American Legacy Foundation, First Look Report 14

Abstract

In the United States, more than 4 million youth between the ages of 12 and 17 are exposed to secondhand smoke in the home. The vast majority of this exposure is a result of parental smoking in the home. This report presents information about youth exposure to secondhand smoke, with special focus on exposure in the home. It explores prevalence of household restrictions on smoking, which can reduce secondhand smoke exposure. Finally, the report takes a brief look at what adults know about the effect of secondhand smoke on children.

Full text

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eScholarship provides open access, scholarly publishing
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Center for Tobacco Control Research and
Education
UC San Francisco
Title:
American Legacy Foundation, First Look Report 14
Author:
Kristen McCausland; Kristin Thomas; Ella Watson-Stryker; James Xiao; Molly Green; Jane Allen;
et al.
Publication Date:
01-01-2005
Series:
Surveys and Program Evaluations from Outside UCSF
Publication Info:
Surveys and Program Evaluations from Outside UCSF, Center for Tobacco Control Research and
Education, UC San Francisco
Permalink:
http://escholarship.org/uc/item/6pc7783q
Keywords:
Tobacco, Cigarette, Youth Smoking
Abstract:
In the United States, more than 4 million youth between the ages of 12 and 17 are exposed to
secondhand smoke in the home. The vast majority of this exposure is a result of parental smoking
in the home. This report presents information about youth exposure to secondhand smoke,
with special focus on exposure in the home. It explores prevalence of household restrictions on
smoking, which can reduce secondhand smoke exposure. Finally, the report takes a brief look at
what adults know about the effect of secondhand smoke on children.

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Secondhand Smoke:
Youth Exposure and Adult Attitudes
RESULTS FROM THREE NATIONAL SURVEYS
FIRST LOOK REPORT 147
January 2005

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Secondhand Smoke: Youth Exposure and Adult Attitudes —
Results from Three National Surveys
2
Legacy First Look Report 14 · January 2005
INTRODUCTION
Secondhand smoke consists of both exhaled smoke and smoke from the burning end of
a tobacco product. Secondhand smoke contains more than 4,000 chemical substances,
including several known human carcinogens (NCI, 2001).
Exposure to secondhand smoke can result in a range of negative health consequences,
particularly for infants,children,and adolescents. In 2001,there were 263 smoking-attrib-
utable sudden infant death syndrome (SIDS) cases in the United States (American
Legacy Foundation, 2004). Secondhand smoke places children of all ages at increased
risk for asthma, ear infections, bronchitis, pneumonia, reduced lung function, respira-
tory infection, and other chronic respiratory symptoms (Cook and Strachan, 1997,
1999;USEPA,1992;USDHHS,2001). Declines in lung function resulting from second-
hand smoke exposure may persist into adulthood and increase the risk of developing
chronic lung disease (Dunn and Zeise,1997). Children exposed to secondhand smoke
miss more school days than children who are not exposed (Mannino et al.,1996,2001b).
In the United States, more than 4 million youth between the ages of 12 and 17 are
exposed to secondhand smoke in the home. The vast majority of this exposure is a result
of parental smoking in the home. This report presents information about youth expo-
sure to secondhand smoke,with special focus on exposure in the home. It explores preva-
lence of household restrictions on smoking,which can reduce secondhand smoke expo-
sure. Finally, the report takes a brief look at what adults know about the effect of sec-
ondhand smoke on children.
DATA AND METHODS
DESIGN AND CONTENT
This report is based on data from the 1999 and 2003 Legacy Media Tracking Surveys
(LMTS) and the 2003 American Smoking and Health Survey (ASHES). LMTS is a
nationally representative telephone survey of youth aged 12 to 17 and young adults aged
18 to 24. Although designed primarily to monitor the progress of the American Legacy
Foundation’s truth®campaign,the survey also includes questions about exposure to sec-
ondhand smoke. The data presented in this report were collected in winter 1999 and fall
2003.
ASHES is a random-digit-dial survey designed to produce a nationally representative sam-
ple of adults aged 18 and older. ASHES produces prevalence estimates of tobacco use
and a variety of other tobacco-related behaviors and beliefs among adults. The survey
includes questions that measure knowledge of the effects of secondhand smoke and preva-
lence of smoking bans in the home. The data presented in this report were collected in
spring 2003.
METHODS
This report presents prevalence estimates from 2003 and,when possible,comparative data
from 1999. Youth data are reported by household smoking status and parental smok-
ing status. All estimates in this report were calculated using sampling weights and con-
trolled for the stratified survey design of the LMTS. Except where noted, only statisti-

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Secondhand Smoke: Youth Exposure and Adult Attitudes —
Results from Three National Surveys
January 2005 · Legacy First Look Report 14
3
cally significant results (p < 0.05) are discussed in this report. Additional data on this
topic, including estimates by gender and race/ethnicity, are available on the American
Legacy Foundation Web site at www.americanlegacy.org.
Youth exposure to secondhand smoke was measured by asking respondents the follow-
ing questions:“During the past 7 days, on how many days were you in the same room
with someone who was smoking cigarettes?”and “During the past 7 days,on how many
days were you in the same car with someone who was smoking cigarettes?” These items
were also used to measure daily secondhand smoke exposure in a room and/or in a car.
Exposure to secondhand smoke specifically occurring in the home was assessed by
learning whether a young person lived with a smoker,then learning whether there were
any smoking restrictions in their home. Respondents were asked,“Other than yourself,
does anyone who lives in your home smoke cigarettes now?”and “What are the rules,if
any,about smoking in your home?” Response options about home restrictions includ-
ed no smoking at all (a complete ban), smoking only in certain rooms of the house (a
partial ban),and no rules about smoking at home (no ban). Although we now know that
smoking outdoors does not completely protect young people from exposure to toxic chem-
icals (Blackburn et al., 2003), for the purpose of this study, complete smoking bans in
the home were considered protective from secondhand smoke exposure. Participants were
considered to be exposed to secondhand smoke if they lived with a smoker and smok-
ing was only partially banned or was not banned at all in the home. To estimate the total
number of youth aged 12 to 17 who were exposed to household secondhand smoke in
2003,the prevalence of secondhand smoke exposure in the home was applied to popu-
lation estimates of youth aged 12 to 17 living in the United States (U.S. Bureau of the
Census, 2004).
ASHES data were used to corroborate the youth perspective on home smoking restric-
tions. Adult respondents were asked,“Is anyone allowed to smoke cigarettes inside your
home?” If so,they were asked,“What are the rules about where they can smoke cigarettes?”
To measure overall concern about secondhand smoke,adult participants were asked,“How
concerned are you about the possible effects your smoking cigarettes could have on the
health of those around you?” Participants were also asked the degree to which they agreed
or disagreed with the following statements:
G It is harmful to a person’s health if they live in a house where a smoker smokes
tobacco indoors.
G Inhaling someone else’s cigarette smoke can cause lung cancer in nonsmokers.
G Children who live with a tobacco smoker are just as likely to develop asthma or
other respiratory problems as children who do not live with a tobacco smoker.
G Smoking cigarettes around a baby increases the chance it will die of sudden
infant death syndrome.
Sample sizes for analyses in this report are presented in Appendix Tables A-1 and A-2.

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Secondhand Smoke: Youth Exposure and Adult Attitudes —
Results from Three National Surveys
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Legacy First Look Report 14 · January 2005
MAIN FINDINGS
YOUTH EXPOSURE TO SECONDHAND SMOKE
Thirteen percent of youth aged 12 to 17 are exposed to secondhand smoke daily as a result
of being in the same room with someone who was smoking cigarettes. About half as many
youth (7 percent) report daily exposure to secondhand smoke in a car.
From 1999 to 2003, the proportion of youth who report daily exposure to secondhand
smoke as a result of being in the same room with a smoker decreased by 42 percent. The
percentage of youth who report no weekly exposure from being in a room with a smok-
er remained constant during this period. Rates of daily exposure in cars declined from
1999 to 2003 by 37 percent among youth. During this period, there was a 22 percent
increase in the proportion of youth who report that they were not exposed to second-
hand smoke in cars at all in the past week.
LIVING WITH A SMOKER
As illustrated in Figure 1,27 percent of youth live in a household with at least one smok-
er. This represents a decline of 32 percent from 1999 to 2003.
Figure 1. Prevalence of
Youth Living in a
Household with At Least
One Smoker
40
27
0
10
20
30
40
50
60
70
LMTS 1999LMTS 2003
Percent

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Secondhand Smoke: Youth Exposure and Adult Attitudes —
Results from Three National Surveys
January 2005 · Legacy First Look Report 14
5
Youth exposure to secondhand smoke is often a result of living with a smoker. As
shown in Figure 2,eight times more youth who live with a smoker are exposed to daily
secondhand smoke in a room and/or in a car than those who live in a nonsmoker
household (40 percent vs. 5 percent). Among youth living in households without any
smokers, the prevalence of daily secondhand smoke exposure remained constant from
1999 to 2003. However, among youth living in households with smokers, a 26 percent
decline occurred.
In 82 percent of the cases where a young person lives with a smoker,that smoker is a par-
ent. About 5.6 million young people between the ages of 12 and 17 currently live in a
household with at least one parent who smokes;of these youth,1.3 million live in a house-
hold with two smoking parents. The number of youth living with a smoking parent has
declined from 1999 to 2003, by an estimated 1 million among those who live with one
smoking parent and 1.2 million among those who live with two smoking parents.
Because parental smoking is a major factor contributing to smoking initiation,young peo-
ple who live with a smoking parent are at increased risk for health problems caused not
only by secondhand smoke exposure but also from active smoking.
Figure 2. Daily Secondhand Smoke Exposure in a Room and/or in a Car by
Household Smoking Status
24
54
5
15
40
5
0
10
20
30
40
50
60
70
OverallHouseholds With a
Smoker
Households Without a
Smoker
Percent
LMTS 1999
LMTS 2003

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Secondhand Smoke: Youth Exposure and Adult Attitudes —
Results from Three National Surveys
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Legacy First Look Report 14 · January 2005
HOUSEHOLD RESTRICTIONS ON SMOKING IN THE HOME
Youth reports indicate that although 70 percent of all households in the United States
completely ban smoking,among households in which a smoker lives,only 46 percent have
rules against smoking in the home. Therefore,the households with the lowest prevalence
of complete bans continue to have the highest potential for secondhand smoke exposure.
Furthermore,as illustrated in Figure 3,among households with a smoker,the prevalence
of complete smoking bans in the home is greater where one parent is a smoker and the
other is a nonsmoker (48 percent) than in two parent households where both parents
smoke (11 percent),one parent households where both parents smoke (28 percent),and
single parent households where the parent smokes (26 percent). These results suggest
that the presence of a nonsmoking parent in the household may be influential in imple-
menting complete smoking bans.
Adult data from ASHES closely reflect these findings. Seventy-one percent of adults report
that no smoking is allowed in their home. Eighty-one percent of nonsmokers — com-
pared with 37 percent of smokers — report that no one is allowed to smoke in their home.
EXPOSURE TO SECONDHAND SMOKE IN THE HOME
About 4 million youth (16 percent of all youth) are exposed to secondhand smoke in their
home. This is a 40 percent decline from 1999, when 26 percent of youth were exposed
to secondhand smoke in the home. As a result, approximately 2.2 million fewer youth
are exposed to secondhand smoke in the home.
Figure 3. Prevalence of Households with Complete Home Smoking Bans by
Number of Parents Who Smoke and Number of Parents in Household
LMTS 1999
LMTS 2003
22
11
41
30
11
28
48
26
0
10
20
30
40
50
60
70
Both Parents
Smoke, Two
Parent Household
Both Parents
Smoke, One
Parent Household
One Parent
Smokes, Two
Parent Household
One Parent
Smokes, One
Parent Household
Percent

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Secondhand Smoke: Youth Exposure and Adult Attitudes —
Results from Three National Surveys
January 2005 · Legacy First Look Report 14
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ADULT BELIEFS ABOUT SECONDHAND SMOKE
Most adults believe that it is harmful to a person’s health to live in a house where smok-
ing is allowed indoors. However,this belief is stronger among nonsmokers (92 percent)
than among smokers (70 percent). Ninety percent of adults who do not smoke and 60
percent of adults who smoke agree that inhaling secondhand smoke can cause lung can-
cer in nonsmokers.
Despite agreeing that secondhand smoke can be harmful,many adults are unclear about
the harmful effects that secondhand smoke has on children. Although research demon-
strates the negative effect of secondhand smoke exposure on asthma and other respira-
tory problems, 57 percent of adults agree that children who live with a smoker are just
as likely to develop asthma or other respiratory problems as children who do not live with
a smoker. Adults are also generally unclear about the role secondhand smoke plays in
SIDS. Only 48 percent of adults agree that smoking cigarettes around a baby increases
the chance the baby will die of SIDS. Fifty percent of nonsmokers and 37 percent of smok-
ers agree with the statement. Notably, one-third (33 percent) of adults responded that
they were neutral or had no opinion when asked about the relationship between second-
hand smoke and SIDS.
SUMMARY
This report provides prevalence estimates for youth exposure to secondhand smoke in
the United States and highlights the progress that has been made in reducing secondhand
smoke exposure among youth from 1999 to 2003. Declines in exposure could be
explained by reductions in the proportion of households with smokers and by the adop-
tion of complete household smoking bans. The decrease in the prevalence of youth liv-
ing in a household with smokers may reflect the decreasing trend in adult smoking and
the more dramatic decline in youth smoking in recent years. The prevalence of complete
home smoking bans increased, particularly among households with smokers, which
highlights the improvement that has been made in protecting youth from secondhand
smoke exposure in households where it is needed most.
Although improvements have been made in positively changing the household smok-
ing environment and reducing secondhand smoke exposure among youth, more than
4 million youth aged 12 to 17 continue to be exposed to secondhand smoke in their homes.
The prevalence of complete household smoking bans in smoker households remains lower
than in nonsmoker households and remains lower in households where both parents
smoke than in households where only one parent smokes. Tobacco control efforts
should continue to promote the adoption of household smoking bans to further reduce
the number of youth exposed to secondhand smoke.
In addition,tobacco control efforts need to further educate parents on the dangers of sec-
ondhand smoke exposure. Most parents agree that it is harmful to a person’s health to
live in a house where smoking is allowed indoors and that secondhand smoke exposure
can increase the risk of cancer in nonsmokers, yet they still do not have a clear under-
standing of the adverse health effects of exposure on children despite what has been estab-
lished in published scientific research.

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A strong,comprehensive tobacco control program,such as California’s Tobacco Control
Program, can influence population norms, including those of smokers, with respect to
where smoking should not be allowed (Gilpin,Lee,and Pierce,2004). For instance,there
were greater increases in support for smoke-free venues even among smokers in California,
as compared to the rest of the United States, which likely reflects the influence of the
California Tobacco Control Program (Gilpin, Lee, and Pierce, 2004).
As part of a comprehensive tobacco control program,media campaigns have been effec-
tive in raising adults’awareness of the adverse health effects of secondhand smoke expo-
sure on children. Independent evaluations of California’s Tobacco Control Program indi-
cated that adults who saw media campaign advertisements were more likely to believe
that secondhand smoke is harmful to nonsmokers, especially children, compared with
adults who did not see the media campaign. In addition,results showed that the media
campaign increased adults’ awareness of the dangers of secondhand smoke and the
likelihood that they would ask another person not to smoke around them (California DHS,
2004; Pierce et al.,1994; Independent Evaluation Consortium,1998). Further research
is needed to understand how media messages that have raised awareness of the dangers
of secondhand smoke exposure ultimately lead to the adoption of household smoking
bans.
Aside from smoking cessation, smoking bans continue to be the most effective way to
protect youth from the adverse health effects of secondhand smoke exposure. While par-
ents can reduce their child’s exposure in the home by eliminating smoking in the home,
eliminating youth exposure to other sources of secondhand smoke,such as in restaurants
and other public venues, requires community-level interventions (Mannino et al.,
2001a). In addition, banning smoking in the home, even when parents smoke, as well
as public smoking restrictions,gives a clear message to teenagers about the unacceptabil-
ity of smoking (Wakefield et al., 2000).
Secondhand Smoke: Youth Exposure and Adult Attitudes —
Results from Three National Surveys
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Legacy First Look Report 14 · January 2005

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Secondhand Smoke: Youth Exposure and Adult Attitudes —
Results from Three National Surveys
January 2005 · Legacy First Look Report 14
9
REFERENCES
American Legacy Foundation. 2004. Secondhand Smoke Tearing Families Apart: The Health and
Economic Burden of Smoking on Children. Policy Report 2. Washington DC: American
Legacy Foundation.
Blackburn, C., N. Spencer, S. Bonas, C. Coe,A. Dolan, and R. Moy. 2003. “Effect of Strategies to
Reduce Exposure of Infants to Environmental Tobacco Smoke in the Home: Cross
Sectional Survey.” British Medical Journal 327(7409):257.
California Department of Health Services (California DHS). “California’s Tobacco Education
Media Campaign.” California Department of Health Services, Tobacco Control Section.
<http://www.dhs.ca.gov/tobacco/documents/FSMediaCamp.pdf>. As obtained on
November 21, 2004.
Cook, D.G., and D.P. Strachan. 1997. “Health Effects of Passive Smoking. 3. Parental Smoking and
Prevalence of Respiratory Symptoms and Asthma in School Age Children.” Thorax
52(12):1081-1094.
Cook, D.G., and D.P. Strachan. 1999. “Health Effects of Passive Smoking. 10. Summary of Effects
of Parental Smoking on the Respiratory Health Effects of Children and Implications for
Research.” Thorax 54(4):357-366.
Dunn,A., and L. Zeise, Eds. 1997. Health Effects of Exposure to Environmental Tobacco Smoke:
Final Report. Sacramento, CA: California Environmental Protection Agency.
Flay, B. 1993. “Youth Tobacco Use: Risks, Patterns, and Control.” In Nicotine Addiction: Principles
and Management, C.T. Orleans and J. Slade, eds., pp. 365-384. New York: Oxford
University Press.
Gilpin, E.A., L. Lee, and J.P. Pierce. 2004. “Changes in Population Attitudes About Where Smoking
Should Not Be Allowed: California Versus the Rest of the USA.” Tobacco Control 13:38-44.
Independent Evaluation Consortium. 1998. Final Report of the Independent Evaluation of the
California Tobacco Control Prevention and Education Program: Wave I Data, 1996-1997.
Rockville, MD: The Gallup Organization.
Mannino, D.M., M. Siegel, C. Hosten, D. Rose, and R. Ethel. 1996. “Environmental Tobacco Smoke
Exposure and Health Effects in Children: Results from the 1991 National Heath Interview
Survey.” Tobacco Control 5(1):13-18.
Mannino, D.M., R. Caraballo, N. Benowitz, and J. Repace. 2001a. “Predictors of Cotinine Levels in
U.S. Children: Data from the Third National Health and Nutrition Examination Survey.”
Chest 123(3):718-724.
Mannino, D.M., J.E. Moorman, B. Kingsley, D. Rose, and J. Repace. 2001b. “Health Effects Related
to Environmental Tobacco Smoke Exposure in Children in the United States.” Archives of
Pediatrics and Adolescent Medicine 155:36-41.
Mumford, E.A., D.T. Levy, and O. Romano. 2004. “Home Smoking Restrictions: Problems in
Classification.” American Journal of Preventive Medicine 27(2):126-131.
National Cancer Institute (NCI). 2001. Risks Associated with Smoking Cigarettes with Low Tar
Machine-Measured Yields of Tar and Nicotine Monograph No. 13. Bethesda, MD: U.S.
Department of Health and Human Services, National Institutes of Health, National
Cancer Institute.
Pierce, J.P., N. Evans,A.J. Farkas, S.W. Cavin, C. Berry, M. Kramer, S. Kealy, B. Rosbrook,W. Choi,
and R.M. Kaplan. 1994. “Tobacco Use in California: An Evaluation of the Tobacco
Control Program, 1989-1993.” La Jolla, CA: University of California, San Diego.

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Secondhand Smoke: Youth Exposure and Adult Attitudes —
Results from Three National Surveys
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Legacy First Look Report 14 · January 2005
U.S. Bureau of the Census. “State Characteristics Population Estimates with 6 Race Groups.”
Population Estimates Program, U.S. Bureau of the Census. Internet File.
<http://www.census.gov/popest/states/asrh/files/SC-EST2003-race6_layout.txt>. Last
updated on September 30, 2004.
U.S. Department of Health and Human Services (USDHHS). 2001. Women and Smoking, A Report
of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services,
Public Health Service, Office of the Surgeon General.
U.S. Environmental Protection Agency (USEPA). 1992. Respiratory Health Effects of Passive
Smoking: Lung Cancer and Other Disorders. EPA/600/6-9/006F. Washington, DC: U.S.
Environmental Protection Agency, Office of Air and Radiation.
Wakefield, M.A., F.J. Chaloupka, N.J. Kaufman, C.T. Orleans, D.C. Barker, and E.E. Ruel. 2000.
“Effect of Restrictions on Smoking at Home, at School, and in Public Places on Teenage
Smoking: Cross-Sectional Study.” British Medical Journal 321(7257):333-337.
ACKNOWLEDGMENTS
Authors: Kristen McCausland,Kristin Thomas,Ella Watson-Stryker,James Xiao,Molly
Green, Jane Allen, Matthew Farrelly, Donna Vallone, Cheryl Healton.
The authors would also like to acknowledge Andrew Jessup and Susan Murchie for
their contributions.

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Secondhand Smoke: Youth Exposure and Adult Attitudes —
Results from Three National Surveys
January 2005 · Legacy First Look Report 14
11
APPENDIX A: SAMPLE SIZES FOR ANALYSES
Table A-1. Sample Sizes from LMTS
LMTS 1999LMTS 2003
Daily Secondhand Smoke Exposure in a Room
Overall
Households With a Smoker
Households Without a Smoker
3,424
1,252
2,171
3,452
905
2,539
Daily Secondhand Smoke Exposure in a Car
Overall
Households With a Smoker
Households Without a Smoker
3,431
1,255
2,175
3,457
905
2,545
Daily Secondhand Smoke Exposure in a Room and/or a Car
Overall
Households With a Smoker
Households Without a Smoker
3,433
1,256
2,176
3,463
905
2,546
Living with a Smoker
Overall
Both Parents Smoke
One Parent Smokes
3,433
3,433
3,433
3,453
3,453
3,453
Household Restrictions on Smoking in the Home
Both Parents Smoke
Two Parent Household
One Parent Household
One Parent Smokes
Two Parent Household
One Parent Household
Exposure to Secondhand Smoke in the Home
Overall
230
47
136
21
468
296
449
145
3,4083,435
Table A-2. Sample Sizes from ASHES 2003
Smokers Nonsmokers
Is anyone allowed to smoke cigarettes inside your home?
It is harmful to a person’s health if they live in a house
where a smoker smokes tobacco indoors.
Inhaling someone else’s cigarette smoke can cause lung cancer
in nonsmokers.
Children who live with a tobacco smoker are just as likely to
develop asthma or other respiratory problems as children
who do not live with a tobacco smoker.
Smoking cigarettes around a baby increases the chance it will
die of sudden infant death syndrome.
6252,122
6222,126
6152,109
599 2,090
567 1,900

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