Exposure to environmental tobacco smoke in a general population

Second-Hand Smoke Exposure Associated with Risk of Respiratory Symptoms, Asthma, and COPD in 20,421 Adults from the General Population

Rationale

Individuals exposed to second-hand smoking may be more susceptible to asthma and chronic obstructive pulmonary disease (COPD). We investigated the risk of respiratory symptoms, asthma, and COPD in adults exposed to second-hand smoking at different stages of life in the general population.

Methods

We identified individuals who had been exposed to second-hand smoking in childhood only, adulthood only, or lifelong in a cohort of 20,421 adults from the Danish General Suburban Population Study and recorded respiratory symptoms, lung function, asthma, and COPD as outcomes.

Results

Among 20,421 adults from the general population, 2,551 (12%) had been lifelong exposed to second-hand smoking, 459 (2%) had been exposed in adulthood only, and 13,998 (69%) had been exposed in childhood only; the mean ages of the three groups were 54 years, 55 years, and 57 years, respectably, compared with 56 years in non-exposed individuals (P<0.001). Equivalent values for the prevalence of current smoking were 25%, 20%, and 18% versus 12% (P<0.001). After adjustment for age, smoking, and sex, the odds ratios for wheezing, severe dyspnoea, cough on exertion, and asthma increased as a function of second-hand smoke exposure (Ps≤0.004); individuals who had been exposed to second-hand smoking lifelong, in adulthood only, or in childhood only versus non-exposed had increased odds ratios for wheezing of 1.62 (95% CI=1.41–1.87), 1.50 (1.15–1.94), and 1.16 (1.04–1.30). Corresponding values were 2.08 (1.52–2.85), 2.05 (1.22-3-44), and 1.23 (0.95–1.59) for severe dyspnoea, 1.56 (1.33–1.83), 1.53 (1.15–2.02), and 1.19 (1.05–1.35) for cough on exertion, 1.36 (1.14–1.63), 1.49 (1.09–2.05), and 1.13 (0.99–1.30) for asthma, and 1.24 (1.03–1.48), 1.25 (0.90–1.74), and 1.09 (0.96–1.24) for COPD. The population attributable fractions of asthma and COPD due to lifelong second-hand smoke exposure were 4.3% and 2.9%.

Conclusion

Individuals exposed to lifelong second-hand smoking have increased risks of respiratory symptoms, asthma, and COPD, and may account for 4.3% and 2.9% of people with asthma and COPD in the general population.

Affecting Factors of Secondhand Smoke Exposure in Korea: Focused on Different Exposure Locations

Exposure to secondhand smoke (SHS) not only can cause serious illness, but is also an economic and social burden. Contextual and individual factors of non-smoker exposure to SHS depend on location. However, studies focusing on this subject are lacking. In this study, we described and compared the factors related to SHS exposure according to location in Korea. Regarding individual factors related to SHS exposure, a common individual variable model and location-specific variable model was used to evaluate SHS exposure at home/work/public locations based on sex. In common individual variables, such as age, and smoking status showed different relationships with SHS exposure in different locations. Among home-related variables, housing type and family with a single father and unmarried children showed the strongest positive relationships with SHS exposure in both males and females. In the workplace, service and sales workers, blue-collar workers, and manual laborers showed the strongest positive association with SHS exposure in males and females. For multilevel analysis in public places, only SHS exposure in females was positively related with cancer screening rate. Exposure to SHS in public places showed a positive relationship with drinking rate and single-parent family in males and females. The problem of SHS embodies social policies and interactions between individuals and social contextual factors. Policy makers should consider the contextual factors of specific locations and regional and individual context, along with differences between males and females, to develop effective strategies for reducing SHS exposure.

A systematic review of secondhand tobacco smoke exposure and smoking behaviors: Smoking status, susceptibility, initiation, dependence, and cessation

OBJECTIVES

To examine the association between secondhand tobacco smoke exposure (SHSe) and smoking behaviors (smoking status, susceptibility, initiation, dependence, and cessation).

METHODS

Terms and keywords relevant to smoking behaviors and secondhand tobacco smoke exposure were used in a search of the PubMed database. Searches were limited to English language peer-reviewed studies up till December 2013. Included papers: a) had clearly defined measures of SHSe and b) had clearly defined measures of outcome variables of interest. A total of 119 studies were initially retrieved and reviewed. After further review of references from the retrieved studies, 35 studies were finally selected that met all eligibility criteria.

RESULTS

The reviewed studies consisted of thirty-five (89.7%) studies with differing measures of SHSe (including questionnaire and biological measures) and varying definitions of main outcome variables of interest between studies. The majority of the studies (77%) were cross-sectional in nature. The majority of studies found that SHSe was associated with greater likelihood of being a smoker, increased susceptibility and initiation of smoking, greater nicotine dependence among nonsmokers, and poorer smoking cessation.

CONCLUSIONS

The review found positive associations between SHSe and smoking status, susceptibility, initiation and nicotine dependence and a negative association with smoking cessation. In light of design limitations, future prospective and clinical studies are needed to better understand the mechanisms whereby SHSe influences smoking behaviors.

Tolerance for and potential indicators of second-hand smoke exposure among nonsmokers: a comparison of self-reported and cotinine verified second-hand smoke exposure based on nationally representative data

OBJECTIVE

We assessed the extent to which self-reported exposure to SHS underestimates the actual exposure to SHS and what factors are associated with a tolerance for SHS exposure in the Korean setting where the smoke-free policy is incomplete.

METHODS

Information on socio-demographic characteristics, alcohol drinking and smoking was collected for 7948 nonsmokers aged ≥ 19 years from the fourth Korea National Health and Nutrition Examination Survey, 2008-2009. Self-reported and cotinine verified SHS exposures were compared. Potential factors associated with cotinine verified but not self-reported SHS exposures were assessed using a logistic regression model.

RESULTS

Self-reported SHS exposure significantly underestimated the actual SHS exposure as determined by cotinine verification (kappa coefficient: 0.1066). At younger age, frequent alcohol drinking in females and a longer smoking duration in males were positively associated with cotinine verified exposure but not with the self-reported SHS exposure; they were also positively associated with cotinine verified exposure irrespective of self-reported SHS exposure.

CONCLUSIONS

Our findings show a tolerance for smoking in Korea. The current partial ban on smoking does not fully protect people from exposure to SHS. Smoking should be banned in all public places. In addition, efforts to de-normalize smoking in the Korean culture need to be strengthened.

Correlates of exposure to secondhand smoke (SHS) at home among non-smoking adults in Bangladesh: findings from the ITC Bangladesh survey

Background

Exposure to secondhand smoke (SHS) is a serious global public health problem. Understanding the correlates of SHS exposure could guide the development of evidence based SHS exposure reduction interventions. The purpose of this study is to describe the pattern of and factors associated with SHS exposure among non-smoking adults in Bangladesh.

Methods

Data come from adult non-smokers who participated in the second wave (2010) of the International Tobacco Control Policy (ITC) Evaluation Bangladesh Survey conducted in all six administrative divisions of Bangladesh. A structured questionnaire gathered information on participants’ demographic characteristics, pattern of SHS exposure, SHS knowledge, and attitudes towards tobacco control. Exposure to SHS at home was defined as non-smokers who lived with at least one smoker in their household and who reported having no home smoking ban. The data were analyzed using chi-square tests and logistic regression procedures.

Results

The SHS exposure rate at home among the participants (N = 2813) was 43%. Several sociodemographic and attitudinal factors were associated with SHS exposure. Logistic regression analyses identified eight predictors of SHS exposure: being female (OR = 2.35), being aged 15–24 (OR = 2.17), being recruited from Dhaka slums (OR = 5.19) or non-tribal/non-border areas outside Dhaka (OR = 2.19) or tribal/border area (OR = 4.36), having lower education (1–8 years: OR = 2.45; illiterate: OR = 3.00, having higher monthly household income (5000 to <10,000 Taka: OR = 2.34; 10,000 Taka or more: OR = 2.28), having a father who smoked in the past or currently smokes (OR = 2.09), having lower concern about the harms of tobacco on children (unconcerned OR = 3.99; moderate concern OR = 2.26), and not knowing the fact that SHS causes lung cancer in non-smokers (OR = 2.04).

Conclusions

Almost half of non-smoking Bangladeshi adults are exposed to SHS at home. The findings suggest the need for comprehensive tobacco control measures that would improve public understanding about health hazards of SHS exposure at home and encourage educational initiatives to promote smoke-free homes. Interventions should deliver targeted messages to reach those in the low socioeconomic status group.

Exposure to environmental tobacco smoke in Chaves after the implementation of the law 37/2007. A cross-sectional study in two healthcare settings

INTRODUCTION

Environmental tobacco smoke (ETS) is currently the main indoor pollutant and causes a high morbility and mortality. A partial restriction came into force in Portugal, in 2008, law 37/2007, trying to control, define and regulate smoke-free environments.

OBJECTIVE

To assess exposure and perceived impact of the law 37/2007 on exposure to ETS among adults attending to the two health care facilities of Chaves (Portugal).

METHOD

A cross-sectional survey on tobacco consumption and exposure to ETS was undertaken in Chaves (Northern Portugal) between November 2009 and February 2010. All the patients, over 17, attending to any of the Chaves Primary Care Facilities were interviewed. Patient enrolment was done on a rolling basis covering all days of the week. A face to face interview was carried out and a carbon monoxide was measured. Prevalence and means are shown with 95% confidence intervals.

RESULTS

287 patients participated in the survey, 56% were males and the mean age was 54 years. Smoking prevalence was 23,6%, significantly higher in males (31% vs 17%). 46,2% reported exposure tobacco smoke elsewhere (53% in males vs. 40% in females). Smokers declared to be more exposed to ETS than non-smokers. 16.2% of the population declared to be exposed at home, 14% at work and 33% at leisure places. The highest decrease in perception of passive exposure was found for restaurants (95%). In nightclubs 68% of the participants stated that exposure has remained unchanged.

CONCLUSION

The tobacco control law offered protection against tobacco smoke in several closed public spaces. However, a significant proportion of the population remains exposed. This study highlights the ineffectiveness of a partial ban. A comprehensive law is, therefore, required in Portugal.

A population based study on the prevalence of cigarette smoking and smokers' characteristics at osogbo, Nigeria

Background

Cigarette smoking has been linked to several cancers worldwide. The characteristics of smokers have not been well documented among Nigerians.

Objective

This study assessed the prevalence and characteristics of cigarette smokers among the residents of Osogbo, in southwestern Nigeria.

Method

The study, a population based cross-sectional study of randomly selected consenting adult residents of Osogbo, was conducted in September of 2011. Data was collected using a semi-structured interviewer administered questionnaire on cigarette smoking.

Results

A total of 759 respondents were interviewed. Mean age was 42.1 ± 12.5 years. There were 364 (48%) males and 395 (52%) females. About 22% had ever smoked while 8.7% were current smokers, smoking an average of 22.9 ± 10.1 cigarettes per day. Males constituted the majority of current smokers. Most smokers (71%) were introduced to smoking by friends and ill health was the most often reported reason for quitting.

Conclusion

Cigarette smoking is commonly practiced among males in the studied population and awareness creation and advocacy should be conducted throughout the city in order to inform current smokers about the hazards and cumulative effects inherent in smoking.

Prevalence of smoking and related risk factors among Physical Education and Sports School students at Istanbul University

The purpose of this study was to evaluate smoking prevalence and factors associated with smoking among students at the Physical Education and Sports School of Istanbul University. A cross-sectional study was performed on total of 373 students who have been continuing their education at the school from February to March 2011. A total of 166 responders were male (44.5%) and 207 responders were female (55.5%) out of 373 participants. Of the 373 students, 94 (25.2%) were current smokers and the average age for beginning smoking was 18.03 ± 2.6 (min: 12-max: 30). In this study, we found that the smoking prevalence associated with some variables such as age place of residence, mother's education, father's education, cigarette or tobacco use in the living place, knowledge status of students about their teacher's smoking habits and alcohol consumption (p ≤ 0.05). These findings suggest that the students, who will train the sportspeople of the future, and should be considered a role model of healthy behavior in society. Consequently, we believe that sports school students should take an active role in providing health education programs to increase their awareness about the detrimental effects of smoking and to extensively quit smoking in public.

Exposure to environmental tobacco smoke among South Korean adults: a cross-sectional study of the 2005 Korea National Health and Nutrition Examination Survey

BACKGROUND

Studies have identified that environmental tobacco smoke exposure is associated with sociodemographic factors such as age, sex, and socioeconomic status, but few studies have been conducted in South Korea. In this study, the authors investigated the extent of environmental tobacco smoke exposure and factors related in a nationally representative sample of Korean adults.

METHODS

The data of 7,801 adults aged 19 years and over collected during the 2005 Korea National Health and Nutrition Examination Survey were analyzed. Information on smoking habits and exposure to environmental tobacco smoke was obtained by self-reports using a standardized questionnaire. Risks of environmental tobacco smoke exposure conferred by sociodemographic variables and behavioral risk factors were evaluated using logistic regression methods.

RESULTS

Overall, 36.1% of nonsmokers (defined as those not currently smoking) and 50.1% of current smokers were found to be exposed to environmental tobacco smoke either at work or at home. Among the nonsmokers, women were more likely to be exposed to environmental tobacco smoke at home (OR = 5.22, 95%CI, 4.08-6.67). Furthermore, an inverse relationship was found between education level and the risk of environmental tobacco smoke exposure at home (OR = 1.73, 95%CI, 1.38-2.17 for those with a high school education; OR = 2.30, 95%CI, 1.68-3.16 for those with a middle school education; and OR = 2.58, 95%CI, 1.85-3.59 for those with less than an elementary school education vs. those with a college education or more). In addition, those with office, sales service, or manual labor jobs were found to be at significantly higher risk of environmental tobacco smoke exposure at work than those with professional, administrative, or managerial jobs. Also, the risk of environmental tobacco smoke exposure in the workplace was significantly higher for alcohol drinkers than non-drinkers (OR = 1.23, 95%CI, 1.07-1.47). After adjusting for age, sex and education, it was found that those exposed to environmental tobacco smoke at home were more likely to have been admitted to hospital during the previous year (OR 1.29, 95%CI, 1.002-1.66).

CONCLUSIONS

In this study of Korean adults, exposure to environmental tobacco smoke at home or work was found to be affected by sex, age, marital status, educational level, and type of occupation. Accordingly, these factors should be given appropriate consideration by those developing policies or interventions designed to control exposure to environmental tobacco smoke.

Quantitative CT measures of emphysema and airway wall thickness are related to D(L)CO

There is limited knowledge on the relationship between diffusing capacity of the lung for carbon monoxide (D(L)CO) and quantitative computed tomography (CT) measures of emphysema and airway wall thickness.

STUDY QUESTION

What is the relationship between D(L)CO and the quantitative CT measures of emphysema and airway wall thickness in subjects with and without COPD?

METHODS

We included 288 COPD subjects (70% men) and 425 non-COPD subjects (54% men). All subjects were current or ex-smokers older than 40 years and all subjects underwent spirometry, diffusing capacity tests and CT examination. Quantitative CT measures included % low attenuation areas < -950 HU (%LAA) and standardized airway wall thickness (AWT-Pi10).

RESULTS

Multiple linear regression analyses showed significant associations between D(L)CO and both %LAA and AWT-Pi10 in the COPD group. The adjusted regression coefficients (SE) for D(L)CO (mmol min(-1) kPa(-1)) were -1.15 (0.11) per 10% increase in %LAA and 0.08 (0.03) per 0.1 mm increase in AWT-Pi10, and the models' adjusted R(2) was 0.65 and 0.49, respectively.

CONCLUSIONS

CT measured emphysema explains a large fraction of the variation of D(L)CO among COPD subjects, and more so in men. Airway wall thickness is also significantly associated with D(L)CO, but explains a much smaller fraction of the variation.

Asthma and health-related quality of life - effect of adjusting for potential confounders

BACKGROUND

Health-related quality of life (HRQoL) is an increasingly important outcome measure in medical research. We wanted to evaluate how adjustment for potential confounders affected the relationship between HRQoL and asthma. Furthermore, we wanted to evaluate the relationship of environmental tobacco smoke (ETS) with HRQoL.

METHODS

We carried out a cross-sectional Norwegian community study in 1996/1997 including 2306 randomly selected subjects aged 26 years-81 years. Data on HRQoL were measured by SF-12. The data were analyzed by robust linear regression analyses with the physical component score (PCS) and the mental component score (MCS) as dependent variables. The effect of adjusting for the potential confounders was analyzed by bootstrap confidence intervals for differences between the adjusted and unadjusted models.

RESULTS

The difference in the asthma coefficients between the unadjusted and adjusted models for both PCS and MCS varied from 0.1 to 1.1. The confidence intervals for these differences for PCS were (-0.3, 1.6) and (0.4, 1.8), using the definition 'asthma last 12 months' and 'physician's diagnosis of asthma', respectively. The confidence intervals for the corresponding differences for MCS were (-0.01, 1.3) and (-0.6, 0.4), respectively. Univariately, PCS was lower among subjects reporting ETS at home compared to people not reporting ETS at home, but this difference did not persist in the multivariate analyses. ETS at home was associated with slightly improved MCS.

CONCLUSION

Adjusting for potential confounders does not change the relationship between asthma and HRQoL overtly.

Secondhand smoke in Geneva, 1996-2006: changes in exposure, opinions, and workplace smoking bans in the absence of national legislation

Postal surveys were conducted in 1996 and 2006 to assess change in duration of exposure to secondhand tobacco smoke (SHS), frequency of smoking bans at the workplace, and opinions on smokefree measures in Geneva, Switzerland in the absence of national smoke-free legislation. A random sample of 742 participants in 1996 and 1487 in 2006 showed length of exposure to SHS decreased from 7 hours/week to 4 hours/week, with the largest decrease among 26-45 year olds. Workplace smoking bans increased from 33.4% to 66.3% (p < 0.001). Agreement that SHS is dangerous to health increased from 77.5% to 86.0% (p = 0.006). Agreement that all restaurant tables should be reserved to nonsmokers also increased, from 14.8% to 41.4% (p < 0.001). Opinions were more favorable to all smoke-free measures in 2006 than in 1996, except, "More information should be given on the health dangers of SHS," suggesting a level of saturation was reached for information on SHS.

Simultaneous determination of nicotine and 3-vinylpyridine in single cigarette tobacco smoke and in indoor air using direct extraction to solid phase

The aim of the present study was to develop a new analytical method of chromatographic determination of two important markers of ETS exposure: nicotine and 3-vinylpyridine (3-ethenylpyridine, 3-EP) in mainstream (MS) and sidestream (SS) smoke of one single cigarette and in indoor air using direct solid phase extraction combined with gas chromatography. The method can be utilised for both nicotine and 3-EP determination in SS and MS of one single cigarette as well as it allows for a precise determination of compound distribution in indoor air. The application of the same analytical method for both kinds of samples allows anticipating indoor air distribution of both analysed compounds in a very precise way. The precision of the method (calculated as a relative standard deviation) was 9.78% for nicotine and 2.67% for 3-EP; whereas the accuracy (evaluated by a recovery study conducted at three different levels) was 70.1 and 87.3%, respectively. The limit of detection was 0.06 µg per cigarette for both nicotine and 3-EP. The method was evaluated by determining the compounds of interest in two commercially available brands of cigarettes as well as in the reference cigarettes 3R4F and also in indoor air polluted with tobacco smoke. Determined levels of compounds of interest in MS varied from 586 to 772 (nicotine) µg per cigarette and from 3.5 to 10.7 (3-EP) µg per cigarette. In SS smoke the level varied from 14,370 to 22,590 (nicotine) µg per cigarette and from 185 to 550 (3-EP) µg per cigarette, whereas levels in indoor air polluted with tobacco smoke varied from 50.1 to 157.3 (nicotine) µg m(-3) and from 7.7 to 20.8 (3-EP) µg m(-3).

Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units: the PERSEO (psychiatric emergency study and epidemiology) survey

BACKGROUND

The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management). The aims of this paper are: (i) to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii) to assess the clinical management, subjective wellbeing and attitudes toward medications.

METHODS

A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period.

RESULTS

Almost half of patients (46%) showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%), than in aggression toward other people (20%). A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%), followed by depression (16%) and personality disorders (14%), and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge), while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge) and depression (41 vs 32% during stay and 44 vs 25% at discharge). Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%). Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self-reported compliance increased during hospital stay.

CONCLUSION

Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.