Interagency Committee on Smoking and Health
Meeting Summary: March 5, 2007
Reducing Exposure to Secondhand Smoke
Addressing Disparities in Secondhand Smoke Exposure:
High Risk Adults
Lourdes Baezconde-Garbanati, Ph.D., M.P.H.,
Assistant Professor, Institute for Prevention Research and Sociology,
Keck School of Medicine, University of Southern California
Dr. Baezconde-Garbanati began by providing a definition of disparities as
being great or fundamental differences that are at the root of inequalities in
health and health outcomes. Socioeconomic status and race and ethnicity play
roles as mediators of disparities. Data indicate the highest smoking prevalence
occurs among individuals of low socioeconomic status (SES), Medicaid populations
and low SES young adult populations.
Regarding secondhand smoke exposure, African-Americans are least protected in
the home and Hispanic/Latinos are least protected in the workplace. Statewide
smoke-free workplace policies vary widely from state to state and even within
states there is variability in the presence, implementation, surveillance and
enforcement of policies. As mentioned by previous speakers, restaurant and bar
workers are less likely to be protected by smoke-free workplace policies, more
likely to have these policies violated and more likely to be exposed to higher
levels of secondhand smoke on the job. In addition, more Hispanic and American
Indian women work in sites without smoke-free workplace policies.
Disparities also exist in the presence of voluntary smoke-free home policies.
In 2003, Asian Americans/Pacific Islanders and Hispanics were more likely to
report smoke-free home rules than Whites, African-Americans and American
Indians. Such voluntary policies are highest among women in the highest SES and
educational groups which is consistent among all ethnic and racial groups except
for Hispanic women.
Given that 33% of all U.S. housing is occupied by renters, many of whom are
living in subsidized multi-unit dwellings; large disparities exist in protection
from unwanted smoke drifting into homes. While it is legal for apartment owners,
managers and home owner associations to designate buildings as smoke-free, many
do not choose to do so. Dr. Baezconde-Garbanati discussed the results of the
first ever survey of Latino renters in California which revealed the "Latino SHS
exposure paradox." This survey found that despite the fact that nearly all
Latinos ban smoking in their homes, they experience high rates of exposure in
multi-unit housing.
Dr. Baezconde-Garbanati identified several emerging opportunities in
smoke-free policy work including work on Indian tribal lands and gaming
facilities as well as implementing outdoor restrictions more broadly. Of the 20
outdoor dining policies that existed in October 2006, 12 of them were in
California. Also in California, Orange County was the first in the nation to
declare an entire coastline smoke-free. Another opportunity is for work on
military bases where a large percentage of active duty military personnel still
smoke.
To conclude her remarks, Dr. Baezconde-Garbanati summarized lessons learned
in the area of disparities and secondhand smoke exposure.
- Not all groups are covered equally by home or workplace
laws with low socioeconomic populations most affected
- Voluntary policies and local policy development should come
first before movement to statewide efforts
- Efforts to eliminate exposure in the home and multi-unit
housing are promising
- The next "frontier" will be working on outdoor dining,
hookah bars, and outdoor common areas
- American Indian sovereignty issues must be respected while
at the same time considering voluntary policies that will protect patrons
and workers in gaming facilities
Following Dr. Baezconde-Garbanati's remarks, Dr. Noonan introduced the final
two speakers.
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