A systematic review of secondhand tobacco smoke exposure and smoking behaviors: Smoking status, susceptibility, initiation, dependence, and cessation

Addict Behav. 2015 Aug:47:22-32. doi: 10.1016/j.addbeh.2015.03.018. Epub 2015 Mar 24.


Objectives: To examine the association between secondhand tobacco smoke exposure (SHSe) and smoking behaviors (smoking status, susceptibility, initiation, dependence, and cessation).

Methods: Terms and keywords relevant to smoking behaviors and secondhand tobacco smoke exposure were used in a search of the PubMed database. Searches were limited to English language peer-reviewed studies up till December 2013. Included papers: a) had clearly defined measures of SHSe and b) had clearly defined measures of outcome variables of interest. A total of 119 studies were initially retrieved and reviewed. After further review of references from the retrieved studies, 35 studies were finally selected that met all eligibility criteria.

Results: The reviewed studies consisted of thirty-five (89.7%) studies with differing measures of SHSe (including questionnaire and biological measures) and varying definitions of main outcome variables of interest between studies. The majority of the studies (77%) were cross-sectional in nature. The majority of studies found that SHSe was associated with greater likelihood of being a smoker, increased susceptibility and initiation of smoking, greater nicotine dependence among nonsmokers, and poorer smoking cessation.

Conclusions: The review found positive associations between SHSe and smoking status, susceptibility, initiation and nicotine dependence and a negative association with smoking cessation. In light of design limitations, future prospective and clinical studies are needed to better understand the mechanisms whereby SHSe influences smoking behaviors.

Keywords: Nicotine dependence; Secondhand smoke; Smoking cessation; Smoking initiation; Smoking status; Smoking susceptibility.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Smoking / epidemiology*
  • Smoking Cessation / statistics & numerical data*
  • Tobacco Smoke Pollution / statistics & numerical data*
  • Tobacco Use Disorder / epidemiology*


  • Tobacco Smoke Pollution