State-Specific Secondhand Smoke Exposure and Current Cigarette Smoking Among Adults

Secondhand smoke (SHS) causes immediate and long-term adverse health effects in nonsmoking adults and children, including heart disease and lung cancer, and SHS exposure occurs primarily in homes and workplaces. Smoke-free policies, including not allowing smoking anywhere inside the home (i.e., having a smoke-free home rule), are the best way to provide protection from exposure to SHS. To assess SHS exposure in homes and indoor workplaces and the prevalence of smoke-free home rules, CDC analyzed 2008 Behavioral Risk Factor Surveillance System (BRFSS) data from 11 states and the U.S. Virgin Islands (USVI). This report summarizes the results, which showed wide variation among states in exposure to SHS in homes (from 3.2% [Arizona] to 10.6% [West Virginia]) and indoor workplaces (from 6.0% [Tennessee] to 17.3% [USVI]). The majority of persons surveyed in the 11 states and USVI reported having smoke-free home rules (from 68.8% [West Virginia] to 85.7% [USVI]). This report also provides the 2008 results for CDC’s annual BRFSS-based state-specific estimates of current smoking in 50 states, the District of Columbia (DC), and three territories (Guam, Puerto Rico, and USVI). As in previous years, the results showed substantial variation in self-reported cigarette smoking prevalence (range: 6.5%-27.4%; median for 50 states and DC = 18.4%). Additional legislation is needed to increase the number of smoke-free workplaces and other public places. Health-care providers should continue to encourage persons to make their homes completely smoke-free.

BRFSS* conducts state-based, random-digit-dialed telephone surveys of the noninstitutionalized U.S. population aged ≥18 years to collect data on health conditions and health risk behaviors. The 2008 BRFSS included data from 414,509 respondents, which were used to assess current smoking prevalence. The questions to assess SHS exposure and home smoking rules§ were offered to states as an optional module and were used by 11 states and USVI, which combined represented approximately 19% of the U.S. adult population in 2008.

BRFSS estimates were weighted to the respondent’s probability of being selected and the age-, sex-, and race/ethnicity-specific populations from 2008 estimates projected from the 2000 Census for each state, DC, and the U.S. territories. These sampling weights were used to calculate all estimates and 95% confidence intervals. Response rates for BRFSS are calculated using Council of American Survey and Research Organizations (CASRO) guidelines. Median survey response rates were 53.3% and median cooperation rates were 75.0%. For comparisons of prevalence between males and females and smokers and nonsmokers statistical significance (p<0.05) was determined using a two-sided z-test. Secondhand Smoke Exposure and Smoke-Free Home Rules

In the 11 states and USVI, the percentage of persons who reported being exposed to SHS inside their home ranged from 3.2% (Arizona) to 10.6% (West Virginia) (median: 7.8%), and SHS exposure in indoor workplaces ranged from 6.0% (Tennessee) to 17.3% (USVI) (median: 8.6%) (Table 1). The percentage of persons who reported that smoking was not allowed anywhere inside their home ranged from 68.8% (West Virginia) to 85.7% (USVI) (median: 78.1%). In all states, nonsmokers (range: 80.4% [West Virginia] to 89.3% [Arizona]; median: 84.7%) were more likely to report having a smoke-free home than smokers (range: 36.4% [West Virginia] to 66.0% [Arizona]; median: 45.0%).

Current Cigarette Smoking Prevalence

In 2008, the median prevalence of adult current smoking in the 50 states and DC was 18.4% (Table 2). Among states, current smoking prevalence was highest in West Virginia (26.6%), Indiana (26.1%), and Kentucky (25.3%); and lowest in Utah (9.2%), California (14.0%), and New Jersey (14.8%). Smoking prevalence was 6.5% in USVI, 11.6% in Puerto Rico and 27.4% in Guam. Median smoking prevalence for the 50 states and DC was 20.4% for men and 16.7% for women. Men had a statistically higher prevalence of smoking than women in 35 states, DC, and the three territories.

Reported by: A Malarcher, PhD, N Shah, BDS, M Tynan, E Maurice, MS, V Rock, MPH, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

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