Race, Poverty Level Affect Risk for Secondhand Smoke Exposure

Nonsmoking Black individuals, compared to Whites, are more likely to report secondhand smoke exposure (SHSe), as are people living below the poverty level, according to a report published in JAMA Internal Medicine.

SHSe may cause adverse outcomes in infants and children, adults, and pregnancies, and there is no safe level of SHSe. Each year, more than 41,000 nonsmoking adults and 900 infants in the United States die as a result of SHSe; it’s estimated that anywhere from about a quarter to more than a third of infant deaths are in Black individuals. Effects of SHSe in infants and children may include sudden infant death syndrome, respiratory tract infections, ear infections, and asthma attacks.

To garner a better understanding of SHSe among nonsmokers and who it affects, the researchers used data from four cycles of the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. NHANES collects sensitive and personal data using computer-assisted personal interviews and audio computer-assisted self-interviews. SHSe among nonsmokers was defined as serum cotinine levels of 0.05 to 10 ng/mL.

Disparities persisted among Black individuals, as well as those below poverty levels, over the entire study period. In the most recent survey cycle (2017-2018), nonsmoker Black individuals had nearly twice the SHSe prevalence as White nonsmokers (48.02% vs. 22.03%), as did those living below versus above the poverty level (44.68% vs. 21.33%). More than a third of children aged 3 to 11 years (38.23%) experienced high rates of SHSe. Factors associated with increased odds of SHSe in the most recent cycle were younger age (odds ratio [OR] for 12-19 years, 1.88; OR for 3-11 years, 2.29), Black race/ethnicity (OR, 2.75), less than a high school education (OR, 1.59), and living below the poverty level (OR, 2.61); this was largely unchanged compared to prior cycles.

“Although the prevalence of SHSe among nonsmokers in the US declined substantially (87.5% to 25.3%) from 1988 to 2012, progress has stagnated since then, with persisting racial and economic disparities,” the researchers wrote. “We conclude that more needs to be done to implement enhanced and equitable comprehensive smoke-free laws throughout the US (currently implemented in only 27 states). The serum cotinine levels in nonsmokers provide a measure of overall SHSe, 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 (eg, cars) for meaningful reduction in SHSe among vulnerable populations (eg, young children).”