Household Smoke - Children in United States

United States

The adverse impact of environmental tobacco smoke (secondhand smoke) on children’s health is widely documented and recognized. While exposure to secondhand smoke is bad for everyone, it is especially harmful to infants and children, whose bodies are still growing and developing. Secondhand smoke exposure is associated with numerous health problems in children, including: 

• Sudden infant death syndrome (SIDS).
• Respiratory infections, like pneumonia and bronchitis.
• More frequent and severe asthma attacks.
• Slower lung development.
• Premature death and disease from exposure to cancer-causing chemicals.

Among children, exposure to secondhand smoke is associated with an increase in emergency department visits and overnight hospital stays. Children with asthma who are exposed to secondhand smoke have more frequent and severe reactions that result in more emergency visits.The estimated economic burden of secondhand smoke among children ages 3-14, measured in emergency department-related costs, was $62.9 million in 2010.

According to data from the National Survey of Children’s Health, the percentage of children ages 0-17 living in households where someone smokes is higher among:

• Non-Hispanic white, multiracial and Black children compared with Hispanic and Asian children.
• Children living in lower-income households. Children living below the poverty level have the highest prevalence. 
• Children living in English-speaking households compared with those in households where English is not the primary language.
• Children living with two parents who are not currently married and children living with their grandparents, compared with those raised by two married parents or a single parent.
• Children living in a household where the highest level of education completed by any adult in the household is high school or GED, compared with children living with adults who have any other level of educational attainment, higher or lower.
• Children who have experienced one or more adverse childhood experiences (ACEs) compared with those who have not experienced any ACEs.

Most secondhand smoke exposure among children happens at home; therefore, many intervention strategies focus on the home environment. In 2017, the Department of Housing and Urban Development banned smoking in all public housing. The potential savings have been estimated at $154 million annually. Expanding this rule to prohibit smoking in all government-subsidized housing would not only protect more nonsmokers from secondhand smoke exposure in their homes. Still, it could also save an additional $360 million in annual smoking-related societal costs.

The Community Preventive Services Task Force recommends smoke-free policies to protect nonsmokers from involuntary exposure to secondhand smoke and reduce tobacco use among smokers. Recent legislation has greatly decreased the amount of secondhand smoke that nonsmokers are exposed to, and these broad policy interventions are tied to improvements in markers of population health. Further, smoke-free housing can promote healthier living environments. Encouraging property managers and landlords to enforce smoke-free policies in multiunit housing can help protect other residents, particularly vulnerable populations such as children, from exposure to secondhand smoke. The Centers for Disease Control and Prevention suggests that implementing smoke-free laws may stimulate voluntary adoption of smoke-free rules for homes and private vehicles. Therefore, such laws could help create healthier home environments for children.

Healthy People 2030 has multiple objectives towards reducing the number of people exposed to secondhand smoke, including: 

• Increasing the proportion of smoke-free homes.
• Reducing the proportion of people who don’t smoke but are exposed to secondhand smoke.
• Increasing successful quit attempts in adults who smoke.

Hahn, Ellen J. “Smokefree Legislation: A Review of Health and Economic Outcomes Research.” American Journal of Preventive Medicine 39, no. 6 Suppl 1 (December 2010): S66-76. https://doi.org/10.1016/j.amepre.2010.08.013.

Kegler, Michelle C., Erin Lebow-Skelley, Jaimie Lea, Adrienne M. Lefevre, Pam Diggs, Sally Herndon, and Regine Haardörfer. “Developing Smoke-Free Policies in Public Housing: Perspectives From Early Adopters in 2 Southern States.” Preventing Chronic Disease 15 (June 21, 2018): 170427. https://doi.org/10.5888/pcd15.170427.

King, Brian A., Richard M. Peck, and Stephen D. Babb. “Cost Savings Associated with Prohibiting Smoking in U.S. Subsidized Housing.” American Journal of Preventive Medicine 44, no. 6 (June 2013): 631–34. https://doi.org/10.1016/j.amepre.2013.01.024.

Merianos, Ashley L., Roman A. Jandarov, and E. Melinda Mahabee-Gittens. “Secondhand Smoke Exposure and Pediatric Healthcare Visits and Hospitalizations.” American Journal of Preventive Medicine 53, no. 4 (October 2017): 441–48. https://doi.org/10.1016/j.amepre.2017.03.020.

Yao, Tingting, Hai-Yen Sung, Yingning Wang, James Lightwood, and Wendy Max. “Healthcare Costs of Secondhand Smoke Exposure at Home for U.S. Children.” American Journal of Preventive Medicine 56, no. 2 (February 2019): 281–87.https://doi.org/10.1016/j.amepre.2018.08.013.