Perceptions of harm from secondhand smoke exposure among U.S. adults, 2009–2010
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Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA
Contractor Support for NCCDPHP/NGIS, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, USA
Emory University, Rollins School of Public Health, Atlanta, USA
Submission date: 2015-07-13
Acceptance date: 2016-02-02
Publication date: 2016-02-02
Corresponding author
Judy Kruger   

Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
Tobacco Induced Diseases 2016;14(February):3
Exposure to secondhand smoke (SHS) causes significant disease and death. We assessed the prevalence and correlates of perceptions about the health harm of SHS among U.S. adults at the national and state level.

Data came from the 2009–2010 National Adult Tobacco Survey, a national landline and cellular telephone survey. Perceptions about the health harms of SHS were assessed as follows: ‘not at all harmful’, ‘somewhat harmful’, and ‘very harmful’. Descriptive statistics were used to assess the prevalence of SHS harm perceptions by tobacco use and sociodemographic factors, including sex, age, race/ethnicity, education, marital status, annual household income, region, sexual orientation, children in the household, and smoke-free law coverage. Logistic regression was used to assess odds of perceiving SHS to be “very harmful” (vs. “not at all harmful” or “somewhat harmful”), adjusting for the aforementioned factors.

Nationally, 64.5 % of adults perceived SHS as ‘very harmful’ (state range: 73.5 % [Utah] to 53.7 % [Kentucky]). By tobacco use, the perception that SHS is ‘very harmful’ was: 76.5 % among nonusers of tobacco; 62.1 % among noncombustible only users; 47.9 % among combustible only users; and 40.8 % among dual combustible and noncombustible users. Following adjustment, the perception that SHS was ‘very harmful’ was higher among females, non-Hispanic minorities and Hispanics, respondents living with children, and states with 100 % smoke-free law coverage. Among current tobacco users the odds of perceiving SHS to be ‘very harmful’ was lower in the Midwest than the West.

Almost two-thirds of American adults perceive SHS as ‘very harmful’; however, currently only half of all Americans are protected by comprehensive state or local smoke-free laws. These findings underscore the importance of public education campaigns to increase awareness of SHS exposure harm and the benefits of smoke-free environments. Expanding comprehensive smoke-free laws could protect all Americans from SHS.

U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: A report of the surgeon general. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.
U.S. Department of Health and Human Services. The health consequences of smoking - 50 years of progress: A report of the surgeon general. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
CDC. State Tobacco Activities Tracking and Evaluation (STATE) System. [www.cdc.STATESystem].
American Nonsmokers’ Rights Foundation. Local 100 % smoke-free laws in all workplaces, restaurants, and bars: effective by year. [].
CDC. State smoke-free laws for worksites, restaurants, and bars-United States, 2000–2010. Morb Mortal Wkly Rep. 2011;60(15):472–5.
CDC. Vital Signs: Disparities in nonsmokers’ exposure to secondhand smoke. Morb Mortal Wkly Rep. 2015;64(4):103–8.
Tan ASL, Bigman CA, Mello S, Sanders-Jackson A. Is exposure to e-cigarette communication associated with perceived harms of e-cigarette secondhand vapour? Results from a national survey of US adults. BMJ Open. 2015;5:e007134.
King BA, Dube SR, Babb SD. Perceptions about the harm of secondhand smoke exposure among U.S. middle and high school students: findings from the 2012 National Youth Tobacco Survey. Tob Induced Diseases. 2013;11:16.
Richardson A, Pearson J, Xiao H, Staigaitis C, Vallone D. Prevalence, harm perceptions, and reasons for using non-combustible tobacco products among current and former smokers. Am J Public Health. 2014;104(8):1437–44.
Liu ST, Nemeth JM, Klein EG, Ferketich AK, Kwan M, Wewers ME. Risk perceptions of smokeless tobacco among adolescent and adult users and nonusers. J Health Communication. 2015;20(5):599–606.
Sami M, Timberlake DS, Nelson R, Goettsch B, Ataian N, Libao P, et al. Smokers’ perceptions of smokeless tobacco and harm reduction. JPHP. 2012;33(2):188–201.
Li Q, Hyland A, O'Connor R, Zhao G, Du L, Li X, et al. Attitudes towards the extension of smoking restrictions to selected outdoor areas in Italy. Tob Control. 2012;21(1):59–62.
McMillen RC, Winickoff JP, Klein JD, Weitzman M. US adult attitudes and practices regarding smoking restrictions and child exposure to environmental tobacco smoke: changes in the social climate from 2000–2001. Pediatrics. 2003;112(1 Pt 1):e55–60.
Gallus S, Rosato V, Zuccaro P, Pacifici R, Colombo P, Manzari M, et al. Support for smoke-free policies among smokers and non-smokers in six cities in China: ITC China Survey. Tob Control. 2010;19 Suppl 2:i40–46.
Fong GT, Hyland A, Borland R, Hammond D, Hastings G, McNeill A, et al. Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: Findings from the ITC Ireland/UK Survey. Tob Control. 2006;15(Suppl III):iii51–8.
Lazuras L, Rodafinos A, Eiser JR. Adolescents’ support for smoke-free public settings: the roles of social norms and beliefs about exposure to secondhand smoke. J Adolesc Health. 2011;49(1):70–5.
Kandra KL, McCullough A, Ranney L, Goldstein AO. Support among middle school and high school students for smoke-free policies, North Carolina, 2009. Prev Chronic Dis. 2013;10:120135.
Borland R, Yong H, Siahpush M, Hyland A, Campbell S, Cummings K, et al. Support for and reported compliance with smoke-free restaurants and bars by smokers in four countries: findings from the International Control (ITC) Four Country Survey. Tob Control. 2006;15(Supple 3):iii23–41.
International Agency for Research on Cancer. Evaluating the Effectiveness of Smoke-free Policies. Lyon, France: World Health Organization Press; 2009.
CDC Fact Sheet. Smoke-free policies receive public support. [].
Hyland A, Higbee C, Borland R, Travers M, Hastings G, Fong G, et al. Attitudes and beliefs about secondhand smoke and smoke-free policies in four countries: Findings from the International Tobacco Control Four Country Survey. Nicotine Tob Res. 2009;11(6):642–9.
Halpern-Felsher BL, Rubinstein ML. Clear the air: Adolescents’ perceptions of the risks associated with secondhand smoke. Prev Medicine. 2005;41(1):16–22.
Duaso M, De Irala J, Canga N. Employees’ perceived exposure to environmental tobacco smoke, passive smoking risk beliefs and attitudes towards smoking: A case study in a university setting. Health Ed Res. 2006;21(1):26–33.
Conlisk E, Proescholdbell SK, Pan WK. Support for tobacco control policies among youth in North Carolina. North Carolina Med J. 2006;67(3):175–9.
Gilpin EA, White MM, Farkas AJ, Pierce JP. Home smoking restrictions: which smokers have them and how they are associated with smoking behavior. Nicotine Tob Res. 1999;1(2):153–62.
Kegler MC, Malcoe LH. Smoking restrictions in the home and car among rural Native American and white families with young children. Prev Med. 2002;35(4):334–42.
Quick BL, Bates BR, Romina S. Examining antecedents of clean indoor air policy support: Implications for campaigns promoting clean indoor air. Health Commun. 2009;24(1):50–9.
Rayens MK, Hahn EJ, Langley RE, Hedgecock S, Butle KM, Greathouse-Maggio L. Public opinion and smoke-free laws. Policy Polit Nurs Pract. 2007;8(4):262–70.
Saad L. Slim majority in U.S. call secondhand smoke very harmful: Views differ between parents who smoke vs. don’t smoke. The Gallup Organization. 2014. [].
CDC. National Adult Tobacco Survey. Historical NATS Data and Documentation. 2009–2010 National Adult Tobacco Survey Weighting Methodology Report; 2011. [].
CDC, Office on Smoking and Health and ICF. 2009–2010 National Adult Tobacco Survey Methodology Report; 2011. [].
Council of American Survey and Research Organizations (CASRO). Code of standards and ethics for survey research. 2011. [ for-survey-research-CASRO].
American Nonsmokers’ Rights Foundation. U.S. Tobacco Control Laws Database.
CDC. Impact of a national tobacco education campaign on weekly numbers of quitline calls and website visitors—United States, March 4–June 23, 2013. Morb Mortal Wkly Rep. 2013;63(37):763–7.
Moore GF, Holliday JC, Moore LAR. Socioeconomic patterning in changes in child exposure to secondhand smoke after implementation of smoke-free legislation in Wales. Nicotine Tob Res. 2011;13(10):903–10.
Mills LM, Semple SE, Wilson IS, MacCalman L, Amos A, Ritchie D, et al. Factors influencing exposure to secondhand smoke in preschool children living with smoking mothers. Nicotine Tob Res. 2012;14(12):1435–44.
Sims M, Mindell JS, Jarvis MJ, Feyerabend C, Wardle H, Gilmore A. Did smoke-free legislation in England reduce exposure to secondhand smoke among non-smoking adults? cotinine analysis from the health survey for England. EHP. 2012;120(3):425–30.
O’Connor R, McNeill A, Borland R, Hammond D, King B, Boudreau C, et al. Smokers’ beliefs about the relative safety of other tobacco products: Findings from the ITC collaboration. Nicotine Tob Res. 2007;9(10):1033–42.
CDC. Comprehensive smoke-free laws—50 largest U.S. cities, 2000 and 2012. Morb Mortal Wkly Rep. 2012;61(45):914–7.
Francis JA, Abramsohn EM, Park HY. Policy-driven tobacco control. Tob Control. 2010;19 Suppl 1:i16–20.
Zhang X, Cowling DW, Tang H. The impact of social norm change strategies on smokers’ quitting behaviors. Tob Control. 2010;19(Supp 1):i51–5.
Tang H, Cowling DW, Lloyd JC, Rogers T, Koumjian KL, Stevens CM, et al. Changes of attitudes and patronage behaviors in response to a smoke-free bar law. Am J Public Health. 2003;93(4):611–7.
Cheng K, Glantz S, Lightwood J. Association between smoke-free laws and voluntary smoke-free home rules. Am J Prev Med. 2011;41(6):566–72.
Nagelhout B, Van den Putte B, de Vries H, Crone M, Fong G, Willemsen M. The influence of newspaper coverage and a media campaign on smokers’ support for smoke-free bars and restaurants and on secondhand smoke harm awareness: Findings from the International Tobacco Control (ITC) Netherlands Survey. Tob Control. 2012;21(1):24–9.
Cheng KW, Okechukwu CA, McMillen R, Glantz SA. Association between clean indoor air laws and voluntary smoke-free rules in homes and cars. Tob Control. 2015;24(2):168–74.
Tang H, Cowling DW, Stevens CM, Lloyd JC. Changes of knowledge, attitudes, beliefs, and preference of bar owner and staff in response to a smoke-free bar law. Tob Control. 2004;13(1):87–9.
Siahpush M, McNeill A, Hammond D, Fong GT. Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: results from the 2002 International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006;15(Suppl III):ii65–iii70.
Blumberg SJ, Luke JV. Wireless substitution: early release of estimates from the National Health Interview Survey, January-June 2010. Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics; 2010. [].
Brewer NT, Weinstein ND, Cuite CL, Herrington JE. Risk perceptions and their relation to risk behavior. Ann Behav Med. 2004;27:125–30.
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