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America's Children: Key National Indicators of Well-Being, 2017

Secondhand Smoke

Children who are exposed to secondhand smoke have an increased probability of experiencing such adverse health effects as infections of the lower respiratory tract, bronchitis, pneumonia, middle ear disease, sudden infant death syndrome (SIDS), and respiratory symptoms.68 Secondhand smoke can also play a role in the development and exacerbation of asthma.68 The U.S. Surgeon General has determined that there is no risk-free level of exposure to secondhand smoke.68 Cotinine, a breakdown product of nicotine, is a marker for recent (previous 1–2 days) exposure to secondhand smoke in nonsmokers.

Indicator PHY2.A: Percentage of children ages 4–11 with specified blood cotinine levels, selected years 1988–2012
Indicator PHY2.A: Percentage of children ages 4–11 with specified blood cotinine levels, selected years 1988–2012

NOTE: Cotinine levels are reported for nonsmoking children only. "Any detectable cotinine" indicates blood cotinine levels at or above 0.05 nanograms per milliliter (ng/mL), the level of cotinine that could be detected in blood in 1988–1994. The average (geometric mean) blood cotinine level in children living in homes where someone smoked was 1.0 ng/mL in 1988–199469 and in 2003–2006.70

SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Survey.

Indicator PHY2.B: Percentage of children ages 4–11 with any detectable blood cotinine level by race and Hispanic origin and poverty status, 2011–2012
Indicator PHY2.B: Percentage of children ages 4–11 with any detectable blood cotinine level by race and Hispanic origin and poverty status, 2011–2012

NOTE: Cotinine levels are reported for nonsmoking children only. "Any detectable cotinine" indicates blood cotinine levels at or above 0.05 nanograms per milliliter (ng/mL), the detectable level of cotinine in the blood in 1988–1994. Beginning in 2007, the National Health and Nutrition Examination Survey allows the reporting of both total Hispanics and Mexican Americans; however, estimates reported here are for Mexican Americans to be consistent with earlier years. Persons of Mexican American origin may be of any race.

SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Survey.

  • The percentage of children ages 4–11 with detectable blood cotinine levels decreased from 85 percent in 1988–1994 to 40 percent in 2011–2012. In 2011–2012, about 10 percent of children ages 4–11 had blood cotinine levels of more than 1.0 nanograms per milliliter (ng/mL), down from 24 percent in 1988–1994.
  • In 2011–2012, 69 percent of Black, non-Hispanic children ages 4–11 had detectable blood cotinine levels, compared with 37 percent of White, non-Hispanic children and 30 percent of Mexican American children.
  • Sixty-five percent of children ages 4–11 living in poverty had detectable blood cotinine levels in 2011–2012, compared with 31 percent of children living above the poverty level.

table icon PHY2A HTML Table | PHY2B HTML Table

68 U.S. Department of Health and Human Services. (2006). The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta, GA: 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.

69 Mannino, D. M., Caraballo, R., Benowitz, N., & Repace, J. (2001). Predictors of cotinine levels in U.S. children: Data from the Third National Health and Nutrition Examination Survey. CHEST, 120, 718–724.

70 Marano, C., Schober, S. E., Brody, D. J., & Zhang, C. (2009). Secondhand tobacco smoke exposure among children and adolescents: United States, 2003–2006. Pediatrics, 124(5), 1299–1305.