Addressing Disparities in Secondhand Smoke Exposure: High Risk Adults
March 5, 2007: Reducing Exposure to Secondhand Smoke
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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