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Story Behind the Curve

Last Updated: January 2023

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.

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.  However, there remains some key vulnerable youth populations

  • Almost two of every five children ages 3 to 11 years, including over half of non-Hispanic, Black children, were exposed to secondhand smoke during 2017- 2018.
  • An estimated 6.7 million (25.3%) of middle and high school students self-reported secondhand smoke exposure in the home in 2019.

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 impacts 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:


  • 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


  • 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 evidence based nurse home visiting program:
    • Universal substance use screening and referral to smoking cessation resources/ referrals (
    • Support parents 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 by MCH Coordinators in local district offices
  • 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.

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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