Secondhand smoke exposure at home and school absenteeism among children in the United States: national estimates of attributable missed school days.

Objective: The number of missed school days attributable to secondhand smoke (SHS) exposure at home among U.S. children has not been quantified. We estimated the association between SHS exposure at home and school absenteeism and derived national estimates of SHS-attributable missed school days. Methods: We analyzed data from the 2016-2024 National Survey of Children's Health for U.S. children aged 6-11 years. Propensity score weighting and two-part models were used to estimate the association between SHS exposure at home and school absenteeism. National estimates of SHS-attributable missed school days were derived by combining model-based attributable fractions with national public school enrollment data. Results: SHS exposure at home was associated with both a higher likelihood of missing school and a greater number of missed school days among children with any absence. In 2024, an estimated 266,008 (95% CI: 139,627, 392,390) missed school days were attributable to SHS exposure at home nationwide, corresponding to 0.95 additional missed school days per exposed child (95% CI: 0.56, 1.34). Conclusions: This study provides the first national estimates of SHS-attributable missed school days among U.S. children. These findings suggest that reducing children's SHS exposure may further improve school attendance and promote more efficient use of educational resources.