Who is Exposed

Report on smoking trends and tobacco smoke exposure

Secondhand Tobacco Smoke: Who is exposed

SHS smoke exposure is higher among people living below the poverty level and those with less education[1]Centers for Disease Control and Prevention. Vital Signs: Disparities in Nonsmokers’ Exposure to Secondhand Smoke—United States, 1999–2012. MMWR Morb Mortal Wkly Rep. 2015;64(04) . According to the CDC, people who live at or below the poverty level and people with lower levels of educational attainment have higher rates of cigarette smoking than the general US population. People who live in poverty smoke cigarettes for a duration of nearly twice as many years as people with a family income of three times the poverty rate.  People with a high school education smoke cigarettes for a duration of more than twice as many years as people with at least a bachelor’s degree. Blue-collar workers are more likely to start smoking cigarettes at a younger age and tend to smoke more heavily than white-collar workers [2]Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status. 2018.

Service workers, especially bartenders and wait staff, report the lowest rates of smoke-free workplace policies than other occupation categories[3]Ibid, Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status. 2018.

Many people in the United States are still exposed to secondhand smoke

  • In 2016 The South had the highest poverty rate relative to the other regions (Northeast, Western, Midwest), where there are fewer smoking restrictions and generally higher smoking rates and higher exposure[4]Jessica L. Semega KRF, and Melissa A. Kollar. Income and Poverty in the United States: 2016. US Census Bureau. 2019:P60-259.
  • Among children who live in homes in which no one smokes indoors, those who live in multi-unit housing (for example, apartments or condos) have 45% higher cotinine levels (or almost half the amount) than children who live in single-family homes. During 2011–2012, 2 out of every five children ages 3 to 11—including 7 out of every ten black children—in the United States were exposed to SHS regularly.
  • During 2011–2012, more than 1 in 3 (36.8%) nonsmokers who lived in rental housing were exposed to SHS.[5]Prevention. Centers for Disease Control and Prevention. Vital Signs: Disparities in Nonsmokers’ Exposure to Secondhand Smoke — United States, 1999–2012. Morbidity and Mortality Weekly … Continue reading.

Racial and ethnic groups

  • Cotinine levels have declined in all racial and ethnic groups. Still, cotinine levels continue to be higher among non-Hispanic Black Americans than non-Hispanic White Americans and Mexican Americans during 2011–2012:
  • Nearly half (46.8%) of Black nonsmokers in the United States were exposed to SHS.
  • About 22 of every 100 (21.8%) non-Hispanic White nonsmokers were exposed to SHS.
  • Nearly a quarter (23.9%) of Mexican American nonsmokers were exposed to SHS[6]Benowitz NL BJ, Caraballo RS, Holiday DB, Wang J. . Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States … Continue reading,[7]David M. Homa P, Linda J. Neff, PhD1, Brian A. King, PhD1, Ralph S. Caraballo, PhD1, Rebecca E. Bunnell, PhD1, Stephen D. Babb, MPH1, Bridgette E. Garrett, PhD1, Connie S. Sosnoff, MA2, Lanqing Wang, … Continue reading.

Where are people exposed?

Occupational exposure

Differences in SHS exposure related to people’s jobs decreased over the past 20 years, but significant disparities still exist. Some groups continue to have high levels of secondhand smoke exposure. These include:

  • Blue-collar workers and service workers
  • Construction workers
  • Casino Workers

Smoking in airports:

A study published in the November 22, 2017 issue of Morbidity and Mortality Weekly Report found that 23 of the world’s 50 busiest airports have smokefree indoor policies. The report affirms a growing trend toward smokefree. Among the top 10 busiest passenger airports worldwide, five are 100% smokefree indoors, and five still allow indoor smoking, despite the known health hazards of SHS[8]Smoking In Airports Is A Public Health Hazard: American Nonsmokers’ Right Foundation; 2019 [Available from: https://no-smoke.org/at-risk-places/airports.

As of January 2, 2018, more than 600 U.S. airports are smokefree indoors, but several popular airports still allow smoking inside, including Las Vegas, Atlanta, and Washington Dulles[9]Ibid, Smoking In Airports Is A Public Health Hazard: American Nonsmokers’ Right Foundation; 2019 [Available from: https://no-smoke.org/at-risk-places/airports.

The science is clear; airport smoking rooms or ventilation systems do not address the health hazards of SHS. Today, 87% of U.S. adults are nonsmokers. Airports can re-purpose smoking areas into more useful passenger amenities while also creating a much healthier environment for everyone.

Prevalence of tobacco-free home policies

According to The Population Assessment of Tobacco and Health (PATH) Study, a large, long-term study of tobacco use and health in the United States, tobacco-free is the norm, but big differences between current tobacco users and non-users remain. Among users, there are differences between combustible and non-combustible users.  Among non-users there are few differences between never and former users.

Prevalence of tobacco free policies in the home100% smokefree policies are more likely to be associated with older age, female, kids under 18 in the household, and higher household income[10]Hyland B HA, Rivard C, Kasza K, Bansal-Travers M, Sheffer CE, Frye C Tobacco Free Home Policies: Longitudinal Findings From Wave 1 (2013-14) And Wave 2 (2014-15) Of The Population Assessment Of … Continue reading.

Current combustible tobacco users are more likely to allow smoking in the home and non-combustible products, such as e-cigarettes. If there is a smokefree home policy, it is more likely not be 100% smokefree[11]Ibid, Hyland B HA, Rivard C, Kasza K, Bansal-Travers M, Sheffer CE, Frye C Tobacco Free Home Policies: Longitudinal Findings From Wave 1 (2013-14) And Wave 2 (2014-15) Of The Population Assessment Of … Continue reading.

Multi-dwelling units

Gaps in protection from SHS tobacco smoke exposure remain[12]The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Publications and Reports of the Surgeon General. Atlanta (GA)2006, [13]Kruger J, Jama A, Kegler M, Baker Holmes C, Hu S, King B. Smoke-Free Rules and Secondhand Smoke Exposure in Vehicles among U.S. Adults-National Adult Tobacco Survey, 2009-2010 and 2013-2014. Int J … Continue reading). While the prevalence of U.S. households with voluntary smoke-free home rules has increased considerably over the last two decades, living spaces still represent a significant source of SHS tobacco smoke exposure in both children and adults[14]Ibid, Kruger J, Jama A, Kegler M, Baker Holmes C, Hu S, King B. Smoke-Free Rules and Secondhand Smoke Exposure in Vehicles among U.S. Adults-National Adult Tobacco Survey, 2009-2010 and 2013-2014. … Continue reading), [15]King BA, Patel R, Babb SD. Prevalence of smokefree home rules–United States, 1992-1993 and 2010-2011. MMWR Morb Mortal Wkly Rep. 2014;63(35):765-9,[16]Ashley MJ, Ferrence R. Reducing children’s exposure to environmental tobacco smoke in homes: issues and strategies. Tob Control. 1998;7(1):61-5, [17]Wilson KM, Klein JD, Blumkin AK, Gottlieb M, Winickoff JP. Tobacco-smoke exposure in children who live in multi-unit housing. Pediatrics. 2011;127(1):85-92. The home can represent a significant source of tobacco smoke, especially for individuals who live close to one another in multi-unit housing (MUH).[18]King BA, Travers MJ, Cummings KM, Mahoney MC, Hyland AJ. Secondhand smoke transfer in multiunit housing. Nicotine Tob Res. 2010;12(11):1133-41.

One-quarter of U.S. residents—approximately 79 million people, including former and current Flight Attendants—live in MUH properties. MUH includes houses attached to one or more other houses and buildings with 2 to 50 or more apartments. Even though most people do not allow smoking in their homes, 36 percent of occupants are regularly exposed to SHS.[19]King BA, Babb SD, Tynan MA, Gerzoff RB. National and state estimates of secondhand smoke infiltration among U.S. multiunit housing residents. Nicotine Tob Res. 2013;15(7):1316-21.  SHS poses serious health threats to residents and staff, old and young, including increased sickness and even death.  Rates of chronic diseases, such as cardiovascular disease, obesity, diabetes, and asthma, are higher in adults who live in public housing and lower-income families, in general [20]Ruel E, Oakley D, Wilson GE, Maddox R. Is public housing the cause of poor health or a safety net for the unhealthy poor? J Urban Health. 2010;87(5):827-38Smoking in units can lead to property damage and increase the amount of time it takes to turn over a unit between residents.

Secondhand smoke infiltrates multi-unit dwellings

A 100% smoke-free building is one where smoking tobacco products are prohibited everywhere. That means no smoking in individual apartments or common indoor and outdoor areas. Some smokefree buildings may allow smoking only in a limited outdoor space. More privately owned or market-based MUHs are adopting 100% smokefree policies. Communities around the country are working on efforts to bring smokefree air to multi-unit housing. Cities like New York, Los Angeles, Seattle, and others have initiated policies to protect tenants from tobacco smoke.

Enforcement of smoke-free home rules does not adequately protect MUH residents from tobacco smoke exposures inside their homes, particularly in subsidized MUH environments. Subsidized housing residents may have fewer housing options available to seek out alternative smoke-free living environments. All publicly funded housing should be required to implement smoke-free building policies to protect these vulnerable populations. Even as policies continue to shift towards smokefree housing, efforts to encourage privately-owned MUH buildings to adopt smokefree policies should continue[21]Op. cit. Licht AS, King BA, Travers MJ, Rivard C, Hyland AJ. Attitudes, experiences, and acceptance of smoke-free policies among US multi-unit housing residents. Am J Public Health. … Continue reading.

On December 5, 2016, the U.S. Department of Housing and Urban Development (HUD) finalized a rule that requires all public housing agency (PHA) homes to implement a smoke-free policy by July 30, 2018[22]Implementing HUD’s SMOKE-FREE POLICY in Public Housing. 2017.  HUD cites both health and property maintenance cost savings as reasons to encourage smokefree housing policies.  More than 600 PHAs in at least 46 states already implemented smokefree policies for public housing before HUD adopted their requirement[23]Are You Exposed to Secondhand Smoke In Your Home? : American Nonsmokers’ Rights Foundation; 2019 [Available from: https://no-smoke.org/at-risk-places/homes/#1518116487199-ad0e0f8a-213e. HUD smokefree policy prohibits lit tobacco products (cigarettes, cigars or pipes) in all living units, common indoor areas, administrative offices, and all outdoor areas within 25 feet of housing and administrative office buildings.

HUD smokefree policy impacts more than 940,000 public housing units, including more than 500,000 units inhabited by elderly residents and 760,000 children living in public housing across the nation. Of the 619 localities throughout the U.S. that have smokefree housing restrictions, about 78% are 100% smokefree facilities[24]Wilson KM, Klein, J. D., Blumkin, A. K., Gottlieb, M., & Winickoff, J. P. Tobacco-smoke exposure in children who live in multiunit housing. Pediatrics, . Pediatrics. 2011;127(1):85-2.

Most state and federal disability laws ensure that people with disabilities have an equal opportunity to access and enjoy their homes [25]National Council on Disability UC. The Americans with Disabilities Act (ADA). 42 US Code § 1210. 1990. However, there are many cases where action is needed to protect tenants. For example, there are legal definitions that designate one to have a specific disability. Those definitions may impact smokefree policy adoption and protections. That said, courts have generally recognized that individuals have a disability when they have severe asthma, allergies, chemical sensitivities, or other respiratory conditions that limit their ability to breathe[26]Solutions CL. How Disability Laws Can Help Tenants Suffering from Drifting Tobacco Smoke. 2020.

There are several options that disabled tenants can request that may be considered reasonable and necessary to accommodate a specific respiratory condition. Actions may include: asking landlords to restrict smoking in common areas, balconies, and apartments that surround your unit, request a move to a vacant unit located away from smoke, or legally break your lease due to lack of reasonable accommodation.  These examples assume that you do not live in rental housing governed by a local rent control ordinance. A rent control ordinance might affect the ability of your landlord to implement various requests for reasonable accommodation[27]Ibid, Solutions CL. How Disability Laws Can Help Tenants Suffering from Drifting Tobacco Smoke. 2020.

References

References
1 Centers for Disease Control and Prevention. Vital Signs: Disparities in Nonsmokers’ Exposure to Secondhand Smoke—United States, 1999–2012. MMWR Morb Mortal Wkly Rep. 2015;64(04)
2 Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status. 2018
3 Ibid, Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status. 2018
4 Jessica L. Semega KRF, and Melissa A. Kollar. Income and Poverty in the United States: 2016. US Census Bureau. 2019:P60-259
5 Prevention. Centers for Disease Control and Prevention. Vital Signs: Disparities in Nonsmokers’ Exposure to Secondhand Smoke — United States, 1999–2012. Morbidity and Mortality Weekly Report (MMWR). 2015;64(04):103-8
6 Benowitz NL BJ, Caraballo RS, Holiday DB, Wang J. . Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States between 1999 and 2004. Am J Epidemiol. 2009;169:236–48
7 David M. Homa P, Linda J. Neff, PhD1, Brian A. King, PhD1, Ralph S. Caraballo, PhD1, Rebecca E. Bunnell, PhD1, Stephen D. Babb, MPH1, Bridgette E. Garrett, PhD1, Connie S. Sosnoff, MA2, Lanqing Wang, PhD2. Vital Signs: Disparities in Nonsmokers’ Exposure to Secondhand Smoke — United States, 1999–2012. Morbidity and Mortality Weekly Report (MMWR). 2015;64(04):103-8
8 Smoking In Airports Is A Public Health Hazard: American Nonsmokers’ Right Foundation; 2019 [Available from: https://no-smoke.org/at-risk-places/airports
9 Ibid, Smoking In Airports Is A Public Health Hazard: American Nonsmokers’ Right Foundation; 2019 [Available from: https://no-smoke.org/at-risk-places/airports
10 Hyland B HA, Rivard C, Kasza K, Bansal-Travers M, Sheffer CE, Frye C Tobacco Free Home Policies: Longitudinal Findings From Wave 1 (2013-14) And Wave 2 (2014-15) Of The Population Assessment Of Tobacco And Health (Path) Study.  Society For Research On Nicotine & Tobacco; Baltimore, Maryland USA: SRNT; 2018
11 Ibid, Hyland B HA, Rivard C, Kasza K, Bansal-Travers M, Sheffer CE, Frye C Tobacco Free Home Policies: Longitudinal Findings From Wave 1 (2013-14) And Wave 2 (2014-15) Of The Population Assessment Of Tobacco And Health (Path) Study.  Society For Research On Nicotine & Tobacco; Baltimore, Maryland USA: SRNT; 2018
12 The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Publications and Reports of the Surgeon General. Atlanta (GA)2006
13 Kruger J, Jama A, Kegler M, Baker Holmes C, Hu S, King B. Smoke-Free Rules and Secondhand Smoke Exposure in Vehicles among U.S. Adults-National Adult Tobacco Survey, 2009-2010 and 2013-2014. Int J Environ Res Public Health. 2016;13(11
14 Ibid, Kruger J, Jama A, Kegler M, Baker Holmes C, Hu S, King B. Smoke-Free Rules and Secondhand Smoke Exposure in Vehicles among U.S. Adults-National Adult Tobacco Survey, 2009-2010 and 2013-2014. Int J Environ Res Public Health. 2016;13(11
15 King BA, Patel R, Babb SD. Prevalence of smokefree home rules–United States, 1992-1993 and 2010-2011. MMWR Morb Mortal Wkly Rep. 2014;63(35):765-9
16 Ashley MJ, Ferrence R. Reducing children’s exposure to environmental tobacco smoke in homes: issues and strategies. Tob Control. 1998;7(1):61-5
17 Wilson KM, Klein JD, Blumkin AK, Gottlieb M, Winickoff JP. Tobacco-smoke exposure in children who live in multi-unit housing. Pediatrics. 2011;127(1):85-92
18 King BA, Travers MJ, Cummings KM, Mahoney MC, Hyland AJ. Secondhand smoke transfer in multiunit housing. Nicotine Tob Res. 2010;12(11):1133-41
19 King BA, Babb SD, Tynan MA, Gerzoff RB. National and state estimates of secondhand smoke infiltration among U.S. multiunit housing residents. Nicotine Tob Res. 2013;15(7):1316-21
20 Ruel E, Oakley D, Wilson GE, Maddox R. Is public housing the cause of poor health or a safety net for the unhealthy poor? J Urban Health. 2010;87(5):827-38
21 Op. cit. Licht AS, King BA, Travers MJ, Rivard C, Hyland AJ. Attitudes, experiences, and acceptance of smoke-free policies among US multi-unit housing residents. Am J Public Health. 2012;102(10):1868-71
22 Implementing HUD’s SMOKE-FREE POLICY in Public Housing. 2017
23 Are You Exposed to Secondhand Smoke In Your Home? : American Nonsmokers’ Rights Foundation; 2019 [Available from: https://no-smoke.org/at-risk-places/homes/#1518116487199-ad0e0f8a-213e
24 Wilson KM, Klein, J. D., Blumkin, A. K., Gottlieb, M., & Winickoff, J. P. Tobacco-smoke exposure in children who live in multiunit housing. Pediatrics, . Pediatrics. 2011;127(1):85-2
25 National Council on Disability UC. The Americans with Disabilities Act (ADA). 42 US Code § 1210. 1990
26 Solutions CL. How Disability Laws Can Help Tenants Suffering from Drifting Tobacco Smoke. 2020
27 Ibid, Solutions CL. How Disability Laws Can Help Tenants Suffering from Drifting Tobacco Smoke. 2020