Objective To summarize information on rates of secondhand smoke (SHS) exposure among healthy and medically at-risk pediatric populations, discusses the clinical manifestations of pediatric disease that are exacerbated by exposure, and provide an overview of promising strategies for reducing SHS in vulnerable pediatric populations. Methods The success of exposure reduction and smoking cessation interventions implemented with parents of healthy children and those with respiratory disease, in the

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... ontext of their child's health care, is reviewed. Results Concurrent implementation of multiple levels of intervention, including clinical interventions within the medical setting, will help to maximize the reduction in childhood SHS exposure. Conclusion Ongoing intervention research and identification of strategies to capitalize on opportunities for providing effective SHS counseling in primary care and specialty clinics will be critical for effective tobacco control among medically at-risk children.