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pie chart: CSHCN who are exposed to second hand smoke in the home pie chart: Non-CSHCN who are exposed to second hand smoke in the home Bar graph: children who are exposed to second hand smoke by poverty status and CSHCN status Bar graph: children who are exposed to second hand smoke by race, ethnicity, and language

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Smoking in the Household

Exposure to environmental smoke—from cigarettes, cigars, or pipes—can be a serious health hazard for children. According to the Centers for Disease Control and Prevention, exposure to secondhand smoke is associated with higher rates of sudden infant death syndrome (SIDS), more frequent and severe asthma, and acute respiratory infections in young children.1 In addition, children who are exposed to smoke in their households are more likely to become smokers themselves.2 Environmental tobacco smoke exposure may be a particular risk for CSHCN given their chronic health conditions.

In the NSCH, parents were asked whether anyone in the household used cigarettes, cigars, or pipe tobacco, and whether anyone smoked in the home, exposing children to second-hand smoke inside the home. Among CSHCN, 30.3 percent live in a household where someone smokes and 10.1 percent were exposed to smoke in their homes. Among non-CSHCN, 25.2 percent live in a household with a smoker and 7.0 percent were exposed to secondhand smoke. This difference remained significant even after statistical adjustment for other differences between CSHCN and non-CSHCN. Across states, the percentage of CSHCN who are exposed to second-hand smoke in the home ranges from 0.9 percent to 23.4 percent. Strikingly, 32.8 percent of children who currently have asthma live in a household with a smoker and 10.6 percent were exposed to secondhand smoke (data not shown).

For both CSHCN and non-CSHCN, exposure to secondhand smoke is more common among those in lower-income households: among CSHCN with household incomes below the Federal poverty level (FPL), 19.1 percent are exposed to secondhand smoke at home, compared to 2.8 percent of CSHCN with household incomes of 400 percent or more of FPL.

CSHCN in certain racial and ethnic groups are at higher risk of exposure to secondhand smoke. Among Black CSHCN, 13.9 percent are exposed to secondhand smoke at home, compared to 10.4 percent of White CSHCN and only 5.3 percent of Hispanic CSHCN in English primary language households. Among CSHCN aged 2-17, those with emotional, behavioral, or developmental conditions are more likely to be exposed to secondhand smoke at home. Of CSHCN with these problems, 14.8 percent are exposed to secondhand smoke, compared to 6.9 percent of CSHCN without these conditions (data not shown).

1 Centers for Disease Control and Prevention, Tobacco Information and Prevention Source, Secondhand Smoke Fact Sheet. February 2004.

2 Gilman, SE, et al., “Parental Smoking and Adolescent Smoking Initiation: An Intergenerational Perspective on Tobacco Control,” Pediatrics. 2009;123(2):e274-e281.
Bauman, K, et al., “Effect of parental smoking classification on the association between parental and adolescent smoking,” Addictive Behaviors. 1990;15(5):413-22.
See also, Osler, M, et al., “Maternal smoking during childhood and increased risk of smoking in young adulthood,” International Journal of Epidemiology. 1995;24(4):710-4.


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