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Fischer F, Minnwegen M, Kaneider U, Kraemer A, Khan MMH. Prevalence and determinants of secondhand smoke exposure among women in Bangladesh, 2011. Nicotine Tob Res 2014; 17:58-65. [PMID: 25125322 DOI: 10.1093/ntr/ntu129] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES The population of Bangladesh is highly susceptible to secondhand smoke (SHS) exposure due to high smoking rates and low awareness about the harmful effects of SHS. This study aims to determine the prevalence of SHS exposure and highlight the essential determinants in developing successful strategies to prevent adverse health effects in Bangladesh. METHODS The analysis is based on the Bangladesh Demographic Health Survey 2011, in which 17,749 women in the reproductive age group (12-49 years) were included. The information regarding SHS exposure at home was derived from the question: "How often does anyone smoke inside your house?" The variable was recoded into 3 groups: daily exposure, low exposure (exposed weekly, monthly, or less than monthly), and no SHS exposure. We performed descriptive and bivariable analyses and multinomial logistic regression. RESULTS A total of 46.7% of the women reported high exposure to SHS at home. According to the multinomial logistic regression model, relatively lower education and lower wealth index were significantly associated with daily SHS exposure at home. The exposure differed significantly between the divisions of Bangladesh. Having children at home (vs. not) and being Islamic (compared to other religious affiliations) were protective factors. CONCLUSIONS The study indicates that women from socioeconomically disadvantaged households are more likely to experience daily exposure to SHS at home. Therefore, especially these groups have to be targeted to reduce tobacco consumption. In addition to aspects of legislation, future strategies need to focus educational aspects to improve the population's health status in Bangladesh.
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Affiliation(s)
- Florian Fischer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Germany
| | - Martina Minnwegen
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Germany
| | - Ulrike Kaneider
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Germany
| | - Alexander Kraemer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Germany
| | - Md Mobarak Hossain Khan
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Germany
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102
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Galán I, Mayo E, López MJ, Pérez-Ríos M, Fu M, Martínez-Sánchez JM, Schiaffino A, Moncada A, Montes A, Nebot M, Fernández E. Validity of self-reported exposure to second-hand smoke in hospitality venues. ENVIRONMENTAL RESEARCH 2014; 133:1-3. [PMID: 24906061 DOI: 10.1016/j.envres.2014.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/14/2014] [Accepted: 04/23/2014] [Indexed: 06/03/2023]
Abstract
The aim was to assess the validity of self-reported exposure to second-hand smoke (SHS) in 50 hospitality venues of Madrid (Spain) in 2010, taking as a reference vapour-phase nicotine measured by active sampling. The questions posed in the questionnaire permitted distinguishing between the different levels of SHS. However, the moderate relationship found (Spearman׳s correlation=0.387, p<0.001) suggests that intensity of exposure to SHS in hospitality venues, based solely on self-reported information, should be used with caution.
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Affiliation(s)
- Iñaki Galán
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain.
| | - Elga Mayo
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - María J López
- Public Health Agency of Barcelona, Barcelona, Spain; Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Spain; Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Mónica Pérez-Ríos
- Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Spain; Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d׳ Oncologia - ICO, L׳Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d׳Investigació Biomèdica de Bellvitge - IDIBELL, L׳Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine-Campus de Bellvitge, Universitat de Barcelona, L׳Hospitalet de Llobregat, Barcelona, Spain
| | - Jose M Martínez-Sánchez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d׳ Oncologia - ICO, L׳Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d׳Investigació Biomèdica de Bellvitge - IDIBELL, L׳Hospitalet de Llobregat, Barcelona, Spain; Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Anna Schiaffino
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d׳ Oncologia - ICO, L׳Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Moncada
- Community Health Unit, Terrassa City Council, Terrassa, Spain
| | - Agustín Montes
- Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Spain; Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manel Nebot
- Public Health Agency of Barcelona, Barcelona, Spain; Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Spain; Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d׳ Oncologia - ICO, L׳Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d׳Investigació Biomèdica de Bellvitge - IDIBELL, L׳Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine-Campus de Bellvitge, Universitat de Barcelona, L׳Hospitalet de Llobregat, Barcelona, Spain
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103
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Xie C, Wen X, Niu Z, Ding P, Liu T, He Y, Lin J, Yuan S, Guo X, Jia D, Chen W. Comparison of secondhand smoke exposure measures during pregnancy in the development of a clinical prediction model for small-for-gestational-age among non-smoking Chinese pregnant women. Tob Control 2014; 24:e179-87. [PMID: 25052864 DOI: 10.1136/tobaccocontrol-2014-051569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/25/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare predictive values of small-for-gestational-age (SGA) by different measures for secondhand smoke (SHS) exposure during pregnancy and to develop and validate a prediction model for SGA using SHS exposure along with sociodemographic and pregnancy factors. METHODS We compared the predictability of different measures of SHS exposure during pregnancy for SGA among 545 Chinese pregnant women, and then used the optimal SHS measure along with other clinically available factors to develop and validate a prediction model for SGA. We fit logistic regression models to predict SGA by single measures of SHS exposure (self-report, serum cotinine and CYP2A6*4) and different combinations (self-report+cotinine, cotinine+CYP2A6*4, self-report+CYP2A6*4 and self-report+cotinine+CYP2A6*4). RESULTS We found that self-reported SHS exposure alone predicted SGA (area under the receiver operating characteristic curve or area under the receiver operating curve (AUROC), 0.578) better than the other two single measures (cotinine, 0.547; CYP2A6*4, 0.529) or as accurately as combined SHS measures (0.545-0.584). The final prediction model that contained self-reported SHS exposure, prepregnancy body mass index, gestational weight gain velocity during the second and third trimesters, gestational diabetes, gestational hypertension and the third-trimester biparietal diameter Z-score could predict SGA fairly accurately (AUROC, 0.698). CONCLUSIONS Self-reported SHS exposure at peribirth performs better in predicting SGA than a single measure of serum cotinine at the same time, although repeated biochemical cotinine assessments throughout pregnancy may be optimal. Our simple prediction model is fairly accurate and can be potentially used in routine prenatal care.
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Affiliation(s)
- Chuanbo Xie
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiaozhong Wen
- Division of Behavioural Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Zhongzheng Niu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Peng Ding
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yanhui He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jianmiao Lin
- Shenzhen Women and Children's Hospital, Shenzhen, China
| | - Shixin Yuan
- Shenzhen Women and Children's Hospital, Shenzhen, China
| | - Xiaoling Guo
- Foshan Women and Children's Hospital, Foshan, China
| | - Deqin Jia
- Foshan Women and Children's Hospital, Foshan, China
| | - Weiqing Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
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104
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Tong VT, Dietz PM, Rolle IV, Kennedy SM, Thomas W, England LJ. Clinical interventions to reduce secondhand smoke exposure among pregnant women: a systematic review. Tob Control 2014; 24:217-23. [PMID: 24789602 DOI: 10.1136/tobaccocontrol-2013-051200] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 04/01/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a systematic review of clinical interventions to reduce secondhand smoke (SHS) exposure among non-smoking pregnant women. DATA SOURCES We searched 16 databases for publications from 1990 to January 2013, with no language restrictions. STUDY SELECTION Papers were included if they met the following criteria: (1) the study population included non-smoking pregnant women exposed to SHS, (2) the clinical interventions were intended to reduce SHS exposure at home, (3) the study included a control group and (4) outcomes included either reduced SHS exposure of non-smoking pregnant women at home or quit rates among smoking partners during the pregnancy of the woman. DATA EXTRACTION Two coders independently reviewed each abstract or full text to identify eligible papers. Two abstractors independently coded papers based on US Preventive Services Task Force criteria for study quality (good, fair, poor), and studies without biochemically-verified outcome measures were considered poor quality. DATA SYNTHESIS From 4670 papers, we identified five studies that met our inclusion criteria: four focused on reducing SHS exposure among non-smoking pregnant women, and one focused on providing cessation support for smoking partners of pregnant women. All were randomised controlled trials, and all reported positive findings. Three studies were judged poor quality because outcome measures were not biochemically-verified, and two were considered fair quality. CONCLUSIONS Clinical interventions delivered in prenatal care settings appear to reduce SHS exposure, but study weaknesses limit our ability to draw firm conclusions. More rigorous studies, using biochemical validation, are needed to identify strategies for reducing SHS exposure in pregnant women.
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Affiliation(s)
- Van T Tong
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patricia M Dietz
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Italia V Rolle
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara M Kennedy
- Research Triangle Institute, International, Atlanta, Georgia, USA
| | - William Thomas
- Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucinda J England
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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105
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Rosen LJ, Myers V, Hovell M, Zucker D, Ben Noach M. Meta-analysis of parental protection of children from tobacco smoke exposure. Pediatrics 2014; 133:698-714. [PMID: 24664094 DOI: 10.1542/peds.2013-0958] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE. METHODS Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed. RESULTS Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P < .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD -0.05, CI -0.13 to 0.03, P = .20). CONCLUSIONS Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement.
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106
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Sureda X, Martínez-Sánchez JM, Fu M, Pérez-Ortuño R, Martínez C, Carabasa E, López MJ, Saltó E, Pascual JA, Fernández E. Impact of the Spanish smoke-free legislation on adult, non-smoker exposure to secondhand smoke: cross-sectional surveys before (2004) and after (2012) legislation. PLoS One 2014; 9:e89430. [PMID: 24586774 PMCID: PMC3937341 DOI: 10.1371/journal.pone.0089430] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/20/2014] [Indexed: 11/19/2022] Open
Abstract
Background In 2006, Spain implemented a national smoke-free legislation that prohibited smoking in enclosed public places and workplaces (except in hospitality venues). In 2011, it was extended to all hospitality venues and selected outdoor areas (hospital campuses, educational centers, and playgrounds). The objective of the study is to evaluate changes in exposure to secondhand smoke among the adult non-smoking population before the first law (2004-05) and after the second law (2011–12). Methods Repeated cross-sectional survey (2004–2005 and 2011–2012) of a representative sample of the adult (≥16 years) non-smoking population in Barcelona, Spain. We assess self-reported exposure to secondhand smoke (at home, the workplace, during leisure time, and in public/private transportation vehicles) and salivary cotinine concentration. Results Overall, the self-reported exposure to secondhand smoke fell from 75.7% (95%CI: 72.6 to 78.8) in 2004-05 to 56.7% (95%CI: 53.4 to 60.0) in 2011–12. Self-reported exposure decreased from 32.5% to 27.6% (−15.1%, p<0.05) in the home, from 42.9% to 37.5% (−12.6%, p = 0.11) at work/education venues, from 61.3% to 38.9% (−36.5%, p<0.001) during leisure time, and from 12.3% to 3.7% (−69.9%, p<0.001) in public transportation vehicles. Overall, the geometric mean of the salivary cotinine concentration in adult non-smokers fell by 87.2%, from 0.93 ng/mL at baseline to 0.12 ng/mL after legislation (p<0.001). Conclusions Secondhand smoke exposure among non-smokers, assessed both by self-reported exposure and salivary cotinine concentration, decreased after the implementation of a stepwise, comprehensive smoke-free legislation. There was a high reduction in secondhand smoke exposure during leisure time and no displacement of secondhand smoke exposure at home.
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Affiliation(s)
- Xisca Sureda
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Jose M. Martínez-Sánchez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Biostatistic Unit, Department of Basic Science, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Satn Cugat del Valles, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Raúl Pérez-Ortuño
- Bioanalysis Research Group, Neuropsychopharmacology Programme, IMIM-Hospital del Mar Research Institute, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Catalan Network of Smoke-free Hospitals, Insitut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - Esther Carabasa
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Catalan Network of Smoke-free Hospitals, Insitut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María J. López
- Evaluation and Interventions Methods Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica-IBB Sant Pau, Barcelona, Spain
| | - Esteve Saltó
- Public Health Agency, Ministry of Health, Generalitat de Catalunya, Barcelona, Spain
- Department of Public Health, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - José A. Pascual
- Bioanalysis Research Group, Neuropsychopharmacology Programme, IMIM-Hospital del Mar Research Institute, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
- Catalan Network of Smoke-free Hospitals, Insitut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- * E-mail:
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107
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Prochaska JJ, Grossman W, Young-Wolff KC, Benowitz NL. Validity of self-reported adult secondhand smoke exposure. Tob Control 2013; 24:48-53. [PMID: 23997071 DOI: 10.1136/tobaccocontrol-2013-051174] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Exposure of adults to secondhand smoke (SHS) has immediate adverse effects on the cardiovascular system and causes coronary heart disease. The current study evaluated brief self-report screening measures for accurately identifying adult cardiology patients with clinically significant levels of SHS exposure in need of intervention. DESIGN AND SETTING A cross-sectional study conducted in a university-affiliated cardiology clinic and cardiology inpatient service. PATIENTS Participants were 118 non-smoking patients (59% male, mean age=63.6 years, SD=16.8) seeking cardiology services. MAIN OUTCOME MEASURES Serum cotinine levels and self-reported SHS exposure in the past 24 h and 7 days on 13 adult secondhand exposure to smoke (ASHES) items. RESULTS A single item assessment of SHS exposure in one's own home in the past 7 days was significantly correlated with serum cotinine levels (r=0.41, p<0.001) with sensitivity ≥75%, specificity >85% and correct classification rates >85% at cotinine cut-off points of >0.215 and >0.80 ng/mL. The item outperformed multi-item scales, an assessment of home smoking rules, and SHS exposure assessed in other residential areas, automobiles and public settings. The sample was less accurate at self-reporting lower levels of SHS exposure (cotinine 0.05-0.215 ng/mL). CONCLUSIONS The single item ASHES-7d Home screener is brief, assesses recent SHS exposure over a week's time, and yielded the optimal balance of sensitivity and specificity. The current findings support use of the ASHES-7d Home screener to detect SHS exposure and can be easily incorporated into assessment of other major vital signs in cardiology.
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Affiliation(s)
- Judith J Prochaska
- Department of Medicine, Stanford University, Stanford Prevention Research Center, Stanford, California, USA
| | - William Grossman
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, USA
| | - Kelly C Young-Wolff
- Department of Medicine, Stanford University, Stanford Prevention Research Center, Stanford, California, USA
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering and Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, San Francisco, California, USA
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