Deep disparities persist in who gets exposed to secondhand smoke

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Harmful secondhand tobacco smoke remains more widespread than most people think, experts say, and exposure is particularly high for children, Black adults and people living below the poverty line.

One of the biggest hurdles is smokers often underestimate the levels of exposure and the effects on nonsmokers' lungs, hearts and brains.

"There's denial among the smokers that they don't smoke around children, they don't smoke in the house, they don't smoke in the car," said Dr. Geetha Raghuveer, a pediatric cardiologist at Children's Mercy Hospital in Kansas City, Missouri. "But that may not be something they can execute all the time."

She said the "intent" might be there to avoid smoking around others, but the reality often differs greatly – and "with the pandemic, at this point in time, people may have been indoors more."

According to the Centers for Disease Control and Prevention, an estimated 58 million people in the U.S. were exposed to secondhand smoke as of 2014, the latest year for which data is available for both children and adults.

More recently, a CDC report in middle school and high school students said about 1 in 4 – or nearly 7 million – reported breathing secondhand smoke in their homes in 2019. That exposure came from the estimated 14% of U.S. adults – 34.1 million – who smoked cigarettes as of 2019. Millions more used cigars, pipes and other burning tobacco products.

The U.S. surgeon general has said there is no risk-free level of secondhand smoke, which contains hundreds of toxins such as nicotine, ammonia and carbon monoxide. Inhaling the smoke can contribute to a range of serious health conditions such as asthma, unhealthy blood vessels, hypertension and premature cardiovascular disease or death.

According to the CDC, nonsmokers who are exposed to secondhand smoke at home or work have a 25% to 30% higher risk of heart disease and a 20% to 30% higher risk of stroke.

People often think of respiratory effects of secondhand smoke but either discount or do not consider cardiovascular issues, experts said. And when it comes to children, there is a tendency to minimize long-term ramifications.

"It's just like high cholesterol or obesity; in a child, they are kind of silent – asymptomatic," Raghuveer said. "Fortunately, we don't have children who have a heart attack or a stroke because of hypertension or obesity or high cholesterol. But at the same time ... these risks only increase in magnitude and severity if exposures and poor lifestyle persist.