Household Smoke - Children in United States

United States

The adverse impact of environmental tobacco smoke, or 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.
• Attention-deficit/hyperactivity disorder (ADHD) symptoms.

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 living in households where someone smokes is higher among:

• Non-Hispanic white and Black children compared with Hispanic and Asian children.
• Children living in lower-income households 
• Children born in the United States who live with caregivers other than parents compared with children who have at least one foreign-born parent. 
• Children living in English-speaking households compared with those in households where English is not the primary language.
• 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. The U.S. Department of Housing and Urban Development banned smoking in all public housing in 2017, with one study estimating the potential savings at $154 million annually. Prohibiting smoking in all government-subsidized housing would not only protect more nonsmokers from secondhand smoke exposure in their homes, but 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 non-smokers 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 multi-unit housing can help protect other residents, particularly vulnerable populations like children, from secondhand smoke exposure. According to the Centers for Disease Control and Prevention, implementing smoke-free laws may stimulate voluntary smoke-free homes and smoke-free rules for 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.

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.

Lin, Li-Zi, Shu-Li Xu, Qi-Zhen Wu, Yang Zhou, Hui-Min Ma, Duo-Hong Chen, Gong-Bo Chen, et al. “Association of Prenatal, Early Postnatal, or Current Exposure to Secondhand Smoke With Attention-Deficit/Hyperactivity Disorder Symptoms in Children.” JAMA Network Open 4, no. 5 (May 20, 2021): e2110931. https://doi.org/10.1001/jamanetworkopen.2021.10931.

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.

Research & Evaluation Group at Public Health Management Corporation. “Smokefree Multi-Unit Housing: American Lung Association Progress Leading up to Implementation of the HUD Ruling.” American Lung Association, March 2019. https://www.lung.org/getmedia/79b32278-68a6-4e90-9fe4-d601eba397ce/smokefree-multi-unit-housing.pdf.pdf.

U.S. Department of Health and Human Services. “Children and Secondhand Smoke Exposure: Excerpts from The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General.” Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2007. CDC:5173. https://stacks.cdc.gov/view/cdc/5173.

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.