Gender differences in the impact of adolescent smoking on lung function and respiratory symptoms. the Nord-Trøndelag Health Study, Norway, 1995-1997

Physical activity, sedentary behaviour and screen time among youths with Down syndrome during the COVID-19 pandemic

BACKGROUND

The COVID-19-related restrictions hampered habitual physical activity (PA), particularly affecting the more vulnerable, such as people with Down syndrome (DS). The study aimed to investigate changes in PA, sedentary behaviour (SB) and screen time (ST) of youths with DS, before, during and after the restrictions, also in relation to parental PA levels.

METHODS

A cross-sectional design with a retrospective assessment of variables for the before and during restrictions periods was adopted. Parents of youths with DS completed an online questionnaire. Sociodemographic aspects, weekly PA levels and youths' daily SB and ST were investigated, referring to three time-points: before the pandemic, during the restrictions and the restrictions-easing phase.

RESULTS

A total of 57 parents voluntarily participated in the study, proxy-reporting on their child (male = 41, female = 16, age = 21.4 ± 7.7 years). A repeated measures multivariate analysis of variance showed negative effects of restrictions (P < 0.05) on PA levels, SB and ST, independently from sociodemographic characteristics. In the restrictions-easing phase, PA levels did not return to before the pandemic values (P < 0.05). A positive correlation between parents and their child's PA was detected before the pandemic (r = 0.38; P < 0.01), no longer reported in the restrictions-easing phase.

CONCLUSIONS

The findings showed the negative impact of restrictions on youths with DS lifestyle. Moreover, the importance of addressing the needs of the disabled community including the whole family is highlighted.

Use of electronic vaping products and mental health among adolescent high school students in the United States: The moderating effect of sex

Although studies have investigated the association between conventional tobacco smoking and mental health outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) and mental health among adolescents. This study aimed to investigate the cross-sectional association between EVPs use, symptoms of depression, and suicidal behaviors among adolescents. Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 14,285 adolescents (50.3% female) was analyzed using binary logistic regression. The outcome variables investigated were symptoms of depression, suicidal ideation, suicide plan, and suicide attempts, and the main explanatory variable was EVPs use. Of the 14,285 adolescents, 22.2%, 19.2%, and 58.8% were current, former and never users of EVPs, respectively. Controlling for other factors, current users of EVPs were significantly more likely to report having symptoms of depression (AOR = 1.82, 95% CI = 1.58-2.09), having suicidal ideation (AOR = 1.55, 95% CI = 1.30-1.86), making a suicide plan (AOR = 1.62, 95% CI = 1.34-1.97), or attempting suicide (AOR = 1.75, 95% CI = 1.41-2.18) when compared to never users of EVPs. Gender moderated the association between EVPs use, symptoms of depression, suicidal ideation, and suicide plan. Racial minority identity, sexual minority identity, sexual violence victimization, victim of school and cyberbullying, alcohol use, and cigarette smoking were all significantly associated with depression and suicidal behaviors. Study findings support the association between EVPs use and adolescent mental health. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying this association.

Loss of life expectancy due to respiratory infectious diseases: findings from the global burden of disease study in 195 countries and territories 1990–2017

Understanding of the patterns of and changes in mortality from respiratory infectious diseases (RID) and its contribution to loss of life expectancy (LE) is inadequate in the existing literature. With rapid sociodemographic changes globally, and the current COVID-19 pandemic, it is timely to revisit the disease burden of RID. Using the approaches of life table and cause-eliminated life table based on data from the Global Burden of Disease Study (GBD), the study analyses loss of LE due to RID in 195 countries/territories and its changes during the period 1990–2017. Results indicate that loss of LE due to RID stood at 1.29 years globally in 2017 globally and varied widely by age, gender, and geographic location, with men, elderly people, and populations in middle/low income countries/territories suffering a disproportionately high loss of LE due to RID. Additionally, loss of LE due to RID decreased remarkably by 0.97 years globally during the period 1990–2017 but increased slightly among populations older than 70 years and in many high income countries/territories. Results suggest that RID still pose a severe threat for population and public health, and that amid dramatic sociodemographic changes globally, the disease burden of RID may resurge. The study presents the first examination of the life-shortening effect of RID at the global and country/territory levels, providing new understanding of the changing disease burden of RID and shedding light on the potential consequences of the current COVID-19 pandemic.

Association between Dietary Patterns and Chronic Obstructive Pulmonary Disease in Korean Adults: The Korean Genome and Epidemiology Study

In addition to smoking, dietary habits may contribute to the development of chronic obstructive pulmonary disease (COPD). This study aimed to examine the association between dietary patterns and lung function in a Korean community cohort. A total of 5436 participants were included from the Ansan–Ansung cohort study. To identify the dietary patterns, we performed principal component factor analysis using the results of a semi-quantitative food frequency questionnaire. The forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were measured by spirometry. Multiple logistic regression models were used to evaluate the association between dietary patterns and lung function after adjusting for confounders. We identified four major dietary patterns; ‘prudent’, ‘coffee, fat, and sweet’, ‘westernized’, and ‘white rice’. After adjusting for potential confounders, the ‘coffee, fat, and sweet’ dietary pattern was negatively associated with lung function, particularly the FEV1/FVC ratio. Participants with high scores for the ‘coffee, fat and sweet’ pattern had a higher risk of COPD among men but not women. Therefore, these results indicate that the ‘coffee, fat and sweet’ dietary pattern is inversely related to lung function in Korean adults. Our results indicate that dietary habits may be modifiable risk factors for COPD.

Analysis of the Relationship between Tobacco Smoking and Physical Activity in Adolescence: A Gender Specific Study

Background and Objective: Although smoking and the physical activity level (PAL) are important determinants of health status in adolescence, there is a lack of information on the relationship between smoking and PAL in early adolescence. The objective of this study was to evaluate the gender-specific relationship between smoking and PAL in 14-to-16-year-old adolescents. Materials and Methods: The sample included 650 adolescents (337 girls, 14.7 ± 0.5 years at first testing wave) from Bosnia and Herzegovina. During the first testing wave, participants were tested using structured questionnaires. Second testing was commenced after approximately 20 months (16.4 ± 0.6 years). The variables were age, gender, socioeconomic status, living environment, cigarette smoking (predictors), and PAL (criterion). Predictors were measured at the first wave, and criterion at the first-wave and second-wave. Results: For girls, smoking was negatively correlated to PAL at the first-wave (OR: 0.75, 95% CI: 0.55-0.95) and at the second-wave (OR: 0.73, 95% CI: 0.71-0.96). No significant association between smoking and PAL was found for boys. Results suggest that adolescent boys and girls do not follow the equal trajectories when it comes to relationships between smoking and PAL. Conclusions: In developing promotional public health actions related to a decrease of smoking and increase of PAL, a gender-specific approach is highly recommended. Further studies analyzing the cause-effect relationship between consumption of other types of psychoactive substances and PAL in this age group are warranted.

Impact of smoking and physical inactivity on self-rated health in women in Colombia

The aim of this study was to assess the association between poor and fair self-rested health, smoking, and leisure-time physical inactivity in Colombian women. A cross-sectional study using the data from the 2010 Colombian National Demographics and Health (ENDS) and Nutritional Situation (ENSIN) Surveys was conducted. Multivariate logistic analysis for self-perceived health status in 12,431 women aged 13–49 years old and 8224 women aged 18–64 years old were performed. Independent variables included smoking, leisure-time physical inactivity, anthropometric and socio-demographic information. Current smoking and leisure-time physical inactivity were associated with poor and fair self-rated health status (OR 1.78, CI 1.41, 2.25; OR 1.30, CI 1.03, 1.62; respectively). Other significantly associated variables were age (OR 1.68, CI 1.46, 1.92 for 30–49 years; OR 2.32, CI 1.96, 2.74 for 50–64 years), socio-economic strata (OR 7.24, CI 3.81, 13.76 for strata 1–3), educational level (OR 1.70 to 2.77 compared to technical or university), obesity (OR 0.81, CI 0.70, 0.93 for normal body mass index), geographical region (OR 0.67, CI 0.53, 0.85 for Bogotá, compared to Amazon and Orinoco regions), and no affiliation to health system (OR 1.22, CI 1.03, 1.44). Smoking and leisure-time physical inactivity were significantly associated with poor and fair self-rated health in Colombian women. Promoting leisure-time physical activity and implementing smoking cessation strategies specifically in female population, mainly from low to medium strata are suggested to improve their self-perceived health status and control chronic noncommunicable diseases.

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The prevalence of current smoking in Colombian adult women in 2010 was 3% and leisure-time physical inactivity was 94%.

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Poor and fair self-perceived health status was significantly associated with the above and with increased age and obesity.

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Low education, low to medium socio-economic strata, region, and no affiliation to health system were also associated.

Prenatal exposure to ambient temperature variation increases the risk of common cold in children

BACKGROUND

Common cold is a frequent upper respiratory tract infection, but the role of ambient temperature in the infection is unclear.

OBJECTIVE

We investigated the role of prenatal exposure to diurnal temperature variation (DTV), the difference between the daily maximal and minimal temperatures, in the risk of common cold in children.

METHODS

We conducted a cohort study of 2598 preschool children in Changsha, China. Occurrence of common cold during the past year was surveyed using questionnaire. We then estimated each child's prenatal exposure to DTV during pregnancy. Multivariate logistic regression model was used to examine the association between occurrence of common cold and prenatal exposure to DTV in terms of odds ratios (OR) and 95% confidence interval (CI).

RESULTS

About 45% children have common cold (≥3 times) during the past year. We found that common cold in children was associated with maternal DTV exposure during pregnancy, particularly during the first trimester with adjusted OR (95% CI) = 1.27 (1.10-1.46). Male and atopic children were more susceptible to the effect of DTV during pregnancy. The risk of common cold due to DTV is higher in children living in the suburban areas and the bigger houses and in those exposed to environmental tobacco smoke, mold/dampness, new furniture and redecoration. We observed that the risk of common cold in children has been increased in recent years due to increasing DTV.

CONCLUSIONS

Common cold in children was associated with maternal exposure to temperature variation during pregnancy, suggesting that the risk of common cold may originate in pregnancy.

Gender Differences in U.S. Adolescent E-Cigarette Use

Purpose of Review

This study aims to review the recent (2012-2017) available gender difference data on e-cigarette use among adolescents.

Recent Findings

E-cigarettes are the most commonly used tobacco product among adolescents, and recent study findings showed that e-cigarette use can lead to cigarette smoking. However, gender differences in e-cigarette use among adolescents are relatively unknown.

Summary

We used the search terms "adolescents" and "e-cigarettes" on PubMed and identified 652 articles. Of these, 16 articles (2.5%) examined gender differences in adolescent e-cigarette use. Boys appear to have greater use of e-cigarettes, but girls may be at increased risk if e-cigarettes are targeted to them, as it has been for cigarettes. Data on gender differences are limited, and future research should continue to examine gender differences in e-cigarette use. Trends in use rates could evolve with new regulations and innovations in e-cigarette marketing and product features.

Sex differences in asthma in swimmers and tennis players

BACKGROUND

Elite athletes, independent of sport, have increased risk of developing asthma, but little is known about sex difference among adolescent athletes.

OBJECTIVE

To investigate and compare sex-related differences according to symptoms and treatment of asthma, allergy, and health among elite athletes and a reference group.

METHODS

Adolescent elite swimmers (n = 101), tennis players (n = 86), and a reference group (n = 1,628) responded to a questionnaire about respiratory symptoms, allergy, health behavior, psychosomatic symptoms, self- esteem, and well-being. The athletes performed a mannitol provocation and a sport-specific exercise provocation. Atopy was assessed by skin prick tests, and fractional exhaled nitric oxide was measured.

RESULTS

The females reported more asthma symptoms than the males in both the reference group (29.1% vs 22.3%) and the athlete group (56.4% vs 40.2%). However, no significant differences were found in physician-diagnosed asthma or treatment with inhaled corticosteroids. More female athletes had a positive mannitol provocation result (48.7% vs 35.8% in male athletes), and more female swimmers had a positive exercise provocation result (15.1% vs 7.7% in male swimmers). The females in all groups had more psychosomatic symptoms compared with the respective males, and the males in the reference group reported higher self-esteem and felt more well-being compared with the reference group females.

CONCLUSION

Overall, we found a higher prevalence of asthma symptoms in the females. However, the frequency of physician-diagnosed asthma and the prescription of inhaled corticosteroids were the same in both sexes. This finding demonstrates an insufficient diagnosis of asthma in females.

Early smoke exposure is associated with asthma and lung function deficits in adolescents

OBJECTIVE

Early life tobacco smoke exposure may influence asthma, lung function and lung function growth into adolescence. We aimed to determine the associations between perinatal smoke exposure and asthma and lung function up to 18 years of age.

METHODS

We prospectively recorded perinatal parental smoking and measured respiratory outcomes at 12 and 18 years in the Melbourne Atopy Cohort Study (MACS), a longitudinal birth cohort. Multiple logistic regression was used to analyse the associations between perinatal smoke exposure and asthma at 12 (n = 370) and 18 years (n = 411). Multiple linear regression was used to investigate the relationship between perinatal smoking and: lung function (12 and 18 years) and lung function growth (between 12 and 18 years).

RESULTS

At 18 years, girls exposed to parental smoking during the perinatal period had increased odds of asthma (OR: 3.45, 95%CI: 1.36, 8.77), reduced pre-bronchodilator Forced expiratory volume in one-second (FEV₁) (-272 ml/s; -438, -107); FEV₁/ forced vital capacity (FVC) (-0.038; -0.065, -0.010); mid expiratory flow (MEF_25-75) (-430 ml/s; -798, -61), and reduced post-bronchodilator FEV₁/FVC (-0.028, -0.053, -0.004). No associations were found for boys (pre-bronchodilator FEV₁ 26ml/s; -202, 255; FEV₁/FVC 0.018; -0.013, 0.049).

CONCLUSIONS

Perinatal smoke may affect risk of asthma, reduce lung function and lung function growth in adolescence. Girls appear to be more susceptible than boys.

Daily Smoking and Subjective Health Complaints in Adolescence

INTRODUCTION

Using data from the Health Behaviour in School-aged Children survey, this study used a repeated cross-sectional design to examine associations between daily smoking, gender, and self-reported health complaints in five cohorts of adolescents over a 16-year period.

METHODS

Data were from nationally representative cohorts of 15-year-old youth in Norway in 1993/1994, 1997/1998, 2001/2002, 2005/2006, and 2009/2010 (n _total = 7761). Dependent variables were psychological, somatic, and total health complaints. A mixed GLM model examined main and interaction effects of smoking (daily, intermittent, nonsmoking), year, and gender in predicting complaints. Time periods were segmented to compare trends across smoking groups in specific periods.

RESULTS

Prevalence of daily smoking declined from 15.5% (1993/1994) to 6.0% (2009/2010). All health complaint scores were significantly higher for smokers and for girls (vs. boys). Smoking status by year interactions were significant for all complaint variables during the period of sharpest decline of daily smoking prevalence (2001/2002-2005/2006), with daily smokers experiencing increases in health complaints while intermittent and nonsmokers did not. Smoking status by gender interactions were significant for all health complaint variables, indicating that the main effect for gender (females higher) was even stronger among smokers compared with nonsmokers. Using year as unit of analysis, the size of mean differences between daily smokers and intermittent/nonsmokers in total complaints was significantly negatively correlated with daily smoking prevalence (-.963, n = 5, p < .01).

CONCLUSIONS

As prevalence of daily smoking declined, daily smokers reported higher levels of complaints, suggesting increasing health problems within this group. Girls who smoke daily had particularly elevated levels of complaints.

IMPLICATIONS

This study indicates that the relationship between daily smoking and concurrent health symptomatology in adolescents is changing over time, with higher levels of health complaints reported as overall smoking prevalence declines. To our knowledge, this finding has not previously been reported. If youth are smoking to cope with distress, pain, or other health concerns, tobacco control objectives will be increasingly difficult to achieve with adolescents. Levels of health complaints are particularly high among girls who are daily smokers. The findings suggest that restrictive measures and persuasive communications may not be sufficient tobacco prevention strategies for adolescent populations. Young smokers may need counseling and support.

Adolescents' smoking experiences, family structure, parental smoking and socio-economic status in Ciudad Juárez, Mexico

BACKGROUND

Cigarette smoking is the leading cause of preventable death worldwide. Tobacco use and secondhand-tobacco smoke (SHS) exposure are classified as a pediatric disease. In Mexico, the prevalence of smoking has decreased among adults but paradoxically increased among adolescents, particularly among young females. This study was designed to determine the association between adolescents' smoking experiences (smoking behaviors and second hand smoke [SHS] exposure), family structure, parental smoking and socio-economic status (SES) in Ciudad Juárez, Mexico.

METHODS

This is a cross-sectional, population-based study. Data was collected from sixth-grade students (N = 506) attending school in Ciudad Juárez, Mexico. Descriptive analyses were conducted. The relationship between key outcome variables (adolescents smoking and SHS exposure) and independent variables (family structure, parental smoking, and SES level) were examined. Adjusted odds ratios were calculated. Multiple logistic regression analysis was performed while controlling for possible confounders (i.e. gender and age).

RESULTS

The overall prevalence of ever/lifetime smoking and SHS exposure at home was 29.6 and 41.1 %, respectively. Results of the logistic regression analysis show that being a member of a non-intact family [(OR = 2.20; 95 % CI = 1.21-3.90) and (OR = 2.45; 95 % CI = 1.19-4.10) respectively], having parents who smoke [(OR = 4.41; 95 % CI = 2.15-5.46) and (OR = 4.95; 95 % CI = 2.25-7.12) respectively], and living in low SES setting [(OR = 1.73; 95 % CI = 1.43-3.30) and (OR = 1.99; 95 % CI = 1.16-4.00) respectively] are significantly associated with ever smoking and SHS exposure at home among sixth grade students.

CONCLUSIONS

The findings of our study show that tobacco use and SHS exposure are strongly associated with adolescents living in low SES, non-intact households that have parents that smoke. To be effective, tobacco strategies specifically tailored for this particularly vulnerable group of adolescents would require a comprehensive, multi-faceted approach centered on prevention, cessation and protection.

The impact of pre- and postnatal exposures on allergy related diseases in childhood: a controlled multicentre intervention study in primary health care

BACKGROUND

Environmental factors such as tobacco exposure, indoor climate and diet are known to be involved in the development of allergy related diseases. The aim was to determine the impact of altered exposure to these factors during pregnancy and infancy on the incidence of allergy related diseases at 2 years of age.

METHODS

Children from a non-selected population of mothers were recruited to a controlled, multicenter intervention study in primary health care. The interventions were an increased maternal and infant intake of n-3 PUFAs and oily fish, reduced parental smoking, and reduced indoor dampness during pregnancy and the children's first 2 years of life. Questionnaires on baseline data and exposures, and health were collected at 2 years of age.

RESULTS

The prevalence of smoking amongst the mothers and fathers was approximately halved at 2 years of age in the intervention cohort compared to the control cohort. The intake of n-3 PUFA supplement and oily fish among the children in the intervention cohort was increased. There was no significant change for indoor dampness. The odds ratio for the incidence of asthma was 0.72 (95% CI, 0.55-0.93; NNTb 53), and 0.75 for the use of asthma medication (95% CI, 0.58-0.96). The odds ratio for asthma among girls was 0.41 (95% CI 0.24-0.70; NNTb 32), and for boys 0.93 (95% CI 0.68-1.26). There were no significant change for wheeze and atopic dermatitis.

CONCLUSION

Reduced tobacco exposure and increased intake of oily fish during pregnancy and early childhood may be effective in reducing the incidence of asthma at 2 years of age. The differential impact in boys and girls indicates that the pathophysiology of asthma may depend on the sex of the children.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN28090297.

Cohort profile of the Young-HUNT Study, Norway: a population-based study of adolescents

The Young-HUNT Study is the adolescent part (13-19 years) of HUNT, the Nord-Trøndelag Health Study, Norway. Three cross-sectional surveys have been conducted: Young-HUNT1 (1995-97), Young-HUNT2 (2000-01) and Young-HUNT3 (2006-08). Major public health issues, including somatic and mental health, quality of life and health behaviours are covered. Young-HUNT was performed in schools visited by trained nurses. Data collection included self-reported questionnaires, structured interviews, clinical measurements and, in Young-HUNT3, buccal smears. The total response rates varied from 90% to 83% and the Young-HUNT database includes 17 820 teenagers. Some Young-HUNT1 participants constitute the baseline for two follow-up studies: a 4-year follow-up through adolescence to Young-HUNT2 and an 11-year follow-up into young adulthood to the adult HUNT3. Longitudinal data are also obtained by linkage of data from Young-HUNT to different national health registers. Linkage to family registers allows the possibility of studying genetic and environmental interactions through generations. Presently 20 PhD students are working with the data, 11 Young-HUNT based PhD theses have been completed and more than 50 scientific papers published.

Higher risk of wheeze in female than male smokers. Results from the Swedish GA 2 LEN study

BACKGROUND

Women who smoke have higher risk of lung function impairment, COPD and lung cancer than smoking men. An influence of sex hormones has been demonstrated, but the mechanisms are unclear and the associations often subject to confounding. This was a study of wheeze in relation to smoking and sex with adjustment for important confounders.

METHODS

In 2008 the Global Allergy and Asthma European Network (GA(2)LEN) questionnaire was mailed to 45.000 Swedes (age 16-75 years), and 26.851 (60%) participated. "Any wheeze": any wheeze during the last 12 months. "Asthmatic wheeze": wheeze with breathlessness apart from colds.

RESULTS

Any wheeze and asthmatic wheeze was reported by 17.3% and 7.1% of women, vs. 15.8% and 6.1% of men (both p<0.001). Although smoking prevalence was similar in both sexes, men had greater cumulative exposure, 16.2 pack-years vs. 12.8 in women (p<0.001). Most other exposures and characteristics associated with wheeze were significantly overrepresented in men. Adjusted for these potential confounders and pack-years, current smoking was a stronger risk factor for any wheeze in women aged <53 years, adjusted odds ratio (aOR) 1.85 (1.56-2.19) vs. 1.60 (1.30-1.96) in men. Cumulative smoke exposure and current smoking each interacted significantly with female sex, aOR 1.02 per pack-year (p<0.01) and aOR 1.28 (p = 0.04) respectively. Female compared to male current smokers also had greater risk of asthmatic wheeze, aOR 1.53 vs. 1.03, interaction aOR 1.52 (p = 0.02). These interactions were not seen in age ≥ 53 years.

DISCUSSION

In addition to the increased risk of COPD and lung cancer female, compared to male, smokers are at greater risk of significant wheezing symptoms in younger age. This became clearer after adjustment for important confounders including cumulative smoke exposure. Estrogen has previously been shown to increase the bioactivation of several compounds in tobacco smoke, which may enhance smoke-induced airway inflammation in fertile women.

Effect of smoking and gender on pulmonary function and clinical features in sarcoidosis

BACKGROUND

The effect of cigarette smoking on the clinical manifestations and progression of sarcoidosis is not well characterized. We sought to determine the effects of smoking in sarcoidosis patients and to evaluate for gender-specific differences.

METHODS

We examined the effects of cigarette smoking in 518 patients seen at the Sarcoidosis and Interstitial Lung Disease Center at Wayne State University using radiographic pattern, pulmonary function testing, and clinical features of the disease. We performed a separate analysis to evaluate for gender-specific differences based on smoking history.

RESULTS

We found that smokers had significantly lower FEV(1) and FEV(1)/FVC values. Total lung capacity was not significantly different between smokers and nonsmokers, but diffusion capacity for carbon monoxide (DL(CO)) was significantly reduced in smokers. Gender-based statistical analysis showed a marked decrease in DL(CO) values among female smokers. Smokers were also found to have a higher incidence of extrapulmonary involvement as multivariate regression analysis demonstrated that both smoking and female gender are significantly associated with the development of extrapulmonary manifestations.

CONCLUSIONS

Our data indicate that both cigarette smoking and gender are important in shaping the clinical manifestations of sarcoidosis. The nature of the gender difference requires further study and may be related to differences in inflammatory response.

The association between endotoxin and lung function among children and adolescents living in a rural area

BACKGROUND⁄

OBJECTIVES

Knowledge of the effects of domestic endotoxin on children's lung function is limited. The association between domestic endotoxin and asthma or wheeze and lung function among school-age children (six to 18 years of age) was examined. The interaction between endotoxin and other personal and environmental characteristics and lung function was also assessed.

METHODS

A case-control study was conducted in and around the rural community of Humboldt, Saskatchewan, between 2005 and 2007. Parents of cases reported either doctor-diagnosed asthma or wheeze in the previous year. Controls were randomly selected from those not reporting these conditions. Data were collected by questionnaire to ascertain symptoms and conditions, while spirometry was used to measure lung function including forced vital capacity and forced expiratory volume in 1 s. Dust collected from the child's play area floor and the child's mattress was used to quantify endotoxin, and saliva was collected to quantify cotinine levels and assess tobacco smoke exposure.

RESULTS

There were 102 cases and 207 controls included in the present study. Lower forced expiratory volume in 1 s was associated with higher mattress endotoxin load among female cases (beta=-0.25, SE=0.07 [P<0.01]). There was a trend toward lower forced vital capacity, which was associated with higher play area endotoxin load among cases with high tobacco smoke exposure (beta=-0.17, SE=0.09 [P<0.10]).

CONCLUSIONS

Findings indicated that high endotoxin levels present in common household areas of rural children with asthma or wheeze may also affect their lung function. These associations may be potentiated by tobacco smoke exposure and female sex.

Relationship of endotoxin and tobacco smoke exposure to wheeze and diurnal peak expiratory flow variability in children and adolescents

BACKGROUND AND OBJECTIVE

The relationship between endotoxin exposure and asthma severity (wheeze and airways obstruction) is not well described. The effects of endotoxin and tobacco smoke exposure on self-reported wheeze and diurnal PEF variability (DV-PEF) were examined in children aged 6-18 years with asthma or wheeze.

METHODS

A cross-sectional study was performed in a rural area. From this study, children who reported wheeze in the previous 12 months or a physician diagnosis of asthma (n = 98) were selected for a case-control study. These subjects, who were the basis for the present analysis, completed: (i) a home environmental assessment, including dust collection to measure endotoxin levels: (ii) a clinic visit, including saliva collection to measure cotinine levels; and (iii) 2 week monitoring of twice daily symptom records, including wheeze, and PEF to calculate DV-PEF.

RESULTS

Among these children, 22.4% reported wheeze during the monitoring period. Greater DV-PEF was associated with higher endotoxin loads in play areas (P < 0.05). The association between salivary cotinine levels and high DV-PEF was modified by gender. In females, higher cotinine levels were associated with an increased risk of high DV-PEF compared with lower cotinine levels (P < 0.05), but this was not observed among males.

CONCLUSIONS

Higher endotoxin exposure was associated with greater DV-PEF among children with asthma or wheeze. While previous studies have suggested that endotoxin exposure protects against the development of asthma, individuals with the disease should avoid high exposure levels to limit exacerbations. The effect of tobacco smoke exposure on lung health may differ between male and female children.

Tobacco use and cessation among women: research and treatment-related issues

The prevalence of tobacco use in women has increased over the past century. This has resulted in dramatic increases in smoking-related lung diseases, such as chronic obstructive pulmonary disease (COPD) and lung cancer. There is growing literature suggesting that women may be more susceptible than men to the effects of tobacco and to the development of COPD. Women may also have specific barriers that interfere with smoking cessation. This article addresses possible differences in lung function decline and nicotine metabolism in women compared to men. Differences in COPD between the sexes are discussed. Finally, barriers to smoking cessation in women are presented.

Gender differences in asthma prevalence: variations with socioeconomic disadvantage

BACKGROUND AND OBJECTIVE

Socioeconomic inequalities in health have been shown to vary for different diseases and by gender. This study aimed to examine gender differences in associations between asthma and socioeconomic disadvantage.

METHODS

Socioeconomic variables were assessed among men and women in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Asthma was determined from spirometry and self-reported doctor diagnosis.

RESULTS

The prevalence of asthma was 12.0% (95% CI: 11.1-13.1), and was significantly higher among women (13.5%) than men (10.5%). For participants aged 18-64 years a higher prevalence of asthma was associated with an education level of secondary school or lower, or not being in the paid labour force among men, and with a gross annual household income of $20,000 or less among women. Among socioeconomically advantaged groups, the prevalence of asthma was significantly higher among women than men.

CONCLUSIONS

Socioeconomic disadvantage was associated with higher asthma prevalence, although this varied by gender depending on the indicator of socioeconomic position used. Men with low education or those not employed in the paid labour force had higher asthma prevalence than more socioeconomically advantaged men. Women with low income had higher asthma prevalence than those with higher income. Among all socioeconomically advantaged groups, and also the low-income group, women experienced a higher prevalence of asthma than men.

An interdisciplinary analysis of sex and gender in relation to the pathogenesis of bronchial asthma

BACKGROUND

An increasing number of studies confirm that pathogenesis and prevalence of bronchial asthma are age and sex dependent. Detailed physiological mechanisms of the changing sex ratios with age are not fully known, however, the gender (socio-cultural) factors are also imperative. Although multiple factors definitely influence the pathogenesis of asthma, only individual or few combinations of these have been investigated.

METHODS

The terms 'sex', 'gender' and plausible combinations of both were systematically researched in selected databases (Medline, Scopus) or other sources, including publications from January 2000 to June 2007. Generated articles were categorized, either as endogenous or exogenous factors influencing the pathogenesis of asthma, and divided into the following subgroups: genetic, immunological, hormonal, gynaecological, nutritional, and environmental parameters.

RESULTS

An increasing number of studies investigate the influence of sex and gender in the aetiology, therapy and prevention of asthma. While their results are still debatable, others regarding its initiation, perpetuation and cessation have been clarified. Recent insights into interactions at biomolecular and immunological levels greatly contribute to clarifying sex-specific influences. Despite occasional oversimplifications, a trend for explanations considering the complex interplay of different factors can be observed. This work is in line with this trend and offers explanation models from our point of view.

CONCLUSIONS

Some disagreements regarding the patho-physiology, diagnosis, treatment and prevention of asthma still prevail. Nevertheless, in order to better appreciate its complexity, openness to and persistent consideration for interdisciplinary as well as sex- and gender-related factors is required of the medical-research community in future investigations.

Reliability and validity of two frequently used self-administered physical activity questionnaires in adolescents

BACKGROUND

To create and find accurate and reliable instruments for the measurement of physical activity has been a challenge in epidemiological studies. We investigated the reliability and validity of two different physical activity questionnaires in 71 adolescents aged 13-18 years; the WHO, Health Behaviour in Schoolchildren (HBSC) questionnaire, and the International Physical Activity Questionnaire (IPAQ, short version).

METHODS

The questionnaires were administered twice (8-12 days apart) to measure reliability. Validity was assessed by comparing answers from the questionnaires with a cardiorespiratory fitness test (VO2peak) and seven days activity monitoring with the ActiReg, an instrument measuring physical activity level (PAL) and total energy expenditure (TEE).

RESULTS

Intraclass correlation coefficients for reliability for the WHO HBSC questionnaire were 0.71 for frequency and 0.73 for duration. For the frequency question, there was a significant difference between genders; 0.87 for girls and 0.59 for boys (p < 0.05). The intraclass correlation coefficients the IPAQ varied between 0.10 and 0.62 for the reliability. Spearman correlation coefficients for validity for both the WHO HBSC questionnaire and the IPAQ (recoded into low, moderate and high activity) measured against VO2peak were fair, ranging between 0.29 - 0.39. The WHO HBSC questionnaire measured against VO2peak for girls were acceptable, ranging between 0.30 - 0.55. Both questionnaires, except the walking question in IPAQ, showed a low correlation with PAL and TEE, ranging between 0.01 and 0.29.

CONCLUSION

These data indicate that the WHO HBSC questionnaire had substantial reliability and were acceptable instrument for measuring cardiorespiratory fitness, especially among girls. None of the questionnaires however seemed to be a valid instrument for measuring physical activity compared to TEE and PAL in adolescents.

[Lung function and exposure to tobacco smoke among adolescents]

OBJECTIVE

To study lung function in adolescents in relation to smoking (active and passive smokers) and to investigate the repercussion on spirometric parameters.

PATIENTS AND METHOD

We studied 301 healthy adolescents with no history of bronchial asthma or colds in the month prior to the study. A questionnaire on tobacco exposure was administered and spirometry (Datospir-92) was performed.

RESULTS

There were 165 boys (54.5%) and 136 girls (45.5%) aged between 14 and 20 years old (16.40+/-1.32). A total of 27.2% were non-smokers and were not exposed to tobacco smoke (NS), 31.3% were passive smokers, with household exposure of 10 cigarettes per day during at least the previous year (PS), and 41.5% were current smokers who had been smoking>or=10 cigarettes/day for at least 1 year (CS). Significant differences were found between age and smoking habits (p=0.0001) and between smoking habits and female sex (girls CS: 33.9% vs boys CS: 21.8 %) (p=0.007). A significant association was found between smoking (NS, PS and CS) and spirometric parameters (ANOVA): forced vital capacity (FVC) (p=0.001), forced expiratory volume in 1 second (FEV1) (p=0.0001), FEV1/FVC (p=0.004), peak expiratory flow (PEF) (p=0.0001), midexpiratory flow at 25% of forced vital capacity (MEF25%) (p=0.01), MEF50% (p=0.0001) and MEF25-75% (p=0.0001); CS in relation to NS was as follows: FEV1, PEF, MEF50%, MEF25-50% (p=0.0001) and FVC, FEV1/FVC, MEF25% (p=0.01); CS in relation to PS: FEV1/ FVC (p=0.02), PEF (p=0.004), MEF50% and MEF25-75% (p=0.003), PS in relation to NS: FVC and FEV1 (p=0.02). Significant differences in FVC, FEV1 and MEF25-75% were found in female CS in comparison with boys.

CONCLUSIONS

The CS group showed a significant decrease in spirometric parameters in relation to the NS group. The airway was affected sooner in the female group of smokers than in the male group, even though the intensity and time of exposure were the same in both groups.

Housing characteristics, home environmental factors and respiratory health in 14,729 Chinese children

BACKGROUND

Very few studies have assessed the relative impact of housing characteristics and home environmental factors on asthma and asthma-related symptoms in Chinese children who have lower rates of asthma. To our knowledge few studies have assessed respiratory symptoms and allergies in this context.

METHODS

To assess the effects of housing characteristics, pet keeping, home decorations and other indoor environmental factors on respiratory health of Chinese children. We studied a population of 14,729 children (1-13 years old) from 12 districts in Liaoning province, Northeast China. Information on respiratory health, housing characteristics, and environmental pollutions were obtained by a standard questionnaire from the American Thoracic Society.

RESULTS

Housing conditions, house adjacent to traffic or not, house with or without pollution source nearby, pet keeping, presence of pests and mold/water damage in the home, home decorations and exposure to environmental tobacco smoke (ETS) were associated with doctor-diagnosed asthma and asthma-related symptoms both in boys and girls. The vulnerability towards exposure to housing conditions and environmental factors differed between males and females. Among boys, the risk of respiratory morbidity appeared to be reduced in households with larger surface areas and more rooms; use of a ventilation device was strongly protective against persistent phlegm (OR=0.68; 95%CI: 0.48, 0.96). Asthma-related symptoms were more associated with different pets among girls than among boys. The presence of a cat in the household was associated with doctor-diagnosed asthma (OR=1.89; 95% CI, 1.11-3.20), current wheeze (OR=2.64; 95% CI, 1.52-4.59), persistent cough (OR=1.84; 95% CI, 1.18-2.87) and persistent phlegm (OR=2.17; 95% CI, 1.21-3.87) only among girls.

CONCLUSION

Living within the vicinity of a source of pollution, traffic, pet keeping, home decorations, pests, mold and ETS are important determinants of children's respiratory health in China.

Characterisation of smoking behaviour across the life course and its impact on decline in lung function and all-cause mortality: evidence from a British birth cohort

OBJECTIVES

To describe smoking trajectories from early adolescence into mid-life and to examine the effects of these trajectories on health and all-cause mortality.

METHODS

A nationally representative birth cohort study including 3387 men and women followed up since their birth in 1946 in England, Scotland and Wales. The main outcome measure is all-cause mortality by age 60 years and rate of decline in forced expiratory volume in 1 second (FEV(1)).

RESULTS

Eighteen per cent of the sample were categorised as lifelong smokers (smokers at all six waves at ages 20, 25, 31, 36, 43, 53 years), of whom 90% had begun smoking by age 18 years. By age 60 years, 10% of all lifelong smokers had died. They had a threefold increase in mortality rate compared with never smokers (hazard ratio (HR) 3.2, 95% confidence interval (CI) 2.1 to 4.8). For predominantly smokers (smokers for at least four of the six data collections), mortality rate remained higher than never smokers (HR 1.6, 95% CI 1.0 to 2.5). Predominantly non-smokers did not differ from those who never smoked (HR 1.3, 95% CI 0.9 to 2.0). Using the most recent smoking status available, current smokers had more than double the risk of mortality compared with never smokers (HR 2.4, 95% CI 1.6 to 3.5). Lifelong smokers and predominantly smokers had a greater rate of decline in lung function than never smokers (regression coefficients -18 ml/year, 95% CI -22 to -13; -6, 95% CI -10.3 to -1.7 respectively). For current smokers, the decline was 8.4 ml/year (95% CI -12.0 to -5.0) faster than never smokers.

CONCLUSIONS

The strength and differentiation of adverse effects identified by using simplified smoking behaviours has highlighted the advantages of obtaining further information on lifelong smoking behaviour from former smokers, rather than just current smoking status.

Effects of environmental tobacco smoke on respiratory health of boys and girls from kindergarten: results from 15 districts of northern China

The effects of childhood environmental tobacco smoke (ETS) exposure on respiratory symptoms were investigated in 6053 kindergarten-aged children residing in 15 districts of northern China. Responses to a self-administered questionnaire completed by parents of children from 30 kindergartens were used to ascertain children with persistent cough, persistent phlegm, asthma symptom, current asthma, wheeze and wheeze without asthma. In first 2 years ETS exposure and current ETS exposure were associated with increased prevalence of persistent cough, persistent phlegm, wheeze and wheeze without asthma. Among boys, ETS exposure was associated with more respiratory symptoms and diseases than in girls. ETS exposure during pregnancy was associated with asthma symptom [odds ratio (OR), 3.00; 95% confidence interval (CI): 1.28-7.03], current asthma (OR, 3.38; 95% CI: 1.25-9.14), persistent cough (OR, 1.64; 95% CI: 1.13-2.37), persistent phlegm (OR, 1.74; 95% CI: 1.01-3.01), wheeze (OR, 1.75; 95% CI: 1.15-2.68), and wheeze without asthma (OR, 1.46; 95% CI: 1.01-2.37) only among boys. In boys, the adjusted ORs for increased risk of asthma symptom and current asthma for household exposures (> or =10 cigarettes smoked per day vs. none smoked) during workday were 2.04 (95% CI: 1.01-3.89) and 2.76 (95% CI: 1.06-9.58), respectively. We conclude that ETS exposure increases the occurrence of respiratory symptoms and diseases during childhood. Boys may be more susceptible to ETS than girls.

PRACTICAL IMPLICATIONS

Environmental tobacco smoke (ETS) is a highly prevalent respiratory irritant. In agreement with previous cross-sectional studies, our study indicates that exposure to ETS may increase the occurrence of respiratory symptoms and diseases in children, and the association of ETS exposure and respiratory health of children increased in strength with number of cigarettes smoked inside the house per day during workday and day-off. Boys may be more susceptible to ETS than girls. These findings support the view that measures should be taken to reduce ETS exposure for children.

Female gender is associated with higher incidence and more stable respiratory symptoms during adolescence

Childhood asthma and wheeze is more common among boys than girls, while the opposite is found in adults. The main objective was to study the incidence and the course of wheeze and asthma during adolescence with focus on gender differences. In addition, we explored associations between lifestyle factors at baseline and wheeze at follow-up. A total of 2399 adolescents answered validated questionnaires on respiratory symptoms and lifestyle in 1995-1997 (13-15 years) and at follow-up in 2000-2001 (17-19 years). The risk of reporting wheeze and asthma at follow-up was greater in girls compared to boys among subjects reporting no respiratory symptoms at baseline; Relative risk: 1.4 and 2.4, respectively. More girls than boys reported current wheeze at follow-up, both among those with current wheeze (girls 60%, boys 48%) and previous wheeze (girls 33%, boys 28%) at baseline. In girls, development of current wheeze was significantly associated with current smoking (OR=2.8) and stable current wheeze was significantly associated with overweight (OR=2.4). Similar associations were not significant in boys. More girls than boys developed wheeze, had stable wheeze or had relapse of previous symptoms during the four year follow-up. The impact of smoking and overweight may put girls at a higher risk of respiratory symptoms than boys. Awareness of the gender difference in respiratory symptoms is important for diagnosis and preventive strategies during adolescence.

Factors related to tobacco use among teenagers

AIM

To examine tobacco use among teenagers, identify factors related to tobacco use, as well as evaluate the outcome of a smoking prevention program.

METHODS

From age 7/8 to 14/15, annual questionnaires about asthma and allergy have been completed in the OLIN paediatric study in Northern Sweden. From 12/13 years, questions about tobacco use, i.e. smoking and snuff, were added. A smoking prevention program was performed during 2 years.

RESULTS

Any tobacco use increased from 5.0% at age 12/13 years, to 14.4% at age 14/15. At age 14/15 years, the prevalence of tobacco use was significantly higher among boys than girls (16.7 and 12.0%, respectively). More girls than boys smoked (8.9 and 2.8%, respectively), while use of snuff was more common among the boys (15.6 and 4.2%, respectively). Significant risk factors for smoking were any of the family members currently smoking, OR 6.1 (95% CI 4.0-9.3) and a physician-diagnosed asthma at the age of 14/15 years, OR 1.9 (95% CI 1.2-3.0). A protective factor against tobacco use was participation in sports, OR 0.3 (95% CI 0.2-0.4). The prevention program did not result in less tobacco use, although it may have delayed smoking initiation.

CONCLUSION

The patterns of tobacco use differed significantly between boys and girls. Though any tobacco use was more common among boys, girls were more likely to smoke, and boys were more likely to use snuff. Having asthma did not prevent the teenagers from smoking. Since having a smoking family member was the major risk factor for tobacco use, prevention programs should be directed at smoking families in addition to the individuals.

Prevalence estimates of asthma or COPD from a health interview survey and from general practitioner registration: what's the difference?

BACKGROUND

The aim of this study was to compare prevalence estimates of asthma or chronic obstructive pulmonary disease (COPD) derived from self-report in a health interview survey and from general practitioners' (GPs') medical records, and to explain any differences.

METHODS

the presence of asthma or COPD was measured by self-report in a random sample of 104 general practices in the Netherlands (n = 19 685) participating in the second Dutch National Survey of General Practice (DNSGP-2). This was compared with the presence of GP-diagnosed asthma or COPD in the same population as recorded using the International Classification of Primary Care by their GPs during a 12-month period. Gender, age, health insurance, ethnic background, educational level, tobacco exposure, and other symptoms and conditions were evaluated as explanatory variables using logistic models.

RESULTS

The prevalence of self-reported asthma or COPD (9.7%) was almost twice as high as the prevalence based on GP information (5.2%). The medical records of patients who reported having asthma or COPD, without having a diagnosis in their medical records, usually included other respiratory conditions. Patients reporting no asthma or COPD but whose medical records carried a diagnosis of asthma or COPD, were relatively older (P < 0.01) and tended to be exposed to smoking in their home (P < 0.05).

CONCLUSIONS

Two methods for estimating prevalence of asthma or COPD yielded different results: compared with GP medical records, self-reported prevalence shows an overestimation in people who suffer from other respiratory conditions and an underestimation in elderly persons living in a smoky environment.

Adolescent respiratory symptoms--girls are at risk: the Young-HUNT study, Norway

The objective was to study sex differences in adolescence regarding prevalence of asthma and current wheeze and to explore the association between respiratory symptoms and hereditary, lifestyle and socioeconomic factors. Young-HUNT included data comprehensive questionnaire on health, disease, lifestyle and social factors from 8817 teenagers 13-19 years conducted in 1995/97 (89% response rate). Questionnaire on respiratory symptoms was based on the International Study of Asthma and Allergy in Childhood (ISAAC). In age groups 13-16 and 17-19 years, current wheeze was reported by 29.0% and 33.5% among girls and 20.4% and 22.1% among boys, whilst the corresponding figures for asthma were 8.5% and 12.2% among girls and 7.1% and 7.0% among boys. Both wheeze and asthma were significantly more prevalent and increased with age in girls compared to boys. Heredity was associated with asthma, but the association was strongest between parents and children of the same sex. Environmental smoking was associated with asthma and wheeze in girls only. Girls reported more asthma and wheeze in association with overweight compared to boys. Girls reported more wheeze and asthma than boys and seemed more susceptible to risk factors such as environmental smoking and overweight than boys. Moreover, girls with mothers having asthma were more likely to be diagnosed as asthmatics themselves.

Deprivation, smoking, and quality of life in asthma

AIMS

To explore associations of deprivation and smoking, with prevalence of asthma, wheeze, and quality of life.

METHODS

Survey, using International Study of Asthma and Allergies in Childhood (ISAAC) methodology, of children aged 13-14 years attending Scottish schools previously surveyed in 1995.

RESULTS

4665/5247 (89%) pupils completed questionnaires. 3656/4665 (78.4%) had missed school for any reason in the last 12 months, 587 (12.6%) because of asthma or wheeze. Compared to children with 1-3 wheeze attacks per year, those with >12 attacks in the last year were more likely to have missed school, twice as likely to have missed physical education in the last month, to report interference with home activities, or to have visited accident and emergency departments, and three times more likely to have been hospitalised. Deprivation was not independently associated with self-reported asthma or wheeze, but was associated with school absence, either for any reason or specifically for asthma or wheeze, but not with use of services such as accident and emergency visits, doctor visits, or hospital admissions. Active smoking was associated with wheezy symptoms, and active and passive smoking with use of medical services. These associations were independent of wheeze severity, treatment taken, and other associated atopic conditions. Smoking also had an impact on school absence and home and school activities.

CONCLUSIONS

Deprivation does not affect the prevalence of asthma or wheeze. Exposure to cigarette smoke was associated with the increased use of services. Deprivation and smoking have independent adverse effects on the quality of life in subjects with asthma or wheeze.

Chronic obstructive pulmonary disease: are women more susceptible than men?

Current data show that women now suffer from COPD at least as commonly as men. They seem to be more predisposed to suffer the adverse respiratory consequences of tobacco smoking with the development of COPD at an earlier age and with a greater degree of lung function impairment for a given amount of tobacco exposure. This may be explained, in part, by women's greater airway responsiveness to exogenous stimuli--an increased responsiveness that is explained largely by differences in lung size and geometry. Hormonal factors and immunologic factors that influence the lung also may differ between the sexes but their significance is poorly understood. Despite the increasing prevalence of COPD among women, their disease is more likely to be overlooked as compared with the same disease in men. This gender bias in diagnosis is not likely to be remedied until physicians begin to use spirometric testing to screen for this common disease. Women who smoke may have greater difficulty quitting than men. There are documented differences in health care use between men and women who have COPD, but too few studies have been done to allow conclusions to be drawn about the impact of sex and gender on the prognosis of the disease.

Quantification of recent smoking behaviour using proton transfer reaction-mass spectrometry (PTR-MS)

Smoking is the most important single risk factor in current public health. Surveillance of exposure to tobacco smoke may be accomplished using environmental monitoring or in-vivo tests for smoking biomarkers. Acetonitrile exhaled in human breath has been described as a potential marker mirroring recent smoking behavior. The aim of this study was to determine exhaled acetonitrile levels in a sample of 268 volunteers (48 smokers, 220 non-smokers) attending a local health fair. Breath specimens were collected into inert sample bags, with parallel collection of ambient air. Subsequently, all samples were analysed using proton transfer reaction-mass spectrometry (PTR-MS). Smokers had elevated levels of exhaled acetonitrile compared with non-smokers (p<0.001). Analysis using the receiver-operating-characteristic curve demonstrated that smoking can be predicted with a sensitivity of 79% and a specificity of 91%, using a cut-off concentration of 20.31 parts per billion of acetonitrile. This first field survey of exhaled acetonitrile in a large group of test persons demonstrates the feasibility of a rapid and non-invasive test for recent exposure to tobacco. We conclude that analysis of exhaled-breath acetonitrile may serve as a method of determining recent active smoking behaviour.