Int. J. Environ. Res. Public Health 2011, 8 4208 measure knowledge, attitudes and avoidance practices. Results: Most respondents were regularly exposed to SHS in various locations during daily life, even though they were very knowledgeable about the dangers of SHS exposure for women and children. However, the subject’s attitudes and avoidance behavior did not reflect the level of knowledge about SHS risks. The results suggests there is a large discrepancy between SHS exposure, knowledge, attitudes and avoidance behavior among highly educated Jordanian women that is likely influenced by culture and traditional gender roles. Public health initiatives are needed in Jordan to address public policy, institutional practices and to empowerment of women to reduce SHS exposure. Keywords: secondhand smoke; Jordan; higher education; women; socioeconomic status 1. Introduction Tobacco is the leading preventable cause of morbidity and mortality in developing countries and is expected to remain so through 2020 [1,2]. There are no safe levels of exposure to smoke for non-smokers [3]. In developed countries there have been major efforts to promote smoking cessation and to educate the public about the adverse effect of smoking, as well as the hazards of SHS. Conversely, most developing countries have not delivered or promoted educational efforts about smoking risks or SHS exposure. There are a limited number of studies that have examined or measured parental knowledge or beliefs regarding the adverse health effects of SHS exposure. These studies found that parents typically have a basic or less comprehensive understanding of the harm inflicted by SHS on pregnant women and children. These studies were done in different populations in developing countries across the globe; one of them was done in the Middle East [4,5]. Knowledge and attitudes regarding SHS exposure are much lower among people with lower socio-economic status (SES) [4]. Many other factors play a role in smoking and SHS exposure in developing countries, especially Arab countries that exhibit higher smoking rates. These factors are not fully understood. Jordan is situated between Saudi Arabia, Iraq, Israel, and Syria. Thus it is a typical Middle Eastern country that represents a conservative culture, special social norms and a male dominated society. Officially, Jordan prohibits smoking in public places and workplaces. However, the enforcement of anti-smoking laws in most public locations is extremely poor [6]. This could be attributed to the fact that more than 50% of Jordanian men smoke. This indicates a substantial lack of correct knowledge and healthy attitudes towards SHS exposure within the general population. As such, smoking may be viewed as a social norm to the Jordanian society. Thus, curbing the tobacco epidemic will require efforts to de-normalize as a major effort of public health initiatives [4]. Among the few recent studies of SHS exposure among Jordanian women, Madanat et al. [7] conducted a random household survey to examine the knowledge about indoor air quality relating to respiratory illness and home environments among Jordanian women. The study used a self-report questionnaire and included two questions regarding SHS exposure. The results showed that even with knowledge of how indoor air quality contributes to respiratory symptoms as a moderator, most households (71%) included indoor smokers. However, the severity and quantity of SHS exposure was