CO and Cigarettes: A Healthy Housing Reflection for the Great American Smokeout

by Amanda L. Reddy

This blog was published on November 20, 2025, in observance of the Great American Smokeout. This event is held on the third Thursday of November each year to encourage and support smokers who want to take the first step toward a smoke-free life. Learn more at cancer.org/smokeout.

A snapshot of Gordon and Amanda Reddy at a preschool Father’s Day celebration, 1982. As Amanda reflects, “This photograph has graced the walls of every dorm room, apartment, or home I have ever lived in and reminds me every day of how lucky I was to have this man for a father.”

When I was growing up, I worried constantly about my dad’s smoking. I worried about what it was doing to his lungs. I worried about secondhand smoke and what it meant for the rest of the family. I worried about fire risks. I worried about addiction. I worried about the smell in my dad’s car and on his hands and clothes.

What I never worried about—not once—was carbon monoxide.

It didn’t occur to me until much later in life, after I had already begun working in healthy housing, that smoking produces carbon monoxide (CO). Not just outdoors. Not just in enclosed cars. But indoors, right where families live, breathe, sleep, and raise their children.

CO is an invisible, odorless gas. It’s a byproduct of incomplete combustion. And it’s present in surprisingly high quantities in tobacco smoke.

In homes where smoking occurs indoors, CO contributes to a baseline of chronic low-level exposure that most families don’t even know is happening. And in some homes, that exposure adds to the load from fuel-burning appliances, poor ventilation, attached garages, portable generators, and seasonal space heaters.

Looking back, I realize that while I spent years worrying about the harms everyone talks about—cancer, COPD, asthma, secondhand smoke, fire risk—I completely missed this one. And I say that without judgment. Because most families miss it, too.

Smoking is only one of many overlooked sources of CO in American homes. Year after year, families are exposed to CO because of:

• Aging furnaces that haven’t been serviced,

• Fireplaces and wood stoves that vent poorly,

• Attached garages where cars idle,

• Portable generators used during power outages,

• Range hoods that don’t vent outdoors,

• Space heaters that aren’t designed for indoor use,

• Poor airflow in multiunit buildings that allows CO to travel between units,

• And more (which you can read about elsewhere on this site: https://www.ncoaa.us/).

CO doesn’t give warning signs. It doesn’t smell. You can’t see it building. And by the time symptoms appear (often dizziness, confusion, nausea, headache), families may not realize the source is environmental, not viral. Too often, the danger is dismissed as “just the flu.”

When I think about my childhood home, I smile. I think about all the laughter and joy and important moments we shared there. My home represented safety, not danger. Nobody in my house was intentionally ignoring the presence of CO or lead or any other potential hazard. Those kinds of risks were simply invisible. That doesn’t make my family or any other family irresponsible. But it does highlight the responsibility of the systems around them (housing providers, local governments, code officials, product manufacturers, clinicians, and public health professionals) to communicate risk clearly and compassionately.

After all, healthy housing isn’t just about the absence of visible hazards like mold, pests, or peeling paint. It requires attention to the environmental factors no one can see without the right knowledge and tools. And it requires the humility to acknowledge that people don’t make choices in a vacuum—they make choices within the constraints, pressures, cultural norms, and built environments that surround them.

Like many other healthy housing challenges, CO risk sits at the intersection of behavior, building systems, and environmental design. That’s why the solutions must be just as integrated.

What families can do—and what systems must do

Families deserve simple, actionable guidance, like:

• Using working CO alarms on every level of the home and near sleeping areas.

• Never using outdoor-rated equipment (like generators or grills) indoors or in garages.

• Maintaining furnaces, stoves, and water heaters annually. If you’re able, consider swapping out gas appliances for electric alternatives.

• Smoking outside (ideally while you work towards quitting).

• Knowing the symptoms of CO exposure (and taking them seriously).

But families cannot solve this alone.

Property owners, building managers, HVAC contractors, clinical providers, public health agencies, and policymakers each play a role. From requiring CO alarms in all units (not just some), to supporting smoke-free building policies, to better training for HVAC professionals, to increased awareness among healthcare providers, to providing resources for appliance maintenance, the broader system shapes whether families are truly protected.

"The most important step is acknowledging that unhealthy CO exposure is predictable, preventable, and not as rare as it should be. And it is everyone’s responsibility." - Amanda Reddy, NCOAA Board Member and Executive Director of the National Center for Healthy Housing

A personal closing note

As part of the National Center for Healthy Housing’s recognition of the Great American Smokeout this week, I also shared a personal reflection about losing my father to smoking-related COPD and what it taught me about my work in public health. I didn’t write that piece thinking about carbon monoxide. But as soon as it was finished, I realized that there was a risk I never saw, a hazard my family never fully understood, and an opportunity to connect these stories now.

If sharing a fuller picture of indoor air hazards helps even one family breathe safer this winter or helps one practitioner consider the invisible dimensions of health, then it’s worth telling both stories.

You can read that reflection here: When Smoking Hits Home: What My Father’s Story Taught Me About Public Health and Healthy Housing

For more information about carbon monoxide: https://www.ncoaa.us/

Amanda Reddy, MS, is the Executive Director of the National Center for Healthy Housing (NCHH) and a member of the Board of Directors of the National Carbon Monoxide Awareness Association (NCOAA). She leads a national effort to advance housing as a platform for health and equity, drawing on more than two decades of experience in environmental health, indoor air quality, and systems-level policy change.

Amanda often says she “took a job and found a calling,” but her path into healthy housing actually began with carbon monoxide. Her master’s thesis focused on carbon monoxide exposure, which led to her first position as a research scientist supporting New York State Department of Health programs to improve indoor and outdoor air quality in homes, schools, workplaces, and community settings. That early work on CO and air quality continues to shape her perspective today.

At NCHH, Amanda works with communities across the country to prevent housing-related illness and injury through evidence-based and equitable solutions. She is a nationally recognized voice at the intersection of housing and health and has served as a strategic and technical advisor to federal, state, and local agencies and organizations. Under her leadership, NCHH has strengthened its impact, visibility, and partnerships, helping advance lasting systems change.

She holds degrees in environmental health from the London School of Hygiene and Tropical Medicine and neuroscience from Mount Holyoke College.