Reducing secondhand smoke exposure and tobacco disparities is personal for this researcher

As a child, researcher Surendranath Shastri, M.D., D.Ph., worshiped his dad. “He was a lifetime smoker, so I thought it was cool to smoke,” says Shastri. “I started smoking around age 18, about the same time I started medical school.”

By his early 20s, Shastri was smoking two packs of cigarettes a day. He lived in India, where smoking was a big part of the culture. Shastri recalls cigarettes were given as a party favor to guests at his wedding.

He knew smoking was dangerous to his own health, but that wasn’t enough to motivate him to quit, despite pleas from his wife. At the time, scientific evidence was still being gathered on the harms of secondhand smoke exposure, and that’s what finally convinced Shastri to quit.   

“When my wife told me she was pregnant with our first child, the first thing that came to my mind was, ‘I must do everything I can to take care of this baby,’” Shastri recalls. “My wife asked me to start by giving up smoking.”

Thinking about the potential effects on their unborn daughter provided strong enough motivation for him to permanently quit smoking at age 26. His daughter is now a doctor with her own children. Shastri is a physician and researcher studying health disparities in cancer, including tobacco use.

Secondhand smoke is harmful

The same year that Shastri quit smoking, the first Surgeon General’s Report dedicated to the health effects of secondhand smoke was released. We now know that secondhand smoke exposure, which includes the smoke directly from a burning cigarette as well as the smoke exhaled by someone smoking, can cause serious health problems in non-smokers, including lung cancer.

“It’s a big myth that secondhand smoke exposure is not as harmful as smoking,” Shastri says. “Secondhand smoke exposure is equally harmful, particularly for young children whose respiratory systems are not as developed and for women who are pregnant.”

According to the Surgeon General, 2.5 million non-smokers have died due to secondhand smoke exposure since 1964. Secondhand smoke exposure can cause heart disease, stroke and sudden infant death syndrome. More than 7,300 nonsmokers die each year from lung cancer caused by exposure to secondhand smoke.

Disparities in secondhand smoke exposure

“The science shows that the health effects from secondhand smoke exposure are long-lasting,” Shastri says. “Although we’ve made progress in the US in reducing secondhand smoke exposure, that progress has stalled over the last decade, and disparities persist.”

From 1988 to 2012, secondhand smoke exposure among non-smokers declined from 87.5% to 25.3%. The latest available data shows the rates have barely decreased since then, to 24.6% in 2018. Shastri and Sanjay Shete, Ph.D., recently published a study in JAMA Internal Medicine that analyzed data on secondhand smoke from 2011-2018 to determine how common the problem is currently.

“We found very clear disparities in terms of who is exposed to secondhand smoke,” Shastri says. “There are significantly higher rates of secondhand smoke exposure in children ages 3 to 11, non-Hispanic Black individuals, and people living below the poverty line, in rental housing or without a high school education.”

Strategies to reduce secondhand smoke exposure

After beginning his career in internal medicine, Shastri was recruited to establish and lead the Preventive Oncology department at one of India’s largest cancer hospitals. In this role, he created the Smokefree Mumbai Campaign and implemented tobacco cessation clinics at cancer centers throughout the country. He’s continued to work on tobacco control projects since joining MD Anderson’s Health Disparities Research team in 2018. 

Shastri’s team is currently working on a pilot project to address secondhand smoke exposure among public housing residents in Houston. The project will begin with a blood test to measure the baseline secondhand smoke exposure levels among non-smoking residents, followed by a series of interventions to identify and fill gaps in existing resources designed to help residents and property managers comply with the 2017 Smoke-Free Public Housing Rule. The project will also offer free, onsite tobacco cessation therapy to residents who smoke. After one year, the team will measure secondhand smoke exposure levels among non-smoking residents again to see if the interventions made a difference.

“It’s critical that we prioritize strategies to reduce secondhand smoke exposure among the groups who are disproportionally affected and may have long-term health issues as a result,” Shastri says. “I can’t think of a more powerful motivation to quit smoking than the health of your loved ones.”

MD Anderson offers resources for individuals who want to quit smoking, including smoking cessation studies for Texas residents and Tobacco Treatment Program for MD Anderson patients and employees. Anyone can call 1-800-QUIT-NOW or visit smokefree.gov to be connected to free quitting resources in their state.