The intersection between adverse childhood experiences and environmental tobacco smoke in U.S. households with children

Dylan B. Jackson, Alexander Testa

Research output: Contribution to journalArticlepeer-review


Introduction: Environmental tobacco smoke (ETS) is a potent risk factor for secondhand smoke (SHS) exposure. Research reveals, moreover, that children who are exposed to SHS are at an increased risk of disease and premature mortality. Limited research, however, has examined whether households with children experiencing accumulating adverse childhood experiences (ACEs) are also more likely to be characterized by ETS - particularly in the form of family members smoking inside the housing unit. Aims and Methods: The current study employs a nationally representative sample of 102 341 households with children from the three most recent cohorts of National Survey of Children's Health. Both multinomial logistic regression and a strategic comparison approach are used to examine the association between ACEs and ETS categories. Results: A large majority of households characterized by ETS report one or more ACEs, while households without ETS are largely void of ACEs. Findings indicate that this association is not merely a function of general family member smoking, as ACEs are strongly and uniquely associated with family smoking inside the housing unit - above and beyond family members smoking more generally. Conclusions: Households exhibiting an accumulation of ACEs may benefit from interventions providing resources and education supporting smoke-free home environments. Such families may also be screened and referred through existing family and parenting programs administered in the home environment (eg, home visiting). Implications: Public health initiatives designed to mitigate child adversities from early life stages may help reduce ETS in housing units - thereby diminishing the risk of secondhand smoke (SHS) exposure among children.

Original languageEnglish (US)
Pages (from-to)732-740
Number of pages9
JournalNicotine and Tobacco Research
Issue number4
StatePublished - Apr 1 2021

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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