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• Vital Signs: Nonsmokers' Exposure to Secondhand Smoke  

Results: During 2007--2008, approximately 88 million nonsmokers aged ≥3 years in the United States were exposed to secondhand smoke. The prevalence of serum cotinine levels ≥0.05 ng/mL in the nonsmoking population declined significantly from 52.5% (95% CI = 47.1%--57.9%) during 1999--2000 to 40.1% (95% CI = 35.0%--45.3%) during 2007--2008. The decline was significant for each sex, age, race/ethnicity, and income group studied except non-Hispanic whites. The change was greatest from 1999--2000 to 2001--2002. For every period throughout the study, prevalence was highest among males, non-Hispanic blacks, children (aged 3--11 years) and youths (aged 12--19 years), and those in households below the federal poverty level.

Conclusions: Secondhand smoke exposure has declined in the United States, but 88 million nonsmokers aged ≥3 years are still exposed, progress in reducing exposure has slowed, and disparities in exposure persist, with children being among the most exposed. Nearly all nonsmokers who live with someone who smokes inside their home are exposed to secondhand smoke. . . .

This is the first reported analysis of 2007--2008 cotinine levels among the full U.S. nonsmoking population aged ≥3 years. The results confirm that secondhand smoke exposure in the United States is far less prevalent at 40% than during 1988--1991, when 88% of the nonsmoking population age ≥4 years had serum cotinine levels ≥0.05 ng/mL (2). This decline is attributable to a number of factors, including decreased smoking prevalence, increases in the number of local and state laws prohibiting smoking in indoor workplaces and public places, increases in voluntary smoking restrictions in workplaces and homes, and changes in public attitudes regarding social acceptability of smoking near nonsmokers and children (1). Although prevalence of exposure has dropped for children and non-Hispanic blacks, groups that traditionally have had higher-than-average exposure levels (1--4), disparities remain. Further, this report shows that millions of nonsmokers in the United States remain exposed to secondhand smoke, including nearly all of those who live with someone who smokes inside the home.

Workplaces and homes usually are the most important sources of secondhand smoke exposure among adults because these are the settings where they typically spend the most time (1). The number of state, local, and voluntary smoke-free policies has greatly increased in recent years and has helped to protect nonsmokers from the toxicants in secondhand smoke. Nonetheless, currently only 24 states and the District of Columbia have comprehensive smoke-free laws covering workplaces, restaurants, and bars†; complete statewide bans are needed in the remaining 26 states because only 47% of the national population is covered by comprehensive state or local laws.§ Smoke-free policies have been shown to greatly reduce the probability and amount of exposure to secondhand smoke in workplaces and public places, as well as adverse health events.¶ Workplace smoking restrictions lead to smoking reductions and cessation among workers.** However, smoke-free policies do not eliminate secondhand smoke exposure from all sources. As workplaces and public places increasingly are made smoke-free, private settings such as homes and vehicles are becoming relatively larger sources of overall exposure (1).

The home is the major source of secondhand smoke exposure for children (1).

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