Burden of Secondhand Smoke Exposure

When people who smoke burn tobacco products (e.g., cigarettes, cigars, cigarillos, pipes) or exhale smoke after puffing smoke in, secondhand smoke (SHS) is released in the air and expose people who do not smoke in the vicinity to the constituents of tobacco smoke. SHS is a risk factor for several adverse health outcomes, including lung cancer, stroke, heart disease, and asthma in adults; and low birthweight, ear infections, asthma, bronchitis, pneumonia, wheezing, worsening of pre-existing lung conditions, sudden infant death syndrome, allergic rhinitis, and attention deficit hyperactivity disorder in children. The conditions such as asthma developed in infancy, childhood or adolescence may continue to adulthood with lifetime repercussion on health. SHS exposure is still responsible for ~3% of all lung cancer deaths in the US each year, equivalent to 3,960 deaths in 2023.^1,2

In 2021, about 24,400 deaths in the United States were due to SHS exposure, showing a significant reduction from an estimated 42,000 SHS-attributable deaths in 2006, including deaths of more than 41,000 adults and nearly 900 infants, that resulted in a loss of nearly 600,000 years of life lost and $6.6 billion of productivity.³ The death and DALY rates per 100,000 population, however, vary widely across states (Maps 3.6.1 and 3.6.2).

Exposure to SHS in indoor workplace and public places (e.g., hotels, restaurants, bars, campuses, daycare facilities, public transportation) has decreased over time due to implementation of comprehensive smoke-free air policies (Figures 3.6.4, 3.6.5, 3.6.6 and 3.6.7). Exposure to SHS at home setting (e.g., housing, cars), on the other hand, is yet to be eliminated and remains an important preventable source of illnesses and deaths of people who do not smoke.

Children are particularly vulnerable to the health risks attributable to SHS exposure at home due to parental smoking. SHS exposure at home accounted for 5.2% of all Emergency Room visits by children aged 3-14 years during 2000-2010.⁴

Moreover, residents in multi-unit housing share space and may be subject to high levels of involuntary exposure to SHS from the residents who smoke even though they do not permit smoking in their own homes. There are additional costs in multi-unit housing involved with smoking-related fire hazards and maintenance of units where smoking is permitted.

In 2011, an estimated 37,791 residents in public housing who never smoked suffered from illnesses and deaths due to exposure to secondhand smoke costing the society $183 to $267 million in healthcare spending and productivity losses.⁵ With an aim to eliminate secondhand smoke exposure in public housing, the US Department of Housing and Urban Development has implemented the Smoke-Free Public Housing Rule since 2017 which is expected to lower the costs of secondhand smoke exposure significantly.⁶