Smoking and Secondhand Smoke Exposure Among Us Women: Analysis of NHANES Measures

Purpose Active smoking and secondhand smoke exposure (SHSe) in women are leading causes of morbidity and mortality and have significant economic costs in the US. The purpose of this study is to compare methods of collecting smoke-exposure data and trends of exposure in a representative population of women in the US. Design A probability sample of women from the National Health and Nutrition Examination Survey (NHANES) was analyzed. Methods The sample included 13,396 women ≥20 years old. Data were analyzed using biochemical and self-report smoke exposure methods available in the NHANES. Rao-Scott chi-squared and logistic regression were used for analysis. Results Women most at risk for active smoking were non-Hispanic white (18.81%) and Black women (20.74%) and women with incomes <$20,000 annually (28.36%). SHSe was more likely among Black women (6.18%). NHANES self-report measures demonstrated a similar upward trend as biochemical serum cotinine levels. Number of household smokers was the most sensitive self-report measure. Discussion This study demonstrated a strong relationship between self-reported smoke exposure and serum cotinine values. Women who are non-Hispanic white, Black and low-income are particularly at risk for smoking and SHSe. In the absence of a gold-standard measure for SHSe, number of household smokers may be a good self-report measure. Implications Providers must continue to assess smoking and smoke exposure, particularly in women. Gender tailored cessation and initiation reduction methods are essential.