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(1) Background: Home tobacco smoke exposure (TSE) and negative neighborhood characteristics adversely affect children’s overall health. The objective was to examine the associations of child TSE status and neighborhood characteristics among U.S. school-aged children. (2) Methods: We conducted a secondary analysis of the 2018–2019 National Survey of Children’s Health (NSCH) data including 17,300 U.S. children ages 6–11 years old. We categorized children’s home TSE status into: (a) no TSE: child did not live with a smoker; (b) thirdhand smoke (THS) exposure alone: child lived with a smoker who did not smoke inside the home; and (c) secondhand smoke (SHS) and THS exposure: child lived with a smoker who smoked inside the home. We conducted a series of weighted linear and logistic regression analyses to assess the associations between child TSE status and neighborhood characteristics, adjusting for covariates. (3) Results: Overall, 13.2% and 1.7% of children were exposed to home THS alone and home SHS and THS, respectively. Compared to children with no TSE, children with home THS exposure alone and children with home SHS and THS exposure had a significantly lower total number of neighborhood amenities and children with SHS and THS exposure had a significantly higher total number of detracting neighborhood elements. (4) Conclusions: Children with TSE demonstrate disparities in the characteristics of the neighborhood in which they live compared to children with no TSE. TSE reduction interventions targeted to children with TSE who live in these neighborhoods are warranted.

Disparities in Neighborhood Characteristics among U.S. Children with Secondhand and Thirdhand Tobacco Smoke Exposure