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Vermonters are healthy

% of children who live in households where someone smokes


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Story Behind the Curve

Last updated: January 30, 2017

By the Division of Maternal and Child Health

Exposure to secondhand smoke in children is decreasing over time—that is, fewer children are reportedly exposed to secondhand smoke. This may reflect downward trends in smoking, or that more adults are smoking outside or in locations where children are not present. In 2003, 28% of children lived in households where someone smoked. In the latest National Survey of Children’s Health, this percentage had decreased to 22%. This is a statistically significant decline.

  • Children whose parents are married (13.8%) are less likely to live in a household where someone smokes, compared to children in unmarried households (37.6%).
  • Vermonters with private health insurance (12.0%) have a lower smoking exposure rate than those with Medicaid (33.7%).
  • Vermont’s smoking exposure rate for children with special health care needs (29.8%) is higher than that for those without such needs (19.3%).
  • Smoking exposure rates decline significantly with increasing household income. Vermont as significantly higher exposure rates in the lowest income category, and comparable rates elsewhere (48.9% for households with incomes less than 100% of the federal poverty level (FPL); 32.0% for 100-199% FPL; 17.4% for 200-299% FPL; and 9.1% for greater than 400% FPL).

For more detail and background, view the Health Department’s Division of Maternal and Child Health information brief at:

This is reflective of a national pattern. According to the Centers for Disease Control and Prevention, exposure to secondhand smoke has steadily decreased in the United States over time. During 1988–1991, almost 90 of every 100 (87.9%) nonsmokers had measurable levels of cotinine, whereas, during 2011–2012, about 25 of every 100 (25.3%) nonsmokers had measurable levels of cotinine.

  • Vermont Department of Health │ Tobacco Control Program
  • Vermont Department of Health │ Maternal and Child Health
  • Vermont Department of Health │ Office of Local Health
  • March of Dimes
  • Vermont Child Health Improvement Program (VCHIP)
  • Vermont Agency of Education
  • Coalition for a Tobacco Free Vermont
  • Community Tobacco Coalitions
  • Youth Groups – OVX & VKATS
What Works
  • Act 135, passed in 2014, extends secondhand smoke protections in workplaces, motor vehicles, public places, on school grounds, and in child care settings.
  • Act 108, passed in 2016, further strengthens the state’s Clean Indoor Act and offers more protection for Vermonters, including exposures from e-cigarette secondhand smoke.
  • Through a national quality improvement initiative, collaborate with Medicaid to promote billing among pediatricians and Ob/Gyns for cessation counseling
  • Through a state collaboration:

    • Remove barriers for beneficiaries to access counseling and pharmacotherapy
    • Promote the benefits to increase quit activity and supports
  • Through the Nurse Family Partnership
  • Support women and their families in quitting tobacco use and reducing exposure to secondhand smoke

    • Work with local WIC offices to ensure all clients have access to smoking cessation resources/ referrals (
    • Educational and promotional materials for all WIC clients
    • Regular chart audits of WIC clients to assure appropriate referral and follow-up
  • Support outreach/ promotion of 802Quits with medical/ social service community

    • Regional MCH coalitions promote messaging around the risks of smoking in pregnancy and quit resources available via phone, in-person (Quit Partners) and online
    • MCH Coordinators in local district offices round at local birth hospitals to identify patients who smoke and provide resources and referral
    • MCH Coordinators in local offices share 802Quits Network outreach materials with partners
  • Explore partnerships to pilot increased quit incentives for pregnant women
  • Digital promotion of 802Quits pregnancy protocol (incentive gift cards, access to nicotine replacement therapy (NRT), personalized counseling sessions available through the Quitline and unlimited through Medicaid)
  • Work collaboratively with the Vermont chapter of ACOG to strengthen its membership and provide training and organizational support to ensure key public health messaging and preventive services including tobacco treatment are integrated into clinical services

Similar to statewide efforts, local partners are using data to drive local strategy. For regional data on Maternal and Infant Health indicators, check out our Public Health Data Explorer.

Why Is This Important?

Young children are most affected by secondhand smoke and least able to avoid it. Most of their exposure to secondhand smoke comes from adults (parents or others) smoking at home. Studies show that children who are exposed to secondhand smoke are more likely to experience:

  • Ear infections
  • More frequent and severe asthma attacks
  • Respiratory symptoms (for example, coughing, sneezing, and shortness of breath)
  • Respiratory infections (bronchitis and pneumonia)
  • A greater risk for sudden unexpected infant death (SUID)

There is no risk-free level of secondhand smoke exposure; even brief exposure can be harmful to health.

Secondhand smoke exposure directly impact healthcare costs: doctor and emergency department visits, hospital stays, medicines, as well as lost school time, and lost time at work for parents.

Sources: American Cancer Society: and Centers for Disease Control and Prevention:

Notes on Methodology

(i) Vermont’s relatively small sample sizes are often associated with suppressed data or wide confidence intervals, hindering interpretation in subgroup analyses. (ii) In 2011-2012, the NSCH changed from a landline-only sample to a dual-frame sample including landlines and cell phones. Therefore, estimates may not be comparable over time; in 2016 the survey methodology/ instrument changed; therefore, data from the 2016 National Survey of Children's Health, CANNOT be compared to prior year surveys do to a change in survey methodology.

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