TU-11.3 Reduce the proportion of adults aged 18 years and older exposed to secondhand smoke

National Data Source
National Health and Nutrition Examination Survey (NHANES); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
Changed Since the Healthy People 2020 Launch
Yes
Measure
percent (age adjusted—see Comments)
Baseline (Year)
37.6 (2005-2008)
Target
33.8
Target-Setting Method
10 percent improvement
Numerator
Number of nonsmokers aged 18 years and older who had a serum cotinine level greater than or equal to 0.05 ng/mL and less than or equal to 10 ng/ml.
Denominator
Number of nonsmokers aged 18 years and older.
Questions Used to Obtain the National Baseline Data

From 2005 National Health and Nutrition Examination Survey:

[NUMERATOR:]

[For ages 12 years and older:]

During the past 5 days did you use any product containing nicotine including cigarettes, pipes, cigars, chewing tobacco, snuff, nicotine patches, nicotine gum, or any other product containing nicotine?

  1. Yes
  2. No
Data Collection Frequency
Periodic
Comparable Healthy People 2010 Objective
Adapted from HP2010 objective

Comments

Methodology Notes

Adults aged 18 years and older are classified as nonsmokers if they respond “no” to using any product containing nicotine in the past 5 days and if their serum cotinine level is less than or equal to 10 ng/mL. Only responses to the questions asked of persons who participated in the examination component of the survey were used, so that serum levels of cotinine could be available for analysis.

The limit of detection used for cotinine was revised to 0.05 ng/mL to be more consistent with other similar measures including indicators from Healthy People 2010 and the National Prevention Strategy. Using a lower level of detection of cotinine, may have allowed us to detect cotinine in persons who are currently categorized as ‘unexposed’.

Age Adjustment

This Indicator uses Age-Adjustment Groups:

  • Total: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
  • Race/Ethnicity: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
Trend Issues
Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Different age adjustment groups are used for the two year and four year data. Two-year estimates are generally less stable and reliable than four-year estimates.
Description of Changes Since the Healthy People 2020 Launch

The limit of detection for cotinine has used for the baseline at launch was 0.015ng/mL. The measure has since been revised to use a limit of detection for cotinine of 0.05ng/mL to be more consistent with other similar measures including indicators from HP2010 and the National Prevention Strategy. As a result of these revisions, the baseline for this measure has been revised from 75.5% to 37.6%. The target has been adjusted from 67.9% to 33.8% using the original target setting method.

Changes Between HP2010 and HP2020
Since HP2010 the language of the objective has been modified from, 'Reduce the proportion of nonsmokers exposed to environmental tobacco smoke' to 'Reduce the proportion of nonsmokers exposed to secondhand smoke'. In HP2010 only one measure was calculated; the measure was for persons ages 4 and older. In HP2020 we have three objectives--ages 3-11, 12-17, and 18+. The HP2010 measure did not use an upper limit for non-smokers cotinine levels. The HP2020 measure is using an upper limit of 10ng/mL. Persons with cotinine levels greater than 10 ng/mL could have been counted as exposed non-smokers in the HP2010 measure, but in the HP2020 measure these persons are considered to be smokers.

References and More Information

  1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.