Cotinine: facts & figures

Exposure to environmental tobacco smoke (ETS) in U.S. nonsmokers


Exposure to ETS in the U.S. population

Exposure to environmental tobacco smoke in nonsmokers defined as blood cotinine level 0.05-10 ng/mL. Data Source: 2015 CDC Morbidity and Mortality Weekly Report.

The percent of nonsmokers exposed to ETS declined significantly from 53% to 25% between 1999 and 2012. However, 58 million non-smokers were still exposed to secondhand smoke in 2011-2012.


Exposure to ETS in the U.S. population by age

Exposure to environmental tobacco smoke in nonsmokers defined as blood cotinine level 0.05-10 ng/mL. Data Source: 2015 CDC Morbidity and Mortality Weekly Report.

A large percent of young children are exposed to ETS: 40.6% or 15 million kids age 3 to 11. Children and adolescents are more likely than adults to live with someone who smokes inside the home. The decline in ETS exposure over time has been slower in young children than in any other age group.


Exposure to ETS in the U.S. population by race/ethnicity

Exposure to environmental tobacco smoke in nonsmokers defined as blood cotinine level 0.05-10 ng/mL. Data Source: 2015 CDC Morbidity and Mortality Weekly Report.

A larger percent of Black, non-Hispanic people are exposed to ETS compared to White, non-Hispanic people and Mexican Americans. Declines were seen in all three racial ethnic groups between 1999 and 2012, but the decline was slower among Black, non-Hispanics. Biomonitoring data for other racial/ethnic groups are not available across this time period.


Exposure to ETS in U.S. population by poverty status

Exposure to environmental tobacco smoke in nonsmokers defined as blood cotinine level 0.05-10 ng/mL. Data Source: 2015 CDC Morbidity and Mortality Weekly Report.

Non-smokers living in poverty are more likely to be exposed to ETS than people above the poverty threshold or people whose poverty status is unknown. In 2012, a family with an annual household income of about $23,000 or less was considered to be living in poverty. Learn more about Income and Poverty in Minnesota.


Cotinine shows exposure to tobacco smoke

Nicotine, found in tobacco products like cigarettes, breaks down in the human body to form cotinine. The level of cotinine measured in a person can show if they are an active smoker or a non-smoker who has been exposed to environmental tobacco smoke (ETS), also known as secondhand smoke. Cotinine itself is not harmful to health.

Exposure to ETS can cause health problems in non-smokers

Tobacco smoke contains hundreds of toxic chemicals. Exposures from smoking or ETS can cause cancer, heart disease, and lung disease.

Children are especially vulnerable to the effects of ETS due to higher breathing rates and ongoing lung development. In babies and children, exposure to ETS increases the risk for sudden infant death syndrome (SIDS), respiratory illness, middle-ear disease, and exacerbation (worsening) of asthma.

Biomonitoring measures cotinine in the body

Biomonitoring measures cotinine in people's serum (the clear part of blood), urine, and saliva. The graphs here show the percent of nonsmokers exposed to ETS based on cotinine measured in serum. Serum cotinine levels reflect recent exposures to tobacco smoke.

There is no safe level of exposure to ETS. Individuals with any detectable cotinine in their bodies are considered exposed to tobacco smoke.

What is being done about ETS in Minnesota?

  • The MDH Tobacco Prevention and Control Program connects the public and health professionals to resources such as smoking cessation, information on the effects of tobacco use, educational materials to prevent tobacco use, and guidance on community-based tobacco prevention programs.
  • The MDH Statewide Health Improvement Partnership works with local communities to reduce ETS exposure in parks, multi-unit housing, and on college campuses.
  • The MDH Minnesota Environmental Public Health Tracking Program tracks data related to Environmental Tobacco Smoke exposure.

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