Introduction
The impact of defining secondhand smoke exposure among nonsmokers using an expanded
serum cotinine range is currently unknown.
Methods
This study assessed the trends in secondhand smoke exposure prevalence among a nationally
representative sample of 23,753 U.S. nonsmokers aged ≥3 years. Serum cotinine ranges
of 0.05–10 ng/mL (established) and of 0.015–10 ng/mL (expanded) were analyzed in 2021
using data from the 2011–2018 National Health and Nutrition Examination Survey.
Results
During 2011–2018, the percentage of people with a serum cotinine range of 0.05–10
ng/mL remained stable (25.3% to 24.6%) across most sociodemographic subgroups but
declined significantly among adult Mexican Americans aged ≥20 years (23.9% to 14.1%).
However, the percentage of people with serum cotinine range of 0.015–10 ng/mL significantly
declined (58.3% to 52.3%) among male individuals (60.9% to 55.0%), among female individuals
(56.2% to 50.0%), among adults aged ≥20 years (55.8% to 49.2%), among Mexican Americans
(60.9% to 41.2%), among people with a college degree or higher (44.4% to 36.0%), among
those who rented their housing (71.7% to 62.5%), among people not living with someone
who smoked inside the home (56.1% to 50.0%), and among Mexican Americans aged ≥20
years (60.9% to 39.1%) (all p<0.05 for linear trend test).
Conclusions
Expanding the serum cotinine range to 0.015–10 ng/mL more than doubles the estimated
proportion of U.S. nonsmokers exposed to secondhand smoke. In contrast to a serum
cotinine range of 0.05–10 ng/mL, it suggests that progress has been made in reducing
population-level secondhand smoke exposure during 2011–2018, especially among nonsmokers
experiencing lower exposure levels.
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Article Info
Publication History
Published online: July 28, 2021
Identification
Copyright
Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
