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Smoke-free laws and secondhand smoke exposure in US non-smoking adults, 1999–2002
  1. Melanie S Pickett1,*,
  2. Susan E Schober2,
  3. Debra J Brody2,
  4. Lester R Curtin2,
  5. Gary A Giovino3
  1. 1Brookline, Massachusetts, USA
  2. 2Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland, USA
  3. 3Roswell Park Cancer Institute, Buffalo, New York, USA
  1. Correspondence to:
 Debra J Brody
 Centers for Disease Control and Prevention, National Center for Health Statistics, 3311 Toledo Road, Room 4215, Hyattsville, MD 20782, USA; sschober{at}


Objectives: To investigate the relationship between smoke-free law coverage and secondhand smoke (SHS) exposure in the United States non-smoking adult population.

Design: We used data from the 1999–2002 National Health and Nutrition Examination Survey, a cross-sectional survey designed to monitor the health and nutritional status of the US population. Serum cotinine levels were available for 5866 non-smoking adults from 57 survey locations. Each location was categorised into one of three groups indicating extensive, limited, and no coverage by a smoke-free law.

Main outcome measures: The proportion of adults with SHS exposure, defined as having serum cotinine levels ⩾ 0.05 ng/ml.

Results: Among non-smoking adults living in counties with extensive smoke-free law coverage, 12.5% were exposed to SHS, compared with 35.1% with limited coverage, and 45.9% with no law. Adjusting for confounders, men and women residing in counties with extensive coverage had 0.10 (95% confidence interval (CI) 0.06 to 0.16) and 0.19 (95% CI 0.11 to 0.34) times the odds of SHS exposure compared to those residing in counties without a smoke-free law.

Conclusions: These results support the scientific evidence suggesting that smoke-free laws are an effective strategy for reducing SHS exposure.

Statistics from


  • * At the time that this research was conducted, Ms Pickett was an Association of Teachers for Preventive Medicine Fellow at the National Center for Health Statistics, Centers for Disease Control and Prevention

  • Funding: The NHANES is supported by direct appropriations from the US Congress. Ms Pickett was supported under a cooperative agreement from the Centers for Disease Control and Prevention through the Association of Teachers of Preventive Medicine

  • Declaration of competing interests: The authors of this manuscript have no competing interests to declare

  • Ethics approval: The NHANES protocol was approved by the National Center for Health Statistics Research Ethics Review Board, Hyattsville, Maryland

  • The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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