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Socioeconomic disparities in secondhand smoke exposure among US never-smoking adults: the National Health and Nutrition Examination Survey 1988-2010.

  • Gan, Wen Qi1
  • Mannino, David M2
  • Jemal, Ahmedin3
  • 1 Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, Kentucky, USA Department of Population Health, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, USA Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Great Neck, New York, USA.
  • 2 Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, Kentucky, USA.
  • 3 Surveillance and Health Services Research, American Cancer Society, Inc, Atlanta, Georgia, USA. , (Georgia)
Published Article
Tobacco control
Publication Date
Nov 01, 2015
DOI: 10.1136/tobaccocontrol-2014-051660
PMID: 25015370


Secondhand smoke (SHS) is a leading preventable cause of illness, disability and mortality. There is a lack of quantitative analyses on socioeconomic disparities in SHS; especially, it is not known how socioeconomic disparities have changed in the past two decades in the USA. To examine socioeconomic disparities and long-term temporal trends in SHS exposure among US never-smoking adults aged ≥20 years. 15 376 participants from the National Health and Nutrition Examination Survey (NHANES) 1999-2010 were included in the analysis of socioeconomic disparities; additional 8195 participants from NHANES III 1988-1994 were included in the temporal trend analysis. SHS exposure was assessed using self-reported exposure in the home and workplace as well as using serum cotinine concentrations ≥0.05 ng/mL. Individual socioeconomic status (SES) was assessed using poverty-to-income ratio. During the period 1999-2010, 6% and 14% of participants reported SHS exposure in the home and workplace, respectively; 40% had serum cotinine-indicated SHS exposure. Individual SES was strongly associated with SHS exposure in a dose-response fashion; participants in the lowest SES group were 2-3 times more likely to be exposed to SHS compared with those in the highest SES group. During the period 1988-2010, the prevalence declined over 60% for the three types of SHS exposure. However, for cotinine-indicated exposure, the magnitudes of the declines were smaller for lower SES groups compared with higher SES groups, leading to widening socioeconomic disparities in SHS exposure. SHS exposure is still widespread among US never-smoking adults, and socioeconomic disparities for cotinine-indicated exposure have substantially increased in the past two decades. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

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