Smoke-free laws and secondhand smoke exposure in US non-smoking adults, 1999–2002

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


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.


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.


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

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