of children’s exposure by providing objective feedback might change the parents’ behavior and child exposure. Approximately 140 Israeli families participated in the study, parents of children up to age 8, in which at least one parent is a smoker. The smoking average per household was 15 cigarettes per day, where one-third of the respondents reported that they smoke inside the home, and an additional third said that they are in the habit of smoking on the terrace but not inside the home.

First, researchers tested children’s level of exposure via a biomarker, nicotine in hair, which indicates cumulative exposure to tobacco smoke. The researchers took hair samples from the children and tested the nicotine levels in each sample in a laboratory. (It is important to note that the test was for nicotine that became an integral part of the strand of hair and not just outside precipitate.)

The findings were very concerning: Nicotine residue was found in 70% of the hair of the children tested, and only 29.7% of those children tested did not show nicotine residue in their hair samples.

The researchers divided the families into two groups: one group that underwent comprehensive instruction about the effects and dangers of exposure to smoking, including feedback and information about the test results, and that was also given tools to protect their children from exposure to cigarette smoke and a recommendation to keep their home and car smoke-free. The second group received feedback about nicotine levels in the children’s hair after six months, at the end of the study.

Six months after the start of the study, the researchers conducted additional nicotine tests on the children’s hair, and one could already see a significant improvement in the data: Among the group that received comprehensive training, the percentage of children whose hair samples contained nicotine decreased from 66% to 53%, whereas in the second group (which did not receive training at the start of the study), the percentage of children whose hair samples contained nicotine decreased from 74% to 49%.

The researchers theorize that the knowledge that the children were tested for tobacco smoke exposure, and that additional testing was planned at six months, resulted in the parents changing their behavior and reducing the children’s exposure. As a result of the study’s findings, the researchers recommend considering conducting such testing to measure exposure on a routine basis among young children in Israel.

Prof. Leah Rosen: “To our great dismay, according to the Ministry of Health’s data, approximately 60% of small children in Israel are exposed to secondhand smoke and its harmful effects. Based on the study’s findings, we believe that conducting nicotine testing – in the hair, urine, or using other testing methods – for every young child in Israel, may change parents’ perceptions about exposing their children to tobacco smoke. Changing this perception can also result in changing behavior, exposure levels, and even social norms regarding passive exposure to smoking – both exposure of children as well as exposure of adults.

We call upon smokers to avoid smoking anyplace where non-smokers and in particular, at-risk populations, including children, pregnant women, the elderly, and those who are ill, could be exposed. Non-smokers must understand that there is a genuine risk in exposure to tobacco smoke, and they must insist upon their right and the right of their children and family members to breathe air that is smoke-free everywhere. Of course, the government has a central role in enforcing laws pertaining to smoking in public places and continuing to enact laws to protect the individual everywhere from exposure to secondhand smoke.”


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