The results of the Global Youth Tobacco Survey (GYTS-4), India, 2019, released by the Union Minister for Health and Family Welfare on Tuesday shows that 29% of school-going children between the ages 13-15 are exposed to second-hand smoke. The survey was conducted in 2019 by the International Institute for Population Sciences under the aegis of the Ministry of Health and Family Welfare.

Over 97,000 school children from 987 schools across all states and Union Territories were surveyed for their usage of tobacco. Overall, fewer children within the 13-15 age bracket use tobacco in any form — the National Fact Sheet notes that there has been a 42% decline in the last decade. However, the number of children who still consume tobacco in some form remains concerning: one-fifth of all survey participants consumed it through cigarettes, bidi, or smokeless tobacco products. Besides these, 29% of all children remained exposed to tobacco smoke.

The cause of concern beyond this is that the median age of initiation for each of these products was around 10 years old. Around half of all users of each tobacco product reported starting their usage before their 10th birthday. Despite the drop in these numbers, exposure to secondhand smoke still puts many children at risk of breathing-related health issues. Much of this exposure took place in outdoor public places (23%), followed by enclosed public places (21%) and at home (11%).

The survey also enumerated students’ perceptions of public health messaging around smoking, and where these messages were most visible. Mass media campaigns were noticed the most (by 52% of students), and an overwhelming majority — 71% — thought that other people smoking around them is harmful to them. More than half the students also consequently favored a ban on smoking inside enclosed public spaces.

“The more and the sooner, we create awareness among children about harms due to tobacco use, the better will be the outcomes in terms of reduction in the prevalence of tobacco use among children and consequently among adults,” the Health Minister noted in a press release.

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The findings align with a previous Nature study that found that school-aged children are more vulnerable to secondhand smoke exposure. The easy availability of tobacco products, and the lack of checks and barriers over age pose a significant problem in the issue of children’s health and exposure to tobacco.

On the one hand, past studies have shown that tobacco companies are increasingly and deliberately targeting Indian children, making it more urgent than ever for public health campaigns and school curricula to raise awareness and offset the effects of such targeted ads. A separate Reuters investigation also found Big Tobacco pushing smoking at colorful kiosks and other places frequented by young people.

Even if children smoke less, secondhand smoke is almost equally detrimental to their health. Of the nearly 7,000 chemicals present in cigarette smoke, 100 are highly toxic and 70 are carcinogenic. According to the World Health Organization, there is no permissible level of smoke that is safe to be around. Experts note that since children’s immune systems are not fully developed along with lung functioning and capacities, they tend to breathe faster. Smoke exposure could cause respiratory diseases and breathing issues that can hinder their development. Moreover, secondhand smoke causes a significant number of early deaths among non-smokers, including children, making the issue a neglected public health crisis in India.

Although government efforts to reduce smoking in public places have been around for a long time, many reports show that they remain largely ineffective in their messaging about how exactly tobacco is harmful for health, and implementation of anti-smoking laws is woefully insufficient. Health officials note that including anti-tobacco awareness in schools themselves, and enlisting parents and teachers in the effort, are the need of the hour. But other experts that say nothing short of a 100% smoking-free environment can mitigate the effects of passive smoking in children, which poses a much more significant challenge.