National estimates and correlates of secondhand smoke exposure in US cancer survivors

Purpose: Cancer survivors comprise a vulnerable population for exposure to secondhand smoke (SHS). This study examined and compared the prevalence, time trends, and predictors of SHS exposure between nonsmoking adult cancer survivors and nonsmoking adults without cancer history (control group). Methods: Data were obtained from the 2001–2012 National Health and Nutrition Examination Survey (survivors: n = 2168; controls: n = 19,436). All adults ≥20 years of age who reported not smoking and had a serum cotinine level of 0.015–10 ng/mL were included in the study. Prevalence and 95% confidence intervals, weighted linear regression of prevalence on year for trend analysis, and logistic regression analysis were performed with adjustments made for the complex survey design. Results: Survivors were significantly less likely to be exposed to SHS (65.4 vs. 70.6%, respectively). Exposure over time decreased by 16% (from 67.1% in 2001 to 53.3% in 2012) among survivors and by 24% (from 72% in 2001 to 56% in 2012) among controls. Exposed survivors were more likely to be young (OR = 0.98 [95% CI = 0.97–0.99]), non-Hispanic Black (2.51 [1.49–4.26]), with some college education (2.47 [1.56–3.93]), a high school education (2.72 [1.76–4.19]), less than a high school education (2.49 [1.58–3.91]), and poor (1.80 [1.10–2.96]). Conclusion: Considerable numbers of US cancer survivors are exposed to SHS and exposure disparities persist. Implications for Cancer Survivors: More efforts are needed to develop and test population policies and clinical-based interventions targeting cancer survivors.