Background: Approaching high socioeconomic females’ group toward environmental tobacco smoking (ETS) has little been studied. Our aim was to assess the high educated females’ knowledge, attitudes and avoidance behavior towards ETS exposure to appropriately focus the targets in smoking prevention programs.

Methods: A quantitative cross-sectional study using a previously validated and standardized face-to- face administered questionnaire was conducted at An-Najah National University (largest Palestinian university in the West Bank) with a convenient sample of two-hundred and two non-smokers females were selected from the university.

Results: We found high exposure rates to ETS among the educated females (nearly 50% were exposed in their homes and 88% in restaurants). The participants reported high levels of knowledge and attitudes regarding the risk and negative influence of ETS exposure on health. Surprisingly, they have reported low levels of practice and avoidance behavior toward ETS exposure compared to their knowledge level.

Conclusions: Implementing smoking prevention initiatives for the highly-educated females with higher socioeconomic status is necessary to limit ETS exposure and might reverse the social and gender disparities about smoking.