Secondhand smoke (SHS) is commonplace in South Dakota. It is casually linked to an increased incidence and severity of childhood and adult asthma; lower respiratory tract infections; symptoms of cough, wheeze, phlegm; acute and chronic otitis media; sudden infant death syndrome; cancers; prematurity; and cardiovascular disease. At this time, the development of specific allergy cannot be causally linked. As there is no risk-free level of secondhand smoke, tobacco smoking cessation is the only effective treatment and should be actively pursued at every opportunity.