Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #147 

November 2006 

Children Living with Adult Smokers, 

United States, 2004 Highlights 

 In 2004, nearly one of every 

three children under 18 

years of age lived in a family

with at least one adult 

smoker. 

 White non-Hispanic children 

and black non-Hispanic 

children were more likely 

than Hispanic children to live

with an adult smoker. 

 Children living in the Northeast and West regions and 

children living in more urban 

areas were substantially less

likely to live with an adult 

who smoked than children 

living in other areas. 

 The likelihood of a child 

living with an adult smoker 

generally declined as family 

income and adult education

levels increased.

 Children with asthma, a 

condition exacerbated by 

exposure to smoke, did not 

differ significantly in the 

likelihood of living with an 

adult smoker from those 

without asthma. 

Steven R. Machlin, MS, Steven C. Hill, PhD, and Lan Liang, PhD 

Introduction 

Exposure to secondhand smoke is harmful to the health of the 

general population and particularly hazardous to children. The 2006

Surgeon General’s Report concluded that children exposed to 

secondhand smoke are at an increased risk for sudden infant death

syndrome (SIDS), acute respiratory infections, ear problems, and 

more severe asthma. The predominant sites of exposure to secondhand smoke for children are their homes. The Surgeon General’s 

Report further concluded that smoking by parents causes respiratory 

symptoms and slows lung growth in their children.* 

 

This Statistical Brief presents estimates of the percentage of children 

under age 18 at the end of 2004 who lived in families containing at 

least one adult who was a current smoker. Variations are examined

by selected characteristics of the child (asthma status, age, race/ 

ethnicity) and co-residing family (number of adults, poverty status, 

geographic location of residence, highest adult education level). The 

estimates shown are derived from smoking information collected in 

the Household Component of the Medical Expenditure Panel Survey 

(MEPS-HC) adult self-administered questionnaire (SAQ) in conjunction with data obtained from the core MEPS-HC questionnaire, and 

apply to an estimated population of 73 million noninstitutionalized

children in the United States who were under the age of 18 on 

December 31, 2004. All differences between estimates discussed 

in the text are statistically significant at the 0.05 level or better. 

Findings 

In 2004, nearly one of every three children under 18 years of age (31.0 percent) lived in a family with at 

least one adult age 18 or older who smoked (figure 1). About one of every six children lived in families 

with three or more adults (estimate not shown in figure), and these children were substantially more likely 

to live with at least one smoker (43.9 percent) than those living with fewer adults (28.1–30.3 percent). 

Children with asthma, a condition exacerbated by exposure to smoke, did not differ significantly in the 

likelihood of living with an adult smoker from those without asthma. 

*U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report 

of the Surgeon General—Executive Summary. 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 likelihood of living with an adult smoker varied by the age and race/ethnicity of the child (figure 2). 

Children under age 5 were less likely than older children to live with an adult who smoked. Among the 

race/ethnicity categories shown, white non-Hispanic children (33.9 percent) and black non-Hispanic 

children (30.7 percent) were more likely than Hispanic children (23.9 percent) to live with an adult smoker. 

White non-Hispanic children were also more likely to live with an adult smoker than children in the other 

race/multiple race non-Hispanic category (27.4 percent). 

 

The likelihood of a child living with an adult smoker also varied by geographic characteristics (figure 3). 

Percentages of children living with at least one adult smoker were higher in the Midwest (36.0) and South 

(33.2) than the Northeast (28.1) or West (25.3) regions. Further, children living in metropolitan statistical 

areas (MSA) were substantially less likely to live with an adult who smoked (29.4 percent) than children 

living outside MSAs (39.2 percent). 

 

The likelihood of a child living with an adult smoker generally declined as family income and adult 

education levels increased (figure 4). Children living in poor families (incomes below the poverty line) 

were nearly twice as likely as those in the highest income category (incomes four times the poverty level 

or more) to live with an adult who smoked (40.2 versus 21.6 percent). Similarly, the presence of an adult 

smoker was substantially less likely for children in families where at least one adult had 13 or more years 

of education (24.8 percent) than in families where no adult had 13 or more years of education (39.7 

percent). 

Data Source 

The estimates in this Statistical Brief are based on data from the MEPS 2004 Full Year Population 

Characteristics data file (HC-082). 

Definitions 

Child living with adult smoker(s) 

For each child, current smoking status was determined for all related co-residing adults based on a 

question in the SAQ asking whether they currently smoked. Missing data on smoking status (about 12 

percent of adults living with children) were imputed using selected correlates of adult smoking status 

(e.g., age, gender, education, race/ethnicity, region, metropolitan statistical area status, and other adult 

family members’ smoking status). 

 

Racial and ethnic classifications 

Classification by race and ethnicity is based on information reported for each child. Respondents were 

asked if each family member was Hispanic or Latino. Respondents were also asked which race or races 

best describes each family member. Race categories include white, black/African American, American 

Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and other. Based on these 

questions, sample children were classified into the following four race/ethnicity categories: Hispanic or 

Latino, white single race non-Hispanic or Latino, black single race non-Hispanic or Latino, and other 

single race or multiple races non-Hispanic or Latino. 

 

Region 

– Northeast: Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, 

New Jersey, and Pennsylvania 

– Midwest: Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South 

Dakota, Nebraska, and Kansas 

– South: Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South 

Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, 

Oklahoma, and Texas 

– West: Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, 

California, Alaska, and Hawaii 

Metropolitan statistical area (MSA) 

Areas designated by the U.S. Office of Management and Budget that are composed of a large population 

nucleus combined with adjacent communities that have a high degree of economic and social integration 
with the nucleus. An MSA has one or more central counties containing the area’s main population 

concentration. 

Asthma condition 

Information on whether the child has asthma was obtained from responses to the following question(s) 

asked in the Priority Conditions section of the MEPS-HC questionnaire: “(Have/Has) PERSON ever been 

told by a doctor or other health professional that PERSON (have/has) asthma?” and, if yes, then 

“(Do/Does) PERSON still have asthma?” In this brief, those with affirmative responses to both questions 

are classified as having asthma and those with negative responses to the first question are classified as 

not having asthma. 

 

Poverty status 

Each sample child was classified according to the total yearly income of his or her family. Within a 

household, all individuals related by blood, marriage, or adoption were considered to be a family. 

Personal income from all family members was summed to create family income. Based on the ratio of 

family income to the Federal poverty thresholds, which vary with family size and age of the head of family, 

categories are defined as follows: 

 – Poor: Persons in families with income less than 100 percent of the poverty line, including those who 

reported negative income 

 – Low income: Persons in families with income from 100–199 percent of the poverty line 

 – Middle income: Persons in families with income from 200–399 percent of the poverty line 

 – High income: Persons in families with income of at least 400 percent of the poverty line. 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is 

cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health 

Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 

References 

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care,

July 2003: 41(7) Supplement: III-5–III-12. 

Suggested Citation 

Machlin, S. R., Hill, S. C., and Liang, L. Children Living with Adult Smokers, United States, 2004. Statistical 

Brief #147. November 2006. Agency for Healthcare Research and Quality, Rockville, Md. 

http://www.meps.ahrq.gov/mepsweb/data_files/ publications/st147/stat147.pdf 
∗ ∗ ∗

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD, Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2004

Figure 1. Percentage of children living with at least one adult

smoker, by number of adults and asthma status, 2004

31.0 30.3 28.1

33.4

43.9

30.8

0

20

40

60

80

100

<18 years 1 2 3+ Yes No

Percent

Overall Number of adults in family Child has asthma

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2004

Figure 2. Percentage of children living with at least one

adult smoker, by age and race/ethnicity, 2004

33.6 31.6

26.7

33.9 30.7

27.4 23.9

0

20

40

60

80

100

0-4 years 5-11 years 12-17 years White nonHispanic,

single race

Black nonHispanic,

single race

Other

race/multiple

race, nonHispanic

Hispanic

Percent

Age Race/ethnicity
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2004

Figure 3. Percentage of children living with at least one

adult smoker, by region and urbanicity, 2004

39.2

29.4

25.3

33.2 36.0

28.1

0

20

40

60

80

100

Northeast Midwest South West MSA Non-MSA

Percent

Region Metropolitan statistical area (MSA)

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2004

Figure 4. Percentage of children living with at least one adult

smoker, by poverty status and highest adult years of education, 2004

24.8

39.7

21.6

30.6

35.9

40.2

0

20

40

60

80

100

Poor Low 

income

Middle

income

 High 

income

<13 years 13+ years

Percent

Poverty status Highest adult education