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America's Children in Brief: Key National Indicators of Well-Being, 2016

Secondhand Smoke

The U.S. Surgeon General has determined that there is no safe level of exposure to secondhand tobacco smoke.39 Children who are exposed to secondhand smoke have an increased risk of adverse health effects, such as respiratory symptoms, lower respiratory tract infections, bronchitis, pneumonia, middle ear disease, and sudden infant death syndrome.39, 40. Further, secondhand smoke can play a role in the development and exacerbation of asthma.39, 40 Cotinine, a breakdown product of nicotine, is used as a marker for exposure to secondhand smoke in nonsmokers. Cotinine levels at or above 0.05 nanograms per milliliter (ng/mL) are often used as an indicator of secondhand smoke exposure in the previous 1 to 2 days. Previous research has found that the likelihood of exposure to secondhand smoke varies by the race and ethnicity of the child.40

Figure 13: Percentage of children ages 4–11 with blood cotinine levels at or above 0.05 nanograms per milliliter (ng/mL) by race and Hispanic origin, 1999–2000 through 2011–2012
Percentage of children ages 4–11 with blood cotinine levels at or above 0.05 nanograms per milliliter (ng/mL) by race and Hispanic origin, 1999–2000 through 2011–2012

NOTE: Cotinine levels are reported for nonsmoking children only (based on an individual's cotinine level of less than 10 ng/mL). "Any detectable cotinine" indicates blood cotinine levels at or above 0.05 nanograms per milliliter (ng/mL). Persons of Hispanic origin may be of any race. Data on race and Hispanic origin are collected separately and combined for reporting according to the 1997 Office of Management and Budget Standards for Data on Race and Ethnicity. Beginning in 2007, the National Health and Nutrition Examination Survey allows for reporting of both total Hispanics and Mexican Americans; however, estimates reported here are for Mexican Americans to be consistent with earlier years.

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

  • In 2011–2012, 69 percent of Black, non-Hispanic; 37 percent of White, non-Hispanic; and 30 percent of Mexican American children ages 4–11 had detectable levels of cotinine, indicating that they had been exposed to secondhand smoke (defined as cotinine levels at or above 0.05 ng/mL) in the previous day or two.
  • From 1999–2000 through 2011–2012, the percentage of all children ages 4–11 with exposure to secondhand smoke declined by 24 percentage points. There were significant declines in secondhand smoke exposure for each racial and ethnic group—25 percentage points among White, non-Hispanic; 18 percentage points among Black, non-Hispanic; and 19 percentage points among Mexican-American children.
  • Throughout the period, the percentage of Black, non-Hispanic children exposed to secondhand smoke was approximately 2 to 2 ½ times higher than that of Mexican American children. For most of the period, the percentage of Black, non-Hispanic children ages 4–11 with secondhand smoke exposure was also higher than that of White, non-Hispanic children. In 2003–2004 and 2007–2008, there were no significant differences between the secondhand smoke exposure rates of Black and White, non-Hispanic children.

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39 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. (2006). The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Retrieved from http://www.surgeongeneral.gov/library/reports/secondhandsmoke/fullreport.pdf

40 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. doi:10.1542/peds.2009-0880