Smoke-free policies critical in reducing secondhand smoke exposure

There was a substantial decline in the prevalence of secondhand smoke exposure among nonsmokers from 1988 to 2012, but progress has since stalled, researchers reported.

Surendra S. Shastri, MD, from the department of health disparities research at The University of Texas MD Anderson Cancer Center, and colleagues conducted a secondary analysis using data from four cycles of the National Health and Nutrition Examination Survey from 2011 to 2018.

The primary outcome was the prevalence of secondhand smoke exposure in nonsmokers (aged at least 3 years) in the U.S. population.

Disparities in secondhand smoke exposure among non-Hispanic Black individuals compared with individuals of other races and those below the poverty levels remained consistent from 2011 to 2018, according to the results. Secondhand smoke exposure prevalence was twice as high among nonsmoker non-Hispanic Black individuals (48.02%) compared with non-Hispanic white individuals (22.03%) and among those living below the poverty level (44.68%) compared with those living above the poverty level (21.33%) in the 2017 to 2018 cycle.

The researchers reported high rates of secondhand smoke exposure among children aged 3 to 11 years (38.23%).

The following were identified as risk factors for secondhand smoke exposure, with little change from 2011 to 2018:

younger age (3-11 years; OR = 2.29; 95% CI, 1.81-2.9; P < .001; 12-19 years; OR = 1.88; 95% CI, 1.43-2.48; P = .004);

non-Hispanic Black race/ethnicity (OR = 2.75; 95% CI, 2.12-3.58; P < .001);

less than high school education (OR = 1.59; 95% CI, 1.19-2.12; P = .02); and

living below the poverty level (OR = 2.61; 95% CI, 2.04-3.35; P < .001).

“We conclude that more needs to be done to implement enhanced and equitable comprehensive smoke-free laws throughout the U.S.,” the researchers wrote in a research letter published in JAMA Internal Medicine. “The serum cotinine levels in nonsmokers provide a measure of overall secondhand smoke exposure, regardless of the sources or locations of exposure; therefore, these laws should be expanded to include other forms of vaping and should include private properties for meaningful reduction in secondhand smoke exposure among vulnerable populations.”