Burden of disease attributable to second-hand smoke exposure: A systematic review

Preventable Deaths Attributable to Second-Hand Smoke in Southeast Asia-Analysis of the Global Burden of Disease Study 2019

Objectives

In addition to harms caused to individuals who smoke, second-hand smoke (SHS or passive smoke) is an important public health issue. We aim to estimate the extent of preventable deaths due to tobacco and SHS exposure in Southeast Asia.

Methods

Data were from the Global Burden of Disease Study 2019. We analysed data from Southeast Asia, including Cambodia, Indonesia, Laos, Malaysia, Maldives, Mauritius, Myanmar, Philippines, Seychelles, Sri Lanka, Thailand, Timor-Leste, and Vietnam.

Results

In 2019, there were 728,500 deaths attributable to tobacco in Southeast Asia, with 128,200 deaths attributed to SHS exposure. The leading causes of preventable deaths were ischemic heart disease, stroke, diabetes mellitus, lower respiratory infections, chronic obstructive pulmonary disease, tracheal, bronchus, and lung cancer. Among deaths attributable to tobacco, females had higher proportions of deaths attributable to SHS exposure than males in Southeast Asia.

Conclusion

The burden of preventable deaths in a year due to SHS exposure in Southeast Asia is substantial. The implementation and enforcement of smoke-free policies should be prioritized to reduce the disease burden attributed to passive smoking in Southeast Asia.

Changes in prevalence and socioeconomic inequalities in secondhand smoke exposure in Spanish children, 2016-2019

INTRODUCTION

Children are vulnerable to secondhand smoke (SHS) exposure, especially those with lower socioeconomic status. This study assesses the changes in prevalence and socioeconomic inequalities in SHS exposure in children younger than 12 years old in Spain between 2016 and 2019.

METHODS

We conducted two cross-sectional studies among representative samples of households with children aged <12 years in Spain, in 2016 (n=2411) and 2019 (n=2412). Families were interviewed to assess children's SHS exposure in private settings and outdoor public venues and their adoption of home and car smoke-free rules. We used the education level of the home main earner as a proxy for socioeconomic position. Changes over time in the prevalence and socioeconomic inequalities of SHS exposure and smoke-free rules were estimated through adjusted Poisson regression models with robust variance according to sociodemographic covariates (adjusted prevalence ratios, APRs).

RESULTS

In 2019, 70.5% of children were exposed to SHS in Spain. No changes between 2016 and 2019 were found for overall SHS exposure, exposure at home, and at school entrances. SHS exposure increased at public transport stations (APR=1.24; 95% CI: 1.03-1.49) and outdoor hospitality venues (APR=1.17; 95% CI: 1.07-1.29) while it decreased in cars (APR=0.74; 95% CI: 0.56-0.98) and parks (APR=0.87; 95% CI: 0.77-0.98). Households with lower education level had higher prevalence of SHS exposure at home in 2019 compared with those with university studies (primary: APR=1.30; 95% CI: 1.11-1.51; secondary: APR=1.12; 95% CI: 1.00-1.25) and were less likely to adopt home indoor smoke-free rules (primary: APR=0.88; 95% CI: 0.79-0.99; secondary: APR=0.95; 95% CI: 0.89-1.02). Socioeconomic inequalities in SHS exposure at home persisted between 2016 and 2019 (p>0.05), while decreased in smoke-free rules in cars (p=0.039).

CONCLUSIONS

Reported SHS exposure among children in Spain remained high between 2016 and 2019. Inequalities persisted at home, highlighting the need for measures to reduce such exposure with an equity perspective.

Evolution and characteristics of studies estimating attributable mortality to second-hand smoke: a systematic review

BACKGROUND

Several studies have estimated the impact of second-hand smoke (SHS) exposure on mortality in the population of different countries. This study aimed to identify and describe studies that have estimated the attributable mortality (AM) associated with SHS exposure in the adult population.

METHODS

A literature search was conducted in MEDLINE, EMBASE, Cochrane Library and CINAHL databases up to January 2023. Studies that estimated the AM associated with SHS exposure in the adult population and used a prevalence-dependent method were included. The main characteristics of the studies and their results were described.

RESULTS

Fifty-three studies were included. Most of them were conducted in North America (n = 13), Europe (n = 14) and China (n = 6) and included lung cancer (n = 46) or ischaemic heart disease (n = 22) as causes of death. There was considerable variety in the population under study regarding the relationship with tobacco: non-smokers (n = 30); never-smokers (n = 9); both non and never-smokers (n = 2); the whole population (n = 1) and not known (n = 11). The age at which AM was estimated also varied between studies, ranging from 15  to 40 years and older.

CONCLUSIONS

Studies estimating AM associated with SHS exposure are heterogeneous in terms of the causes of death studied, the age at which mortality is attributed, or the population to which mortality referred: consensus should be reached. Despite their importance, studies assessing AM to SHS are infrequent in low- and middle-income countries.

Occupational second-hand smoke exposure: A comparative shotgun proteomics study on nasal epithelia from healthy restaurant workers

Non-smokers exposed to second-hand smoke (SHS) present risk of developing tobacco smoke-associated pathologies. To investigate the airway molecular response to SHS exposure that could be used in health risk assessment, comparative shotgun proteomics was performed on nasal epithelium from a group of healthy restaurant workers, non-smokers (never and former) exposed and not exposed to SHS in the workplace. HIF1α-glycolytic targets (GAPDH, TPI) and proteins related to xenobiotic metabolism, cell proliferation and differentiation leading to cancer (ADH1C, TUBB4B, EEF2) showed significant modulation in non-smokers exposed. In never smokers exposed, enrichment of glutathione metabolism pathway and EEF2-regulating protein synthesis in genotoxic response were increased, while in former smokers exposed, proteins (LYZ, ATP1A1, SERPINB3) associated with tissue damage/regeneration, apoptosis inhibition and inflammation that may lead to asthma, COPD or cancer, were upregulated. The identified proteins are potential response and susceptibility/risk biomarkers for SHS exposure.

Secondhand smoke exposure in public outdoor spaces in the Netherlands: The stronger the smell, the more exposure to nicotine

INTRODUCTION

While secondhand smoke exposure in outdoor spaces has been investigated before, no data on outdoor secondhand smoke exposure have been collected in the Netherlands. Such data could help policymakers gain support for smoke-free outdoor public spaces.

METHODS

Between May and November 2021, we visited 25 outdoor locations across the Netherlands. At each location, we conducted four measurements with smokers and one measurement without smokers. During each measurement, we counted the number of smokers present and we rated tobacco smell intensity on a five-point scale. Airborne nicotine and 3-ethenylpyridine (3-EP) data were collected through active sampling on thermal desorption tubes. The contents of these tubes were later analyzed using gas chromatography-mass spectrometry. Using linear mixed models, we investigated the association between levels of nicotine and the presence of smokers, the number of smokers, and the intensity of tobacco smell. We also investigated these association with levels of 3-EP.

RESULTS

Nicotine levels were higher when smokers were present (B=1.40; 95% CI: 0.69-2.11, p<0.001). For each additional smoker present, we measured higher levels of nicotine (B=0.23; 95% CI: 0.10-0.37, p=0.001). When the smell of tobacco smoke was noted to be stronger by the researchers, higher levels of nicotine were measured through sampling (B=0.85; 95% CI: 0.44-1.26, p<0.001). We found similar results for 3-EP levels.

CONCLUSIONS

This study showed that both nicotine and 3-EP are useful in quantifying levels of secondhand smoke in various outdoor locations. The level of nicotine exposure outdoors was positively associated with the number of smokers nearby. The intensity of the tobacco smell was also related to nicotine exposure: the stronger the smell of tobacco smoke, the more nicotine was measured in the air.

A systematic review of second-hand smoking mass media campaigns (2002-2022)

BACKGROUND

Second-hand smoking (SHS) increases the risk of chronic disease in adults and poses a serious health threat to children. Mass media campaigns are instrumental in raising awareness and reducing SHS exposure. There is a need to identify recent SHS mass media campaigns and assess their sustainability in terms of knowledge, attitudes, and behavioural changes. This systematic review summarises the characteristics and outcomes of mass media campaigns on SHS prevention.

METHODS

PubMed, Embase, Web of Science, and grey literature were searched in November 2022 for SHS campaigns implemented between 2016 and 2022. The eligibility criteria included campaigns on the dangers or effects of SHS with any target group, dissemination medium, study design, or language. The database search identified 1,413 peer-reviewed titles, of which 82 full-texts were screened, with 14 meeting the eligibility criteria. The grey literature search identified 9,807 sources, of which 61 were included. We extracted data on the campaign characteristics, metrics, and smoking-related outcomes. The JBI critical appraisal tool was used to assess the risk of bias of the included studies.

RESULTS

We found 73 SHS campaigns conducted between 2002 and 2022, across 50 countries. The campaigns reached 378 million people. The reported recall rates range from 8 to 76%. Of the 11 studies that reported smoking-related outcomes, 10 reported increased knowledge in understanding SHS risks (73-85%), five reported an increased prevalence of smoke-free homes, and two reported an increase in number of participants persuading others to quit smoking. Two studies reported a decrease in overall smoking, whereas three studies observed a reduction in smoking in the presence of children.

CONCLUSION

The available data provide some support for the effectiveness of SHS campaigns in reducing smoking behaviours in homes and around children. However, the certainty of evidence was low due to the lack of a control group and the substantial heterogeneity in the outcomes assessed. Future campaigns need comprehensive evaluation and reporting to reduce publication bias.

Prevalence of Underreported Nicotine Exposure Among US Nonsmoking Adults: A Comparison of Self-Reported Exposure and Serum Cotinine Levels From NHANES 2013-2020

INTRODUCTION

Secondhand smoke (SHS) poses a significant health risk. However, individuals who do not smoke may be unaware of their exposure, thereby failing to take protective actions promptly.

AIMS AND METHODS

We assessed the prevalence of underreported nicotine exposure in a nationally representative sample of US nonsmoking adults using data from the US National Health and Examination Survey. Individuals with underreported nicotine exposure were defined as those who reported no exposure to all tobacco products (traditional tobacco, nicotine replacements, and e-cigarettes) or SHS, yet had detectable levels of serum cotinine (>0.015 ng/mL). We fitted logistic regression models to determine sociodemographic and chronic condition factors associated with underreported nicotine exposure.

RESULTS

Our analysis included 13 503 adults aged 18 years and older. Between 2013 and 2020, the prevalence of self-reported SHS exposure, serum cotinine-assessed nicotine exposure, and underreported nicotine exposure among US nonsmokers were 22.0%, 51.2%, and 34.6%, respectively. Remarkably, 67.6% with detectable serum cotinine reported no SHS exposure. Males, non-Hispanic blacks, individuals of other races (including Asian Americans, Native Americans, and Pacific Islanders), and those without cardiovascular diseases were more likely to underreport nicotine exposure than their counterparts. The median serum cotinine value was higher in respondents who reported SHS exposure (0.107 ng/mL) than in those who reported no exposure (0.035 ng/mL). We estimate that approximately 56 million US residents had underreported nicotine exposure.

CONCLUSIONS

Over a third of US nonsmokers underreport their nicotine exposure, underlining the urgent need for comprehensive public awareness campaigns and interventions. Further research into sociodemographic determinants influencing this underreporting is needed.

IMPLICATIONS

Understanding the extent of underreported nicotine exposure is crucial for developing effective public health strategies and interventions. It is imperative to bolster public consciousness about the risks associated with SHS. Additionally, surveillance tools should also incorporate measures of exposure to outdoor SHS and e-cigarette vapor to enhance the quality of data monitoring. Findings from this study can guide tobacco control initiatives and inform smoke-free air legislation.

The global, regional, and national disease burden of breast cancer attributable to tobacco from 1990 to 2019: a global burden of disease study

OBJECTIVE

Tobacco has been identified as a significant contributory element to the development of breast cancer. Our objective was to evaluate the spatiotemporal trends of tobacco-related breast cancer at the global, regional, and national scales during 1990-2019.

METHODS

We extracted data on mortality, disability adjusted of life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) from the Global Burden of Disease (GBD) study 2019. Estimated annual percentage change (EAPC) was computed to assess the temporal change in ASDR and ASMR.

RESULTS

In 2019, the deaths and DALYs attributed to tobacco-related breast cancer were estimated to be 35,439 (95% UI: 22,179-48,119) and 1,060,590 (95% UI: 622,550-1,462,580), respectively. These figures accounted for 5.1% and 5.2% of the total burden of breast cancer. ASMR and ASDR increased in low SDI regions, remained stable in low-middle and middle SDI regions and declined in high and high-middle SDI regions. The burden of breast cancer attributable to tobacco varied notably among regions and nations. Oceania, Southern Latin America, and Central Europe were the GBD regions with the highest number of ASMR and DALYs. There was a positive relationship between age-standardized rate and SDI value in 2019 across 204 nations or territories. A negative association was observed between the EAPC in ASMR or ASDR and the human development index (HDI) in 2019 (R = -0.55, p < 0.01 for ASMR; R = -0.56, p < 0.01 for ASDR).

CONCLUSION

Tobacco is one important and modifiable risk factor for breast cancer. The heterogeneity in both the spatial and temporal distribution can be attributed to factors such as aging, population growth, and SDI. These findings substantiate the necessity of expediting the enforcement of tobacco-free legislation in order to safeguard populations from the detrimental effects of tobacco.

Health effects associated with exposure to secondhand smoke: a Burden of Proof study

Despite a gradual decline in smoking rates over time, exposure to secondhand smoke (SHS) continues to cause harm to nonsmokers, who are disproportionately children and women living in low- and middle-income countries. We comprehensively reviewed the literature published by July 2022 concerning the adverse impacts of SHS exposure on nine health outcomes. Following, we quantified each exposure-response association accounting for various sources of uncertainty and evaluated the strength of the evidence supporting our analyses using the Burden of Proof Risk Function methodology. We found all nine health outcomes to be associated with SHS exposure. We conservatively estimated that SHS increases the risk of ischemic heart disease, stroke, type 2 diabetes and lung cancer by at least around 8%, 5%, 1% and 1%, respectively, with the evidence supporting these harmful associations rated as weak (two stars). The evidence supporting the harmful associations between SHS and otitis media, asthma, lower respiratory infections, breast cancer and chronic obstructive pulmonary disease was weaker (one star). Despite the weak underlying evidence for these associations, our results reinforce the harmful effects of SHS on health and the need to prioritize advancing efforts to reduce active and passive smoking through a combination of public health policies and education initiatives.

Use of nicotine replacement therapy to reduce children's exposure to second-hand smoke in the home: a qualitative pilot study involving local community pharmacies

BACKGROUND

In Scotland, and in several other countries, most second-hand smoke exposure now occurs in low-income households, where housing constraints and sole parenting often make it harder to create a smoke-free home. This pilot study provided people who smoke with a free 12-week supply of nicotine replacement therapy through local community pharmacies to reduce smoking indoors.

METHODS

Twenty-five parents/caregivers who smoked in the home and cared for children at least weekly were recruited via Facebook during the COVID-19 pandemic. Air quality (PM2.5) was monitored in participant homes for seven days before their first pharmacy visit and 12 weeks later. Qualitative interviews (N = 14) were conducted with 13 participants who completed the study and one who withdrew part-way through. The interviews explored views/experiences of using nicotine replacement therapy to help create a smoke-free home. Another participant took part in a shorter telephone discussion at their request, with detailed notes taken by the interviewer, because of their speech disorder.

RESULTS

Three participants reported smoking outdoors only, one of whom subsequently quit smoking. Six participants reported reduced cigarette consumption by 50% in the home, four reported no (sustained) reduction and one reported increased smoking indoors. Self-reported outcomes were not always consistent with PM2.5 readings. Participants' experiences of accessing nicotine replacement therapy through community pharmacies varied. Some suggested ongoing support to use nicotine replacement products could better assist behavioural change, and that access could be streamlined by posting products to the home. Several suggested that focusing on changing home smoking behaviours using nicotine replacement therapy might facilitate a future quit attempt.

CONCLUSION

Access to free nicotine replacement therapy for temporary use indoors may support some people who smoke to reduce children's exposure to second-hand smoke. Our findings confirm the need to modify the intervention before undertaking a definitive trial to assess the effectiveness of this approach. This work is now underway.

A Brief Digital Screening and Intervention Tool for Parental and Adolescent Tobacco and Electronic Cigarette Use in Pediatric Medical Care in Canada: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Though rates of tobacco smoking have decreased consistently over the past 3 decades, cigarette use remains the top preventable cause of premature death in North America. The Clinical Effort Against Secondhand Smoke Exposure (CEASE) is a medical clinic-based intervention that systematically screens parents for tobacco use and offers them direct access to evidence-based smoking cessation services. While the effectiveness of CEASE for parents who smoke has already been demonstrated in the United States, the CEASE model has not yet been tested in Canada, among parents who use e-cigarettes, or among adolescents who use cigarettes and e-cigarettes.

OBJECTIVE

We aim to demonstrate the feasibility and evaluate the preliminary effectiveness of the CEASE program for parental smoking cessation and its adapted version for adolescent smoking cessation and adolescent and parental vaping cessation.

METHODS

We will approach parents or guardians of children aged between 0 and 17 years, as well as adolescent patients aged between 14 and 17 years, from a tertiary care pediatric hospital in Montreal, Quebec, Canada, for participation in this single-blinded, pilot randomized controlled trial. Eligible participants are those who report using tobacco cigarettes or e-cigarettes at least once in the last 7 days and present to an outpatient pediatric clinic for a scheduled appointment. Our recruitment target is 100 participants: 50 parents or guardians of children aged 17 years or younger, and 50 adolescents aged between 14 and 17 years. The feasibility of implementation of the CEASE model will be measured by recruitment and retention rates for all 4 participant groups (stratified as follows: parents who use cigarettes, parents who use e-cigarettes exclusively, adolescents who use cigarettes, and adolescents who use e-cigarettes exclusively). Parent and adolescent participants within each group are randomized to the intervention and control groups using a 1:1 ratio through a computer-generated randomization list. Preliminary effectiveness outcomes include self-reported smoking and e-cigarette cessation, use of cessation resources, changes in smoking and e-cigarette use, motivation to quit, and quit attempts among participants. Participants complete electronic questionnaires on a tablet in the clinic at baseline as well as electronic follow-up questionnaires at 1, 3, and 6 months. Individuals reporting successful quit attempts are invited to provide a urine sample for cotinine testing to biochemically confirm quit. Analyses include descriptive statistics as well as exploratory trajectory analyses of smoking, e-cigarette use, and motivation to quit.

RESULTS

Research activities began in June 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 15 months.

CONCLUSIONS

There is a strong need for effective and cost-effective smoking and vaping cessation interventions for parents and adolescents. If successful, this study will help inform the preparation of a fully powered randomized controlled trial of CEASE in Canada in these populations.

TRIAL REGISTRATION

Clinicaltrials.gov NCT05366790; https://www.clinicaltrials.gov/study/NCT05366790.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47978.

Second-hand smoke exposure and cervical cancer: a systematic review and meta-analysis

PURPOSE

The association between second-hand smoke (SHS) exposure and cervical cancer (CC) risk is still unclear. The aim of this study is to provide an accurate and updated estimate of this association.

METHODS

Through an original methodology to identify original publications, we conducted a systematic review and meta-analysis of all epidemiological studies published up to October 2022 evaluating the association between SHS exposure and CC risk among female non-smokers. Meta-analytic estimates were obtained using random-effects models and dose-response relationships were derived using log-linear functions.

RESULTS

Out of 25 eligible studies, 21 were included in the meta-analysis, providing a pooled relative risk (RR) of cervical intraepithelial neoplasia (CIN) of grade 2 or higher of 1.52 (95% confidence interval, CI 1.30-1.78, 21 studies) for overall SHS exposure versus non-exposure. When restricting the analysis to invasive CC, the pooled RR was 1.42 (95% CI 1.17-1.71, 13 studies), whereas the pooled RR for CIN was 1.50 (95% CI 1.22-1.84, 6 studies). Analyzing RR by setting or source of SHS exposure resulted in significant associations with CC risk for SHS exposure at home (RR for CIN2+  1.49, 95% CI 1.21-1.84, 14 studies), in non-specified settings (RR for CIN2+  1.64, 95% CI 1.20-2.23, 8 studies) and from partner (RR for CIN2+  1.55, 95% CI 1.25-1.94, 10 studies). The risk of CIN2+ significantly increased linearly with the intensity and pack-years of SHS exposure.

CONCLUSION

This comprehensive review and meta-analysis confirmed the association of SHS exposure with CC, further suggesting the need to raise concern about SHS exposure in the population.

Exposure to secondhand and thirdhand smoke in private vehicles: Measurements in air and dust samples

BACKGROUND

This study aimed to estimate airborne nicotine concentrations and nicotine, cotinine, and tobacco-specific nitrosamines (TSNAs) in settled dust from private cars in Spain and the UK.

METHODS

We measured vapor-phase nicotine concentrations in a convenience sample of 45 private cars from Spain (N = 30) and the UK (N = 15) in 2017-2018. We recruited non-smoking drivers (n = 20), smoking drivers who do not smoke inside the car (n = 15), and smoking drivers who smoke inside (n = 10). Nicotine, cotinine, and three TSNAs (NNK, NNN, NNA) were also measured in settled dust in a random subsample (n = 20). We computed medians and interquartile ranges (IQR) of secondhand smoke (SHS) and thirdhand smoke (THS) compounds according to the drivers' profile.

RESULTS

24-h samples yielded median airborne nicotine concentrations below the limit of quantification (LOQ) (IQR:

CONCLUSIONS

All cars of smokers had measurable SHS and THS pollution, the exposure levels markedly higher in vehicles of drivers where smoking took place. Our results evidence the need for policies to prohibit smoking in vehicles, but also urge for more comprehensive strategies aiming towards the elimination of tobacco consumption.

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Key Words

• Airborne nicotine
• Automobile
• Dust
• Thirdhand smoke
• Tobacco smoke pollution
• Tobacco-specific nitrosamines

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MESH Headings

• Nicotine/analysis
• Cotinine
• Tobacco Smoke Pollution/analysis
• Dust
• Nitrosamines/analysis
• Tobacco

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Affiliation(s)

Xavier Continente Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
Elisabet Henderson Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
Laura López-González Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.
Esteve Fernández Unitat de Control de Tabac, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain; Institut D'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 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, 08907, L'Hospitalet de Llobregat, Spain; Centre for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
Olena Tigova Unitat de Control de Tabac, Institut Català d'Oncologia, Av. Granvia de l'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain; Institut D'Investigació Biomèdica de Bellvitge, Av. Granvia de l'Hospitalet 199, 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, 08907, L'Hospitalet de Llobregat, Spain; Centre for Biomedical Research in Respiratory Diseases (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
Sean Semple Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
Rachel O'Donnell Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
Ana Navas-Acién Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, United States.
Núria Cortés-Francisco Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
Noelia Ramírez Institut d'Investigació Sanitària Pere Virgili, Dr. Mallafré Guasch, 4, 43007, Tarragona, Spain; Universitat Rovira i Virgili, Department of Electronic Engineering, Escorxador, s/n, 43003, Tarragona, Spain; Centre for Biomedical Research in Diabetes and Associated Metabolic Diseases (CIBERDEM), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
Ruaraidh Dobson Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
Maria José López Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut (DCEXS), Universitat Pompeu Fabra, Doctor Aiguader, 88, 08003, Barcelona, Spain.

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Smoking cessation and relapse-prevention interventions tailored for expectant and new fathers: protocol of a systematic review and network meta-analysis

INTRODUCTION

Exposure of pregnant women and newborns to secondhand smoke (SHS) can lead to adverse maternal and neonatal health outcomes. Among expectant and new fathers, who are the main source of SHS exposure for pregnant women, new mothers and babies, smoking rates remain high. A partner's pregnancy potentially constitutes a critical period where expectant and new fathers are motivated to quit smoking. However, there is no consensus on the optimal form and delivery of smoking cessation and relapse-prevention interventions. We present a systematic review and network meta-analysis protocol that aims to synthesise and evaluate the effectiveness of smoking cessation and relapse-prevention interventions tailored for this population.

METHODS AND ANALYSIS

To identify relevant studies, we will conduct a comprehensive search, in English and Chinese, of 10 electronic databases. The review will include randomised and quasi-randomised controlled trials that compare behavioural interventions (tailored and non-tailored) with/without the addition of pharmacotherapy with usual care, a minimal or placebo control for assisting expectant and new fathers to quit smoking and prevent smoking relapse. The primary outcome of interest is the self-reported and/or biochemically verified smoking abstinence at ≥1-month follow-up. Two reviewers will independently screen, select and extract relevant studies, and perform a quality assessment. Disagreements will be resolved by a consensus or third-party adjudication. The Cochrane Risk of Bias tool V.2 will be used to assess the risk of bias in the included studies. We will obtain the results of the systematic review through pooled quantitative analyses using a network meta-analysis. Sensitivity and subgroup analyses will be performed.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review of published data. The findings will be disseminated via peer-reviewed publication.

PROSPERO REGISTRATION NUMBER

CRD42022340617.

Trends and factors associated with secondhand smoke exposure among US cancer survivors, 2013-2020

BACKGROUND

Secondhand smoke (SHS) poses a significant public health threat. Cancer survivors are at a greater risk of adverse health outcomes from SHS because of its association with poor prognosis and other downstream clinical events.

METHODS

A nationally representative sample of US adults aged 20 years and older was analyzed from the National Health and Nutrition Examination Survey between 2013 and 2020. Data on indoor SHS exposure were reported by 16,778 adults who were not currently smoking (1775 cancer survivors; 15,003 individuals without a cancer history). The weighted prevalence of SHS exposure was estimated and compared across sociodemographic and health-related characteristics. Multivariable logistic regression models were fitted to identify correlates of SHS exposure.

RESULTS

Of the 1775 nonsmoking cancer survivors (mean age, 64.9 years; 57.0% female; 84.4% non-Hispanic Whites), 15.8% reported SHS exposure. No significant change in trends of SHS exposure was observed during the study period. The prevalence of SHS exposure was higher in cancer survivors who were younger, racial minorities, and had a household income below 130% of the federal poverty level. After adjustment for multiple correlates, age below 40 years, low income, smoking history, and diagnosis within 2 years were associated with SHS exposure. Cancer survivors were most likely to report that SHS exposure occurred at home or in a car.

CONCLUSIONS

The prevalence of SHS exposure among cancer survivors remained steady in the past decade. However, disparities exist in SHS exposure among cancer survivors across sociodemographic characteristics and smoking status. Smoking cessation programs should be promoted among caregivers and families of cancer survivors.

Effect of educational intervention in reducing exposure to second hand tobacco smoke among 12-year-old children as determined by their salivary cotinine levels and knowledge, attitude and behavior - a randomized controlled trial

Background

Tobacco use is one of the most important public health concerns, with approximately 8.7 million tobacco-related deaths each year, primarily in low- and middle-income countries. Even more concerning is the fact that 1.3 million of these deaths are seen in nonsmokers, including babies and children. This study was performed to determine whether a school-based "tobacco-free" educational intervention program among 12-year-old children would be effective in reducing their exposure to second-hand tobacco smoke (SHS) by improving their knowledge, attitude and behavior post intervention and estimating salivary cotinine levels as markers of SHS exposure.

Materials and method

A randomized controlled trial was performed by a cluster random sampling technique, with 30 participants each in the experimental and control arms. A knowledge, attitude, avoidance behavior and self-efficacy of avoidance questionnaire was administered, followed by estimation of salivary cotinine levels. The experimental arm received the "tobacco-free" intervention, which comprised a 40-min health education session, with the first follow-up at 15 days and the second at 30 days after the intervention. After the intervention, the questionnaire was readministered, followed by re-estimation of salivary cotinine levels.

Results

One month after the intervention, the number of participants who had a smoker who lived with them and the number of people who smoked inside the house were reduced in the experimental group compared to the control group. In the knowledge domain and the attitude domain, 80% and 60% of the items showed a statistically significant improvement in the experimental group compared to the control group. In the avoidance behavior domain and the Self-Efficacy of Avoidance Domain, all the items showed improvement in the experimental group compared to the control group. When the mean salivary cotinine levels were compared pre- and postintervention, it was found that although the mean postintervention salivary cotinine levels increased in both the experimental and control groups, the increase was less in the experimental group than in the control group.

Conclusion

The present study has been shown to be effective in improving the knowledge, attitude and avoidance behavior of adolescents toward exposure to secondhand smoke.

Higher Prevalence and Severity of Eosinophilic Otitis Media in Patients with Asthma-COPD Overlap Compared with Asthma Alone

INTRODUCTION

Eosinophilic otitis media (EOM) is well-known to frequently co-exist with adult-onset asthma. Both diseases are similar type 2 inflammation and are considered to have a "one airway, one disease" relationship. Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO), characterized by airway obstruction caused by airway wall thickening (AWT), is a severe condition with a higher incidence of mortality compared to asthma alone or COPD alone. Based on the "one airway, one disease" concept, we hypothesized that the inflammatory pathophysiology of EOM differs depending on its comorbidity with ACO or with asthma alone.

METHODS

A total of 77 chronic rhinosinusitis (CRS) patients with asthma were enrolled in this study. The subjects were divided into 2 groups: a group with comorbid asthma alone (asthma group; 46 patients), and a group with comorbid ACO (ACO group; 31 patients). The 2 groups were compared and assessed with regard to various factors, including the patients' clinical characteristics, prevalence rate of EOM, EOM severity, EOMs relationships with smoking and AWT, and the eosinophil and neutrophil cell counts in the middle ear effusion (MEE).

RESULTS

The ACO group included significantly more males (p < 0.05), was significantly older (p < 0.05), and showed significantly lower lung function values (FEV1 [L], FEV1 [%pred]) (p < 0.01) compared with the asthma group. The ACO group also had a significant history of smoking as shown by the Brinkman index (p < 0.01) and greater AWT as assessed by high-resolution computed tomography (p < 0.05). The EOM prevalence rate was significantly higher in the ACO group (p < 0.05), especially with increased ACO severity (p < 0.05). The EOM severity was also significantly higher in the ACO group (p < 0.05) and also correlated with the ACO severity (p < 0.05). The pretreatment ear clinical characteristics score and the average air conduction hearing level were significantly higher in the ACO group (p < 0.05). The eosinophil percentage in the MEE/otorrhea was significantly lower in the ACO group (25.3%) than in the asthma group (54.7%) (p < 0.05). Conversely, the neutrophil percentage was significantly higher in the ACO group (75.7% vs. 41.9%) (p < 0.05).

CONCLUSIONS

Our findings suggest that, in CRS patients with asthma, comorbidity with ACO may be a clinical factor leading to increased EOM prevalence and severity, as well as a higher neutrophil infiltration percentage in the middle ear. Cessation of smoking and early therapeutic intervention for ACO may mitigate progression of bronchial remodeling (i.e., reduce AWT) and help reduce the prevalence and severity of EOM.

Home Care Aides' Perspectives of Occupational Tobacco Smoke Exposure: A Q Methodology Study

INTRODUCTION

The increased growth of older adults has generated demand for home care aides (HCAs). Occupational tobacco smoke exposure (OTSE) may risk their health which should be paid attention to.

AIMS AND METHODS

This study explored the HCAs' perspectives of OTSE to inform health promotion programs catering to individual needs. A two-stage Q methodology was employed for data collection and analysis. Thirty-nine Q statements were extracted in the first stage and then 51 HCAs with OTSE were recruited to complete Q sorting in the second stage. PQ Method software was used for data analysis. Principal component analysis was performed to determine the most appropriate number of factors.

RESULTS

The five factors identified from HCAs' perspective of OTSE explained 51% of the variance. The HCAs agreed that OTSE could increase cancer risk. The HCAs with factor I did not care about OTSE, tending to complete their work. The HCAs with factor II agreed with the health hazards of OTSE, but did not know how to help their clients stop smoking. The HCAs with factor III cared about OTSE but were afraid of disrupting the client-provider relationship. The HCAs with factor IV regarded OTSE as a priority for occupational interventions whereas the HCAs with factor V did not think OTSE was an issue and believed that they could balance work and OTSE health hazards.

CONCLUSIONS

Our findings will inform the design of home care pre-service and on-the-job training courses. Long-term care policies should be developed to promote smoke-free workplaces.

IMPLICATIONS

There are five types of HCAs' perspectives on OTSE. The tailor interventions can be developed to help them avoid the OTSE (eg, opening windows for ventilation or using air purification equipment) and have an OTSE-free space.

Burden of diseases attributable to second-hand smoke exposure in Iran adolescents from 2009 to 2020

Exposure to second-hand smoke (SHS) is prevalent in many countries, but the problem's scope is poorly understood globally, especially in developing countries. We aimed to estimate SHS exposure and its national and subnational burden of diseases in Iran, the second-largest country in the Middle East, during 2009-2020. The burden of diseases from SHS was estimated as disability-adjusted life years (DALYs) for adolescents (10-18) year's non-smokers. Using comparative risk assessment methodologies, the calculations were based on disease-specific relative risk estimates with national and subnational SHS exposure data, and the uncertainty and sensitivity analysis was performed. The results of study showed that the trend of exposure to SHS is increasing in Iran. The highest DALY was related to lower respiratory infection (LRI), asthma, and otitis media, respectively. The national average asthma burden (DALY/100,000) has increased from 17.4 (11.8_23.9) in 2009 to 21.3 (13.9_30) in 2020, LRI decreased from 25.8 (21.5_30.2) to 19.8 (16.7_23.1), and national average burden of otitis media (DALY/100,000) has increased from 3.1(1.9_4.6) to 3.9(2.4_5.6). The increasing trend of otitis media and asthma DALYs attributable to SHS exposure in Iran requires more attention from policymakers to protect the population.

Passive exposure and perceptions of smoke-free policies in hospital and university campuses among nursing students: A cross-sectional multicenter study

INTRODUCTION

Outdoor smoke-free regulations reduce exposure to secondhand smoke (SHS) and help to denormalize tobacco use. As future key agents in health promotion, nursing students' attitudes should agree with tobacco-control policies. The objectives of this study were: 1) assess nursing students' exposure to SHS in nursing schools, 2) explore their perceptions of compliance with the existing smoke-free regulations in acute-care hospitals; and 3) describe their support for indoor and outdoor smoking bans on hospital and university campuses.

METHODS

This was a cross-sectional multicenter study conducted in 2015-2016 in all 15 university nursing schools in Catalonia, Spain. A questionnaire gathered information on SHS exposure, awareness of the smoke-free regulation in acutecare hospitals, and support for smoke-free policies in indoor and outdoor areas of hospitals and university campuses. Participants were nursing students attending classes on the day of the survey. We performed descriptive analyses and calculated adjusted prevalence ratios (APR) and 95% confidence interval (CI).

RESULTS

Of 4381 respondents, 99.1% had seen people smoking in outdoor areas of their university campus, and 75.2% had been exposed to SHS on the campus (6.0% indoors and 69.2% outdoors). Nearly 60% were aware of the smoking regulation in place in acute-care hospitals. There was widespread support for smoke-free indoor hospital regulation (98.7%), but less support (64.8%) for outdoor regulations. Approximately 33% supported the regulation to make outdoor healthcare campuses smoke-free, which was higher among third-year students compared to first-year students (APR=1.41; 95% CI: 1.24-1.62), among never smokers (41.4%; APR=2.84; 95% CI: 2.21-3.64) compared to smokers, and among those who were aware of the regulation (38.4%; 95% CI: 1.37-1.75).

CONCLUSIONS

Exposure to SHS on university campuses is high. Nursing students express low support for strengthening outdoor smoking bans on hospital and university campuses. Interventions aiming to increase their support should be implemented.

Acute upper respiratory infections admissions in England and Wales

Acute respiratory infections block the bronchial and/or nasal systems' airways. These infections may present in a variety of ways, from minor symptoms like the common cold to more serious illnesses like pneumonia or lung collapse. Acute respiratory infections cause over 1.3 million infant deaths under the age of 5 each year throughout the world. Among all illnesses, respiratory infections make for 6% of the worldwide disease burden. We aimed to examine the admissions related to acute upper respiratory infections admissions in England and Wales for the period between April 1999 and April 2020. This was an ecological study using publicly available data extracted from the Hospital Episode Statistics database in England, and the Patient Episode Database for Wales for the period between April 1999 and April 2020. The acute upper respiratory infections-related hospital admissions were identified using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems 5th Edition (used by National Health Service [NHS] to classify diseases and other health conditions) (J00-J06). The total annual number of admissions for various reasons increased by 1.09-fold (from 92,442 in 1999 to 193,236 in 2020), expressing an increase in hospital admission rate of 82.5% (from 177.30 [95% confidence interval {CI}: 176.15-178.44] in 1999 to 323.57 [95%CI: 322.13-325.01] in 2020 per 100,000 persons, P < .01). The most common causes were acute tonsillitis and acute upper respiratory infections of multiple and unspecified sites, which accounted for 43.1% and 39.4%, respectively. Hospital admissions rate due to acute upper respiratory infections increased sharply during the study period. The rates of hospital admissions were higher among those in the age group below 15 and 75 years and above for the majority of respiratory infections, with a higher incidence in females.

Impact of National Tobacco Control Policy on Rates of Hospital Admission for Pneumonia: When Compliance Matters

A number of studies claim that tobacco control (TC) regulations are associated with reductions in smoking-related hospitalisation rates, but very few have estimated the impact of TC laws (TCL) at both countrywide and regional levels, and none of them have studied the impact of TCL in relation to compliance with TC regulations. This study evaluates the effects of Russian TCL on hospital admission (HA) rates for pneumonia countrywide and in 10 Russian regions and the extent of these effects in connection with the compliance with TCL. Methods: HA rates for pneumonia from 2005-2019 were analysed to compare the periods before and after the adoption of TCL in 2013. An interrupted time series design and a Poisson regression model were used to estimate the immediate and long-term effects of TCL on pneumonia annual hospitalisation rates after the TCL adoption, compared with the pre-law period. The 10 Russian regions were compared using the TCL implementation scale (TCIS) developed on the basis of the results of the Russian TC policy evaluation survey; Spearman's rank correlation and linear regression models were employed. Results showed a 14.3% reduction in HA rates for pneumonia (RR 0.88; p = 0.01) after the adoption of TCL in Russia with significant long-term effect after 2013 (RR 0.86; p = 0.006). Regions with better enforcement of TCL exhibited greater reductions in pneumonia HA rates (rsp = -0.55; p = 0.04); (β = -4.21; p = 0.02). Conclusions: TCL resulted in a sustained reduction in pneumonia hospitalisation rates, but these effects, varying by region, may depend on the scale of the TCL enforcement.

Global, regional, and national deaths, disability-adjusted life years, years lived with disability, and years of life lost for the global disease burden attributable to second-hand smoke, 1990-2019: A systematic analysis for the Global Burden of Disease Study

BACKGROUND

Smoke-free policies have led to a decline in smoking prevalence. Nevertheless, as the global population grows, more non-smokers are exposed to second-hand smoke (SHS) hazards. Mitigating SHS hazards requires a systematic analysis of the global disease burden attributable to SHS.

METHODS

Data on SHS was extracted from the Global Burden of Disease Study 2019. First, we measured the disease burden of SHS by the number of cases and age-standardized rates of deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) from 1990 to 2019. Second, trends in the disease burden of SHS in different periods were estimated based on the annual percentage change (APC) by joinpoint regression analysis. Finally, using histogram plots, world maps, Pearson correlation analysis, and population attributable fraction (PAF), we conducted a stratified analysis of SHS exposure by sex, age, geographic location, sociodemographic index (SDI) level, and disease.

RESULTS

The number of deaths caused by SHS remained stable between 1990 and 2019, and the number of YLDs more than doubled in three decades. In contrast, the number of DALYs and YLLs caused by SHS decreased. The declining trend in deaths (APC = -1.42 % [95 % UI -1.79 %, -1.05 %]), DALYs (APC = -1.91 % [95 % UI -2.15 %, -1.67 %]), and YLLs (APC = -1.28 % [95 % UI -1.93 %, -0.64 %]) had slowed down in recent years, while SHS-related YLDs were still increasing (APC = 1.84 % [95 % UI 0.74 %, 2.96 %]). From 2010 to 2019, we found that SHS exposure increased the risk of tracheal, bronchus, and lung cancer (PAF increased by 11.75 %), breast cancer (PAF increased by 5.36 %), diabetes mellitus (PAF increased by 8.24 %), and ischemic heart disease (PAF increased by 4.46 %). In addition, the disease burden caused by SHS was highest in middle SDI and low-middle SDI countries.

CONCLUSION

The global disease burden attributable to SHS is still severe, and policymakers need to implement more effective measures to reduce the harm of SHS.

Concordance assessment through comparison with urine cotinine: Does self-report adequately reflect passive smoking?

INTRODUCTION

There is a paucity of studies evaluating passive smoking (PS) by comparing self-report (SR) and biomarkers. Our study aimed to confirm whether SR could accurately reflect PS compared to biomarkers, a golden standard for assessing the exposure of non-smokers.

METHODS

We used the 2014-2020 Korea National Health and Nutrition Examination Survey data and selected 29622 non-smokers aged >19 years as the study participants. The PS rate by SR was assessed during the last 7 days, and participants were interviewed to investigate their exposure at home, work, indoors, and in public places. In addition, participants having a limit of detection ≥0.5 ng/mL in urine cotinine (UC) was defined as the exposure group. All analyses reflected the weights of complex sampling. We first compared the rates of PS using biomarkers and SR, and then the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated based on biomarkers.

RESULTS

PS exposure by UC was the highest (44.4%), and the exposure by SR was significantly lower (5.1-29.5%). Kappa and sensitivity in PS in the indoor home (HPS) were lower than those in indoor workplaces (WPS) and indoor public places (PPS). Moreover, overall sensitivity and PPV were lower, and specificity and NPV were relatively higher in accuracy. Lastly, the sensitivity was poor, and the specificity was relatively good, which means that measurement by SR would identify people who were actually exposed to PS as non-exposed.

CONCLUSIONS

Despite exposure to PS, the use of the SR method is more likely to classify participants in the non-exposed group. Hence, to overcome measurement error in SR and reflect exposure in any place and setting, biomonitoring and SR should be performed.

Applying persuasive messages to reduce public outdoor smoking: A pseudo-randomized controlled trial

Despite efforts to create dedicated smoking areas and no-smoking signs, many smokers continue to light their cigarettes in front of public building entrances-leading to concerns over health consequences for non-smokers passing by. To increase compliance with no-smoking requests, behavioral interventions that tap into habitual and automatic processes seem promising. A pseudo-randomized controlled trial was conducted to assess the differential impact of seven behavioral interventions based on Cialdini's principles of persuasion. Over a period of 9 weeks, the number of smokers was counted (total n = 17,930 observations) in front of a German University Medical Center. Relative to a baseline and a control condition, interventions based on the principles of reciprocity, scarcity, and authority were most effective in reducing the number of observed smokers in front of the building entrance (41.5%, 45.7%, and 52.1% reduction rates, respectively). Having observed smokers' behavior in vivo, this study provides substantial evidence for the impact of persuasive strategies on outdoor smoking. In the future, this knowledge should be used to protect non-smokers from second-hand smoke by increasing the use of designated smoking areas, leave to another place to smoke, or not smoke at all.

[Questions and Answers in Tobacco Smoking]

Smoking is an addictive, chronic and relapsing disease that, due to its high prevalence, morbidity and mortality, has become one of the main public health problems worldwide, affecting both smokers and rest of population involuntarily exposed to smoke tobacco.To overcome this pandemic, it is essential that all health professionals intervene on the problem in a manner adapted to their level of care, from giving brief advice for stop smoking to proposing intensive cognitive-behavioral and pharmacological treatment.Smoking cessation treatments have proven to be safe and effective, but unfortunately, the personal and economic resources dedicated to smoker care are not proportional to the magnitude of the problem, with few specialized consultations and lack of funding for pharmacological treatments.In addition, we must confront the arguments of the tobacco industry that interferes in the fight against smoking with new products that they pretend to offer as «harm reduction strategies» when really it is their way of attracting new addicts to tobacco products.

Awareness of hazards due to tobacco among people aged 15 years and older in Chongqing, China, in 2020: A cross-sectional analysis

INTRODUCTION

Tobacco smoke contains a large number of harmful substances and carcinogens. Smoking and secondhand smoke cause a variety of cancers and diseases, seriously endangering human health. However, the status and characteristics of the awareness of hazards due to tobacco among people aged ≥15 years in Chongqing, China, are still unknown.

METHODS

A multistage stratified cluster random sampling method was used to select ten districts and counties in Chongqing Municipality, China and a total of 6622 people were investigated between August and October 2020. The chi-squared test was used to analyze the awareness of hazards due to tobacco in various populations after the data had been cleaned and weighted.

RESULTS

In 2020, the awareness rates of people aged ≥15 years in Chongqing, China, about a specific disease caused by smoking were lung cancer (77.1%), heart disease (45.1%), stroke (40.1%), and penile erectile dysfunction (24.2%). However, only 22.1% of the respondents knew that smoking could simultaneously lead to all four diseases mentioned above. Adult lung cancer was the disease with the highest awareness rating (72.5%), followed by children's lung disease (54.2%) and adult heart disease (46.1%). A total of 42.0% of respondents knew that secondhand smoke could cause the three diseases simultaneously. Only 22.0% of those correctly understood the harm of low-tar cigarettes. The logistic regression results showed that education level and occupation were risk factors for lack of awareness of hazards due to tobacco. In contrast, media campaigns on tobacco control were a protective factor.

CONCLUSIONS

The awareness of hazards due to tobacco among people aged ≥15 years in Chongqing, China, still needs to be improved. More graphic health warning labels and mass media campaigns about the hazards of tobacco should be carried out to raise people's awareness and warn about the health risks of smoking.

How sports clubs decide to adopt an outdoor smoke-free policy: a qualitative study applying the Garbage Can Model

Background

Outdoor smoke-free policies (SFPs) at sports clubs can contribute to protecting people from second-hand smoke (SHS). However, in absence of national legislation, it is uncertain whether and how sports clubs decide to adopt an SFP. The aim of this study was to explore the decision-making process at sports clubs in relation to the adoption of an outdoor SFP.

Methods

Semi-structured interviews were held with key stakeholders at 20 Dutch sports clubs (in field hockey, football, tennis, or korfball) with an outdoor SFP. Thematic analysis was applied, and themes were defined in line with the four streams of the Garbage Can Model (GCM).

Results

We identified four motivating factors for sports clubs to start the decision-making process: 1) SHS as a problem, 2) intolerance of smoking behavior, 3) advantages of an outdoor SFP, and 4) external pressure to become smoke-free. The decision-making process involved a variety of participants, but the board, influential club members, and smokers usually played major roles. Decisions were discussed during both formal and informal choice opportunities, but only made during formal choice opportunities. With regard to solutions, sports clubs adopted a partial or total outdoor SFP. In addition, sports clubs followed different strategies with regard to the decision-making process, which we classified along two dimensions: 1) autocratic vs. democratic and 2) fast vs. slow.

Conclusion

A number of factors motivated sports clubs to start the decision-making process. These factors were mainly linked to a strong non-smoking norm. Decision-making involved different participants, with a key role for the board, influential club members, and smokers. Governments and other external organizations may contribute to SFP adoption at sports clubs in several ways. They may advise clubs on strategies of decision-making and how to involve smokers in this process.

Predicting Young Adult Tobacco, Drug and Alcohol Use Among Participants in the CAMP Trial

The development of substance abuse in youth with asthma have seldom been examined with longitudinal research. The prospective and well-characterized CAMP cohort provides outcome data on youth with asthma over 13 years. This manuscript seeks to determine the contributions of asthma features and child behavioral/emotional functioning to subsequent tobacco, alcohol, and drug use in early adulthood. Childhood smoking exposures as well as parent report and youth report of substance use were prospectively assessed concurrently with assessments of asthma symptoms, study medication, and lung development. Logistic regression models evaluated predictors of adolescent and young adult tobacco, alcohol, and drug use. Use of tobacco products was reported by 33% of youth with mild/moderate asthma. Tobacco use was significantly associated with self-reported externalizing behaviors. Early life passive smoke exposure, especially in utero exposure, makes a significant contribution to tobacco use (OR1.58). Greater risk for tobacco use is conveyed by self-reported externalizing behaviors, which are consistently robust predictors of any future use of tobacco products, alcohol and drugs. These findings provide evidence for health care providers to use routine behavioral screening in youth with asthma.

Association of exposure to environmental tobacco smoke at home and risk of mortality among US never smokers by race/ethnicity, education, and income

Environmental tobacco smoke (ETS) increases the risk of mortality among nonsmokers. Yet, few studies have examined this association among racial/ethnic minorities or among people with less education or income. We assessed self-reported ETS exposure at home among never smoking participants (n = 110,945) of the 1991-2010 National Health Interview Surveys. Deaths through 2015 were identified by the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality were estimated using Cox proportional hazards regression models with age as the underlying time metric and adjusted for sex, race/ethnicity, education, household income, body mass index, region of residence, and survey year. We further stratified all-cause mortality analyses by race/ethnicity, household income, and education. Relative to no ETS at home, every day exposure was associated with higher risk of all-cause mortality (HR = 1.33, 95%CI: 1.23, 1.45), with similar HRs observed across strata of education and income. HRs were similar among non-Hispanic Black (HR = 1.28, 95%CI: 1.08, 1.53) and non-Hispanic White adults (HR = 1.34, 95%CI: 1.21, 1.48) although somewhat higher among Hispanic adults (HR = 1.65, 95%CI: 1.29, 2.10; P for pairwise comparison = 0.04). ETS exposure at home is an important contributor to mortality across strata of race/ethnicity, education, and income in the US.

A comprehensive economic assessment of the health effects of tobacco use and implications for tobacco control in Bangladesh

BACKGROUND

Despite modest progress in reducing tobacco use, tobacco remains one of the major risk factors for non-communicable diseases in Bangladesh.

METHODS

Using disease-specific, prevalence-based, cost-of-illness approach, this research estimated the economic costs of tobacco use and exposure to secondhand smoke based on data collected from a nationally representative survey of 10 119 households in 2018.

RESULTS

The study estimated that 1.5 million adults were suffering from tobacco-attributable diseases and 61 000 children were suffering from diseases due to exposure to secondhand smoke in Bangladesh in 2018. Tobacco use caused 125 718 deaths in that year, accounting for 13.5% of all-cause deaths. The total economic cost was 305.6 billion Bangladeshi taka (BDT) (equivalent to 1.4% of gross domestic product or US$3.61 billion), including direct costs (private and public health expenditures) of BDT83.9 billion and indirect costs (productivity loss due to morbidity and premature mortality) of BDT221.7 billion. The total economic cost of tobacco more than doubled since 2004.

CONCLUSION

Tobacco use imposes a significant and increasing disease and financial burden on society. The enormous tobacco-attributable healthcare costs and productivity loss underscore the need to strengthen the implementation of tobacco control policies to curb the epidemic.

Public Health Burden of Secondhand Smoking: Case Reports of Lung Cancer and a Literature Review

Secondhand smoke (SHS), composed of mainstream and sidestream smoke, is a known human carcinogen. It contains a variety of harmful substances at even higher concentrations than mainstream smoke itself, which is inhaled during firsthand smoking. Exposure to SHS, affecting more than a third of the worldwide population, increases the likelihood of lung cancer by roughly 30%, with specific contributions depending on the histological type of cancer. This study aimed to present the harmful potential of SHS through case reports and describe the burden of SHS via a literature review. From a collection of lung cancer case reports occurring in never smokers from the Olomouc district over the last 10 years, 2 cases with no risk factors for lung cancer except for significant exposure to SHS were identified. Both cases were of young women who lived in households where their parents smoked during childhood. They suffered from rarer histological types of lung cancer in which the association with SHS has not yet been analyzed. As the literature confirms, SHS has the most adverse effects in individuals exposed during childhood. It is necessary to both take measures to reduce the prevalence of SHS, especially among children in households and pay due attention to the smoking history of patients, including current and previous exposure to SHS, when obtaining anamnestic data. Furthermore, the effect of SHS on rarer histological types of lung cancer should be studied.

Single CT Appointment for Double Lung and Colorectal Cancer Screening: Is the Time Ripe?

Annual screening of lung cancer (LC) with chest low-dose computed tomography (CT) and screening of colorectal cancer (CRC) with CT colonography every 5 years are recommended by the United States Prevention Service Task Force. We review epidemiological and pathological data on LC and CRC, and the features of screening chest low-dose CT and CT colonography comprising execution, reading, radiation exposure and harm, and the cost effectiveness of the two CT screening interventions. The possibility of combining chest low-dose CT and CT colonography examinations for double LC and CRC screening in a single CT appointment is then addressed. We demonstrate how this approach appears feasible and is already reasonable as an opportunistic screening intervention in 50–75-year-old subjects with smoking history and average CRC risk. In addition to the crucial role Computer Assisted Diagnosis systems play in decreasing the test reading times and the need to educate radiologists in screening chest LDCT and CT colonography, in view of a single CT appointment for double screening, the following uncertainties need to be solved: (1) the schedule of the screening CT; (2) the effectiveness of iterative reconstruction and deep learning algorithms affording an ultra-low-dose CT acquisition technique and (3) management of incidental findings. Resolving these issues will imply new cost-effectiveness analyses for LC screening with chest low dose CT and for CRC screening with CT colonography and, especially, for the double LC and CRC screening with a single-appointment CT.

Association between secondhand smoke exposure in pregnant women and their socioeconomic status and its interaction with age: a cross-sectional study

Background

Existing evidence highlights that exposure to secondhand smoke (SHS) is a risk factor for pregnant women’s health and is possibly affected by individual characteristics. This study aimed to explore the effect of individual socioeconomic status (SES) on SHS exposure among pregnant women in the third trimester and the interaction effect of age.

Methods

A total of 678 nonsmoking pregnant women with a median age of 29.0 years from 14 communities in a medium-sized city were recruited for this survey. Exposure to SHS was defined as the self-reported smoking habit of a spouse/partner. Individual SES characteristics consisted of marital status, educational attainment, employment and per capita monthly income.

Results

There were 238 (35.1%) participants who suffered from SHS exposure. Compared to the pregnant women who were employed, those who were unemployed were more likely to suffer from SHS exposure (OR = 1.572, 95% CI: 1.013–2.441). Participants who had a high school or technical secondary school education were more likely to be exposed to SHS than those with a college education or above (OR = 1.601, 95% CI: 1.029–2.449). Advanced age was a protective factor for participants with a college education or above (OR = 0.939, 95% CI: 0.884–0.997), but age increased the risk of SHS exposure among women who had unstable marriages (OR = 1.256, 95% CI: 1.019–1.549).

Conclusion

Exposure to SHS was very common among pregnant women in the third trimester. Pregnant women with a low SES and an older age should be considered a key population for the implementation of public health interventions.

Clinical Outcomes of Treatment Strategies for Postoperative Plate Fracture and In Situ Fracture of the Femoral Shaft

Objective

To investigate the treatment and clinical efficacy of postoperative plate fracture and in situ fracture of the femoral stem.

Methods

We have retrospectively analyzed the clinical data, revised surgery information, and clinical efficacy of patients with postoperative plate fracture of the femoral stem in our hospital. A total of 33 cases were included whose original fractures were located in the upper and cadaveric femur and treated with paralleling intramedullary pins for revision surgery, as well as patients whose original fractures were located in the lower femur which were fixed with retrograde intramedullary nailing or anatomical locking and compression splints in the distal femur. For the selection of bone grafting, the original fracture site with Fernadez-Esteve scab grades I and II was treated with an autologous iliac bone graft. Postoperatively, patients were evaluated for fracture healing time, the clinical outcome of the affected limb, and complications in the iliac bone donor area.

Results

All patients were followed up until fracture healing, and all patients achieved clinical healing with a healing rate of 100% and a mean healing time of 6.3 months. No internal fixation failure such as rebreakage or loosening of the internal fixation occurred in all patients during the follow-up period. According to the Tohner-Wrnch criteria, 23 cases were excellent, 10 cases were good, and 0 cases were poor, with an excellent rate of 100%. Complications in the autologous iliac bone donor area amounted to 36.7%.

Conclusion

For patients with original fractures located in the upper femoral segment or cadre, it is recommended to perform revision surgery with a paralleling intramedullary pin, while patients with original fractures located in the lower femoral segment are fixed with the retrograde intramedullary nailing or an anatomical type of distal femoral locking and compression splint. Patients with postoperative plate fractures of the femoral stem do not require routine autologous bone grafting for revision surgery.

Short-Term Effects of Side-Stream Smoke on Nerve Growth Factor and Its Receptors TrKA and p75NTR in a Group of Non-Smokers

Environmental tobacco smoke remains a major risk factor, for both smokers and non-smokers, able to trigger the initiation and/or the progression of several human diseases. Although in recent times governments have acted with the aim of banning or strongly reducing its impact within public places and common spaces, environmental tobacco smoke remains a major pollutant in private places, such as the home environment or cars. Several inflammatory and long-term biomarkers have been analysed and well-described, but the list of mediators modulated during the early phases of inhalation of environmental tobacco smoke needs to be expanded. The aim of this study was to measure the short-term effects after exposure to side-stream smoke on Nerve Growth Factor and its receptors Tropomyosin-related kinase A and neurotrophin p75, molecules already described in health conditions and respiratory diseases. Twenty-one non-smokers were exposed to a home-standardized level of SS as well as to control smoke-free air. Nerve Growth Factor and inflammatory cytokines levels, as well the expression of Tropomyosin-related kinase A and neurotrophin receptor p75, were analysed in white blood cells. The present study demonstrates that during early phases, side-stream smoke exposure induced increases in the percentage of neurotrophin receptor p75-positive white blood cells, in their mean fluorescent intensity, and in gene expression. In addition, we found a positive correlation between the urine cotinine level and the percentage of neurotrophin receptor-positive white blood cells. For the first time, the evidence that short-term exposure to side-stream smoke is able to increase neurotrophin receptor p75 expression confirms the very early involvement of this receptor, not only among active smokers but also among non-smokers exposed to SS. Furthermore, the correlation between cotinine levels in urine and the increase in neurotrophin receptor p75-positive white blood cells could represent a potential novel molecule to be investigated for the detection of SS exposure at early time points.

Sex-Specific Association between Environmental Tobacco Smoke Exposure and Asthma Severity among Adults with Current Asthma

Background: Tobacco smoke has been associated with negative health outcomes, including those with chronic respiratory illnesses, such as asthma. This study aimed to assess the relationship between exposure to environmental tobacco smoke (ETS), as well as tobacco use (cigarette and electronic cigarettes), on asthma severity among adults with current asthma, with stratification by sex to understand potential biological sex differences. Methods: The study population consisted of Californian adults 18 years or older with self-reported physician/health care diagnosis of asthma and still having current asthma from 2020 California Health Interview Survey. All descriptive statistics and analyses were sex-stratified and survey-weighted. Crosstabulations were used to understand the association between asthma attack and ETS or firsthand smoke exposure, while binary logistic regression models were used to assess the effect of ETS exposure, current smoking status, and control variables on asthma attack in the past 12 months, with a sub-analysis among non-smoking adults with asthma. Results: Among the primary variable of interest, 35% of males and 30% of females reported ETS exposure in the past 12 months, while 13% of males and 6% of females reported being a current smoker. Past year asthma attack was reported among 43% and 55% of males and females, respectively. Among males, after adjusting for all control variables, asthma attack was significantly higher among those with ETS exposure (OR: 1.75, 95% CI: 1.01–3.02) and among current smokers (OR: 3.82, 95% CI: 1.49, 9.81). Male non-smokers with ETS exposure had a 109% higher odds of asthma attack, compared to non-exposure individuals. Conclusion: Using a population-based survey, our results highlight the ongoing burden of tobacco use and exposure particularly among males with current asthma, further corroborate the literature on the relationship between tobacco and asthma, and highlight putative sex-specific outcomes.

Mode of Cannabis Use and Factors Related to Frequency of Cannabis Use Among Breastfeeding Mothers: Results from an Online Survey

Background: In the United States, 5% of breastfeeding mothers report using cannabis. Frequent cannabis use results in higher delta-9-tetrahydrocannabinol (THC) in breast milk, and mode of cannabis use may also impact risk to the infant. The aim of this study was to understand how breastfeeding mothers use cannabis and factors related to frequency of its use. Methods: An anonymous online survey was conducted among mothers who used cannabis while breastfeeding. Frequency of cannabis use was ascertained along with modes of and reasons for cannabis use. Respondents were grouped by frequency of use: less-than-daily (n = 686), low-daily (1-3 times/day; n = 423), and high-daily (≥4 times/day; n = 218). Chi-square and analysis of variance tested between-group differences, and ordinal logistic regression examined factors associated with cannabis use frequency. Results: Smoking (88%) was the most common mode of cannabis consumption, followed by vaping (48%) and oral/edibles (36%). Smoking and vaping differed by cannabis use frequency. Only 54% used cannabis to get high, but was reported more among frequent users. In contrast, 89% of mothers used cannabis for mental or physical health symptoms, including anxiety, depression, gastrointestinal symptoms, chronic pain, and posttraumatic stress disorder. These symptoms differed by cannabis use frequency. Reporting more symptoms was associated with higher frequency of use. The odds of increasing cannabis use frequency was 2.7 for those reporting 1-2 health reasons, 5.6 for those reporting 3-4 health reasons, and 13.1 for reporting ≥5 health reasons. Conclusions: Strategies are needed to address maternal mental and physical health, which may be key to reducing cannabis use among breastfeeding mothers.

The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Factors Related to Smoking Cessation

BACKGROUND

Smoking cessation is not an easy accomplishment. However, the benefits are several for those who do it, such as cardiovascular risk reduction 1 year after quitting smoking. This study aimed to verify the factors related to smoking cessation in civil servants of The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

METHODS

This study had a longitudinal design using data from a prospective cohort of civil servants (ELSA-Brasil). Our variable of interest was smoking cessation. The relationship between socio-demographic characteristics, job stress, health-related variables, legislation, and smoking cessation was analyzed by Cox proportional hazard models. The analyses were stratified by gender. Second-hand smoke exposure, age, education, excessive alcohol consumption, common mental disorder, and smoking control law were the variables considered in the final model.

RESULTS

Information of 2020 women and 2429 men was analyzed. Individuals without second-hand smoke exposure, with up to 49 years of age, with higher education, without excessive alcohol consumption, without common mental disorders, and who initiated smoking in 1989 or after the smoking control law had a higher risk of stopping smoking. The risks magnitudes were higher for women.

CONCLUSIONS

Our study reinforces the necessity of alcohol consumption regulation, the relevance of Public Health Policies, and the need for more smoking cessation measures focused on men, on people with mental disorders, alcoholism, and older adults. Also, our results did not show significant risks regarding the psychosocial working environment.

Prevalence of second-hand tobacco smoke in relation to smoke-free legislation in the European Union

Exposure to second-hand smoke (SHS) is an important public health problem. We assessed SHS exposure in restaurants and bars across the European Union (EU) and studied associations with country-level smoke-free legislation. Data of Eurobarometer surveys 2014 and 2017 were used to estimate country-specific prevalence of observing smoking in restaurants and bars, which can be considered a marker of SHS exposure. Additionally, we used multilevel logistic regression models to study associations with comprehensiveness of national smoke-free regulations in restaurants and bars, which were derived from the Tobacco Control Scale. In total, 44,809 people from all 28 EU member states were included in the analysis. The results of the multilevel logistic analysis show that in countries with complete and extensive bans, respondents were less likely to have observed people smoking inside restaurants than in countries with partial bans, which represented the lowest level of smoke-free policy implementation (OR 0.24, 95%CI 0.10-0.57 for complete ban and OR 0.23, 95%CI 0.10-0.54 for incomplete but extensive ban). Also, the prevalence of seeing people smoking in a bar was lower in the countries with an extensive ban (OR 0.23 95%CI 0.11-0.45) and with a complete ban (OR 0.20 95%CI 0.10-0.40). Between 2014 and 2017, SHS exposure in restaurants and bars decreased significantly. Our results confirm that in countries with extensive or complete smoking bans, people were less exposed to SHS in restaurants and bars; and that partial bans are less effective in reducing SHS exposure.

Changes in parental smoking behavior and children's health status in Chile

Studies on parental smoking behavior have mostly been conducted for developed countries and show that current parental smoking is negatively associated with children's current health. Using four waves of a Chilean longitudinal survey (Encuesta de Protección Social), we estimate probit and ordinary least squares models relating parents' self-report of their children's current health status to several covariates, including current parental smoking status and change (transitions) in parental smoking status across the waves of the survey. The data were collected in the years 2004, 2006, 2009, and 2015. The working sample includes 25,052 observations. The study revealed that parents' self-report of their children's current health status is strongly associated with current and past parental smoking status. Parents who smoke have an increased 11.17% probability of reporting that their children are in fair, poor, or very poor health status, when compared to non-smoking parents. The effect is stronger if the smoker is the mother, and it is exacerbated if she is less educated or unemployed/inactive. In addition, quitting smoking has a significant positive effect on children's reported health status, which is greater if the mother quits smoking. Cessation among mothers who are unemployed or inactive is also associated with a more positive assessment of their children's health status. The findings suggest that cessation programs may have health benefits not only for smoking parents, but also for their children. Improving coverage or establishing a national cessation program may have important present and future effects on population health and well-being.

Hospital admission trends due to respiratory diseases in England and Wales between 1999 and 2019: an ecologic study

BACKGROUND

Identifying trends of hospital admissions for respiratory diseases is crucial for public health and research to guide future clinical improvements for better outcomes. This study aims to define the trends of respiratory disease-related hospital admissions (RRHA) in England and Wales between 1999 and 2019.

METHODS

An ecological study was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data for respiratory diseases were extracted for the period between April 1999 and March 2019. The trend in hospital admissions was assessed using a Poisson model.

RESULTS

Hospital admission rate increased by 104.7% [from 1535.05 (95% CI 1531.71-1538.38) in 1999 to 3142.83 (95% CI 3138.39-3147.26) in 2019 per 100,000 persons, trend test, p < 0.01]. The most common causes were influenza and pneumonia, chronic lower respiratory diseases, other acute lower respiratory infections, which accounted for 26.6%, 26.4%, and 14.9%, respectively. The age group 75 years and above accounted for 34.1% of the total number of hospital admissions. Males contributed to 50.5% of the total number of hospital admissions. Hospital admission rate in females increased by 119.8% [from 1442.18 (95% CI 1437.66-1446.70) in 1999 to 3169.38 (95% CI 3163.11-3175.64) in 2019 per 100,000 persons, trend test, p < 0.001]. Hospital admission rate increased by 92.9% in males [from 1633.25 (95% CI 1628.32-1638.17) in 1999 to 3149.78 (95% CI 3143.46-3156.09) in 2019 per 100,000 persons, trend test, p < 0.001].

CONCLUSION

During the study period, hospital admissions rate due to respiratory diseases increased sharply. The rates of hospital admissions were higher among males for the vast majority of respiratory diseases. Further observational studies are warranted to identify risk factors for these hospital admissions and to offer relevant interventions to mitigate the risk.

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.

Associations between Second-Hand Tobacco Smoke Exposure and Cardiorespiratory Fitness, Physical Activity, and Respiratory Health in Children

BACKGROUND

Cardiorespiratory fitness (CRF) and physical activity (PA) are associated with a plethora of positive health effects. Many UK children fail to meet the recommended level of PA, with an observed decline in CRF levels over recent decades. Second-hand tobacco smoke (SHS) is responsible for a significant proportion of the worldwide burden of disease, but little is understood regarding the impact of SHS exposure on CRF and PA in children. The aim of this study was to test the associations between SHS exposure and CRF, PA, and respiratory health in children.

METHOD

Children (9-11 years) from UK primary schools in deprived areas participated (n = 104, 38 smoking households). Surveys determined household smoking, and exhaled carbon monoxide was used to indicate children's recent SHS exposure. CRF (VO_2peak) was assessed via maximal treadmill protocol using breath-by-breath analysis. Fractional exhaled nitric oxide and spirometry were utilised as indicators of respiratory health.

RESULTS

Linear regression models demonstrated that SHS exposure was negatively associated with allometrically scaled VO_2peak (B = -3.8, p = 0.030) but not PA or respiratory health.

CONCLUSION

The results indicate that SHS is detrimental to children's CRF; given that approximately one-third of children are regularly exposed to SHS, this important finding has implications for both public health and the sport and exercise sciences.

Secondhand Smoke Exposure of Expectant Mothers in China: Factoring in the Role of Culture in Data Collection

Cancer is the leading cause of death worldwide. Tobacco smoking, including secondhand smoking, causes cancer and is responsible for over 22% of global cancer deaths. The adverse impacts of secondhand smoke are more pronounced for expectant mothers, and can deteriorate both mothers’ and infants’ health and well-being. Research suggests that secondhand smoke significantly increases expectant mothers’ risk of miscarriage, cancer, and other chronic disease conditions, and exposes their unborn babies to an increased likelihood of having life-long poor health. In China, a pregnant woman’s family members, such as her husband, parents, or in-laws, are the most likely people to be smoking around her. Due to traditional Chinese cultural practices, even though some expectant mothers understand the harm of secondhand smoke, they may be reluctant to report their family members’ smoking behaviors. Resulting in severe underreporting, this compromises health experts’ ability to understand the severity of the issue. This paper proposes a novel approach to measure secondhand smoke exposure of pregnant women in the Chinese context. The proposed system could act as a stepping stone that inspires creative methods to help researchers more accurately measure secondhand smoking rates of expectant mothers in China. This, in turn, could help health experts better establish cancer control measures for expectant mothers and decrease their cancer risk.