Two articles in this edition of Tobacco Control, by Ashley and Ferrence1 and Lund et al,2address an issue that is likely to become increasingly important in the new millennium. How will children be protected from the known health threat of exposure to environmental tobacco smoke (ETS) when that exposure occurs in places, such as the home or the private automobile, that are traditionally considered off limits to governmental or other outside intervention?

The overall problem is enormous. According to data collected in 1992–93 in the United States, 21.9% of children under 18 years of age are exposed to ETS at home by their parents.3 As Aligne and Stoddard recently noted: “Parental smoking is an important preventable cause of morbidity and mortality among American children; it results in annual direct medical expenditures of $4.6 billion and loss of life costs of $8.2 billion.”5 A 1998 Canadian study has found that nearly half (47%) of children in that country are exposed to ETS in the home, whether by parents, visitors, or babysitters.4 The authors concluded: “Additional efforts to reduce children’s exposure to tobacco smoke are warranted.”5

Societies will differ regarding the pace and extent of such interventions. Lund et al have begun to quantify the awareness of parents in Nordic countries of the harm to children caused by exposure to ETS. Their results are encouraging. In addition, according to a recent survey conducted in Massachusetts, …