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James L. Pirkle,¹ John T. Bernert,¹ Samuel P. Caudill,¹ Connie S. Sosnoff,¹ and Terry F. Pechacek²

¹Division of Laboratory Science, National Center for Environmental Health, and ²Office of Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Abstract
The objective of this study was to describe the exposure of nonsmokers in the U.S. population to secondhand smoke (SHS) using serum cotinine concentrations measured over a period of 14 years, from October 1988 through December 2002. This study consists of a series of National Health and Nutrition Examination Surveys (NHANES) measuring serum cotinine as an index of SHS exposure of participants. Study participants were individuals representative of the U.S. civilian, noninstitutionalized population, ≥ 4 years of age. We analyzed serum cotinine and interview data from NHANES obtained during surveys conducted during four distinct time periods. Our results document a substantial decline of approximately 70% in serum cotinine concentrations in nonsmokers during this period. This decrease was reflected in all groups within the population regardless of age, sex, or race/ethnicity. The large decrease that we observed in serum cotinine concentrations suggests a substantial reduction in the exposure of the U.S. population to SHS during the 1990s. The exposure of nonsmokers to SHS represents an important public health concern. Our findings suggest that recent public health efforts to reduce such exposures have had an important effect, although children and non-Hispanic black nonsmokers show relatively higher levels of serum cotinine. Key words: biomarker, cotinine, environmental tobacco smoke, ETS, health and nutrition examination survey, NHANES, secondhand smoke, SHS, tandem mass spectrometry. Environ Health Perspect 114:853-858 (2006) . doi:10.1289/ehp.8850 available via http://dx.doi.org/ [Online 2 February 2006]

Address correspondence to J. Bernert, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-47, Atlanta, GA 30341 USA. Telephone: (770) 488-7911. Fax: (770) 488-0181. E-mail: jbernert@cdc.gov

We thank J.R. Alexander, J.R. Akins, M.K. DeLong, T. Harmon, J.E. McGuffey, M.A. Morrison, and S. Wolfe for their contributions to National Health and Nutrition Examination Survey serum cotinine analyses.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Disease Registry. Use of trade names and commercial sources is for identification only and does not constitute endorsement by the U.S. Department of Health and Human Services or the Centers for Disease Control and Prevention.

The authors declare they have no competing financial interests.

Received 14 November 2005 ; accepted 2 February 2006.