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Secondhand smoke exposure has declined among most, not all, cancer survivors
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Secondhand smoke exposure has declined among cancer survivors, according to study results.
However, certain groups remained vulnerable to secondhand smoke exposure, including black survivors, those who had smoking-related cancers, and those who lived below the federal poverty level.
Although secondhand smoke exposure rates appeared comparable among adult cancer survivors and the general U.S. population, researchers expected to see lower rates of secondhand tobacco exposure among survivors.
“This is concerning because those who have had or have cancer represent a group of people whose health outcomes are adversely influenced by any form of tobacco exposure, whether direct (smoking) or secondhand,” study researcher Oladimeji Akinboro, MD, MPH, chief medical resident in the department of medicine at Montefiore New Rochelle Hospital, told HemOnc Today. “It also is concerning because it may be a reflection that those who have had cancer along with their close household and social contacts may not fully appreciate that ongoing exposure of cancer patients and survivors to tobacco smoke — secondhand smoke exposure inclusive — may be particularly harmful to them.”
Akinboro and colleagues used interview and serum cotinine data from the National Health and Nutrition Examination Survey from 1999 to 2012 to determine the prevalence, trends and correlates of secondhand smoke exposure among nonsmoking adult cancer survivors in the United States.
Previously, there has been very little data examining secondhand smoke exposure in adult survivors, even though this group is particularly vulnerable to the effects of tobacco.
“This is in spite of research showing that secondhand smoke exposure among adult cancer patients and survivors leads to worse outcomes, such as higher death rates, particularly among patients with certain types of lung cancer,” Akinboro said. “In addition, secondhand smoke exposure leads to higher rates of strokes and heart attacks in cancer survivors, similar to those who have not had cancer. And notably, ongoing concurrent exposure to secondhand tobacco smoke in the home makes it less likely that smoking cancer patients and survivors will quit smoking.”
The analysis included 686 nonsmoking adult cancer survivors (51% men; 73% aged 60 years; 1999/2000 survey, n = 82; 2001/2002 survey, n = 106; 2003/2004 survey, n = 118; 2005/2006 survey, n = 79; 2007/2008 survey, n = 145; 2009/2010 survey, n = 87; 2011/2012 survey, n = 69).
A majority (57%) formerly smoked, and 43% never smoked.
A serum cotinine level from 0.05 ng/mL to 10 ng/mL defined secondhand smoke exposure.
Researchers reported a 28.26% (95% CI, 24.97-31.55) weighted aggregate prevalence rate of secondhand smoke exposure over the entire study period. Weighted aggregate prevalence of self-reported indoor secondhand smoke exposure was 4.53% (95% CI, 3.48-5.57).
Prevalence of secondhand smoke exposure declined from 39.61% in 1999/2000 to 15.86% in 2011/2012, equating to an average annual percentage change between successive survey cycles of –6.31% (95% CI, –11.1 to –1.2). Comparatively, the weighted prevalence of secondhand smoke exposure among all adults, regardless of whether they had a cancer history, was 47.26% in 1999/2000 and 21.13% in 2011/2012.
Average annual percentage change among cancer survivors appeared greatest among those aged 60 years or older (–7.15%), women (–6.06%), those with at least a high school education (–7.66%) and those with higher household incomes (–5.12%).
Results of a multivariate analysis showed survivors aged at least 60 years had less likelihood of being exposed to secondhand smoke than those aged 20 to 39 years (adjusted OR [aOR] = 0.44; 95% CI, 0.27-0.73), whereas non-Hispanic black survivors had a greater likelihood than non-Hispanic white survivors (aOR = 2.96; 95% CI, 2-4.37).
Greater likelihood for secondhand smoke exposure also occurred among those with only a high school education (aOR = 1.83; 95% CI, 1.35-2.49), with less than a high school education (aOR = 2; 95% CI, 1.33-3.03), who lived below the federal poverty level (aOR = 2.83; 95% CI, 1.62-4.94), and who had a history of smoking-related cancer (aOR = 1.4; 95% CI, 1.04-1.88).
These results should prompt action to reduce secondhand smoke exposure, Akinboro said.
“As a society, we can reduce secondhand smoke exposure by intensifying local, state and federal measures and policies that prohibit smoking in the workplace, in public places and multiunit housing,” he said.
Other ideas include to encourage smoke-free rules in homes and vehicles and by supporting public health campaigns.
“Clinicians and health systems can also assist cancer survivors in this regard by engaging and encouraging smoking household and social contacts of cancer survivors to support the care of their loved ones by voluntarily complying with smoke-free home rules, and even quitting smoking altogether,” Akinboro said. “We encourage cancer patients and survivors to be active, rather than passive, in minimizing or eliminating their exposure to secondhand smoke exposure, by advocating and adopting smoke-free home and smoke-free vehicle rules, and avoiding settings outside the home where they are likely to be exposed to tobacco smoke.”
Additional research is needed to evaluate how secondhand smoke exposure can affect response to cancer treatments, rates of relapse and recurrence, and impact on cancer-related mortality, he added. – by Alexandra Todak
For more information:
Oladimeji Akinboro, MD, MPH, can be reached at Department of Medicine, Montefiore new Rochelle Hospital, 16 Guion Place, New Rochelle, NY 10801; email: oladimeji.akinboro@gmail.com
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Carolyn Heckman
Secondhand smoke exposure can cause cancer, as well as respiratory and cardiovascular disease, including among cancer survivors. This study begins to fill an important gap in our knowledge of secondhand smoke exposure in cancer survivors. Researchers used high-quality data from the National Health and Nutrition Examination Survey, as well as blood cotinine as an objective biomarker of nicotine exposure.
It is gratifying that secondhand smoke exposure declined greatly from 39.61% in 1999-2000 to 15.68% in 2011-2012. However, self-reported secondhand smoke exposure was only 4.53% overall. The rates of secondhand smoke exposure are similar to those found in nonsmokers in the general population, which is concerning given cancer survivors’ greater risk for disease. Higher secondhand smoke exposure occurred among individuals aged younger than 60 years, black individuals, the less educated, poor individuals or those who had a smoking-related cancer history, suggesting potential opportunities for tobacco control and cessation interventions among underserved cancer survivors.
It is interesting that self-reported secondhand smoke exposure appeared so much lower than the cotinine data would suggest. However, one limitation of the study is that participants reported secondhand smoke exposure for the household but not the workplace or other places where they spend time. This would be an important issue for future research.
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