Introduction The purpose of this study was to determine the levels, sources, and locations of and influential factors for exposure to environmental tobacco smoke (ETS) among pediatric patients from inner-city families. Method Descriptive and associative analysis of ETS exposure in children 6 to 10 years of age was performed with survey data collected at Children's Hospital of Michigan through mothers' report and children's urine cotinine. Results The sample included 397 participants, 82.4% of whom were African American. Urine cotinine levels were correlated with reported ETS exposure and 71% of children with urine cotinine levels > 10 ng/mL. The mean duration of ETS exposure was 14.3 minutes (SD = 11.0) in the past week and 58.9 minutes (SD = 50.8) in the past month. Smoking parents (∼30%), grandparents (∼30%), and non-family members (∼28%) were the major ETS sources, and relatives' homes (∼40%), the children's own homes (∼24%), automobiles (∼15%), and friends' homes (∼11%) were the main ETS locations. Child ETS exposure was inversely correlated with having a non-single mother, maternal education, income, use of prenatal preventive care, and satisfactory parenting. Discussion ETS exposure in inner-city children was prevalent. Findings of this study may aid pediatric practitioners and public health workers in providing targeted interventions.