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

    • National Survey of Children's Health (NSCH). Funded by the Health Resources and Services Administration's (HRSA's) Maternal and Child Health Bureau (MCHB), this survey provides national and state-level data on the physical and emotional health of American children 0 - 17 years old. Information is collected on factors related to the health and well-being of children, including access to and utilization of health care, receipt of care in a medical home, family interactions, parental health, school and after-school experiences, and neighborhood characteristics.

      Since 2003, the NSCH has provided both national and state-level prevalence estimates for a variety of child health and health care indicators. MCHB also fielded the National Survey of Children with Special Health Care Needs (NS-CSHCN) in 2001, 2005-2006, and 2009-2010. Its purpose was to assess the prevalence and impact of special health care needs among children and their families in the U.S. The 2016 NSCH underwent significant redesign and administration changes and differs greatly from the prior survey cycles. From 2016 onward, the purpose of the NSCH remains the same, but the two individual surveys were combined into a single survey conducted every year.

      You can access data from and information about the current NSCH through the Health Resources and Services Administration’s Maternal and Child Health Bureau, the Data Resource Center for Child & Adolescent Health, or the U.S. Census Bureau.  Data from and information about past NSCH and NS-CSHCN are available through the Data Resource Center for Child & Adolescent Health or the CDC’s National Center for Health Statistics

    • Association of Maternal and Child Health Programs. 2014. Life course indicator: Exposure to secondhand smoke inside the home. Washington, DC: Association of Maternal and Child Health Programs.

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

National Center for Education in Maternal and Child Health

Georgetown University