摘要：Objectives. We sought to describe the prevalence of secondhand tobacco smoke incursions reported by multiunit housing (MUH) residents, pinpoint factors associated with exposure, and determine whether smoke-free building policy was associated with prevalence of reported tobacco smoke incursions. Methods. Data are from a 2011 nationally representative dual-frame survey (random-digit-dial and Internet panels) of US adults aged 18 years and older. Individuals who lived in MUH and who reported no smoking in their homes for the past 3 months, whether or not they reported being smokers themselves, were included in this study. Incursions were defined as smelling tobacco smoke in their building or unit. Results. Of 562 respondents, 29.5% reported smoke incursions in their buildings. Of these, 16% reported incursions in their own unit, 36.2% of which occurred at least weekly. Government-subsidized housing and partial smoke-free policies were associated with a higher likelihood of reporting smoke incursions. Conclusions. Many residents of multiunit housing are exposed to tobacco smoke in their units and buildings. Partial smoke-free policies do not appear to protect residents and might increase the likelihood of incursions in residents’ individual units. The United States Surgeon General has extensively documented the harmful effects of smoking tobacco among adults 1 and the negative effects of secondhand tobacco smoke (SHS) on both adults and children. 2 Even brief exposures to SHS can result in sustained vascular injury 3 and changes in endothelial function. 4 In addition, studies have shown that very low levels of SHS exposure are associated with cognitive deficits 5 and decreased antioxidant levels 6 in children. Young children breathe faster than adults, 7 have a tendency to mouth surfaces and objects, 8 and may spend more of their time in the home, 9 especially in places where outdoor activities might be perceived as unsafe. 10 These all may increase their potential for tobacco smoke inhalation and ingestion. 11 In a recent US Centers for Disease Control and Prevention study, 54% of children aged 3 to 11 years had biological evidence of SHS exposure; however, only 18% had a household member who smoked in the home, 12 suggesting the significant contribution of other sources of tobacco smoke. Approximately 25% of US residents live in multiunit housing, 13 where air circulation patterns facilitate the spread of tobacco smoke from unit to unit. 14 Tobacco smoke permeates housing complexes through air ducts, cracks in the floor and walls, stairwells, hallways, elevator shafts, electrical lines, and open windows. 15 US residents spend about 69% of their time in private residences 16 ; thus, drifting smoke from other residences may provide a significant source of exposure for those in nonsmoking homes. A study of real-time SHS transfer in multiunit housing (MUH) between smoke-free and smoke-permitting units demonstrated incursions into both smoke-free units and adjacent hallways 15 ; another study of low-income MUH in Boston, Massachusetts, demonstrated SHS contamination in homes where residents reported that neither household members nor visitors smoked. 17 In an analysis of national data, cotinine levels for children living in apartments were 45% higher than for those living in detached homes. 18 These studies suggest a significant role for SHS exposure in MUH. Recently, studies have begun to examine the prevalence of incursions in MUH. The first major national study discovered that 29% of US multiunit housing residents lived in a smoke-free building, and of those who did not but had voluntary smoke-free home rules, 44% reported incursions in their unit. 19 In New York State, 46.2% of residents of MUH reported experiencing an incursion in their home, and more than 9% experienced incursions daily. 20 Other local studies have shown similar rates of SHS incursions in MUH. 21,22 In 2012, the US Department of Housing and Urban Development (HUD) reissued recommendations that strongly encouraged all of their housing units go smoke-free 23 ; however, this is not yet a requirement, and policies regulating SHS exposure in personal living spaces remain limited. 22 Estimates show that although most residents of MUH would prefer to live in a smoke-free environment, 20,22 most MUH developments do not have comprehensive smoke-free policies. 22 We reported on a national survey of MUH residents to examine factors associated with tobacco smoke incursions. We hypothesized that type of smoke-free building policy (comprehensive, partial, or none) would be associated with prevalence of reported SHS incursions.
