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Wang Y, Sung HY, Lightwood J, Yao T, Max WB. Healthcare utilisation and expenditures attributable to current e-cigarette use among US adults. Tob Control 2023; 32:723-728. [PMID: 35606163 DOI: 10.1136/tobaccocontrol-2021-057058] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
AIMS This study estimated annual healthcare expenditures attributable to current e-cigarette use among US adults, including current exclusive and dual/poly e-cigarette use. METHODS Analysing the 2015-2018 National Health Interview Survey data, we estimated the impacts of e-cigarette use on healthcare utilisation among adults aged 18+ years. Healthcare utilisation outcomes were hospital nights, emergency room (ER) visits, doctor visits and home visits. Current e-cigarette use was categorised as exclusive and dual/poly e-cigarette use. The econometric model included two equations: health status as a function of e-cigarette use and other independent variables, and healthcare utilisation as a function of health status, e-cigarette use, and other independent variables. Using an 'excess utilisation' approach, we multiplied the e-cigarette-attributable fraction derived from the model by annual health expenditures to calculate healthcare expenditures attributable to current exclusive and dual/poly e-cigarette use, the sum of which were expenditures attributable to all current e-cigarette use. RESULTS Current exclusive and dual/poly e-cigarette use, with 0.2% and 3.5% prevalence in 2015-2018, were associated with higher odds of reporting poor health status than never tobacco users. Poor health status was associated with higher odds of using the four healthcare services and a greater number of ER and doctor visits. Annual healthcare expenditures attributable to all current e-cigarette use was $15.1 billion ($2024 per user) in 2018, including $1.3 billion attributable to exclusive e-cigarette use ($1796 per user) and $13.8 billion attributable to dual/poly e-cigarette use ($2050 per user). CONCLUSION Adult current e-cigarette use was associated with substantial excess healthcare utilisation and expenditures.
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Affiliation(s)
- Yingning Wang
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - James Lightwood
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Tingting Yao
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - Wendy B Max
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
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Ünver Ş, Tekmanli HH, Alkan Ö. Passive smoking as a risk factor among older adults: an ordered probability approach for Türkiye. Front Public Health 2023; 11:1142635. [PMID: 37397727 PMCID: PMC10310956 DOI: 10.3389/fpubh.2023.1142635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Background/aim Older adults represent a significant proportion of the population of many societies, and being one of the disadvantaged groups, they struggle with various difficulties in their social lives. Undoubtedly, passive smoking is one of these difficulties. Passive smoking among older adults, which is an important public health problem, is an issue that needs to be investigated. The aim of this study is to determine the relationship between the demographic and socio-economic characteristics of adults aged 60 and older in Türkiye and their exposure to secondhand smoke (SHS). Methods In this study, a microdata set of the 2016 and 2019 Turkey Health Survey conducted by the Turkish Statistical Institute (TUIK) was used. This survey was conducted by TUIK in the relevant years using a stratified sampling method to best represent the whole of Turkey. The study considered only demographic and socio-economic characteristics to investigate passive smoking. Since all the variables used in the study were categorical, the relationship between the dependent variable and the independent variables was first investigated using chi-square tests. In addition, since the dependent variable has an ordered-categorical probability form, the generalized ordinal logit model was used for the analysis of passive smoking and related factors. Results The rate of exposure to tobacco smoke of older adults who participated in the study in 2016 was 16%, while the rate of those who participated in the study in 2019 was 21%. Conclusion According to the findings of the study, older, uneducated, and uninsured smokers carry a more serious SHS risk. It may be beneficial for society for policy makers to carry out studies by considering these features a priority and focusing on policies in this context. Expanding smoke-free areas to cover older adult, increasing penalties as a deterrent, facilitating education, increasing state support for education, increasing education and public service announcements about tobacco harms, and facilitating social security are the main examples. This study's findings are crucial as a source of information for the development of policies and programs aimed at preventing the exposure of older adults to tobacco smoke.
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Affiliation(s)
- Şeyda Ünver
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Türkiye
| | - Hasan Hüseyin Tekmanli
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Türkiye
| | - Ömer Alkan
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Türkiye
- Master Araştırma Eğitim ve Danışmanlık Hizmetleri Ltd. Şti., Ata Teknokent, Erzurum, Türkiye
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John RM, Dauchy EP. Healthcare costs attributable to secondhand smoke exposure among Indian adults. Nicotine Tob Res 2022; 24:1478-1486. [PMID: 35176165 DOI: 10.1093/ntr/ntac048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This paper estimates the direct economic costs of diseases attributable to secondhand smoking (SHS) in India for persons aged 15 years and above. METHODS Nationally representative data on health care expenditures, healthcare utilization, and SHS prevalence were used to estimate economic costs attributable to SHS. A prevalence-based attributable risk approach was used for estimating the attributable direct costs. To estimate the SHS-attributable fraction, the excess utilization of healthcare among SHS exposed non-smokers compared to unexposed non-smokers was estimated using a method of propensity score matching. RESULTS The annual direct economic costs attributable to SHS from all diseases in India in the year 2017 for persons aged 15+ years amounted to INR 566.7 billion (USD 8.7 billion). This amounted to INR 705 per adult non-smoker. The SHS attributable costs were higher among the youngest age group 20-24, and women bear 71% of the direct medical costs attributable to SHS. CONCLUSIONS The annual direct economic costs of SHS amount to approximately 0.33% of India's GDP, or 8.1% of total healthcare expenditures in India. It is also much larger than the total excise tax revenue from cigarettes and bidis. As bidi smoking is the most popular form of smoking in India and bidis are mostly consumed by the poor, a disproportionate burden of SHS is likely borne by poor households in India. IMPLICATIONS In India, 38.7% of adults are exposed to secondhand smoking (SHS) at home and 30.2% at work. However, there is no estimate of the economic burden of any kind from SHS exposure in India. This study used a prevalence-based attributable risk approach combined with a propensity score matching technique to estimate excess healthcare utilization for SHS exposed non-smokers and the annual direct economic costs of SHS in India. Annual direct SHS-attributable costs in India is INR 566.7 billion (USD 8.7 billion) SHS costs constituted 0.33% of GDP and 8.1% of healthcare expenditures in India.
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Affiliation(s)
- Rijo M John
- Rajagiri College of Social Sciences Kochi, Kerala, India
| | - Estelle P Dauchy
- International Research Campaign for Tobacco-Free Kids, Washington, DC
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Wu CW, Chuang HY, Watanabe K, Wu PS, Pan HC, Wang CL, Yang CC, Hung CH, Dai CY, Ho CK, Kawakami N. Association between secondhand smoke and peripheral arterial disease: a meta-analysis of cross-sectional studies. Int Arch Occup Environ Health 2022; 95:1091-1101. [PMID: 35083550 DOI: 10.1007/s00420-022-01837-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The association between secondhand smoke (SHS) and peripheral arterial disease (PAD) was inconsistent and the studies were relatively scarce, hence, we conducted a meta-analysis of the association between SHS and PAD. MATERIALS AND METHODS We systematically searched three electronic databases (PubMed, EMBASE, and Web of Science), and calculated the pooled prevalence risk ratio (RR) and estimated standard error by random effect model from the meta-analysis. Furthermore, we performed a subgroup meta-analysis according to the location of SHS exposure. RESULTS We initially identified 502 articles from the electronic database, and 6 articles, cross-sectional data from 4 cross-sectional studies and 2 prospective cohort studies, were included in the meta-analysis. Among these six articles, two studies showed a significant correlation between SHS exposure and PAD, whereas no study showed a negative correlation between SHS exposure and PAD. In the meta-analysis, pooled prevalence showed a significant association between SHS exposure and PAD (RR = 1.23; 95% confidence interval [CI] 1.08-1.41; z = 3.02, p = 0.003). In the subgroup analysis based on location of SHS exposure, the prevalence RR of PAD at home was 1.30 (95% CI 1.14-1.49, Z-3.99, p < 0.0001). The prevalence RR in the subgroup of SHS exposure at work was not significant (RR = 0.89; 95% CI 0.55-1.44; z = 0.48, p = 0.63). CONCLUSION Exposure to SHS was significantly and positively associated with PAD. Moreover, we found a significant association between exposure to SHS and PAD at home, but the association was not significant at work.
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Affiliation(s)
- Chih-Wei Wu
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, No. 482, Shanming Rd., Siaogang Dist., Kaohsiung City, 812, Taiwan
- Department of Family Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
| | - Hung-Yi Chuang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Kazuhiro Watanabe
- Department of Public Health, School of Medicine, Kitasato University, Sagamihara, Japan
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Pei-Shan Wu
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Hui-Chen Pan
- Department of Family Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
| | - Chao-Ling Wang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Chen-Cheng Yang
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, No. 482, Shanming Rd., Siaogang Dist., Kaohsiung City, 812, Taiwan.
- Department of Family Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan.
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan.
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan.
| | - Chih-Hsing Hung
- Environmental and Occupational Medicine Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
| | - Chia-Yen Dai
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Chi-Kung Ho
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Le T, Martín-Aragón Baudel M, Syed A, Singhrao N, Pan S, Flores-Tamez VA, Burns AE, Man KNM, Karey E, Hong J, Hell JW, Pinkerton KE, Chen CY, Nieves-Cintrón M. Secondhand Smoke Exposure Impairs Ion Channel Function and Contractility of Mesenteric Arteries. FUNCTION 2021; 2:zqab041. [PMID: 34553140 PMCID: PMC8448673 DOI: 10.1093/function/zqab041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/05/2021] [Accepted: 08/16/2021] [Indexed: 01/11/2023] Open
Abstract
Cigarette smoke, including secondhand smoke (SHS), has significant detrimental vascular effects, but its effects on myogenic tone of small resistance arteries and the underlying mechanisms are understudied. Although it is apparent that SHS contributes to endothelial dysfunction, much less is known about how this toxicant alters arterial myocyte contraction, leading to alterations in myogenic tone. The study's goal is to determine the effects of SHS on mesenteric arterial myocyte contractility and excitability. C57BL/6J male mice were randomly assigned to either filtered air (FA) or SHS (6 h/d, 5 d/wk) exposed groups for a 4, 8, or 12-weeks period. Third and fourth-order mesenteric arteries and arterial myocytes were acutely isolated and evaluated with pressure myography and patch clamp electrophysiology, respectively. Myogenic tone was found to be elevated in mesenteric arteries from mice exposed to SHS for 12 wk but not for 4 or 8 wk. These results were correlated with an increase in L-type Ca2+ channel activity in mesenteric arterial myocytes after 12 wk of SHS exposure. Moreover, 12 wk SHS exposed arterial myocytes have reduced total potassium channel current density, which correlates with a depolarized membrane potential (Vm). These results suggest that SHS exposure induces alterations in key ionic conductances that modulate arterial myocyte contractility and myogenic tone. Thus, chronic exposure to an environmentally relevant concentration of SHS impairs mesenteric arterial myocyte electrophysiology and myogenic tone, which may contribute to increased blood pressure and risks of developing vascular complications due to passive exposure to cigarette smoke.
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Affiliation(s)
- Thanhmai Le
- Department of Pharmacology, University of California Davis, Davis, CA 95616, USA
| | | | - Arsalan Syed
- Department of Pharmacology, University of California Davis, Davis, CA 95616, USA
| | - Navid Singhrao
- Department of Pharmacology, University of California Davis, Davis, CA 95616, USA
| | - Shiyue Pan
- Department of Pharmacology, University of California Davis, Davis, CA 95616, USA
| | | | - Abby E Burns
- Department of Pharmacology, University of California Davis, Davis, CA 95616, USA
| | - Kwun Nok Mimi Man
- Department of Pharmacology, University of California Davis, Davis, CA 95616, USA
| | - Emma Karey
- Department of Pharmacology, University of California Davis, Davis, CA 95616, USA
| | - Junyoung Hong
- Department of Pharmacology, University of California Davis, Davis, CA 95616, USA
| | - Johannes W Hell
- Department of Pharmacology, University of California Davis, Davis, CA 95616, USA
| | - Kent E Pinkerton
- Center for Health and the Environment, University of California, Davis, CA 95616, USA
| | - Chao-Yin Chen
- Department of Pharmacology, University of California Davis, Davis, CA 95616, USA
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Dadipoor S, Nejatizade AA, Farshidi H, Gharibzade A, Aghamolaei T, Ghanbarnejad A. Determinants of environmental tobacco smoke at work and at home: analysis of baseline data from the Kong Cohort Study, Southern Iran. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1967480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sakineh Dadipoor
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abdul Azim Nejatizade
- Department of Medical Genetics, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hossein Farshidi
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abdullah Gharibzade
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Ghanbarnejad
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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7
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Klein JD, Chamberlin ME, Kress EA, Geraci MW, Rosenblatt S, Boykan R, Jenssen B, Rosenblatt SM, Milberger S, Adams WG, Goldstein AO, Rigotti NA, Hovell MF, Holm AL, Vandivier RW, Croxton TL, Young PL, Blissard L, Jewell K, Richardson L, Ostrow J, Resnick EA. Asking the Right Questions About Secondhand Smoke. Nicotine Tob Res 2021; 23:57-62. [PMID: 31407779 DOI: 10.1093/ntr/ntz125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/25/2019] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA.,Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL, USA
| | | | | | - Mark W Geraci
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Susan Rosenblatt
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Rachel Boykan
- Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Brian Jenssen
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Sharon Milberger
- Michigan Developmental Disabilities Institute, Wayne State University, Detroit, MI, USA
| | - William G Adams
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Melbourne F Hovell
- Division of Health Promotion and Behavioral Science, San Diego State University School of Public Health, San Diego, CA, USA
| | - Amanda L Holm
- Center of Health Promotion and Disease Prevention, Henry Ford Health System, Detroit, MI, USA
| | - Richard W Vandivier
- Department of Medicine, Pulmonary Sciences & Critical Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Thomas L Croxton
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Patricia L Young
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Lani Blissard
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Kate Jewell
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Leisa Richardson
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - John Ostrow
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Elissa A Resnick
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
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Komonpaisarn T. Economic cost of tobacco smoking and secondhand smoke exposure at home in Thailand. Tob Control 2021; 31:714-722. [PMID: 33632807 DOI: 10.1136/tobaccocontrol-2020-056147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/26/2020] [Accepted: 01/02/2021] [Indexed: 11/04/2022]
Abstract
IntroductionSmoking is an important public health concern. This study is the first that attempts to estimate the economic cost of smoking and secondhand smoke (SHS) exposure at home in Thailand.MethodA prevalence-based cost of illness approach following the guideline by WHO is employed.ResultIn 2017, the direct morbidity cost attributable to smoking and SHS exposure at home in Thailand was estimated to be at least US$265.97 million and US$23.66 million, respectively. Indirect morbidity costs from workday loss totalling US$25.04 million can be linked to smoking, while US$1.72 million was the result of SHS exposure at home. Smoking-attributable premature deaths resulted in an opportunity loss to the country equivalent to US$2.48 billion, while the figure was US$181.41 million for SHS exposure at home. Total years of life lost due to smoking and SHS-attributable premature deaths are estimated to have been at least 390 955 years for males and 82 536 years for females. The total economic cost from both types of tobacco exposure amounted to US$2.98 billion, equivalent to 17.41% of Thailand's current health expenditure or 0.65% of its gross domestic product in 2017.ConclusionSmoking imposed a substantial economic burden on Thailand in 2017. Seven per cent of this cost was imposed on non-smokers sharing a residence with smokers. Females bore 80% of this SHS-related cost. The findings call for prompt responses from public health agencies in Thailand to launch effective tobacco control policies.
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Affiliation(s)
- Touchanun Komonpaisarn
- Centre for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, Thailand
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Driezen P, Fong GT, Hyland A, Craig LV, Sansone G, Hitchman SC, Cummings KM. Self-Reported Exposure to Secondhand Smoke and Support for Complete Smoking Bans in Multiunit Housing Among Smokers in the United States, Canada, and the United Kingdom. Prev Chronic Dis 2020; 17:E147. [PMID: 33241991 PMCID: PMC7735481 DOI: 10.5888/pcd17.200201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction Involuntary exposure to secondhand smoke most frequently occurs at home, which is problematic for residents of multiunit housing (MUH). The primary objective of this study was to estimate the extent of secondhand smoke incursions into the homes of MUH smokers who banned smoking in their homes but lived in buildings where smoking is allowed. Methods We used data from Wave 9 of the International Tobacco Control Four Country Survey. We estimated 1) the prevalence of complete smoking bans among smokers living in single-family homes vs MUH in the United States (n = 3,208), Canada (n = 1,592), and the United Kingdom (n = 1,403) from 2013 to 2015; 2) the extent of secondhand smoke incursions into the homes of MUH smokers who banned smoking in their units but lived in buildings that allow smoking; and 3) MUH smokers’ preferences for complete smoking bans in MUH. Weighted multivariable logistic regression estimated the country-specific adjusted prevalence of all outcomes. Results Overall, 53.0% of smokers living in single-family homes completely banned smoking in their homes, compared with 44.8% of smokers in MUH. Across all 3 countries, only 27.8% of MUH smokers reported that smoking was completely prohibited in their building. A similar percentage of MUH smokers who banned smoking in their home but lived in buildings allowing smoking reported a secondhand smoke incursion into their home in the United States (29.9%; 95% CI, 20.4%–41.5%), Canada (38.4%; 95% CI, 26.7%–51.6%), and the United Kingdom (24.7%; 95% CI, 15.7%–36.7%). Across all 3 countries, 36.1% (95% CI, 33.4%–38.9%) of smokers in MUH reported they preferred a complete smoking ban in all building areas. Conclusion A need remains to educate MUH operators and residents about the benefits of comprehensive smoke-free policies.
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Affiliation(s)
- Pete Driezen
- Department of Psychology, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada, N2L 3G1.
| | - Geoffrey T Fong
- University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
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10
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Carreras G, Lugo A, Gallus S, Cortini B, Fernández E, López MJ, Soriano JB, López-Nicolás A, Semple S, Gorini G. Burden of disease attributable to second-hand smoke exposure: A systematic review. Prev Med 2019; 129:105833. [PMID: 31505203 DOI: 10.1016/j.ypmed.2019.105833] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/30/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
Our aim was to provide a systematic review of studies on the burden of disease due to second-hand smoke (SHS) exposure, reviewing methods, exposure assessment, diseases causally linked to SHS, health outcomes, and estimates available to date. A literature review of studies on the burden of disease from SHS exposure, available in PubMed and SCOPUS, published 2007-2018 in English language, was carried out following the PRISMA recommendations. Overall, 588 studies were first identified, and 94 were eligible. Seventy-two studies were included in the systematic review. Most of them were based on the comparative risk assessment approach, assessing SHS exposure using mainly surveys on exposure at home/workplaces. Diseases more frequently studied were: lung cancer, ischemic heart disease, stroke, chronic obstructive pulmonary disease, asthma and breast cancer in adults; lower respiratory tract infection, otitis media, asthma, sudden infant death syndrome and low birth weight in children. The SHS exposure assessment and the reported population attributable fractions (PAF) were largely heterogeneous. As an example, the PAF from lung cancer varied between 0.6% and 20.5%. Moreover, PAF were estimated applying relative risks and SHS exposures with no consistent definitions or with different age classes. The research gap on the SHS exposure burden is shrinking. However, estimates are not yet available for a number of countries, particularly the Middle Eastern and African countries, and not all diseases with the strongest evidence of causation, such as sudden infant death syndrome, have been explored. Moreover, in some cases the applied methodology revealed relatively low quality of data.
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Affiliation(s)
- Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy.
| | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Via La Masa 19, 20156 Milan, Italy
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Via La Masa 19, 20156 Milan, Italy
| | - Barbara Cortini
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Esteve Fernández
- Catalan Institute of Oncology (ICO), Granvia de L'Hospitalet, 199-203, PC 08908 L'Hospitalet de Llobregat, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, Campus de Bellvitge, School of Medicine and Health Sciences, University of Barcelona, Feixa Llarga, s/n, PC 08907 L'Hospitalet de Llobregat, Spain
| | - Maria José López
- Public Health Agency of Barcelona (ASPB). Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0. PC 28029, Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain
| | - Joan B Soriano
- Hospital Universitario La Princesa (IISP), Diego de León, 62 1st floor, PC 28006 Madrid, Spain
| | - Angel López-Nicolás
- Polytechnic University of Cartagena (UPCT), Plaza Cronista Isidoro Valverde, s/n, PC 30202 Cartagena, Spain
| | - Sean Semple
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, Scotland, UK
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy
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Exposure to Secondhand Tobacco Smoke at Airport Terminals. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2019; 2019:9648761. [PMID: 30853997 PMCID: PMC6377972 DOI: 10.1155/2019/9648761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 01/16/2023]
Abstract
Background Airports may represent significant sources of secondhand smoke (SHS) exposure for both travelers and employees. While previously common smoking rooms have largely disappeared from US airports, smoking continues to occur outdoors at terminal entrances. SHS may be especially high at arrival areas, since they oftentimes are partially enclosed by overhead departures, creating stagnant microenvironments. This study assessed particulate matter <2.5 microns in diameter (PM2.5), a common surrogate for SHS, at airport terminal locations to evaluate both outdoor exposure risk and possible indoor drift of SHS from outdoor sources. Methods A convenience sample of nine airport terminal arrival areas in the US state of Florida was surveyed between February and July 2018. PM2.5 levels were assessed outdoors and indoors at terminal entrances and at control areas far into terminal interiors. We also examined the impact of smoking location on SHS exposure by correlating cigarette and passing vehicle counts with PM2.5 levels at terminals with contrasting proximity of designated smoking locations to terminal entrances. Results Although outdoor PM2.5 levels (mean 17.9, SD 6.1 µg/m3) were significantly higher than indoors (p < 0.001), there was no difference between indoor areas directly inside terminal entrances and areas much further interior (mean 8.8, SD 2.6 vs mean 8.5, SD 3.0 µg/m3, p=0.49). However, when smoking areas were in close proximity to terminal entrances, the number of lit cigarettes and vehicular traffic per minute predicted 70% of the variance of PM2.5 levels (p < 0.001), which was attributable mostly to the cigarette number (β = 0.83; 95% CI (0.55 to 1.11); p < 0.001). This effect was not observed at smoking areas further away. Conclusion PM2.5 data did not suggest indoor drift from outside smoking. Nevertheless, absolute exposure outdoors was high and correlated with the location of designated smoking areas. Further studies are needed to examine the effect of microclimate formation on exposure risk.
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Yao T, Sung HY, Wang Y, Lightwood J, Max W. Healthcare Costs of Secondhand Smoke Exposure at Home for U.S. Children. Am J Prev Med 2019; 56:281-287. [PMID: 30553690 PMCID: PMC6340755 DOI: 10.1016/j.amepre.2018.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this study is to estimate healthcare utilization and healthcare costs due to secondhand smoke exposure at home for children in the U.S. METHODS Using data from the 2000, 2005, and 2010 U.S. National Health Interview Surveys, the authors analyzed the association between secondhand smoke exposure at home and utilization of three types of healthcare services (hospital nights, emergency room visits, and doctor visits) for children aged 3-14 years (N=16,860). A zero-inflated Poisson regression model was used to control for sociodemographic characteristics and the number of months without health insurance. The authors determined excess healthcare utilization attributable to secondhand smoke exposure at home for children and then estimated annual secondhand smoke-attributable healthcare costs as the product of annual excess healthcare utilization and unit costs obtained from the 2014 Medical Expenditures Panel Survey. This study was conducted from 2016 to 2018. RESULTS The prevalence of secondhand smoke exposure at home for children in 2000, 2005, and 2010 was 25.0%, 12.3%, and 9.1%, respectively. Secondhand smoke exposure at home was positively associated with emergency room visits, but was not significantly associated with nights at the hospital or doctor visits for children. Secondhand smoke exposure at home for children resulted in an excess of 347,156 emergency room visits in 2000, 124,412 visits in 2005, and 101,570 visits in 2010, which amounted to $215.1 million, $77.1 million, and $62.9 million in excess annual healthcare costs (2014 dollars) in 2000, 2005, and 2010, respectively. CONCLUSIONS Although U.S. healthcare costs attributable to secondhand smoke exposure at home for children are declining, interventions to reduce secondhand smoke exposure at home for children are still needed to reduce the economic burden attributable to secondhand smoke exposure.
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Affiliation(s)
- Tingting Yao
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, California.
| | - Hai-Yen Sung
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, California
| | - Yingning Wang
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, California
| | - James Lightwood
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, San Francisco, California
| | - Wendy Max
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, California
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