Smoking During Pregnancy & Second-hand Smoke

The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures for the 2015-2017 grant cycle. Performance Measure 14 includes (A) the percent of women who smoke during pregnancy; and (B) the percent of children who live in households where someone smokes. This evidence brief points to a selection of resources for state MCH programs about smoking during pregnancy and second-hand smoke, with emphasis on evidence-based information.


The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this goal as follows:
Women who smoke during pregnancy are more likely to experience a fetal death or deliver a low birth weight baby. Further, secondhand smoke (SHS) is a mixture of mainstream smoke (exhaled by smoker) and the more toxic side stream smoke (from lit end of nicotine product) which is classified as a "known human carcinogen" by the US Environmental Protection Agency, the US National Toxicology Program, and the International Agency for Research on Cancer. Adverse effects of parental smoking on children have been a clinical and public health concern for decades and were documented in the 1986 U.S. Surgeon General Report. The only way to fully protect non-smokers from indoor exposure to SHS is to prevent all smoking in the space; separating smokers from non-smokers, cleaning the air, and ventilating buildings do not eliminate exposure. Unfortunately, millions (more than 60%) of children are exposed to SHS in their homes. These children have an increased frequency of ear infections; acute respiratory illnesses and related hospital admissions during infancy; severe asthma and asthma-related problems; lower respiratory tract infections leading to 7,500 to 15,000 hospitalizations annually in children under 18 months; and sudden infant death syndrome (SIDS). Higher intensity medical services are also required by children of parents who smoke including an increased need for intensive care unit services when admitted for flu, longer hospital stays; and more frequent use of breathing tubes during admissions.

Read More about Performance Measure 14

Performance Measure 14

  1. Percent of women who smoke during pregnancy and
  2. Percent of children who live in households where someone smokes


  1. To decrease the number of women who smoke during pregnancy and
  2. To decrease the number of households where someone smokes.



  1. Women who report smoking during pregnancy
  2. Parent report of cigar, cigarette, or pipe tobacco use by household members


  1. All women who delivered a live birth in a calendar year B) All children, ages 0 to 18 years
  2. All children, ages 0 to 18 years

Units: 100

Text: Percent

Healthy People 2020 Objectives

Related to Tobacco Use (TU) Objective 6: Increase smoking cessation during pregnancy (Target: 30.0%) and related to Tobacco Use (TU) Objective 11.1: Reduce the proportion of children aged 3 to 11 years exposed to secondhand smoke. (Baseline: 52.2% , Target 47%)

Related to Respiratory Diseases (RD) Objective 7.5: Increase the proportion of persons with current asthma who have been advised by a health professional to change things in their home, school, and work environments to reduce exposure to irritants or allergens to which they are sensitive according to National Asthma Education and prevention Program guidelines. (Baseline: 50.8%, Target: 54.5%)

Data Sources and Data Issues

This is an integrated measure with two data sources:

  1. National Vital Statistics System (NVSS) for smoking during pregnancy and
  2. The revised National Survey of Children's Health (NSCH) beginning in 2017. States can use data from the 2011-2012 NSCH as a baseline.

Data and Statistics

A. Smoking During Pregnancy

B. Secondhand Smoke

C. General

Policy Recommendations

Key Websites


Further Reading

Related NCEMCH Resources

  • Tobacco, Alcohol, and Substance Use During Preconception and Pregnancy resource brief

1Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p. 88.

Smoking During Pregnancy and Second-hand Smoke: Evidence Brief, 1st ed. (November 2014).

Author: Beth DeFrancis, M.L.S., NCEMCH