An Epidemiological Study of Population Health Reveals Social Smoking as a Major Cardiovascular Risk Factor

Am J Health Promot. 2018 Jun;32(5):1221-1227. doi: 10.1177/0890117117706420. Epub 2017 May 2.


Purpose: To present nationally representative data on the prevalence of "social" smoking and its relationship to cardiovascular health.

Design: A population-based, cross-sectional survey on cardiovascular health and its risk factors across the United States.

Setting: Million Hearts® cardiovascular screenings that took place in community settings.

Participants: De-identified data were collected on a convenient sample of 39, 555 participants.

Measures: Reported smoking status, blood pressure, and total cholesterol.

Analysis: The prevalence of current smoking, social smoking, and non-smoking were cross-tabulated and stratified by sample characteristics. The adjusted estimates were derived from multiple logistic regression models, adjusting for demographics and other biometric measures.

Results: Ten percent identified as social smokers. Social smokers were more likely to be aged between 21 and 40, male, and Hispanic. Social smokers had significantly higher risks of having hypertension (odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.80-2.41) and elevated cholesterol (OR: 1.53, 95% CI: 1.33-1.75) than non-smokers. There was no significant difference between social smokers and current smokers (OR = 0.94, 95% CI = 0.80-1.14 for hypertension and OR = 0.95, 95% CI = 0.81-1.11 for elevated cholesterol).

Conclusion: This is the first population health study to compare the blood pressure and cholesterol levels of people who self-identify as current verses social smokers. Although previous smoking behavior was not controlled for in the analysis, this study demonstrates there is no significant difference in the prevalence of elevated blood pressure or cholesterol among the 2 smoking groups.

Keywords: health promotion; heart disease; million hearts®; population health; smoking.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / chemically induced*
  • Cross-Sectional Studies
  • Epidemiologic Studies
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Population Surveillance*
  • Prevalence
  • Risk Factors
  • Social Behavior*
  • Tobacco Smoking / adverse effects*
  • Tobacco Smoking / epidemiology*
  • United States
  • Young Adult