Tobacco Smoke Exposure in a Sample of Boston Public Housing Residents

doi:10.1016/j.amepre.2012.09.048

American Journal of Preventive Medicine

Volume 44, Issue 1, January 2013, Pages 63-66

https://doi.org/10.1016/j.amepre.2012.09.048 Get rights and content

Background

There is no safe level of tobacco smoke exposure. Nonsmoking residents of public housing are at particular risk of suffering the health consequences of tobacco smoke exposure.

Purpose

To compare levels of tobacco smoke exposure among nonsmoking residents of the Boston Housing Authority (BHA) to previously published data from the National Health and Nutrition Examination Survey and identify factors associated with such exposure in the BHA.

Methods

Nonsmoking adults and children from two BHA housing developments were invited to participate in a tobacco smoke exposure screening in which they completed a short survey and provided a saliva sample for cotinine analysis. Data were collected in 2011 and analyzed in 2012.

Results

Of 51 eligible study participants, 88% (95% CI=76%, 95%) had detectable cotinine levels (0.15 ng/mL lower limit of detection) compared to at most 56% of residents nationally (using a more sensitive 0.05 ng/mL lower limit of detection). Geometric mean cotinine levels among study participants were 0.52 ng/mL (95% CI=0.37 ng/mL, 0.74 ng/mL) compared to at most 0.10 ng/mL nationally. Residents living in homes with strict no-smoking rules had lower cotinine levels than those without such rules (0.40 ng/mL vs 1.07 ng/mL, p=0.006).

Conclusions

Tobacco smoke exposure is substantially higher in this sample of nonsmoking BHA residents than among nonsmoking Americans nationally. A comprehensive prohibition on smoking in BHA housing units enacted in October 2012 will help protect this highly exposed group of residents and serve as a model for other housing authorities.

Introduction

Involuntary tobacco smoke exposure has adverse health consequences for both children and adults, and there is no safe level of exposure to tobacco smoke.¹ Residents in multiunit housing may be unable to reduce their tobacco smoke exposure to safe (i.e., zero) levels due to the many air pathways from unit to unit and among common areas and units. Most nonsmoking residents of multiunit housing self-report tobacco smoke entering their units, and 9.2% report daily tobacco smoke incursions.² Policies designed to eliminate such exposure in multiunit housing, particularly public housing, have a strong legal and ethical rationale³ and are gaining momentum.4, 5

In October 2012, the Boston Housing Authority (BHA) of Boston MA, became the nation's largest urban housing authority to adopt a comprehensive no-smoking policy when it banned smoking in all of its 11,000 units.⁶ This study was a pilot assessment of tobacco smoke exposure in the BHA prior to the implementation of its no-smoking rule, a policy that could be replicated in other major public housing authorities nationally. To inform tobacco control research and policy priorities, cotinine levels in this population at high risk of exposure are compared to national exposure data.

Section snippets

Setting

A convenience sample of self-reported nonsmoking adult and child residents was recruited using flyers offering a “secondhand smoke exposure screening” posted in public areas of two BHA developments in February and April 2011. Participants consenting to take part in the study had to be English speakers or be assisted by an English speaker. After providing consent (parents provided consent for their children), participants completed a 14-item survey, provided a saliva sample for cotinine

Results

Of 61 residents who consented to participate in the study, ten were excluded (five insufficient saliva samples, five cotinine values >15 ng/mL [ranging from 61 ng/mL to 303 ng/mL]). The 51 remaining residents came from 38 different households. Demographic characteristics and survey responses are listed in Table 1. Thirty-one percent of respondents were children.

A total of 88% of residents overall (95% CI=76%, 95%) and 90% of homes with no resident smokers (95% CI=77%, 96%) had detectable

Discussion

In exploring cotinine levels among nonsmoking residents within the BHA, tobacco smoke exposure was detectable in 88% of residents assessed using a lower limit of detection of 0.15 ng/mL. The prevalence of detectable exposure in this sample is much higher than what has been reported in national data, even though the national studies use tests with more-sensitive lower limits of detection (0.05 ng/mL). All else being equal, the national studies would be expected, given the lower limit, to yield a

References (20)

B.A. Berman et al.
Household smoking behavior and ETS exposure among children with asthma in low-income, minority households
Addict Behav
(2003)
M. Wakefield et al.
Restrictions on smoking at home and urinary cotinine levels among children with asthma
Am J Prev Med
(2000)
R. Ahlstrom et al.
A comparison of odor perception in smokers, nonsmokers, and passive smokers
Am J Otolaryngol
(1987)
The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General
B.A. King et al.
Multiunit housing residents' experiences and attitudes toward smoke-free policies
Nicotine Tob Res
(2010)
J.P. Winickoff et al.
Regulation of smoking in public housing
N Engl J Med
(2010)
Non-smoking policies in public housing
Housing authorities/commissions which have adopted smoke-free policies
M. Rocheleau
Boston set to become largest city in US to ban smoking in public housing
Saliva collection and handling advice

There are more references available in the full text version of this article.

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Brief reportTobacco Smoke Exposure in a Sample of Boston Public Housing Residents

Background

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Setting

Results

Discussion

Addict Behav

Am J Prev Med

Am J Otolaryngol

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General

Multiunit housing residents' experiences and attitudes toward smoke-free policies

Nicotine Tob Res

Regulation of smoking in public housing

N Engl J Med

Non-smoking policies in public housing

Housing authorities/commissions which have adopted smoke-free policies

Boston set to become largest city in US to ban smoking in public housing

Saliva collection and handling advice

Brief report
Tobacco Smoke Exposure in a Sample of Boston Public Housing Residents