Article Text

Assessing secondhand smoke exposure with reported measures
  1. Erika Avila-Tang1,2,3,
  2. Jessica L Elf2,
  3. K Michael Cummings4,
  4. Geoffrey T Fong5,6,
  5. Melbourne F Hovell7,
  6. Jonathan D Klein3,
  7. Robert McMillen3,8,
  8. Jonathan P Winickoff3,9,
  9. Jonathan M Samet10
  1. 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, Illinois, USA
  4. 4Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  5. 5Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  6. 6Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  7. 7Center for Behavioral Epidemiology, San Diego State University, San Diego, California, USA
  8. 8Department of Psychology, Mississippi State University, Starkville, Mississippi, USA
  9. 9Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
  10. 10Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
  1. Correspondence to Dr Erika Avila-Tang, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 4th floor, Baltimore, Maryland 21205, USA; etang{at}


Non-smokers are exposed to tobacco smoke from the burning cigarette and the exhaled smoke from smokers. In spite of decades of development of approaches to assess secondhand smoke exposure (SHSe), there are still unresolved methodological issues. This manuscript summarises the scientific evidence on the use of SHSe reported measures and their methods, objectives, strengths and limitations; and discusses best practices for assessing behaviour leading to SHSe for lifetime and immediate or current SHSe. Recommendations for advancing measurement science of SHSe are provided. Behavioural measures of SHSe commonly rely on self-reports from children and adults. Most commonly, the methodology includes self, proxy and interview-based reporting styles using retrospective recall or diary-style reporting formats. The reporting method used will vary based upon the subject of interest, assessment objectives and cultural context. Appropriately implemented, reported measures of SHSe provide an accurate, timely and cost-effective method for assessing exposure time, location and quantity in a wide variety of populations.

  • Secondhand smoke exposure
  • questionnaires
  • self-report
  • biological markers
  • environmental exposure
  • validation
  • surveillance and monitoring
  • prevalence
  • human rights
  • secondhand smoke
  • advertising and promotion
  • global health
  • low/middle income country
  • packaging and labelling
  • social psychology
  • research methods
  • psychosocial theories
  • primary health care
  • taxation and price
  • environmental tobacco smoke
  • litigation
  • health services
  • globalisation

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Funding This work was supported by grants from the Flight Attendant Medical Research Institute to the Johns Hopkins Center of Excellence; the University of California, San Francisco Bland Lane Center of Excellence; and the American Academy of Pediatrics Julius B Richmond Center of Excellence. The funding organisation had no role in the preparation of the manuscripts.

  • Competing interests KMC has received payment as an expert witness in litigation against the tobacco industry.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Manuscript does not contain original data.

Linked Articles

  • Editorial
    Alistair Woodward
  • Review
    Benjamin J Apelberg Lisa M Hepp Erika Avila-Tang Lara Gundel S Katharine Hammond Melbourne F Hovell Andrew Hyland Neil E Klepeis Camille C Madsen Ana Navas-Acien James Repace Jonathan M Samet Patrick N Breysse
  • Review
    Erika Avila-Tang Wael K Al-Delaimy David L Ashley Neal Benowitz John T Bernert Sungroul Kim Jonathan M Samet Stephen S Hecht