Secondhand Smoke Exposure Among Nonsmoking Cancer Survivors

Key Points

  • From 1999/2000 to 2011/2012, exposure to secondhand smoke among nonsmoking cancer survivors declined from 39.6% to 15.7%. However, certain sociodemographic subgroups—former smokers and those with smoking-related cancers—remain disproportionally burdened.
  • The study findings highlight the need to adopt effective strategies to eliminate secondhand smoke exposure among socioeconomically disadvantaged nonsmoking cancer survivors.
  • Increasing local, state, and federal measures and policies that prohibit smoking in the workplace, public areas, and multiunit housing can reduce secondhand smoke exposure.

According to the Centers for Disease Control and Prevention (CDC), tobacco use and exposure accounts for about one-third of all cancer-related deaths in the United States. Moreover, exposure to secondhand tobacco smoke is attributable to more than 7,000 lung cancer–related deaths each year in the United States.

A study investigating the prevalence, trends, sociodemographic, and clinical factors associated with secondhand smoke exposure among nonsmoking adult cancer survivors has found that although exposure to secondhand smoke has declined from 39.6% to 15.7% over the past decade, certain sociodemographic subgroups—former smokers and those with smoking-related cancers—are disproportionally burdened. The study findings highlight the need to adopt effective strategies to eliminate secondhand smoke exposure among socioeconomically disadvantaged nonsmoking cancer survivors. The study by Akinboro et al was published in Cancer Epidemiology, Biomarkers & Prevention.

Study Methodology

The researchers analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES) on 686 nonsmoking adults aged 20 years and older with a history of cancer. Information from a home interview followed by a physical examination and collection of biologic specimens at a mobile examination center were obtained from consecutive 2-year cross-sectional cycles of the NHANES data from 1999 to 2012.

Secondhand smoke exposure was defined as serum cotinine of between 0.05 and 10 ng/mL among nonsmokers. Multivariable logistic regression was used to examine the associations of secondhand smoke exposure with sociodemographic, smoking, and clinical characteristics. Survey weights were applied in estimating prevalence rates, adjusted odds ratios, and confidence intervals (CI).

Study Findings

The weighted aggregate secondhand smoke exposure and self-reported indoor secondhand smoke exposure prevalence rates over the study period were 28.26% (95% confidence interval [CI] = 24.97%–31.55%) and 4.53% (95% CI = 3.48%–5.57%), respectively. Secondhand smoke exposure declined from 39.61% (95% CI = 27.88–51.34%) in 1999/2000 to 15.68% (95% CI = 9.38%–21.98%) in 2011/2012 (P < .001). Age ≥ 60 years was protective against secondhand smoke exposure, whereas being black, having less than a high school education, poverty, and a smoking-related cancer history were associated with higher odds of secondhand smoke exposure.

Impact of Secondhand Smoke Exposure on Cancer Survivors

“We were surprised to discover that rates of secondhand tobacco exposure among nonsmoking adult cancer survivors were similar to those reported for the general population of U.S. adults,” said Oladimeji Akinboro, MD, MPH, Chief Medical Resident in the Department of Medicine at Montefiore New Rochelle Hospital in New York and lead author of this study, in a statement. “This is concerning because those who have had or have cancer represent a group of people whose health outcomes are adversely influenced by any form of tobacco exposure, whether direct smoking or secondhand exposure…."

“Cancer patients and survivors must be encouraged to be their own advocates regarding secondhand smoke exposure, in adopting voluntary smoke-free home and vehicle rules and avoiding settings outside the home where they are more likely than not to be involuntarily exposed to tobacco smoke. Smoking households and social contacts of cancer patients and survivors also need to be engaged, and as a society, we can reduce secondhand smoke exposure by intensifying local, state, and federal measures and policies that prohibit smoking in the workplace, in public places, and multiunit housing.”

The study authors reported no conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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