Secondhand tobacco smoke exposure among hospitalized nonsmokers with coronary heart disease

Asking the Right Questions About Secondhand Smoke

INTRODUCTION

Despite knowledge about major health effects of secondhand tobacco smoke (SHS) exposure, systematic incorporation of SHS screening and counseling in clinical settings has not occurred.

METHODS

A three-round modified Delphi Panel of tobacco control experts was convened to build consensus on the screening questions that should be asked and identify opportunities and barriers to SHS exposure screening and counseling. The panel considered four questions: (1) what questions should be asked about SHS exposure; (2) what are the top priorities to advance the goal of ensuring that these questions are asked; (3) what are the barriers to achieving these goals; and (4) how might these barriers be overcome. Each panel member submitted answers to the questions. Responses were summarized and successive rounds were reviewed by panel members for consolidation and prioritization.

RESULTS

Panelists agreed that both adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from any tobacco products in their usual environment. The panel found that consistent clinician training, quality measurement or other accountability, and policy and electronic health records interventions were needed to successfully implement consistent screening.

CONCLUSIONS

The panel successfully generated screening questions and identified priorities to improve SHS exposure screening. Policy interventions and stakeholder engagement are needed to overcome barriers to implementing effective SHS screening.

IMPLICATIONS

In a modified Delphi panel, tobacco control and clinical prevention experts agreed that all adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from tobacco products. Consistent training, accountability, and policy and electronic health records interventions are needed to implement consistent screening. Increasing SHS screening will have a significant impact on public health and costs.

Association between Household Exposure to Secondhand Smoke and Dental Caries among Japanese Young Adults: A Cross-Sectional Study

The long-term effects of secondhand smoke (SHS) on dental caries among Japanese young adults remain unclear. The purpose of this cross-sectional study was to evaluate whether household exposure to SHS is associated with dental caries in permanent dentition among Japanese young adults. The study sample included 1905 first-year university students (age range: 18–19 years) who answered a questionnaire and participated in oral examinations. The degree of household exposure to SHS was categorized into four levels according to the SHS duration: no experience (−), past, current SHS < 10 years, and current SHS ≥ 10 years. Dental caries are expressed as the total number of decayed, missing, and filled teeth (DMFT) score. The relationships between SHS and dental caries were determined by logistic regression analysis. DMFT scores (median (25th percentile, 75th percentile)) were significantly higher in the current SHS ≥ 10 years (median: 1.0 (0.0, 3.0)) than in the SHS—(median: 0.0 (0.0, 2.0)); p = 0.001). DMFT ≥ 1 was significantly associated with SHS ≥ 10 years (adjusted odds ratio: 1.50, 95% confidence interval: 1.20–1.87, p < 0.001). Long-term exposure to SHS (≥10 years) was associated with dental caries in permanent dentition among Japanese young adults.

Second-Hand Smoke Exposure Among Coronary Heart Disease Patients

Purpose

The objectives of this study were to assess second-hand smoke (SHS) exposure among coronary heart disease (CHD) patients at home, in transportation, workplace, public and social places; to examine the demographic factors that predict SHS exposure; and to investigate the relationship between SHS exposure and CHD complications, age at the time of diagnosis, and number of admissions in the last year.

Patients and Methods

A descriptive cross-sectional design was used with a convenient sample of 400 CHD patients from three hospitals in Jordan. A modified version of the Smoking Scale for Adults (SS-A) was used.

Results

The percentage of SHS exposure was 64% in public places, 51.5% in social places, 48.5% in the household, 31% in transportation, while it was only 14.8% in the workplace. In addition, being male, employed, having a younger age and lower education significantly predicted higher exposure to SHS. Exposure to SHS was positively associated with CHD complications and the number of admissions, while it was negatively associated with the age at diagnosis with CHD.

Conclusion

Collaboration is needed among all health care sectors to adopt educational strategies about SHS exposure and to activate policies to prohibit smoking in public places.

Secondhand Smoke Exposure Among High-Risk Patients in the United States (NHANES 2001-2012): Implications for Clinical Practice

INTRODUCTION

Patients with cancer, cardiovascular disease (CVD), and respiratory disease are susceptible to health consequences related to secondhand smoke (SHS) exposure. This study examined the prevalence, time trends, and correlates of SHS exposure among these patients compared with individuals without these diseases (control).

METHODS

Data were obtained from the 2001-2012 National Health and Nutrition Examination Survey. All adults (≥20 years old) who were nonsmokers and exposed to SHS (serum cotinine level 0.015-10 ng/mL), had cancer (n = 1,440), CVD (congestive heart failure, coronary heart disease, angina, heart attack, or stroke; n = 1,754), respiratory disease (asthma, chronic bronchitis, emphysema; n = 1,444), or none of these diseases (control; n = 11,615) were included in the analysis. Weighted prevalence, weighted second-degree polynomial linear regression of prevalence on year for trend analysis, and multivariable logistic regression analyses were performed with adjustments to the complex survey design.

RESULTS

SHS exposure was the highest among patients with respiratory disease (72.1%), followed by patients with CVD (70.6%), controls (70.4%), and patients with cancer (65.4%). From 2001 to 2012, exposure decreased the most among CVD patients (19.6%), followed by controls (16.0%), cancer patients (14.7%), and respiratory patients (10.0%). Exposed individuals in all groups were more likely to be younger, Black, and less educated. Exposed patients with respiratory disease were more likely to be former smokers (p < .05 for all).

CONCLUSIONS

SHS exposure among these patients is high and comparable to the general population. Strengthening smoke-free policies in all settings is critical. More efforts are needed to address SHS exposure more effectively in clinical care settings.

IMPLICATIONS

Despite the negative health effect of SHS exposure among patients with cancer, CVD, and respiratory disease, modest progress has been made in reducing their exposure. Continued efforts to strengthen smoke-free policies in workplaces, public place, and multiunit housing is critical. In addition, exposure to SHS among these patients seems to be overlooked in clinical care settings. More efforts are needed to address this problem more effectively in health care settings and investigate specific interventions directed at increasing patients' awareness about the risk of exposure to SHS and helping them to reducing their exposure.

Reduced Thalamus Volume May Reflect Nicotine Severity in Young Male Smokers

Introduction

Nicotine acts as an agonist at presynaptic nicotinic acetylcholine receptors and to facilitate synaptic release of several neurotransmitters including dopamine and glutamate. The thalamus has the highest density of nicotinic acetylcholine receptors in the brain, which may make this area more vulnerable to the addictive effects of nicotine. However, the volume of thalamus abnormalities and the association with smoking behaviors in young smokers remains unknown.

Methods

Thirty-six young male smokers and 36 age-, gender- and education-matched nonsmokers participated in the current study. The nicotine dependence severity and cumulative effect were assessed with the Fagerström test for nicotine dependence (FTND) and pack-years. We used subcortical volume analyses method in FreeSurfer to investigate the thalamus volume differences between young smokers and nonsmokers. Correlation analysis was used to investigate the relationship between thalamus volume and smoking behaviors (pack-years and FTND) in young smokers.

Results and Conclusions

Relative to nonsmokers, the young smokers showed reduced volume of bilateral thalamus. In addition, the left thalamus volume was correlated with FTND in young smokers. It is hoped that our findings can shed new insights into the neurobiology of young smokers.

Implications

In this article, we investigated the changes of thalamus volume in young male smokers compared with nonsmokers. Reduced left thalamus volume was correlated with FTND in young smokers, which may reflect nicotine severity in young male smokers.

Immune-regulating effects of exercise on cigarette smoke-induced inflammation

Long-term cigarette smoking (LTCS) represents an important risk factor for cardiac infarction and stroke and the central risk factor for the development of a bronchial carcinoma, smoking-associated interstitial lung fibrosis, and chronic obstructive pulmonary disease. The pathophysiologic development of these diseases is suggested to be promoted by chronic and progressive inflammation. Cigarette smoking induces repetitive inflammatory insults followed by a chronic and progressive activation of the immune system. In the pulmonary system of cigarette smokers, oxidative stress, cellular damage, and a chronic activation of pattern recognition receptors are described which are followed by the translocation of the NF-kB, the release of pro-inflammatory cytokines, chemokines, matrix metalloproteases, and damage-associated molecular patterns. In parallel, smoke pollutants cross directly through the alveolus-capillary interface and spread through the systemic bloodstream targeting different organs. Consequently, LTCS induces a systemic low-grade inflammation and increased oxidative stress in the vascular system. In blood, these processes promote an increased coagulation and endothelial dysfunction. In muscle tissue, inflammatory processes activate catabolic signaling pathways followed by muscle wasting and sarcopenia. In brain, several characteristics of neuroinflammation were described. Regular exercise training has been shown to be an effective nonpharmacological treatment strategy in smoke-induced pulmonary diseases. It is well established that exercise training exerts immune-regulating effects by activating anti-inflammatory signaling pathways. In this regard, the release of myokines from contracting skeletal muscle, the elevations of cortisol and adrenalin, the reduced expression of Toll-like receptors, and the increased mobilization of immune-regulating leukocyte subtypes might be of vital importance. Exercise training also increases the local and systemic antioxidative capacity and several compensatory mechanisms in tissues such as an increased anabolic signaling in muscle or an increased compliance of the vascular system. Accordingly, regular exercise training seems to protect long-term smokers against some important negative local and systemic consequences of smoking. Data suggest that it seems to be important to start exercise training as early as possible.

Prevalence and socioeconomic inequalities in indoor exposure to secondhand smoke at home among children 0-5years in Ghana

BACKGROUND

Daily exposure to secondhand smoke (ESHS) among children can be fatal for their health. With increasing prevalence of smoking in low-income countries, particularly among low socioeconomic status (SES) groups amidst poor tobacco legislations, children in these countries can be at risk of ESHS at home. This study investigated the prevalence and socioeconomic inequalities in indoor daily of ESHS at home among children aged 0-5years in Ghana.

METHODS

Population-based data collected through interviews in 2014 in 4616 households, 98.5% response rate, were used. Logistic regression analyses were used to investigate socioeconomic inequalities in daily ESHS among children at home.

RESULTS

One out of every ten children was exposed to daily secondhand smoke at home. The proportion of children's ESHS by wealth quintile ranges from richest (6.5%) to poorest (46.3%). Children of male-headed households were at higher risk of daily ESHS (OR 1.71, CI 1.27-2.31). A child living in a household where the head had no formal education had four folds the risk of daily ESHS compared with another in a household headed by a person with higher educational attainment. In rural setting, a child living in a poorest household (measured by wealth index) had more than two folds the risk of daily ESHS compared with another in the richest household. Correspondingly, a child living in the poorest household in an urban area had 8 times (OR 8.05, CI 4.03-16.08) the risk of daily ESHS compared with the counterpart in the richest household.

CONCLUSIONS

Children from socioeconomically disadvantaged and male-headed households both in rural and urban areas were at higher risk of daily ESHS at homes. However, children in the poorest households in urban areas had the highest concentration of ESHS among socioeconomically disadvantaged children. Interventions to end smoking indoors at home is urgently needed to protect children from its harmful effects.

Coronary Atherosclerosis: Pathophysiologic Basis for Diagnosis and Management

Coronary atherosclerosis is a long lasting and continuously evolving disease with multiple clinical manifestations ranging from asymptomatic to stable angina, acute coronary syndrome (ACS), heart failure (HF) and sudden cardiac death (SCD). Genetic and environmental factors contribute to the development and progression of coronary atherosclerosis. In this review, current knowledge related to the diagnosis and management of coronary atherosclerosis based on pathophysiologic mechanisms will be discussed. In addition to providing state-of-the-art concepts related to coronary atherosclerosis, special consideration will be given on how to apply data from epidemiologic studies and randomized clinical trials to the individual patient. The greatest challenge for the clinician in the twenty-first century is not in absorbing the fast accumulating new knowledge, but rather in applying this knowledge to the individual patient.

The implication of frontostriatal circuits in young smokers: A resting-state study

The critical roles of frontostriatal circuits had been revealed in addiction. With regard to young smokers, the implication of frontostriatal circuits resting-state functional connectivity (RSFC) in smoking behaviors and cognitive control deficits remains unclear. In this study, the volume of striatum subsets, i.e., caudate, putamen, and nucleus accumbens, and corresponding RSFC differences were investigated between young smokers (n1  = 60) and nonsmokers (n2  = 60), which were then correlated with cigarette smoking measures, such as pack_years-cumulative effect of smoking, Fagerström Test for Nicotine Dependence (FTND)-severity of nicotine addiction, Questionnaire on Smoking Urges (QSU)-craving state, and Stroop task performances. Additionally, mediation analysis was carried out to test whether the frontostriatal RSFC mediates the relationship between striatum morphometry and cognitive control behaviors in young smokers when applicable. We revealed increased volume of right caudate and reduced RSFC between caudate and dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex in young smokers. Significant positive correlation between right caudate volume and QSU as well as negative correlation between anterior cingulate cortex-right caudate RSFC and FTND were detected in young smokers. More importantly, DLPFC-caudate RSFC strength mediated the relationship between caudate volume and incongruent errors during Stroop task in young smokers. Our results demonstrated that young smokers showed abnormal interactions within frontostriatal circuits, which were associated with smoking behaviors and cognitive control impairments. It is hoped that our study focusing on frontostriatal circuits could provide new insights into the neural correlates and potential novel therapeutic targets for treatment of young smokers. Hum Brain Mapp 37:2013-2026, 2016. © 2016 Wiley Periodicals, Inc.

Smoking determines the 10-year (2004-2014) prognosis in patients with Acute Coronary Syndrome: the GREECS observational study

Background

Smoking has long been positively associated with the development and progression of coronary heart disease. However, longitudinal cohort studies evaluating smoking habits among cardiac patients as well as the role of socio-demographic factors determining such behaviours are scarce and have been focused on primary care practice. Thus the aim of the present work was to examine the association of active smoking and behaviours and exposure to second-hand smoke, with the 10-year Acute Coronary Syndrome (ACS) prognosis, among cardiovascular patients.

Methods

From October 2003 to September 2004, a sample of six Greek hospitals was selected and almost allconsecutive 2172 ACS patients were enrolled. In 2013–14, the 10-year follow-up was performed in 1918 participants (11 % loss to follow-up). Smoking habits at the time of entry to the study, as well as during the follow-up period were studied using a standard questionnaire.

Results

Patients who had >60 pack-years of smoking had 57.8 % higher ACS mortality and 24.6 % higher risk for any ACS event. Nested model, adjusted only for age and sex, revealed that for every 30 pack-years of smoking increase, the associated ACS risk increased by 13 % (95 % CI 1.03, 1.30, p = 0.001). When further adjusted analysis, including several potential confounders, was applied the tested relationship was still significant (95 %CI 1.03, 1.30, p = 0.09). Accordingly, the risk for fatal ACS events increased by 8 % for every 30 pack-years of smoking increase (95 % CI 1.03, 1.63, p = 0.06). Moreover, 52 % of the patients reported being exposed to secondhand smoke and when further adjustments were made, it was revealed that they had 33 % (95 % CI 1.12, 1.60, p = 0.01) higher risk of having recurrent ACS events.

Conclusions

Active smoking and second-hand smoke among cardiac patients still represent a substantial clinical burden. Thus, smoking cessation policies should be incorporated into the long-term therapeutic management.