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Critselis E, Panagiotakos DB, Georgousopoulou EN, Katsaounou P, Chrysohoou C, Pitsavos C. Exposure to second hand smoke and 10-year (2002-2012) incidence of cardiovascular disease in never smokers: The ATTICA cohort study. Int J Cardiol 2019; 295:29-35. [PMID: 31375335 DOI: 10.1016/j.ijcard.2019.07.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite WHO Framework Convention of Tobacco Control (FCTC) adoption, effective implementation of national smoking bans remains pending in several countries. This study quantified the association of second hand smoke (SHS) exposure and 10-year cardiovascular disease (CVD) among never smokers in such settings. METHODS In 2001-2002, a sample of 1514 males and 1528 females (range: 18-89 years old) were randomly selected in Greece. Frequency and duration of SHS exposure (i.e. exposure extending >30 min/day) within the home and/or workplace were assessed by interview. Following a 10-year follow-up period (2002-2012), incidence of non-fatal and fatal CVD (ICD-10) was evaluated among n = 2020 participants. The analytic study sample consisted of all never smokers (n = 910). RESULTS Despite national smoking ban implementation (2009), 44.6% (n = 406) of never smokers reported SHS exposure. While SHS exposed never smokers exhibited a more favorable profile of CVD-related risk factors at baseline, they subsequently developed similar 10-year CVD incidence rates, at a younger mean age (p = 0.001), than their non-exposed counterparts. Following adjustment for several lifestyle and clinical factors, SHS exposed never smokers exhibited a two-fold elevated 10-year CVD risk (adj. HR: 2.04, 95% CI: 1.43-2.92), particularly among women (adj. HR: 2.45, 95% CI: 1.45-4.06). SHS exposure accounted for 32% excess Population Attributable Risk (PAR) for 10-year CVD events in never smokers, with highest rates (PAR: 52%) being among those exposed in the workplace. CONCLUSION The prevention of SHS associated CVD and related healthcare costs mandates additional strategies for securing the effective implementation of comprehensive WHO FCTC based national smoking bans.
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Affiliation(s)
- Elena Critselis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; University of Canberra, Faculty of Health, Canberra, Australia; University of La Trobe, College of Science, Health & Engineering, Melbourne, Australia.
| | - Ekavi N Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; University of Canberra, Faculty of Health, Canberra, Australia; University of Notre Dame Australia, Medical School, Sydney, Australia
| | - Paraskevi Katsaounou
- Pulmonary and Critical Care Department, First ICU, School of Medicine, University of Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
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Lee PN, Forey BA, Hamling JS, Thornton AJ. Environmental tobacco smoke exposure and heart disease: A systematic review. World J Meta-Anal 2017; 5:14-40. [DOI: 10.13105/wjma.v5.i2.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/10/2017] [Accepted: 03/02/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To review evidence relating passive smoking to heart disease risk in never smokers.
METHODS Epidemiological studies were identified providing estimates of relative risk (RR) of ischaemic heart disease and 95%CI for never smokers for various indices of exposure to environmental tobacco smoke (ETS). “Never smokers” could include those with a minimal smoking experience. The database set up included the RRs and other study details. Unadjusted and confounder-adjusted RRs were entered, derived where necessary using standard methods. The fixed-effect and random-effects meta-analyses conducted for each exposure index included tests for heterogeneity and publication bias. For the main index (ever smoking by the spouse or nearest equivalent, and preferring adjusted to unadjusted data), analyses investigated variation in the RR by sex, continent, period of publication, number of cases, study design, extent of confounder adjustment, availability of dose-response results and biomarker data, use of proxy respondents, definitions of exposure and of never smoker, and aspects of disease definition. Sensitivity analyses were also run, preferring current to ever smoking, or unadjusted to adjusted estimates, or excluding certain studies.
RESULTS Fifty-eight studies were identified, 20 in North America, 19 in Europe, 11 in Asia, seven in other countries, and one in 52 countries. Twenty-six were prospective, 22 case-control and 10 cross-sectional. Thirteen included 100 cases or fewer, and 11 more than 1000. For the main index, 75 heterogeneous (P < 0.001) RR estimates gave a combined random-effects RR of 1.18 (95%CI: 1.12-1.24), which was little affected by preferring unadjusted to adjusted RRs, or RRs for current ETS exposure to those for ever exposure. Estimates for each level of each factor considered consistently exceeded 1.00. However, univariate analyses revealed significant (P < 0.001) variation for some factors. Thus RRs were lower for males, and in North American, larger and prospective studies, and also where the RR was for spousal smoking, fatal cases, or specifically for IHD. For case-control studies RRs were lower if hospital/diseased controls were used. RRs were higher when diagnosis was based on medical data rather than death certificates or self-report, and where the never smoker definition allowed subjects to smoke products other than cigarettes or have a limited smoking history. The association with spousal smoking specifically (1.06, 1.01-1.12, n = 34) was less clear in analyses restricted to married subjects (1.03, 0.99-1.07, n = 23). In stepwise regression analyses only those associations with source of diagnosis, study size, and whether the spouse was the index, were independently predictive (at P < 0.05) of heart disease risk. A significant association was also evident with household exposure (1.19, 1.13-1.25, n = 37). For those 23 studies providing dose-response results for spouse or household exposure, 11 showed a significant (P < 0.05) positive trend including the unexposed group, and two excluding it. Based on fewer studies, a positive, but non-significant (P > 0.05) association was found for workplace exposure (RR = 1.08, 95%CI: 0.99-1.19), childhood exposure (1.12, 0.95-1.31), and biomarker based exposure indices (1.15, 0.94-1.40). However, there was a significant association with total exposure (1.23, 1.12-1.35). Some significant positive dose-response trends were also seen for these exposure indices, particularly total exposure, with no significant negative trends seen. The evidence suffers from various weaknesses and biases. Publication bias may explain the large RR (1.66, 1.30-2.11) for the main exposure index for smaller studies (1-99 cases), while recall bias may explain the higher RRs seen in case-control and cross-sectional than in prospective studies. Some bias may also derive from including occasional smokers among the “never smokers”, and from misreporting smoking status. Errors in determining ETS exposure, and failing to update exposure data in long term prospective studies, also contribute to the uncertainty. The tendency for RRs to increase as more factors are adjusted for, argues against the association being due to uncontrolled confounding.
CONCLUSION The increased risk and dose-response for various exposure indices suggests ETS slightly increases heart disease risk. However heterogeneity, study limitations and possible biases preclude definitive conclusions.
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Fatmi Z, Coggon D. Coronary heart disease and household air pollution from use of solid fuel: a systematic review. Br Med Bull 2016; 118:91-109. [PMID: 27151956 PMCID: PMC4973663 DOI: 10.1093/bmb/ldw015] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Evidence is emerging that indoor air pollution (IAP) from use of solid fuels for cooking and heating may be an important risk factor for coronary heart disease (CHD). SOURCES OF DATA We searched the Ovid Medline, Embase Classic, Embase and Web of Science databases from inception through to June 12, 2015, to identify reports of primary epidemiological research concerning the relationship of CHD to IAP from solid fuel, the likely magnitude of any increase in risk, and potential pathogenic mechanisms. AREAS OF AGREEMENT The current balance of epidemiological evidence points to an increased risk of CHD from IAP as a consequence of using solid, and especially biomass, fuels for cooking and heating. Relative risks from long-term exposure could be 2- to 4-fold. AREAS OF CONTROVERSY The evidence base is still limited, and although an association of CHD with such IAP from solid fuel is consistent with the known hazards from smoking, environmental tobacco smoke and ambient air pollution, and supported by evidence of effects on inflammatory processes, atherosclerosis and blood pressure, it requires confirmation by larger and more robust studies. GROWING POINTS The completion of two relatively small case-control studies on CHD and IAP from use of biomass fuel demonstrates the feasibility of such research, and is an encouragement to further, larger studies using similar methods. AREAS TIMELY FOR DEVELOPING RESEARCH The need for such research is particularly pressing because the incidence of CHD in developing countries is rising, and IAP may interact synergistically with the risk factors that are driving that increase. Furthermore, relatively cheap methods are available to reduce IAP from use of solid fuels, and there are indications from intervention studies that these may impact beneficially on CHD as well as other diseases caused by such pollution.
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Affiliation(s)
- Zafar Fatmi
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - David Coggon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Passos VMDA, Giatti L, Barreto SM. Tabagismo passivo no Brasil: resultados da Pesquisa Especial Do Tabagismo, 2008. CIENCIA & SAUDE COLETIVA 2011; 16:3671-8. [DOI: 10.1590/s1413-81232011001000004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 02/16/2011] [Indexed: 11/22/2022] Open
Abstract
O objetivo foi descrever prevalência e características sócio-demográficas associadas ao tabagismo passivo no domicílio e no trabalho, em participantes (15+ anos) de amostra populacional da Pesquisa Especial do Tabagismo, sub-amostra da PNAD 2008. O tabagismo passivo é definido como a exposição ao tabaco por não-fumante, em casa, no trabalho ou em outros locais fechados, excluídas ocupações ao ar livre. Associações com características sócio-demográficas foram estimadas por análise de regressão logística. Nos 25.005 não-fumantes, a exposição domiciliar é diária para 12,5% e ocasional para 21%. À regressão multinomial (referência: não-expostos), a exposição diária diminui com aumento de idade e tanto a exposição diária como a ocasional diminuem com maiores escolaridade e renda. Comparada à Região Sudeste, há menor exposição diária no Norte e no Centro-Oeste, e maior ocasional no Nordeste. Dos 10.933 trabalhadores, 55% dos homens e 45% das mulheres relataram exposição no trabalho e 67% exposição domiciliar adicional. A exposição no trabalho é maior em homens, nos mais velhos (55+anos) e com menor escolaridade e renda; e menor no Sul. A desigualdade social no Brasil se revela também na maior exposição ao tabagismo passivo daqueles com menor escolaridade e renda.
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Takagi H, Umemoto T. The specter of publication bias: adjustment for publication bias in the evidence on cardiac death associated with passive smoking in nonsmoking women. Int J Cardiol 2011; 149:388-9. [PMID: 21453980 DOI: 10.1016/j.ijcard.2011.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 03/03/2011] [Indexed: 01/20/2023]
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Huss A, Kooijman C, Breuer M, Böhler P, Zünd T, Wenk S, Röösli M. Fine particulate matter measurements in Swiss restaurants, cafés and bars: what is the effect of spatial separation between smoking and non-smoking areas? INDOOR AIR 2010; 20:52-60. [PMID: 19958392 DOI: 10.1111/j.1600-0668.2009.00625.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED We performed 124 measurements of particulate matter (PM(2.5)) in 95 hospitality venues such as restaurants, bars, cafés, and a disco, which had differing smoking regulations. We evaluated the impact of spatial separation between smoking and non-smoking areas on mean PM(2.5) concentration, taking relevant characteristics of the venue, such as the type of ventilation or the presence of additional PM(2.5) sources, into account. We differentiated five smoking environments: (i) completely smoke-free location, (ii) non-smoking room spatially separated from a smoking room, (iii) non-smoking area with a smoking area located in the same room, (iv) smoking area with a non-smoking area located in the same room, and (v) smoking location which could be either a room where smoking was allowed that was spatially separated from non-smoking room or a hospitality venue without smoking restriction. In these five groups, the geometric mean PM(2.5) levels were (i) 20.4, (ii) 43.9, (iii) 71.9, (iv) 110.4, and (v) 110.3 microg/m(3), respectively. This study showed that even if non-smoking and smoking areas were spatially separated into two rooms, geometric mean PM(2.5) levels in non-smoking rooms were considerably higher than in completely smoke-free hospitality venues. PRACTICAL IMPLICATIONS PM(2.5) levels are considerably increased in the non-smoking area if smoking is allowed anywhere in the same location. Even locating the smoking area in another room resulted in a more than doubling of the PM(2.5) levels in the non-smoking room compared with venues where smoking was not allowed at all. In practice, spatial separation of rooms where smoking is allowed does not prevent exposure to environmental tobacco smoke in nearby non-smoking areas.
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Affiliation(s)
- A Huss
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg, Bern, Switzerland
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L'Heureux J. Second-hand smoke exposure: responses from home care and therapeutic group home nurses: a call to action. HOME HEALTHCARE NURSE 2009; 27:114-119. [PMID: 19212225 DOI: 10.1097/01.nhh.0000346315.54078.be] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Home care visiting nurses and those working in a therapeutic group home expressed concerns about their inadvertent exposure to secondhand smoke when caring for patients who live where cigarettes or tobacco products are used. The American Lung Association Fact Sheet on Secondhand Smoke Exposure cites the Environmental Protection Agency (EPA) classification of secondhand smoke as a cause of human cancer. Secondhand smoke causes approximately 3,400 lung cancer deaths and 22,700 to 69,600 heart disease deaths among adult nonsmokers in the United States each year (American Lung Association, 2009). For this study, home care nurses and those working in a therapeutic group home for the mentally ill in Augusta, Maine, were interviewed. This report describes their exposure and how secondhand smoke can be eliminated with minimal disruption to patient care. The interviewed nurses discussed the repeated exposures they experienced while caring for multiple smoking patients in residences that included apartment buildings and group homes and while transporting patients with private automobiles in which the use of cigarettes, cigarillos, cigars, pipes, and tobacco products can be common. Concerns about secondhand smoke exposures frequently focused on the unpleasant smoke odor retained on clothes and nursing equipment when people smoke during a patient visit. Protective actions also were reported. Strategies for action are discussed.
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Affiliation(s)
- Juliana L'Heureux
- Maine Association of Mental Health Services, Augusta, Maine 04330, USA.
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Hemsing N, Greaves L. Women, environments and chronic disease: shifting the gaze from individual level to structural factors. ENVIRONMENTAL HEALTH INSIGHTS 2009; 2:127-35. [PMID: 21572841 PMCID: PMC3091340 DOI: 10.4137/ehi.s989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Chronic heart and respiratory diseases are two of the leading causes of morbidity and mortality affecting women. Patterns of and disparities in chronic diseases between sub-populations of women suggest that there are social as well as individual level factors which enhance or impede the prevention or development of chronic respiratory and cardiovascular diseases. By examining the sex, gender and diversity based dimensions of women's lung and heart health and how these overlap with environmental factors we extend analysis of preventive health beyond the individual level. We demonstrate how biological, environmental and social factors interact and operate in women's lives, structuring their opportunities for health and abilities to prevent or manage chronic cardiovascular and respiratory diseases. METHODS This commentary is based on the findings from two evidence reviews, one conducted on women's heart health, and another on women's lung health. Additional literature was also reviewed which assessed the relationship between environmental factors and chronic heart and lung diseases. This paper explores how obesogenic environments, exposure to tobacco smoke, and the experience of living in deprived areas can affect women's heart and respiratory health. We discuss the barriers which impede women's ability to engage in physical activity, consume healthy foods, or avoid smoking, tobacco smoke, and other airborne contaminants. RESULTS Sex, gender and diversity clearly interact with environmental factors and shape women's promotion of health and prevention of chronic respiratory and cardiovascular diseases. The environments women live in structure their opportunities for health, and women navigate these environments in unique ways based on gender, socioeconomic status, race/ethnicity and other social factors. DISCUSSION Future research, policy and programs relating to the prevention of chronic disease need to move beyond linear individually-oriented models and address these complexities by developing frameworks and interventions which improve environmental conditions for all groups of women. Indeed, in order to improve women's health, broad social and economic policies and initiatives are required to eliminate negative environmental impacts on women's opportunities for health.
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Affiliation(s)
- Natalie Hemsing
- Tobacco Research Coordinator, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia, Canada
| | - Lorraine Greaves
- Executive Director, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia, Canada
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Abstract
Involuntary exposure to environmental tobacco smoke (ETS) is a serious and entirely preventable public health hazard. It has become clear that ETS adversely affects the health of all who breathe its toxins. Independent of active smoking, ETS exposure is a modifiable risk factor for chronic obstructive pulmonary disease. The expanding body of research presented in this article provides evidence that the damaging consequences of ETS reach far beyond the lungs. Having been determined the third leading cause of preventable death in this country, this is a problem that must be addressed aggressively.
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Affiliation(s)
- Jane Z Reardon
- Department of Medicine, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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Widome R, Jacobs DR, Schreiner PJ, Iribarren C. Passive smoke exposure trends and workplace policy in the Coronary Artery Risk Development in Young Adults (CARDIA) study (1985-2001). Prev Med 2007; 44:490-5. [PMID: 17433426 PMCID: PMC3902070 DOI: 10.1016/j.ypmed.2007.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 02/13/2007] [Accepted: 02/14/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There has been reduced active smoking, decreased societal acceptance for smoking indoors, and changing smoking policy since the mid-1980s. We quantified passive smoke exposure trends and their relationship with workplace policy. METHOD We studied 2504 CARDIA participants (Blacks and Whites, 18-30 years old when recruited in 1985-86 from four US cities, reexamination 2, 5, 7, 10, and 15 years later) who never reported current smoking and attended examinations at 10 or 15 years. RESULTS.: In non-smokers with a college degree (n=1581), total passive smoke exposure declined from 16.3 h/week in 1985/86 to 2.3 h/week in 2000/01. Less education tended to be associated with more exposure at all timepoints, for example, in high school or less (n=292) 22.2 h/week in 1985/86 to 8.5 h/week in 2000/01. Those who experienced an increase in the restrictiveness of self-reported workplace smoking policy from 1995/96 to 2000/01 were exposed to almost 3 h per week less passive smoke than those whose workplace policies became less restrictive in this time period. CONCLUSIONS The increasing presence of restrictive workplace policies seemed to be a component of the substantial decline in self-reported passive smoke exposure since 1985.
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Affiliation(s)
- Rachel Widome
- The Healthy Youth Development Prevention Research Center, Division of General Pediatrics and Adolescent Health, McNamara Alumni Center, University of Minnesota, Minneapolis, MN 55455-2002, USA.
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Cramer M, Roberts S, Xu L. Evaluating community-based programs for eliminating secondhand smoke using evidence-based research for best practices. FAMILY & COMMUNITY HEALTH 2007; 30:129-143. [PMID: 19241649 DOI: 10.1097/01.fch.0000264410.20766.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Extensive research has been conducted on the hazardous effects of tobacco use, and more recently attention has focused on the harmful effects of secondhand smoke (SHS). A growing body of evidence-based research supports best practices for eliminating SHS. This article describes the evaluation and outcomes of a community-based coalition in the midwest that used best practices to educate and change public attitudes on SHS, and thereby promote social policy change for tobacco-free environments. The evaluation model incorporated evidence-based indicators as measures for coalition goal achievement and found the best practices program to be effective for eliminating SHS exposure.
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Affiliation(s)
- Mary Cramer
- Gerontological, Psychosocial, Family Nurse Practitioner and Community Health Department, College of Nursing, University of Nebraska Medical Center, Omaha, NE 68198, USA.
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Abstract
There is very little systematically collected evidence on the overall contribution of environmental risk factors to the global burden of disease. The World Health Organization (WHO) recently completed a comprehensive, systematic, and transparent estimate of the disease burden attributable to the environment highlighting the full potential for environmental interventions to improve human health. This report is the result of a systematic literature review on environmental risks completed by a survey of expert opinion using a variant of the Delphi method. More than 100 experts provided quantitative estimates on the fractions of 85 diseases attributable to the environment. They were asked to consider only the contributions of the "reasonably modifiable environment"-that is, the part of environment that can plausibly be changed by existing interventions. The report estimates that 24% of the global burden of disease was due to environmental risk factors. Environmental factors were judged to play a role in 85 of the 102 diseases taken into account. Major diseases were, for example, diarrheal diseases with fractions attributable to the environment of 94%, lower respiratory infections with 41%, malaria with 42%, and unintentional injuries with 42%. The evidence shows that a large proportion of this "environmental disease burden" could be averted by existing cost-effective interventions such as clean water, clean air, and basic safety measures. In children, 34% of the disease burden is attributable to the environment, and much of this burden is in developing countries.
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Affiliation(s)
- Annette Prüss-Ustün
- Department of Public Health and the Environment, World Health Organization, Geneva, Switzerland.
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Wen W, Shu XO, Gao YT, Yang G, Li Q, Li H, Zheng W. Environmental tobacco smoke and mortality in Chinese women who have never smoked: prospective cohort study. BMJ 2006; 333:376. [PMID: 16837487 PMCID: PMC1550443 DOI: 10.1136/bmj.38834.522894.2f] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2006] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the association of environmental exposure to tobacco smoke from husbands and from work, as well as from family members in early life, with all cause mortality and mortality due to cancer or cardiovascular disease in Chinese women. DESIGN Ongoing prospective cohort study in Shanghai, China. PARTICIPANTS Of 72,829 women who had never smoked, 65,180 women provided information on smoking by their husbands, and 66,520 women provided information on exposure to tobacco smoke at work and in early life from family members. MAIN OUTCOME MEASURES All cause mortality and cause specific mortality with the main focus on cancer and cardiovascular disease. Cumulative mortality according to exposure status, and hazard ratios. RESULTS Exposure to tobacco smoke from husbands (mainly current exposure) was significantly associated with increased all cause mortality (hazard ratio 1.15, 95% confidence interval 1.01 to 1.31) and with increased mortality due to cardiovascular disease (1.37, 1.06 to 1.78). Exposure to tobacco smoke at work was associated with increased mortality due to cancer (1.19, 0.94 to 1.50), especially lung cancer (1.79, 1.09 to 2.93). Exposure in early life was associated with increased mortality due to cardiovascular disease (1.26, 0.94 to 1.69). CONCLUSIONS In Chinese women, exposure to environmental tobacco smoke is related to moderately increased risk of all cause mortality and mortality due to lung cancer and cardiovascular disease.
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Affiliation(s)
- Wanqing Wen
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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