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Pérez A, Valencia S, Jani PP, Harrell MB. Use of Electronic Nicotine Delivery Systems and Age of Asthma Onset Among US Adults and Youths. JAMA Netw Open 2024; 7:e2410740. [PMID: 38758558 PMCID: PMC11102021 DOI: 10.1001/jamanetworkopen.2024.10740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/11/2024] [Indexed: 05/18/2024] Open
Abstract
Importance The association of use of electronic nicotine delivery systems (ENDS) with the age of asthma onset is unknown. Objective To explore the association of past 30-day ENDS use with the age of asthma onset in adults and youths who did not have asthma or chronic obstructive pulmonary disease and never used cigarettes. Design, Setting, and Participants This cohort study was a secondary analysis of waves 1 to 6 of the US nationally representative Population of Tobacco and Health Study (2013-2021). Eligible participants included adults (≥18 years) and youths (12-17 years) who did not have asthma or chronic obstructive pulmonary disease at the first wave of participation. Data analysis was conducted from September 2022 to April 2024. Exposure Past 30-day ENDS use at the first wave of participation in the study preceding the onset of asthma. Main outcome and measures Lower and upper age limits were estimated using the age reported at the first wave of participation and the number of weeks between follow-up waves until asthma was first reported or censored. The association of past 30-day ENDS use with the age of asthma onset was estimated using weighted interval-censoring Cox regression. The cumulative hazard function for the age of asthma onset was estimated using interval-censoring survival analysis. Results A total of 24 789 participants were included, with 7766 adults (4461 female [weighted percentage, 59.11%] and 3305 male [weighted percentage, 40.89%]), representing 80.0 million adults, and 17 023 youths (8514 female [weighted percentage, 50.60%] and 8496 male [weighted percentage 49.32%]), representing 33.9 million youths. By age 27 years, 6.2 per 1000 adults reported asthma incidence (hazard ratio [HR], 0.62%; 95% CI, 0.46%-0.75%). While controlling for covariates, there was a 252% increased risk of the onset of asthma at earlier ages for adults who used ENDS in the past 30 days vs adults who did not (adjusted HR, 3.52; 95% CI, 1.24-10.02). For youths, there was no association of ENDS use in the past 30 days with age of asthma onset (adjusted HR, 1.79; 95% CI, 0.67-4.77), which could be due to a lack of statistical power. Conclusion and relevance In this cohort study, past 30-day ENDS use among adults was associated with earlier ages of asthma onset. These findings suggest that prevention and cessation programs directed to adults who use ENDS are needed to educate the public, protect public health, prevent adverse health outcomes, and motivate users to stop. Furthermore, modifying symptom-screening asthma guidelines, resulting in earlier asthma detection and treatment, may reduce morbidity and mortality due to asthma.
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Affiliation(s)
- Adriana Pérez
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, School of Public Health, Austin
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, Austin
| | - Sarah Valencia
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, Austin
| | - Pushan P. Jani
- Division of Pulmonary and Sleep Medicine, The University of Texas Health Science Center at Houston, School of Medicine, Houston
| | - Melissa B. Harrell
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, Austin
- Department of Epidemiology, The University of Texas Health Science Center at Houston, School of Public Health, Austin
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Kawachi H, Teramoto M, Muraki I, Shirai K, Yamagishi K, Tamakoshi A, Iso H. Childhood secondhand smoke exposure and respiratory disease mortality among never-smokers: the Japan collaborative cohort study for evaluation of cancer risk. J Public Health (Oxf) 2023; 45:604-611. [PMID: 37164769 DOI: 10.1093/pubmed/fdad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/17/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The main source of secondhand smoke (SHS) exposure during childhood occurs at home due to close family members who smoke. This study examined the association between childhood SHS exposure and the risk of respiratory disease mortality among non-smoking adults. METHODS Data from 44 233 never-smoking Japanese men and women aged 40-79 years who participated in the JACC study between 1988 and 1990 were analyzed. The Cox proportional hazards model was used to calculate hazard ratios and 95% confidence intervals of respiratory disease mortality according to the number of smoking family members during childhood. Subdistribution HRs (SHRs) were calculated as a competing risk analysis. RESULTS A total of 735 deaths from respiratory diseases were documented in a median follow-up of 19.2 years. Living with three or more smoking family members during childhood was associated with a higher risk of respiratory disease mortality in adulthood among women; multivariable SHR compared with participants with no family member smokers during childhood was 1.60 (1.01-2.54) for participants with three or more family members who smoked during their childhood. CONCLUSIONS SHS exposure from three or more family members during childhood was associated with an increased risk of respiratory disease-related mortality in adulthood.
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Affiliation(s)
- Haruna Kawachi
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, 565-0871, Japan
| | - Masayuki Teramoto
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, 565-0871, Japan
| | - Isao Muraki
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, 565-0871, Japan
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, 565-0871, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba, Tsukuba, 305-8575, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University, Graduate School of Medicine, Sapporo, 060-8638, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, 565-0871, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, 162-8655, Japan
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Zhai C, Hu D, Yu G, Hu W, Zong Q, Yan Z, Wang Y, Wang L, Zhang T, Sun H, Cai L, Cui L, Wang F, Zou Y. 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. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 862:160677. [PMID: 36481152 DOI: 10.1016/j.scitotenv.2022.160677] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Chunxia Zhai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Dingtao Hu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Clinical Cancer Institute, Center for Translational Medicine, Naval Medical University, Shanghai, China
| | - Guanghui Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wanqin Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qiqun Zong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ziye Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuhua Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Linlin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Tingyu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Hongyu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ling Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Liangyu Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Fang Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanfeng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
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Becerra BJ, Arias D, Becerra MB. Sex-Specific Association between Environmental Tobacco Smoke Exposure and Asthma Severity among Adults with Current Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095036. [PMID: 35564431 PMCID: PMC9104276 DOI: 10.3390/ijerph19095036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/16/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Benjamin J. Becerra
- Center for Health Equity, Department of Information and Decision Sciences, California State University-San Bernardino, San Bernardino, CA 92407, USA;
| | - Devin Arias
- Center for Health Equity, Department of Health Science & Human Ecology, California State University-San Bernardino, San Bernardino, CA 92407, USA;
| | - Monideepa B. Becerra
- Center for Health Equity, Department of Health Science & Human Ecology, California State University-San Bernardino, San Bernardino, CA 92407, USA;
- Correspondence:
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Wei CF, Lin CC, Tsai MS, Guo YL, Lin SJ, Liao HF, Hsieh WS, Chen MH, Chen PC. Associations Between Infant Developmental Delays and Secondhand Smoke Exposure Modified by Maternal Prepregnancy Overweight and Obesity Status. Nicotine Tob Res 2021; 23:1475-1483. [PMID: 33556174 DOI: 10.1093/ntr/ntab024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/03/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Secondhand smoke exposure during pregnancy has long been associated with adverse health outcomes in children, but only a few studies have examined its effect modifiers. In this study, we applied effect modification analysis for maternal prepregnancy weight status on detrimental neurodevelopmental effect of secondhand smoke exposure during pregnancy and infancy in a nationwide representative population. AIMS AND METHODS Term singleton mother-infant pairs with nonsmoking mothers were included for main analysis (N = 15 987) from the Taiwan Birth Cohort Study (TBCS), and were further matched with propensity score (n = 5434). We extracted secondhand smoke exposure during pregnancy and infancy, and eight neurodevelopmental milestones from the responses in the baseline visit at 6 months, and 18-month follow-up of TBCS. The associations between secondhand smoke exposure and neurodevelopmental achievement were analyzed with multivariable logistic regression and Cox model. Propensity score weighting and matching were applied for high-versus-low analysis, and relative excess risk due to interaction were used to estimate effect modification. RESULTS Higher secondhand smoke exposure was associated with increased likelihood of delayed milestone achievement across gross motor, fine motor, language-related, and social-related domains. The associations in fine motor domains remained observable in propensity score-weighted and -matched models. We identified additive interaction with self-reported maternal overweight and obesity status before pregnancy in milestone development for walking with support, scribbling, and waving goodbye. CONCLUSIONS Secondhand smoke exposure during pregnancy and infancy were associated with delayed neurodevelopmental milestone achievement at 18 months, and the associations were modified by maternal prepregnancy overweight and obesity status. IMPLICATIONS The study results suggested the association between maternal secondhand smoke exposure during pregnancy and infancy and delayed fine motor and language-related milestone achievement at 18 months in multivariable, propensity score weighting, and matching populations. The results of positive effect modifications for maternal prepregnancy overweight and obesity status suggested the importance of concurrent interventions on smoke-free environment and maternal health during pregnancy.
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Affiliation(s)
- Chih-Fu Wei
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ching-Chun Lin
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Meng-Shan Tsai
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Yueliang Leon Guo
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.,National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Shio-Jean Lin
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Hua-Fang Liao
- School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Mei-Huei Chen
- Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.,Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Pau-Chung Chen
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.,National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.,Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.,Innovation and Policy Center for Population Health and Sustainable Environment, National Taiwan University College of Public Health, Taipei, Taiwan
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Carreras G, Lachi A, Cortini B, Gallus S, López MJ, López-Nicolás Á, Lugo A, Pastor MT, Soriano JB, Fernandez E, Gorini G, Castellano Y, Fu M, Ballbè M, Amalia B, Tigova O, López MJ, Continente X, Arechavala T, Henderson E, Gallus S, Lugo A, Liu X, Borroni E, Colombo P, Semple S, O’Donnell R, Dobson R, Clancy L, Keogan S, Byrne H, Behrakis P, Tzortzi A, Vardavas C, Vyzikidou VK, Bakelas G, Mattiampa G, Boffi R, Ruprecht A, De Marco C, Borgini A, Veronese C, Bertoldi M, Tittarelli A, Gorini G, Carreras G, Cortini B, Verdi S, Lachi A, Chellini E, López-Nicolás Á, Trapero-Bertran M, Guerrero DC, Radu-Loghin C, Nguyen D, Starchenko P, Soriano JB, Ancochea J, Alonso T, Pastor MT, Erro M, Roca A, Pérez P, García-Castillo E. Burden of disease from exposure to secondhand smoke in children in Europe. Pediatr Res 2021; 90:216-222. [PMID: 33149260 DOI: 10.1038/s41390-020-01223-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006-2017 for the 28 European Union (EU) countries. METHODS Exposure to SHS was estimated using a multiple imputation procedure based on the Eurobarometer surveys, and SHS exposure burden was estimated with the comparative risk assessment method using meta-analytical relative risks. Data on deaths and disability-adjusted life years (DALYs) were collected from National statistics and from the Global Burden of Disease Study. RESULTS Exposure to SHS and its attributable burden stalled in 2006-2017; in pregnant women, SHS exposure was 19.8% in 2006, 19.1% in 2010, and 21.0% in 2017; in children it was 10.1% in 2006, 9.6% in 2010, and 12.1% in 2017. In 2017, 35,633 DALYs among children were attributable to SHS exposure in the EU, mainly due to low birth weight. CONCLUSIONS Comprehensive smoking bans up to 2010 contributed to reduce SHS exposure and its burden in children immediately after their implementation; however, SHS exposure still occurs, and in 2017, its burden in children was still relevant. IMPACT Exposure to secondhand smoke at home and in pregnancy is a major cause of disease among children. Smoking legislation produced the adoption of voluntary smoking bans in homes; however, secondhand smoke exposure at home still occurs and its burden is substantial. In 2017, the number of deaths and disability-adjusted life years in children attributable to exposure to secondhand smoke in the European Union countries were, respectively, 335 and 35,633. Low birth weight caused by secondhand smoke exposure in pregnancy showed the largest burden. Eastern European Union countries showed the highest burden.
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Affiliation(s)
- Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy.
| | - Alessio Lachi
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Barbara Cortini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milan, Italy
| | - Maria José López
- Public Health Agency of Barcelona (ASPB), Barcelona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.,IIB Sant Pau, Barcelona, Spain
| | | | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milan, Italy
| | | | - Joan B Soriano
- Hospital Universitario La Princesa (IISP), Madrid, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Esteve Fernandez
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Catalan Institute of Oncology (ICO), L'Hopitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hopitalet de Llobregat, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
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Ksinan AJ, Sheng Y, Do EK, Schechter JC, Zhang J(J, Maguire RL, Hoyo C, Murphy SK, Kollins SH, Rubin B, Fuemmeler BF. Identifying the Best Questions for Rapid Screening of Secondhand Smoke Exposure Among Children. Nicotine Tob Res 2021; 23:1217-1223. [PMID: 33249470 PMCID: PMC8186417 DOI: 10.1093/ntr/ntaa254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/28/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Many children suffer from secondhand smoke exposure (SHSe), which leads to a variety of negative health consequences. However, there is no consensus on how clinicians can best query parents for possible SHSe among children. We employed a data-driven approach to create an efficient screening tool for clinicians to quickly and correctly identify children at risk for SHSe. METHODS Survey data from mothers and biospecimens from children were ascertained from the Neurodevelopment and Improving Children's Health following Environmental Tobacco Smoke Exposure (NICHES) study. Included were mothers and their children whose saliva were assayed for cotinine (n = 351 pairs, mean child age = 5.6 years). Elastic net regression predicting SHSe, as indicated from cotinine concentration, was conducted on available smoking-related questions and cross-validated with 2015-2016 National Health and Nutrition Examination Survey (NHANES) data to select the most predictive items of SHSe among children (n = 1670, mean child age = 8.4 years). RESULTS Answering positively to at least one of the two final items ("During the past 30 days, did you smoke cigarettes at all?" and "Has anyone, including yourself, smoked tobacco in your home in the past 7 days?") showed area under the curve = .82, and good specificity (.88) and sensitivity (.74). These results were validated with similar items in the nationally representative NHANES sample, area under the curve = .82, specificity = .78, and sensitivity = .77. CONCLUSIONS Our data-driven approach identified and validated two items that may be useful as a screening tool for a speedy and accurate assessment of SHSe among children. IMPLICATIONS The current study used a rigorous data-driven approach to identify questions that could reliably predict SHSe among children. Using saliva cotinine concentration levels as a gold standard for determining SHSe, our analysis employing elastic net regression identified two questions that served as good classifier for distinguishing children who might be at risk for SHSe. The two items that we validated in the current study can be readily used by clinicians, such as pediatricians, as part of screening procedures to quickly identify whether children might be at risk for SHSe.
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Affiliation(s)
- Albert J Ksinan
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA
| | | | - Elizabeth K Do
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA
| | - Julia C Schechter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | | | - Rachel L Maguire
- Department of Biological Sciences, North Carolina State University, Raleigh, NC
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, NC
| | - Susan K Murphy
- Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Bruce Rubin
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA
| | - Bernard F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA
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He Z, Wu H, Zhang S, Lin Y, Li R, Xie L, Li Z, Sun W, Huang X, Zhang CJP, Ming WK. The association between secondhand smoke and childhood asthma: A systematic review and meta-analysis. Pediatr Pulmonol 2020; 55:2518-2531. [PMID: 32667747 DOI: 10.1002/ppul.24961] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) exposure can trigger asthma exacerbations in children. Different studies have linked increased asthma symptoms and even deaths in children with SHS, but the risk has not been quantified uniformly across studies. We aimed to investigate the role of SHS exposure as a risk factor of asthma among children. METHODS We performed a systematic review in PubMed, Scopus, and Google Scholar from June 1975 to 10 March 2020. We included cohort, case-control, and cross-sectional studies reporting odds ratio (OR) or relative risk estimates and confidence intervals of all types of SHS exposure and childhood asthma. RESULTS Of the 26 970 studies identified, we included 93 eligible studies (42 cross-sectional, 41 cohort, and 10 case-control) in the meta-analysis. There were significantly positive associations between SHS exposure and doctor-diagnosed asthma (OR = 1.24; 95% confidence interval (CI) = 1.20-1.28), wheezing (OR = 1.27; 95% CI = 1.23-1.32) and asthma-like syndrome (OR = 1.34; 95% CI = 1.34-1.64). The funnel plots of all three outcomes skewed to the right, indicating that the studies generally favor a positive association of the disease with tobacco exposure. Subgroup analysis demonstrated that younger children tended to suffer more from developing doctor-diagnosed asthma, but older children (adolescents) suffered more from wheezing. There was no evidence of significant publication or small study bias using Egger's and Begg's tests. CONCLUSION The results show a positive association between prenatal and postnatal secondhand smoking exposure and the occurrence of childhood asthma, asthma-like syndrome, and wheezing. These results lend support to continued efforts to reduce childhood exposure to secondhand smoke.
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Affiliation(s)
- Zonglin He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Huailiang Wu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Siyu Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Yuchen Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Rui Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Lijie Xie
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Zibo Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Weiwei Sun
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Xinyu Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Casper J P Zhang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China.,School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.,Harvard Medical School, Harvard University, Boston, Massachusetts
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9
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Zheng F, Gonçalves FM, Abiko Y, Li H, Kumagai Y, Aschner M. Redox toxicology of environmental chemicals causing oxidative stress. Redox Biol 2020; 34:101475. [PMID: 32336668 PMCID: PMC7327986 DOI: 10.1016/j.redox.2020.101475] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022] Open
Abstract
Living organisms are surrounded with heavy metals such as methylmercury, manganese, cobalt, cadmium, arsenic, as well as pesticides such as deltamethrin and paraquat, or atmospheric pollutants such as quinone. Extensive studies have demonstrated a strong link between environmental pollutants and human health. Redox toxicity is proposed as one of the main mechanisms of chemical-induced pathology in humans. Acting as both a sensor of oxidative stress and a positive regulator of antioxidants, the nuclear factor erythroid 2-related factor 2 (NRF2) has attracted recent attention. However, the role NRF2 plays in environmental pollutant-induced toxicity has not been systematically addressed. Here, we characterize NRF2 function in response to various pollutants, such as metals, pesticides and atmospheric quinones. NRF2 related signaling pathways and epigenetic regulations are also reviewed.
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Affiliation(s)
- Fuli Zheng
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, China; Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY, 10461, United States.
| | - Filipe Marques Gonçalves
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY, 10461, United States
| | - Yumi Abiko
- Environmental Biology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan
| | - Huangyuan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, China.
| | - Yoshito Kumagai
- Environmental Biology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan.
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY, 10461, United States.
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10
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Buteau S, Shekarrizfard M, Hatzopolou M, Gamache P, Liu L, Smargiassi A. Air pollution from industries and asthma onset in childhood: A population-based birth cohort study using dispersion modeling. ENVIRONMENTAL RESEARCH 2020; 185:109180. [PMID: 32278153 DOI: 10.1016/j.envres.2020.109180] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/30/2019] [Accepted: 01/23/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Despite evidence that ambient air pollution may play a role in the development of asthma, little is known about the potential contribution of industrial emissions. OBJECTIVE We used a population-based birth cohort to investigate the association between asthma onset in childhood and residential exposure to industrial emissions, estimated from atmospheric dispersion modeling. METHODS The study population comprised all children born in the province of Quebec, Canada, 2002-2011. Asthma onset were ascertained from health administrative databases with validated algorithms. We used atmospheric dispersion modeling to develop time-varying annual mean concentration of ambient PM2.5, NO2 and SO2 at participants' residence from industries. For each pollutant, we assessed the association between industrial emissions exposure and childhood asthma onset using Cox proportional hazard model, adjusted for sex, material and social deprivation and calendar year. Sensitivity analysis included adjusting for long-term regional and traffic-related ambient PM2.5 and NO2, and assessing potential confounding by unmeasured secondhand smoke. RESULTS The cohort included 722,667 children and 66,559 incident cases of asthma. For all pollutants, we found a non-linear association between childhood asthma onset and residential ambient air pollutant concentration from industries, with stronger effects at lower concentrations. A change from 25th to the 75th percentile in the mean annual ambient concentration of PM2.5 (0.13 μg/m3), NO2 (1.0 μg/m3) and SO2 (1.6 μg/m3) from industrial emissions was associated with a 19% (95% CI: 17-20%), 21% (95% CI: 19-23%) and 23% (95% CI: 21-24%) increase in the risk of asthma onset in children, respectively. For PM2.5 and NO2, associations were persisting after adjustments for long-term regional PM2.5 and traffic-related NO2 ambient concentration. CONCLUSION Residential exposure to industrial emissions estimated from dispersion modeling was associated with asthma onset in childhood. Importantly, associations were stronger at lower concentrations and independent from those of other sources, thus adding up to the burden of regional and traffic-related air pollution.
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Affiliation(s)
- Stéphane Buteau
- Institut National de Sante Publique du Quebec (INSPQ), Montreal, Quebec, Canada
| | - Maryam Shekarrizfard
- Department of Civil Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Marianne Hatzopolou
- Department of Civil Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Philippe Gamache
- Institut National de Sante Publique du Quebec (INSPQ), Montreal, Quebec, Canada
| | - Ling Liu
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Canada
| | - Audrey Smargiassi
- Institut National de Sante Publique du Quebec (INSPQ), Montreal, Quebec, Canada; University of Montreal, Public Health Research Center, Montreal, Quebec, Canada.
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11
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Carreras G, Lugo A, Gallus S, Cortini B, Fernández E, López MJ, Soriano JB, López-Nicolás A, Semple S, Gorini G. Burden of disease attributable to second-hand smoke exposure: A systematic review. Prev Med 2019; 129:105833. [PMID: 31505203 DOI: 10.1016/j.ypmed.2019.105833] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/30/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
Our aim was to provide a systematic review of studies on the burden of disease due to second-hand smoke (SHS) exposure, reviewing methods, exposure assessment, diseases causally linked to SHS, health outcomes, and estimates available to date. A literature review of studies on the burden of disease from SHS exposure, available in PubMed and SCOPUS, published 2007-2018 in English language, was carried out following the PRISMA recommendations. Overall, 588 studies were first identified, and 94 were eligible. Seventy-two studies were included in the systematic review. Most of them were based on the comparative risk assessment approach, assessing SHS exposure using mainly surveys on exposure at home/workplaces. Diseases more frequently studied were: lung cancer, ischemic heart disease, stroke, chronic obstructive pulmonary disease, asthma and breast cancer in adults; lower respiratory tract infection, otitis media, asthma, sudden infant death syndrome and low birth weight in children. The SHS exposure assessment and the reported population attributable fractions (PAF) were largely heterogeneous. As an example, the PAF from lung cancer varied between 0.6% and 20.5%. Moreover, PAF were estimated applying relative risks and SHS exposures with no consistent definitions or with different age classes. The research gap on the SHS exposure burden is shrinking. However, estimates are not yet available for a number of countries, particularly the Middle Eastern and African countries, and not all diseases with the strongest evidence of causation, such as sudden infant death syndrome, have been explored. Moreover, in some cases the applied methodology revealed relatively low quality of data.
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Affiliation(s)
- Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy.
| | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Via La Masa 19, 20156 Milan, Italy
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Via La Masa 19, 20156 Milan, Italy
| | - Barbara Cortini
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy
| | - Esteve Fernández
- Catalan Institute of Oncology (ICO), Granvia de L'Hospitalet, 199-203, PC 08908 L'Hospitalet de Llobregat, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, Campus de Bellvitge, School of Medicine and Health Sciences, University of Barcelona, Feixa Llarga, s/n, PC 08907 L'Hospitalet de Llobregat, Spain
| | - Maria José López
- Public Health Agency of Barcelona (ASPB). Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0. PC 28029, Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain
| | - Joan B Soriano
- Hospital Universitario La Princesa (IISP), Diego de León, 62 1st floor, PC 28006 Madrid, Spain
| | - Angel López-Nicolás
- Polytechnic University of Cartagena (UPCT), Plaza Cronista Isidoro Valverde, s/n, PC 30202 Cartagena, Spain
| | - Sean Semple
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, Scotland, UK
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, 50139 Florence, Italy
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12
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Continente X, Arechavala T, Fernàndez E, Pérez-Ríos M, Schiaffino A, Soriano JB, Carreras G, López-Nicolás Á, Gorini G, López MJ. Burden of respiratory disease attributable to secondhand smoke exposure at home in children in Spain (2015). Prev Med 2019; 123:34-40. [PMID: 30817956 DOI: 10.1016/j.ypmed.2019.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
This study aimed to estimate the number of incident cases and hospital admissions attributable to secondhand smoke (SHS) exposure at home for asthma, otitis media (OM), and lower respiratory infections (LRI) in children in Spain. The burden of respiratory disease caused by SHS exposure was estimated in terms of incident cases and hospitalized cases for asthma, OM, and LRI. Estimates were calculated using the population attributable fraction. The age-specific (0-1 year, 0-4 years, 5-11 years, and 0-11 years) prevalence of SHS exposure in children was estimated through a telephone survey performed in a representative sample of Spanish households with children in 2016. The risk estimates for all diseases were selected from international meta-analyses. The number of hospitalized cases was obtained for each disease from the Hospital Minimum Data Set provided by the Ministry of Health of Spain. Incident cases were obtained from the Global Health Data Exchange. In 2015, SHS exposure caused an estimated total of 136,403 incident cases of the following respiratory diseases: 9058 (8.5%) cases of asthma, 120,248 (8.5%) of OM, and 7097 (13.5%) of LRI in children aged 0-14 years old in Spain. Likewise, SHS exposure caused a total of 3028 hospitalized cases, with 379 (8.5%) for asthma and 167 (8.5%) for OM in children 0-11 years old, and 2482 (11.6%) for LRI in children <2 years old. The high burden of respiratory disease attributed to SHS exposure supports the need to improve protection of children against SHS exposure by extending smoke-free regulations to homes and cars.
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Affiliation(s)
- Xavier Continente
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, PC 28029 Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research, Barcelona), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain
| | - Teresa Arechavala
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) (Experimental and Health Sciences Department, Pompeu Fabra University), Dr. Aiguader, 88, PC 08003 Barcelona, Spain
| | - Esteve Fernàndez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia (ICO), Granvia de L'Hospitalet, 199-203, PC 08908 L'Hospitalet de Llobregat, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, Campus de Bellvitge, School of Medicine and Health Sciences, Universitat de Barcelona, Feixa Llarga, s/n, PC 08907 L'Hospitalet de Llobregat, Spain
| | - Mónica Pérez-Ríos
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Xunta de Galicia, San Caetano, s/n, PC 15704 Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, School of Medicine, University of Santiago de Compostela, Praza do Obradoiro, s/n, PC 15782 Santiago de Compostela, Spain
| | - Anna Schiaffino
- Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Granvia de L'Hospitalet, 199, PC 08908 L'Hospitalet de Llobregat, Spain; Direcció General de Planificació en Salut, Departament de Salut, Generalitat de Catalunya, Travessera de les Corts, 131-159 (Pavelló Ave Maria), PC 08028 Barcelona, Spain
| | - Joan B Soriano
- Fundación para la Investigación Biomédica del Hospital Universitario La Princesa (IISP) (The Biomedical Research Foundation of University Hospital La Princesa), Diego de León, 62 1st floor, PC 28006 Madrid, Spain
| | - Giulia Carreras
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO) (Oncological Network, Prevention & Research Institute), Via Cosimo Il Vecchio, 2, PC 50139 Firenze, Italy
| | - Ángel López-Nicolás
- Universidad Politécnica de Cartagena (UPCT) (Polytechnic University of Cartagena), Plaza Cronista Isidoro Valverde, s/n, PC 30202 Cartagena, Spain
| | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO) (Oncological Network, Prevention & Research Institute), Via Cosimo Il Vecchio, 2, PC 50139 Firenze, Italy
| | - Maria José López
- Agència de Salut Pública de Barcelona (Public Health Agency, Barcelona), Pl. Lesseps, 1, PC 08023 Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, PC 28029 Madrid, Spain; Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research, Barcelona), Sant Antoni Maria Claret, 167, PC 08025 Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF) (Experimental and Health Sciences Department, Pompeu Fabra University), Dr. Aiguader, 88, PC 08003 Barcelona, Spain.
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13
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Challenges and opportunities for greater tobacco control in Japan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 70:78-86. [PMID: 31121458 DOI: 10.1016/j.drugpo.2019.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/26/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022]
Abstract
Japan is a high tobacco burden country with over 20 million smokers in 2017. Tobacco control measures in Japan has been criticised as largely inadequate and ineffective despite ratifying the World Health Organization's Framework Convention on Tobacco Control in 2004. Numerous factors such as pro-tobacco legislators, regulatory oversight of the primary Japanese tobacco company from the Ministry of Finance and industry interference on the policy-making process in Japan have prevented aggressive tobacco control efforts. Given the intricate challenges in Japan, it is important to develop feasible and effective smoking cessation strategies. In this paper, we have analysed the trends in tobacco prices, sale and smoking prevalence, major tobacco/smoking policies and some of the industry-related challenges that have prevented the development of effective tobacco control measures in Japan. We have emphasised the need for stronger implementation of the World Health Organization's Framework Convention on Tobacco Control and its MPOWER policy package and to separate the tobacco industry from the tobacco control policymaking process to promote cessation and abstinence from smoking and better sensitisation against exposure to second-hand smoke.
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14
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Buteau S, Doucet M, Tétreault LF, Gamache P, Fournier M, Brand A, Kosatsky T, Smargiassi A. A population-based birth cohort study of the association between childhood-onset asthma and exposure to industrial air pollutant emissions. ENVIRONMENT INTERNATIONAL 2018; 121:23-30. [PMID: 30172232 DOI: 10.1016/j.envint.2018.08.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Studies of the association between air pollution and asthma onset have mostly focused on urban and traffic-related air pollution. We investigated the associations between exposure to industrial emissions and childhood-onset asthma in a population-based birth cohort in Quebec, Canada, 2002-2011. METHODS The cohort was built from administrative health databases. We developed separately for PM2.5 and SO2 different metrics representing children's time-varying residential exposure to industrial emissions: 1) yearly number of tons of air pollutant emitted by industries located within 2.5 km of the residence; 2) distance to the nearest "major emitter" (≥100 tons) of either PM2.5 and SO2 within 7.5 km of the residence, and; 3) tons of air pollutant emitted by the nearest "major emitter" within 7.5 km, weighted by the inverse of the distance and the percentage of time that the residence was downwind. To handle the large number of zeros (i.e., children unexposed) we decomposed the exposure variable into two covariates simultaneously included in the regression model: a binary indicator of exposure and a continuous exposure variable centered at the mean value among exposed children. We performed Cox models using age as the time axis, adjusted for gender, material and social deprivation and calendar year. We indirectly adjusted for unmeasured secondhand smoke. RESULTS The cohort included 722,667 children and 66,559 incident cases of asthma. Across the different exposure metrics, mean percentage changes in the risk of asthma onset in children exposed to the mean relative to those unexposed ranged from 4.5% (95% CI: 2.8, 6.3%) to 10.6% (95% CI: 6.2, 15.2%) for PM2.5 and, from 1.1% (95% CI: -0.1, 3.3%) to 8.9% (95% CI: 7.1, 11.1%) for SO2. Indirect adjustment for secondhand smoke did not substantially affect the associations. In children exposed, the risk of asthma onset increased with the magnitude of the exposure for all metrics, except the distance to the nearest major emitter of SO2. CONCLUSIONS In this population-based birth cohort, residential exposure to industrial air pollutant emissions was associated with childhood-onset asthma. Additional studies with improved models for estimating exposure to industrial point-sources are needed to further support the observed associations.
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Affiliation(s)
- Stéphane Buteau
- Institut national de sante publique du Quebec (INSPQ), Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mariève Doucet
- Institut national de sante publique du Quebec (INSPQ), Montreal, Quebec, Canada; Department of Medicine, Laval University, Quebec, Quebec, Canada
| | | | - Philippe Gamache
- Institut national de sante publique du Quebec (INSPQ), Montreal, Quebec, Canada
| | - Michel Fournier
- Montreal's Public Health Department, Montreal, Quebec, Canada
| | - Allan Brand
- Institut national de sante publique du Quebec (INSPQ), Montreal, Quebec, Canada
| | - Tom Kosatsky
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Audrey Smargiassi
- Institut national de sante publique du Quebec (INSPQ), Montreal, Quebec, Canada; Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, Quebec, Canada; University of Montreal, Public Health Research Institute, Montreal, Quebec, Canada.
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15
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Abreo A, Gebretsadik T, Stone CA, Hartert TV. The impact of modifiable risk factor reduction on childhood asthma development. Clin Transl Med 2018; 7:15. [PMID: 29892940 PMCID: PMC5995769 DOI: 10.1186/s40169-018-0195-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/04/2018] [Indexed: 01/14/2023] Open
Abstract
Childhood asthma is responsible for significant morbidity and health care expenditures in the United States. The incidence of asthma is greatest in early childhood, and the prevalence is projected to continue rising in the absence of prevention and intervention measures. The prevention of asthma will likely require a multifaceted intervention strategy; however, few randomized controlled trials have assessed such approaches. The purpose of this review was to use previous meta-analyses to identify the most impactful risk factors for asthma development and evaluate the effect of risk factor reduction on future childhood asthma prevalence. Common and modifiable risk factors with large effects included acute viral respiratory infections, antibiotic use, birth by cesarean section, nutritional disorders (overweight, obesity), second hand smoke exposure, allergen sensitization, breastfeeding, and sufficient prenatal vitamin D level. Evaluation and estimates of risk factor modification on populations at risk should guide scientists and policymakers toward high impact areas that are apt for additional study and intervention.
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Affiliation(s)
- Andrew Abreo
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tebeb Gebretsadik
- Department of Biostatistics, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cosby A Stone
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tina V Hartert
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA.
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16
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Molnar DS, Granger DA, Shisler S, Eiden RD. Prenatal and postnatal cigarette and cannabis exposure: Effects on Secretory Immunoglobulin A in early childhood. Neurotoxicol Teratol 2018; 67:31-36. [PMID: 29597003 PMCID: PMC5970978 DOI: 10.1016/j.ntt.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 12/27/2022]
Abstract
AIMS Secretory Immunoglobulin A (SIgA) plays a critical role in immune functioning by preventing pathogens from adhering to epithelial mucosa. Most infectious agents enter the body via mucosal surfaces, thus SIgA serves in the defense against respiratory, intestinal, and urinogenitary infections, as well as periodontal disease and caries. This study examined the possibility that pre- and postnatal exposure to cigarette and cannabis is associated with individual differences in Secretory Immunoglobulin A (SIgA) levels in early childhood. METHODS Participants were 50 mother/infant (29 boys; 35% Caucasian) dyads recruited at their first prenatal appointment in a large northeastern community hospital in the United States. Repeated assessments of pre- and postnatal cigarette and cannabis were conducted beginning in the first trimester of pregnancy, using multiple methods (i.e., saliva, meconium, self-report). Infants were grouped into those prenatally exposed to either cigarette only (n = 19), cigarette and cannabis (n = 19), or with no prenatal substance exposure (n = 12). At age 5 years, the children's saliva was collected and assayed for SIgA. RESULTS There were group differences in SIgA levels as a function of prenatal exposure to cigarette and cannabis - children in the cigarette only and the cigarette and cannabis groups had higher SIgA levels compared to the non-exposed children. Children who experienced the combination of postnatal exposure to cigarette and cannabis had higher levels of SIgA, even after accounting for prenatal exposures and other covariates relevant to immune system functioning. CONCLUSIONS Prenatal and postnatal exposure to cigarette and cannabis may be associated with hyperactivity of mucosal immunity in early childhood. Links between cigarette and cannabis exposure and health problems in early childhood may be partially explained by prenatal and postnatal exposure-related changes in mucosal immunity.
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Affiliation(s)
- Danielle S Molnar
- Department of Child and Youth Studies, Brock University, St. Catharines, ON, Canada; Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA.
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, USA; Johns Hopkins University School of Nursing, USA; Johns Hopkins Bloomberg School of Public Health, USA; Johns Hopkins University School of Medicine, USA
| | - Shannon Shisler
- Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
| | - Rina D Eiden
- Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
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17
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Pattemore PK, Silvers KM, Frampton CM, Wickens K, Ingham T, Fishwick D, Crane J, Town GI, Epton MJ. Hair nicotine at 15 months old, tobacco exposure and wheeze or asthma from 15 months to 6 years old. Pediatr Pulmonol 2018; 53:443-451. [PMID: 29210195 DOI: 10.1002/ppul.23903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/06/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the relationship between hair nicotine levels at 15 months of age and prior parent-reported smoking exposure, and the risk of wheezing and current asthma from 15 months to 6 years of age. STUDY DESIGN We measured hair nicotine levels at 15 months of age in 376 of 535 infants enrolled in a prospective birth cohort in Christchurch, New Zealand. We obtained detailed information from parents about smoking exposure during pregnancy and in the home at 3 and 15 months of age. Data for demographics, wheezing, and asthma were obtained from yearly questionnaires up to age 6 years. We assessed hair nicotine levels in relation to reported smoke exposure in pregnancy and up to age 15 months, and the association between high levels of hair nicotine and annual reports of current wheeze and current asthma using multiple logistic regression. RESULTS Hair nicotine increased with numbers of smokers and daily cigarettes smoked at home, and was also strongly associated with smoking in pregnancy. High level of hair nicotine was associated with increased risk of wheeze (Odds ratio 2.30, P = 0.001) and, though not significant, of current asthma (Odds ratio 2.02, P = 0.056) at 15 months of age, after controlling for socio-economic status, ethnicity, body mass index, respiratory infections in the first 3 months of life, and duration of exclusive breastfeeding. At older ages the associations were non-significant. CONCLUSION In children aged 15 months hair nicotine level was related to smoking exposure, and was associated with increased risk of wheeze and asthma.
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Affiliation(s)
- Philip K Pattemore
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Karen M Silvers
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Chris M Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Kristin Wickens
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Tristram Ingham
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - David Fishwick
- Centre for Workplace Health and the University of Sheffield, Sheffield, UK
| | - Julian Crane
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - G Ian Town
- University of Canterbury, Christchurch, New Zealand
| | - Michael J Epton
- Department of Medicine, University of Otago, Christchurch, New Zealand.,Canterbury Respiratory Research Group, Christchurch Hospital, Christchurch, New Zealand
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18
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Hutchinson SG, van Breukelen G, van Schayck CP, Essers B, Hammond SK, Muris JWM, Feron FJM, Dompeling E. Motivational interviewing and urine cotinine feedback to stop passive smoke exposure in children predisposed to asthma: a randomised controlled trial. Sci Rep 2017; 7:15473. [PMID: 29133798 PMCID: PMC5684321 DOI: 10.1038/s41598-017-15158-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/18/2017] [Indexed: 02/01/2023] Open
Abstract
We tested the effectiveness of a program consisting of motivational interviewing (MI) and feedback of urine cotinine to stop passive smoking (PS) in children at risk for asthma. Fifty-eight families with children 0-13 years with a high risk of asthma and PS exposure were randomised in a one-year follow-up study. The intervention group received the intervention program during 6 sessions (1/month) and the control group received measurements (questionnaires, urine cotinine, and lung function) only. The primary outcome measure was the percentage of families stopping PS (parental report verified and unverified with the child's urine cotinine concentration <10 μg/l) in children during the intervention program. The analyses were performed with Mixed Logistic Regression. After 6 months, a significant group difference was observed for the unverified parental report of stopping PS in children: 27% of parents in the intervention group versus 7% in the control group. For the verified parental report, the difference was similar (23% versus 7%) but was not statistically significant. Despite a limited sample size, the results suggest that the intervention program is probably an effective strategy to stop PS in children. A program longer than 6 months might be necessary for a longer lasting intervention effect.
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Affiliation(s)
- Sasha G Hutchinson
- Department of Paediatric Pulmonology, Maastricht University Medical Center (MUMC+)/CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Gerard van Breukelen
- Department of Methodology and Statistics, MUMC+/CAPHRI, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Constant P van Schayck
- Department of Family Medicine, MUMC+/CAPHRI, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Brigitte Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, MUMC+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - S Katharine Hammond
- School of Public Health, University of California, Mail/140 Warren, Berkeley, CA, 94720-7360, USA
| | - Jean W M Muris
- Department of Family Medicine, MUMC+/CAPHRI, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Frans J M Feron
- Department of Social Medicine, MUMC+/CAPHRI, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Edward Dompeling
- Department of Paediatric Pulmonology, Maastricht University Medical Center (MUMC+)/CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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19
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Been JV, Mackay DF, Millett C, Soyiri I, van Schayck CP, Pell JP, Sheikh A. Smoke-free legislation and paediatric hospitalisations for acute respiratory tract infections: national quasi-experimental study with unexpected findings and important methodological implications. Tob Control 2017; 27:e160-e166. [DOI: 10.1136/tobaccocontrol-2017-053801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/03/2022]
Abstract
ObjectivesWe investigated whether Scottish implementation of smoke-free legislation was associated with a reduction in unplanned hospitalisations or deaths (‘events’) due to respiratory tract infections (RTIs) among children.DesignInterrupted time series (ITS).Setting/participantsChildren aged 0–12 years living in Scotland during 1996–2012.InterventionNational comprehensive smoke-free legislation (March 2006).Main outcome measureAcute RTI events in the Scottish Morbidity Record-01 and/or National Records of Scotland Death Records.Results135 134 RTI events were observed over 155 million patient-months. In our prespecified negative binomial regression model accounting for underlying temporal trends, seasonality, sex, age group, region, urbanisation level, socioeconomic status and seven-valent pneumococcal vaccination status, smoke-free legislation was associated with an immediate rise in RTI events (incidence rate ratio (IRR)=1.24, 95% CI 1.20 to 1.28) and an additional gradual increase (IRR=1.05/year, 95% CI 1.05 to 1.06). Given this unanticipated finding, we conducted a number of post hoc exploratory analyses. Among these, automatic break point detection indicated that the rise in RTI events actually preceded the smoke-free law by 16 months. When accounting for this break point, smoke-free legislation was associated with a gradual decrease in acute RTI events: IRR=0.91/year, 95% CI 0.87 to 0.96.ConclusionsOur prespecified ITS approach suggested that implementation of smoke-free legislation in Scotland was associated with an increase in paediatric RTI events. We were concerned that this result, which contradicted published evidence, was spurious. The association was indeed reversed when accounting for an unanticipated antecedent break point in the temporal trend, suggesting that the legislation may in fact be protective. ITS analyses should be subjected to comprehensive robustness checks to assess consistency.
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20
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Genuneit J, Seibold AM, Apfelbacher CJ, Konstantinou GN, Koplin JJ, La Grutta S, Logan K, Perkin MR, Flohr C. Overview of systematic reviews in allergy epidemiology. Allergy 2017; 72:849-856. [PMID: 28052339 DOI: 10.1111/all.13123] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a substantial body of evidence on the epidemiology of allergic conditions, which has advanced the understanding of these conditions. We aimed to systematically identify systematic reviews and meta-analyses on the epidemiology of allergic diseases to assess what has been studied comprehensively and what areas might benefit from further research. METHODS We searched PubMed and EMBASE up to 12/2014 for systematic reviews on epidemiological research on allergic diseases. We indexed diseases and topics covered and extracted data on the search characteristics of each systematic review. RESULTS The search resulted in 3991 entries after removing duplicates, plus 20 other items found via references and conference abstracts; 421 systematic reviews were relevant and included in this overview. The majority contained some evidence on asthma (72.9%). Allergic rhinitis, atopic eczema and food hypersensitivity were covered in 15.7%, 24.5% and 9.0%, respectively. Commonly studied risk factors for atopic eczema included dietary and microbial factors, while for asthma, pollution and genetic factors were often investigated in systematic reviews. There was some indication of differing search characteristics across topics. CONCLUSION We present a comprehensive overview with an indexed database of published systematic reviews in allergy epidemiology. We believe that this clarifies where most research interest has focussed and which areas could benefit from further research. We propose that this effort is updated every few years to include the most recently published evidence and to extend the search to an even broader list of hypersensitivity/allergic disorders.
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Affiliation(s)
- J. Genuneit
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm Germany
| | - A. M. Seibold
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm Germany
| | - C. J. Apfelbacher
- Institute of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg Germany
| | - G. N. Konstantinou
- Department of Allergy and Clinical Immunology; 424 General Military Training Hospital; Thessaloniki Greece
| | - J. J. Koplin
- Murdoch Children's Research Institute; University of Melbourne; Melbourne VIC Australia
| | - S. La Grutta
- National Research Council of Italy; Institute of Biomedicine and Molecular Immunology; Palermo Italy
| | - K. Logan
- Children's Allergies Department; Division of Asthma, Allergy and Lung Biology; King's College London; London UK
| | - M. R. Perkin
- Population Health Research Institute; St George's, University of London; London UK
| | - C. Flohr
- Unit for Population-Based Dermatology Research; St John's Institute of Dermatology; King's College London and Guy's and St Thomas’ NHS Foundation; London UK
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21
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Paton J, Bindels P, McMurray A, Biggins J, Nantanda R, Østergaard MS. A young child with a history of wheeze. NPJ Prim Care Respir Med 2017; 27:19. [PMID: 28303014 PMCID: PMC5434789 DOI: 10.1038/s41533-017-0020-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/03/2017] [Accepted: 02/14/2017] [Indexed: 12/12/2022] Open
Abstract
The parents of a 3-year old boy are anxious about their son who has recurring episodes of wheezing. They are frustrated that no one seems to be able to give them answers to their questions and would like a referral to a specialist. Does their son have asthma and what is the prognosis; how can the recurrent wheezing be managed and can the risk of asthma be reduced; are there lifestyle changes that could improve the environment and avoid triggers? Communication and support from the family practice team were essential. Listening to the parents' concerns, explaining the diagnostic uncertainty, being realistic about what drug treatments could achieve, and providing practical advice on inhaler use and trigger avoidance reassured the parents that there was a strategy for managing their son's wheeze. The specialist referral was postponed.
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Affiliation(s)
- James Paton
- School of Medicine Dentistry & Nursing, Child Health, College of Medical, Veterinary, and Life Sciences, Queen Elizabeth University Hospital, University of Glasgow, Zone 1, Ground Floor, Office Block, Glasgow, UK.
| | - Patrick Bindels
- Department of General Practice, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Ann McMurray
- Department of Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, Scotland, UK
| | - Jodie Biggins
- Patient and Public Involvement Group, Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Rebecca Nantanda
- Makerere University Lung Institute Makerere University College of Health Sciences, Kampala, Uganda
| | - Marianne Stubbe Østergaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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22
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Barnish MS, Tagiyeva N, Devereux G, Aucott L, Turner S. Changes in the relationship between asthma and associated risk factors over fifty years. Pediatr Allergy Immunol 2017; 28:162-169. [PMID: 27779796 DOI: 10.1111/pai.12674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Childhood asthma is a common condition whose prevalence is changing. We hypothesized that the relationship between asthma and associated risk factors has changed over a 50-year period. METHODS An ecological study design was used. Children aged 8-13 attending schools in Aberdeen city were surveyed on seven occasions between 1964 and 2014. The following were determined: history of asthma, history of eczema, parental smoking, parental asthma, sex and socio-economic status. Analysis was by a structural change model with two knots. The outcome reported was the change in odds ratio between asthma and a given risk factor during a given period. RESULTS There were 23,241 questionnaires distributed and 17,439 returned (75%). The odds ratio (OR) for a child with asthma to have eczema increased between 1989 and 1999 by 1.031 [95% CI 1.028, 1.035] and by 1.042 between 2004 and 2014 [1.038, 1.047]. The OR for a child with asthma to have a parent who smoked rose by 1.032 [1.028, 1.036] between 1989 and 1999 and by 1.043 [1.038, 1.047] between 2004 and 2014), and to have a parent with asthma (1.027 [1.022, 1.031] for 1994-99 and 1.042 [1.037, 1.048] for 2004-2014). The OR for a child with asthma being male, but not and being from the most deprived communities, rose between 1989-1999 and 2004-2014. CONCLUSIONS The relationship between asthma prevalence and particular risk factors changed over the 50-year period of study, and this might reflect changes in children's environment and/or susceptibility.
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Affiliation(s)
- Maxwell S Barnish
- Child Health, University of Aberdeen, Aberdeen, UK.,Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | | | - Graham Devereux
- Child Health, University of Aberdeen, Aberdeen, UK.,Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Medical Statistics, University of Aberdeen, Aberdeen, UK
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
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23
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Hansen S, Hoffmann-Petersen B, Sverrild A, Bräuner EV, Lykkegaard J, Bodtger U, Agertoft L, Korshøj L, Backer V. The Danish National Database for Asthma: establishing clinical quality indicators. Eur Clin Respir J 2016; 3:33903. [PMID: 27834178 PMCID: PMC5103671 DOI: 10.3402/ecrj.v3.33903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 12/12/2022] Open
Abstract
Asthma is one of the most common chronic diseases worldwide affecting more than 300 million people. Symptoms are often non-specific and include coughing, wheezing, chest tightness, and shortness of breath. Asthma may be highly variable within the same individual over time. Although asthma results in death only in extreme cases, the disease is associated with significant morbidity, reduced quality of life, increased absenteeism, and large costs for society. Asthma can be diagnosed based on report of characteristic symptoms and/or the use of several different diagnostic tests. However, there is currently no gold standard for making a diagnosis, and some degree of misclassification and inter-observer variation can be expected. This may lead to local and regional differences in the treatment, monitoring, and follow-up of the patients. The Danish National Database for Asthma (DNDA) is slated to be established with the overall aim of collecting data on all patients treated for asthma in Denmark and systematically monitoring the treatment quality and disease management in both primary and secondary care facilities across the country. The DNDA links information from population-based disease registers in Denmark, including the National Patient Register, the National Prescription Registry, and the National Health Insurance Services register, and potentially includes all asthma patients in Denmark. The following quality indicators have been selected to monitor trends: first, conduction of annual asthma control visits, appropriate pharmacological treatment, measurement of lung function, and asthma challenge testing; second, tools used for diagnosis in new cases; and third, annual assessment of smoking status, height, and weight measurements, and the proportion of patients with acute hospital treatment. The DNDA will be launched in 2016 and will initially include patients treated in secondary care facilities in Denmark. In the nearby future, the database aims to include asthma diagnosis codes and clinical data registered by general practitioners and specialised practitioners as well.
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Affiliation(s)
- Susanne Hansen
- Research Centre for Prevention and Health, Rigshospitalet Glostrup Hospital, Glostrup, Denmark
| | | | - Asger Sverrild
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Elvira V Bräuner
- Research Centre for Prevention and Health, Rigshospitalet Glostrup Hospital, Glostrup, Denmark
- Department of Occupational and Environmental Medicine, Bispebjerg - Frederiksberg Hospital, Copenhagen, Denmark
| | - Jesper Lykkegaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Region Zealand, Denmark
- Department of Respiratory Medicine, Zealand University Hospital Roskilde, Region Zealand, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lone Agertoft
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Vibeke Backer
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark;
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24
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Hawkins SS, Hristakeva S, Gottlieb M, Baum CF. Reduction in emergency department visits for children's asthma, ear infections, and respiratory infections after the introduction of state smoke-free legislation. Prev Med 2016; 89:278-285. [PMID: 27283094 PMCID: PMC8323994 DOI: 10.1016/j.ypmed.2016.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/28/2016] [Accepted: 06/05/2016] [Indexed: 11/18/2022]
Abstract
Despite the benefits of smoke-free legislation on adult health, little is known about its impact on children's health. We examined the effects of tobacco control policies on the rate of emergency department (ED) visits for childhood asthma (N=128,807), ear infections (N=288,697), and respiratory infections (N=410,686) using outpatient ED visit data in Massachusetts (2001-2010), New Hampshire (2001-2009), and Vermont (2002-2010). We used negative binomial regression models to analyze the effect of state and local smoke-free legislation on ED visits for each health condition, controlling for cigarette taxes and health care reform legislation. We found no changes in the overall rate of ED visits for asthma, ear infections, and upper respiratory infections after the implementation of state or local smoke-free legislation or cigarette tax increases. However, an interaction with children's age revealed that among 10-17-year-olds state smoke-free legislation was associated with a 12% reduction in ED visits for asthma (adjusted incidence rate ratios (aIRR) 0.88; 95% CI 0.83, 0.95), an 8% reduction for ear infections (0.92; 0.88, 0.97), and a 9% reduction for upper respiratory infections (0.91; 0.87, 0.95). We found an overall 8% reduction in ED visits for lower respiratory infections after the implementation of state smoke-free legislation (0.92; 0.87, 0.96). The implementation of health care reform in Massachusetts was also associated with a 6-9% reduction in all children's ED visits for ear and upper respiratory infections. Our results suggest that state smoke-free legislation and health care reform may be effective interventions to improve children's health by reducing ED visits for asthma, ear infections, and respiratory infections.
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Affiliation(s)
| | - Sylvia Hristakeva
- Boston College, Department of Economics, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
| | - Mark Gottlieb
- Northeastern University School of Law, Public Health Advocacy Institute, 360 Huntington Avenue, Suite 117CU, Boston, MA 02115-5004, USA.
| | - Christopher F Baum
- Boston College, School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA; Boston College, Department of Economics, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA; Deutsches Institut für Wirtschaftforschung (DIW Berlin), Department of Macroeconomics, Mohrenstraße 58, 10117 Berlin, Germany.
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25
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Tétreault LF, Doucet M, Gamache P, Fournier M, Brand A, Kosatsky T, Smargiassi A. Severe and Moderate Asthma Exacerbations in Asthmatic Children and Exposure to Ambient Air Pollutants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E771. [PMID: 27490556 PMCID: PMC4997457 DOI: 10.3390/ijerph13080771] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is well established that short-term exposure to ambient air pollutants can exacerbate asthma, the role of early life or long-term exposure is less clear. We assessed the association between severe asthma exacerbations with both birth and annual exposure to outdoor air pollutants with a population-based cohort of asthmatic children in the province of Quebec (Canada). METHOD Exacerbations of asthma occurring between 1 April 1996 and 31 March 2011 were defined as one hospitalization or emergency room visit with a diagnosis of asthma for children (<13 years old) already diagnosed with asthma. Annual daily average concentrations of ozone (O₃) and nitrogen dioxide (NO₂) were estimated at the child's residential postal code. Satellite based levels of fine particulate (PM2.5) estimated for a grid of 10 km by 10 km were also assigned to postal codes of residence for the whole province. Hazard ratios (HRs) were estimated from Cox models with a gap time approach for both birth and time-dependant exposure. RESULTS Of the 162,752 asthmatic children followed (1,020,280 person-years), 35,229 had at least one asthma exacerbation. The HRs stratified by age groups and adjusted for the year of birth, the ordinal number of exacerbations, sex, as well as material and social deprivation, showed an interquartile range increase in the time-dependant exposure to NO₂ (4.95 ppb), O₃ (3.85 ppb), and PM2.5 (1.82 μg/m³) of 1.095 (95% CI 1.058-1.131), 1.052 (95% CI 1.037-1.066) and 1.025 (95% CI 1.017-1.031), respectively. While a positive association was found to PM2.5, no associations were found between exposure at birth to NO₂ or O₃. CONCLUSIONS Our results support the conclusion, within the limitation of this study, that asthma exacerbations in asthmatic children are mainly associated with time dependent residential exposures less with exposure at birth.
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Affiliation(s)
- Louis-Francois Tétreault
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montréal, QC H2L 1M3, Canada.
- Direction Régionale de Santé Publique du CIUSSS Centre-Sud-de-l'Île-de-Montréalde Montréal, Montréal, QC H2L 1M3, Canada.
| | - Marieve Doucet
- Institut Natonal de la Santé Publique du Québec, Québec, QC H2L 1M3, Canada.
- Department of Medicine, Laval University, Québec, QC H2L 1M3, Canada.
| | - Philippe Gamache
- Institut Natonal de la Santé Publique du Québec, Québec, QC H2L 1M3, Canada.
| | - Michel Fournier
- Direction Régionale de Santé Publique du CIUSSS Centre-Sud-de-l'Île-de-Montréalde Montréal, Montréal, QC H2L 1M3, Canada.
| | - Allan Brand
- Institut Natonal de la Santé Publique du Québec, Québec, QC H2L 1M3, Canada.
| | - Tom Kosatsky
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada.
| | - Audrey Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montréal, QC H2L 1M3, Canada.
- Institut Natonal de la Santé Publique du Québec, Québec, QC H2L 1M3, Canada.
- Université de Montréal Public Health Research Institute, Montreal, QC H2L 1M3, Canada.
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26
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Tétreault LF, Doucet M, Gamache P, Fournier M, Brand A, Kosatsky T, Smargiassi A. Childhood Exposure to Ambient Air Pollutants and the Onset of Asthma: An Administrative Cohort Study in Québec. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:1276-82. [PMID: 26731790 PMCID: PMC4977042 DOI: 10.1289/ehp.1509838] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 12/18/2015] [Indexed: 05/06/2023]
Abstract
BACKGROUND Although it is well established that air pollutants can exacerbate asthma, the link with new asthma onset in children is less clear. OBJECTIVE We assessed the association between the onset of childhood asthma with both time of birth and time-varying exposures to outdoor air pollutants. METHOD An open cohort of children born in the province of Québec, Canada, was created using linked medical-administrative databases. New cases of asthma were defined as one hospital discharge with a diagnosis of asthma or two physician claims for asthma within a 2 year period. Annual ozone (O3) levels were estimated at the child's residence for all births 1999-2010, and nitrogen dioxide (NO2) levels during 1996-2006 were estimated for births on the Montreal Island. Satellite based concentrations of fine particles (PM2.5) were estimated at a 10 km × 10 km resolution and assigned to residential postal codes throughout the province (1996-2011). Hazard ratios (HRs) were assessed with Cox models for the exposure at the birth address and for the time-dependent exposure. We performed an indirect adjustment for secondhand smoke (SHS). RESULTS We followed 1,183,865 children (7,752,083 person-years), of whom 162,752 became asthmatic. After controlling for sex and material and social deprivation, HRs for an interquartile range increase in exposure at the birth address to NO2 (5.45 ppb), O3 (3.22 ppb), and PM2.5 (6.50 μg/m3) were 1.04 (95% CI: 1.02, 1.05), 1.11 (95% CI: 1.10, 1.12), and 1.31 (95% CI: 1.28, 1.33), respectively. Effects of O3 and PM2.5 estimated with time-varying Cox models were similar to those estimated using exposure at birth, whereas the effect of NO2 was slightly stronger (HR = 1.07; 95% CI: 1.05, 1.09). CONCLUSIONS Asthma onset in children appears to be associated with residential exposure to PM2.5, O3 and NO2. CITATION Tétreault LF, Doucet M, Gamache P, Fournier M, Brand A, Kosatsky T, Smargiassi A. 2016. Childhood exposure to ambient air pollutants and the onset of asthma: an administrative cohort study in Québec. Environ Health Perspect 124:1276-1282; http://dx.doi.org/10.1289/ehp.1509838.
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Affiliation(s)
- Louis-Francois Tétreault
- Department of Environmental and Occupational Health, School of Public Health University of Montreal, Montréal, Québec, Canada
- Direction de santé publique, Centre intégré universitaire de santé et de services sociaux (CIUSSS) Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - Marieve Doucet
- Institut national de la santé publique du Québec, Québec, Québec, Canada
- Department of Medicine, Laval University, Québec, Québec, Canada
| | - Philippe Gamache
- Institut national de la santé publique du Québec, Québec, Québec, Canada
| | - Michel Fournier
- Direction de santé publique, Centre intégré universitaire de santé et de services sociaux (CIUSSS) Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - Allan Brand
- Institut national de la santé publique du Québec, Québec, Québec, Canada
| | - Tom Kosatsky
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Audrey Smargiassi
- Department of Environmental and Occupational Health, School of Public Health University of Montreal, Montréal, Québec, Canada
- Institut national de la santé publique du Québec, Québec, Québec, Canada
- Université de Montréal Public Health Research Institute, Montréal, Québec, Canada
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27
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Jassal MS, Riekert KA, Borrelli B, Rand CS, Eakin MN. Cost Analysis of Motivational Interviewing and Preschool Education for Secondhand Smoke Exposures. Nicotine Tob Res 2016; 18:1656-64. [PMID: 26802112 PMCID: PMC6095228 DOI: 10.1093/ntr/ntw001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 12/29/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This study determines if expenditures associated with implementing a combined motivational interviewing (MI) and Head Start-level education program (MI+Education), as compared to education alone, yield cost savings to society. METHODS Post hoc cost analyses were applied to a randomized controlled-trial of MI among predominantly African American, low-income caregivers of 330 Baltimore City Head Start students who reside with a smoker. The primary outcome was the cost savings of MI+Education from averted direct secondhand smoke exposure (SHSe)-related acute healthcare events and inferred indirect costs (work days lost, transportation and reduction in cigarettes smoked). The net direction of savings was defined by the sum of averted direct and indirect costs of the MI+Education intervention at 3, 6 and 12 months, benchmarked against the Education alone cohort at the equivalent time periods. RESULTS The costs saved by the MI+Education intervention, relative to Education alone, resulted in savings at solely the 12-month follow-up time point. Significant savings were appreciated from averted emergency department (ED) visits at 12 months ($4410; 95% simulation interval [SI]: $2241, $6626) for the MI+Education group. The total savings at 12 months ($2274; 95% SI: -3916, $8442) could not overcome additional program costs of implementing MI to Head Start-level education ($13 695; 95% SI: $11 250, $16 034). CONCLUSIONS This study is the first to examine the cost of either intervention on SHSe-attributed pediatric healthcare costs from a population level relevant for federal and community decision makers. Intervention costs could not be offset by short-term savings but a trend towards positive savings was appreciated 1 year after implementation. IMPLICATIONS Behavioral interventions are effective in reducing SHSe in children. However, many of these interventions are not implemented in community settings due to lack of resources and money. Behavioral strategies may be a cost-saving addition to the national initiatives to create smoke-free home environments. The long-term benefits of MI, as evidenced from cost savings from averted ED visits, appeared to show MI+Education to be a robust long-term strategy. The decrease of acute healthcare services at 12 months may be informative for policy decision makers seeking to allocate limited resources to reduce the usage of costly ED services and hospital readmissions.
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Affiliation(s)
- Mandeep S Jassal
- Division of Pediatric Pulmonology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD;
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Belinda Borrelli
- Department of Health Policy and Health Services Research, Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Cynthia S Rand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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Aurrekoetxea JJ, Murcia M, Rebagliato M, Guxens M, Fernández-Somoano A, López MJ, Lertxundi A, Castilla AM, Espada M, Tardón A, Ballester F, Santa-Marina L. Second-hand smoke exposure in 4-year-old children in Spain: Sources, associated factors and urinary cotinine. ENVIRONMENTAL RESEARCH 2016; 145:116-125. [PMID: 26656512 DOI: 10.1016/j.envres.2015.11.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/16/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Second-hand smoke exposure (SHS) in children remains as a major pollution problem, with important consequences for children's health. This study aimed to identify the sources of exposure to SHS among 4-year-old children, comparing self-reports to a urinary biomarker of exposure, and characterize the most important variables related to SHS exposure in this population. METHODS 4-year-old children's exposure to SHS was assessed by a parental-reported questionnaire and by urinary cotinine (UC) measurements in 1757 participants from 4 different areas of the Spanish INMA (INfancia y Medio Ambiente - Environment and Childhood) Project. The questionnaire about SHS included information about smoking habits at home by household members, and about exposure to SHS in other places including other homes, bars, restaurants or transportation. The association between quantified UC levels (>4ng/ml) and sociodemographic variables and the different sources of SHS exposure was examined using logistic regression. RESULTS Based on parental reports, 21.6% of the children were exposed to SHS at home and 47.1% elsewhere; making a total 55.9% of the children exposed to SHS. In addition, 28.2% of the children whose parents reported being not regularly exposed to SHS had quantified UC values. Children from younger mothers (<34 vs. ≥39.4 y) had a higher odds of exposure to SHS [OR (95% CI): 2.28 (1.70-3.05) per year], as well as from families with a lower educational level [OR secondary: 2.12 (1.69-2.65); primary or less: 2.91 (2.19-3.88)]. The odds of quantifiable UC in children dropped after the smoking ban in public places [OR=0.59 (0.42-0.83)]. Regarding the sources of SHS exposure we observed that quantifiable UC odds was increased in children whose parents smoked at home in their presence [OR mother occasionally: 13.39 (7.03-25.50); mother often: 18.48 (8.40-40.66); father occasionally: 10.98 (6.52-18.49); father often: 11.50 (5.96-22.20)] or in children attending other confined places, mainly other houses where people smoked [OR: 2.23 (1.78-2.80)]. CONCLUSIONS Children's SHS exposure is nowadays an unresolved major public health problem in Spain. After the ban of smoking in public places health care professionals should put more emphasis to the parents on the importance of controlling the exposure of their children in private spaces.
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Affiliation(s)
- Juan José Aurrekoetxea
- Public Health Department, Basque Government, San Sebastian, Spain; University of the Basque Country (UPV/EHU), San Sebastian, Spain; Biodonostia Health Research Institute, San Sebastian, Spain.
| | - Mario Murcia
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; FISABIO-Universitat de València-Universitat Jaume I, Joint Research Unit, Av. Catalunya 21, 46020 Valencia, Spain.
| | - Marisa Rebagliato
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; FISABIO-Universitat de València-Universitat Jaume I, Joint Research Unit, Av. Catalunya 21, 46020 Valencia, Spain; Universitat Jaume I, Av. de Vicent Sos Baynat, s/n, 12071 Castelló de la Plana, Spain.
| | - Mònica Guxens
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; Pompeu Fabra Universtiy, Barcelona, Spain; Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Ana Fernández-Somoano
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; Department of Preventive Medicine and Public Health, University of Oviedo, Oviedo, Spain.
| | - María José López
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; Public Health Agency of Barcelona, Barcelona, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain.
| | - Aitana Lertxundi
- University of the Basque Country (UPV/EHU), San Sebastian, Spain; Biodonostia Health Research Institute, San Sebastian, Spain.
| | - Ane Miren Castilla
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; Public Health Laboratory, Basque Government, Spain.
| | | | - Adonina Tardón
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; Department of Preventive Medicine and Public Health, University of Oviedo, Oviedo, Spain.
| | - Ferran Ballester
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; FISABIO-Universitat de València-Universitat Jaume I, Joint Research Unit, Av. Catalunya 21, 46020 Valencia, Spain.
| | - Loreto Santa-Marina
- Public Health Department, Basque Government, San Sebastian, Spain; Biodonostia Health Research Institute, San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain.
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Okoli CTC, Rayens MK, Wiggins AT, Ickes MJ, Butler KM, Hahn EJ. Secondhand tobacco smoke exposure and susceptibility to smoking, perceived addiction, and psychobehavioral symptoms among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:96-103. [PMID: 26503903 PMCID: PMC5523056 DOI: 10.1080/07448481.2015.1074240] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To examine the association of secondhand smoke (SHS) exposure with susceptibility to smoking, perceived addiction, and psychobehavioral effects of exposure among never- and ever-smoking college students. PARTICIPANTS Participants were 665 college students at a large, southeastern university in the United States. METHODS This study is a secondary analysis of online cross-sectional survey data from randomly selected students in April 2013. RESULTS Thirty-eight percent of the sample had moderate to high SHS exposure. Among never-smokers, SHS exposure was associated with increased susceptibility to initiating smoking. Among ever-smokers, SHS exposure was not associated with their perceived addiction to tobacco. In the total sample, SHS exposure was associated with greater psychobehavioral symptoms of exposure. CONCLUSIONS SHS exposure may the increase risk of smoking, especially among never-smoking college students. This study strengthens the need for prevention strategies that limit SHS exposure in college environments.
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Affiliation(s)
| | - Mary Kay Rayens
- a University of Kentucky College of Nursing Lexington , Kentucky
| | - Amanda T Wiggins
- a University of Kentucky College of Nursing Lexington , Kentucky
| | - Melinda J Ickes
- b University of Kentucky College of Education Lexington , Kentucky
| | - Karen M Butler
- a University of Kentucky College of Nursing Lexington , Kentucky
| | - Ellen J Hahn
- a University of Kentucky College of Nursing Lexington , Kentucky
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Tian M, Liang H, Qin QZ, Zhang WX, Zhang SS. ADRB2 polymorphisms in allergic asthma in Han Chinese children. Int Forum Allergy Rhinol 2015; 6:367-72. [PMID: 26633084 DOI: 10.1002/alr.21673] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/08/2015] [Accepted: 10/02/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Single-nucleotide polymorphisms (SNPs) in the human β2 adrenergic receptor (ADRB2) gene have been linked to pathogenesis of and treatment responses in asthma. In China, where asthma is common, little information exists regarding ADRB2 variants and their effects on asthma. The current study sought to investigate the relationship between variations in ADRB2 and childhood asthma. METHODS Blood samples were collected from 298 pediatric asthma cases treated in our hospital from July 2013 to September 2014; 304 samples were collected from healthy children for a control group. Six loci (at base positions -47, 79, -2387, 46, 523, and 491) of ADRB2 were genotyped using the TaqMan probe assay; SHEsis was used to determine haplotypes. Allele frequencies and genotype distributions were compared between groups using chi square and t tests. RESULTS No significant differences in genotype or allele frequencies were found between the groups for the polymorphic loci -2387 bp (T>C), 46 bp (G>A), and 523 bp (C>A) (p > 0.05). However, genotype frequencies for the ADRB2 SNPs at -47 bp (C>T) and 79 bp (G>C) differed significantly between asthma and control groups (p < 0.05). Further, linkage disequilibrium was found between these 2 SNPs (D' = 0.990, r(2) = 0.962), as well as between SNPs at 46 and 523 bp (D' = 0.985, r(2) = 0.607). Finally, of the 4 haplotypes analyzed in these samples (haplotypes III, IV, IX, and XI), the frequency of haplotype III was significantly lower in the asthma group than the control group (p < 0.05; odds ratio [OR] = 0.72; 95% confidence interval [CI], 0.48 to 0.97). CONCLUSION Variations of ADRB2 at base positions -47 (C>T) and 79 (G>C), as well as haplotype III, may contribute to susceptibility to childhood asthma.
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Affiliation(s)
- Man Tian
- Respiratory Department, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Hui Liang
- Respiratory Department, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Qiao-Zhi Qin
- Respiratory Department, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Wen-Xin Zhang
- Respiratory Department, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Shan-Shan Zhang
- Respiratory Department, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
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31
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Been JV, Szatkowski L, van Staa TP, Leufkens HG, van Schayck OC, Sheikh A, de Vries F, Souverein P. Smoke-free legislation and the incidence of paediatric respiratory infections and wheezing/asthma: interrupted time series analyses in the four UK nations. Sci Rep 2015; 5:15246. [PMID: 26463498 PMCID: PMC4604467 DOI: 10.1038/srep15246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 09/17/2015] [Indexed: 11/15/2022] Open
Abstract
We investigated the association between introduction of smoke-free legislation in the UK (March 2006 for Scotland, April 2007 for Wales and Northern Ireland, and July 2007 for England) and the incidence of respiratory diseases among children. We extracted monthly counts of new diagnoses of wheezing/asthma and RTIs among children aged 0–12 years from all general practices in the Clinical Practice Research Datalink during 1997–2012. Interrupted time series analyses were performed using generalised additive mixed models, adjusting for underlying incidence trends, population size changes, seasonal factors, and pandemic influenza, as appropriate. 366,642 new wheezing/asthma diagnoses and 4,324,789 RTIs were observed over 9,536,003 patient-years. There was no statistically significant change in the incidence of wheezing/asthma after introduction of smoke-free legislation in England (incidence rate ratio (IRR) 0.94, 95% CI 0.81–1.09) or any other UK country (Scotland: IRR 0.99, 95% CI 0.83–1.19; Wales: IRR 1.09, 95% CI 0.89–1.35; Northern Ireland: IRR 0.96, 95% CI 0.76–1.22). Similarly no statistically significant changes in RTI incidence were demonstrated (England: IRR 0.95, 95% CI 0.86–1.06; Scotland: IRR 0.96, 95% CI 0.83–1.11; Wales: IRR 0.97, 95% CI 0.86–1.09; Northern Ireland: IRR 0.90, 95% CI 0.79–1.03). There were no demonstrable reductions in the incidence of paediatric wheezing/asthma or RTIs following introduction of smoke-free legislation in the UK.
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Affiliation(s)
- Jasper V Been
- Division of Neonatology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, Netherlands.,Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.,Department of Paediatrics, Maastricht University Medical Centre, Maastricht, Netherlands.,School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Lisa Szatkowski
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Division of Epidemiology and Public Health, Nottingham City Hospital, Nottingham, United Kingdom
| | - Tjeerd-Pieter van Staa
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Hubert G Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Onno C van Schayck
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.,School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Aziz Sheikh
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.,School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands.,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, USA
| | - Frank de Vries
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.,Department of Clinical Pharmacy &Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands.,MRC Epidemiology Lifecourse Unit, Southampton General Hospital, Southampton, United Kingdom
| | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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Cao S, Yang C, Gan Y, Lu Z. The Health Effects of Passive Smoking: An Overview of Systematic Reviews Based on Observational Epidemiological Evidence. PLoS One 2015; 10:e0139907. [PMID: 26440943 PMCID: PMC4595077 DOI: 10.1371/journal.pone.0139907] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/19/2015] [Indexed: 12/16/2022] Open
Abstract
Purpose We aim to systematically summarize the available epidemiological evidence to identify the impact of environmental tobacco smoke on health. Methods A systematic literature search of PubMed, Embase, Web of Science, and Scopus for meta-analyses was conducted through January 2015. We included systematic reviews that investigated the association between passive smoking and certain diseases. Quantitative outcomes of association between passive smoking and the risk of certain diseases were summarized. Results Sixteen meta-analyses covering 130 cohort studies, 159 case-control studies, and 161 cross-sectional studies and involving 25 diseases or health problems were reviewed. Passive smoking appears not to be significantly associated with eight diseases or health problems, but significantly elevates the risk for eleven specific diseases or health problems, including invasive meningococcal disease in children (OR 2.18; 95% CI 1.63–2.92), cervical cancer (OR 1.73; 95% CI 1.35–2.21), Neisseria meningitidis carriage (OR 1.68; 95% CI 1.19–2.36), Streptococcus pneumoniae carriage (OR 1.66; 95% CI 1.33–2.07), lower respiratory infections in infancy (OR 1.42; 95% CI 1.33–1.51), food allergy (OR 1.43; 95% CI 1.12–1.83), and so on. Conclusions Our overview of systematic reviews of observational epidemiological evidence suggests that passive smoking is significantly associated with an increasing risk of many diseases or health problems, especially diseases in children and cancers.
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Affiliation(s)
- Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chen Yang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Gan
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Gao YH, Zhao HS, Zhang FR, Gao Y, Shen P, Chen RC, Zhang GJ. The Relationship between Depression and Asthma: A Meta-Analysis of Prospective Studies. PLoS One 2015. [PMID: 26197472 PMCID: PMC4510436 DOI: 10.1371/journal.pone.0132424] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Previous studies have suggested that asthmatic patients often have comorbid depression; however, temporal associations remain unclear. Objectives To determine whether depression predicts asthma and, conversely, whether asthma predicts depression. Methods A literature search was conducted without language restrictions using Pubmed, Embase, Cochrane and PsycINFO for studies published before January, 2015. Papers referenced by the obtained articles were also reviewed. Only comparative prospective studies with reported risk estimates of the association between depression and asthma were included. In order to investigate whether one of these conditions was predictive of the other, studies were excluded if enrolled participants had pre-existing depression or asthma. A random-effects model was used to calculate the pooled risk estimates for two outcomes: depression predicting asthma and asthma predicting depression. Results Seven citations, derived from 8 cohort studies, met our inclusion criteria. Of these, six studies reported that depression predicted incident adult-onset asthma, including 83684 participants and 2334 incident cases followed for 8 to 20 years. Conversely, two studies reported that asthma predicted incident depression. These studies involved 25566 participants and 2655 incident cases followed for 10 and 20 years, respectively. The pooled adjusted relative risks (RRs) of acquiring asthma associated with baseline depression was 1.43 (95% CI, 1.28–1.61) (P<0.001). The adjusted RRs for acquiring depression associated with baseline asthma was 1.23 (95% CI, 0.72–2.10) (P = 0.45). Conclusions Depression was associated with a 43% increased risk of developing adult-onset asthma. However, asthma did not increase the risk of depression based on limited studies. Further prospective studies ascertaining the true association between asthma and subsequent risk of depression are warranted.
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Affiliation(s)
- Yong-hua Gao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hua-si Zhao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Fu-rui Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yang Gao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Pamela Shen
- Medical Sciences Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Rong-chang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- * E-mail: (GJZ); (RCC)
| | - Guo-jun Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- * E-mail: (GJZ); (RCC)
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Feleszko W, Ruszczyński M, Jaworska J, Strzelak A, Zalewski BM, Kulus M. Environmental tobacco smoke exposure and risk of allergic sensitisation in children: a systematic review and meta-analysis. Arch Dis Child 2014; 99:985-92. [PMID: 24958794 DOI: 10.1136/archdischild-2013-305444] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Environmental tobacco smoke (ETS) exposure in children is linked with the development of allergic asthma. However, its influence on allergic sensitisation in children has not been conclusively determined. OBJECTIVE To systematically review existing evidence of ETS exposure's impact on markers of allergic sensitisation in children. METHODS CENTRAL, MEDLINE and EMBASE databases were searched. Included studies assessed following markers of atopic sensitisation: total immunoglobulin E (tIgE) concentrations, at least one specific IgE (sIgE+), and positive skin-prick tests (SPTs+) in ETS-exposed and non-exposed children. RESULTS 8 studies on the influence of ETS on tIgE concentration (2603 patients), 6 studies on ETS and sIgE+ (9230 participants) and 14 papers on ETS and SPT (14 150 patients) met our inclusion criteria. ETS was shown to raise tIgE concentrations by 27.7 IU/mL (95% CI 7.8 to 47.7; I(2)=58%; results based on 3 studies) and to increase the risk of atopic sensitisation, as assessed by sIgE+ (OR=1.12, 95%CI 1.00 to 1.25; I(2)=54%; results based on 4 studies) and SPT+ (OR=1.15; 95% CI 1.04 to 1.28; I(2)=0%; results based on 10 studies). In a subgroup analysis, this effect was most pronounced in children <7 years (preschoolers) by OR=1.20; (95% CI 1.05 to 1.38) and OR=1.30 (95% CI 1.05 to 1.61), (for sIgE+ and SPT+, respectively). CONCLUSIONS Current analysis supports an association between ETS exposure in early childhood and the increased risk of allergic sensitisation. Subgroup meta-analyses demonstrate that younger children suffer the most from detrimental immunomodulating effects of ETS exposure. This study underscores ETS as an important but avoidable risk factor for the development of allergic disease in children.
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Affiliation(s)
- Wojciech Feleszko
- Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | - Marek Ruszczyński
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Joanna Jaworska
- Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Strzelak
- Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | | | - Marek Kulus
- Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland
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Harris MN, Lundien MC, Finnie DM, Williams AR, Beebe TJ, Sloan JA, Yawn BP, Juhn YJ. Application of a novel socioeconomic measure using individual housing data in asthma research: an exploratory study. NPJ Prim Care Respir Med 2014; 24:14018. [PMID: 24965967 PMCID: PMC4498187 DOI: 10.1038/npjpcrm.2014.18] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/19/2014] [Accepted: 03/25/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A housing-based socioeconomic index (HOUSES) was previously developed to overcome an absence of socioeconomic status (SES) measures in common databases. HOUSES is associated with child health outcomes in Olmsted County, Minnesota, USA, but generalisability to other geographic areas is unclear. AIM To assess whether HOUSES is associated with asthma outcomes outside Olmsted County, Minnesota, USA. METHODS Using a random sample of children with asthma from Sanford Children's Hospital, Sioux Falls, SD, USA, asthma status was determined. The primary outcome was asthma control status using Asthma Control Test and a secondary outcome was risk of persistent asthma. Home address information and property data were merged to formulate HOUSES. Other SES measures were examined: income, parental education (PE), Hollingshead and Nakao-Treas index. RESULTS Of a random sample of 200 children, 80 (40%) participated in the study. Of those, 13% had poorly controlled asthma. Addresses of 94% were matched with property data. HOUSES had moderate-good correlation with other SES measures except PE. Poor asthma control rates were 31.6%, 4.8% and 5.6% for patients in the lowest, intermediate and highest tertiles of HOUSES, respectively (P=0.023). HOUSES as a continuous variable was inversely associated with poorly controlled asthma (adjusted odds ratio (OR)=0.21 per 1 unit increase of HOUSES, 95% confidence interval (CI), 0.05-0.89, P=0.035). HOUSES as a continuous variable was inversely related to risk of persistent asthma (OR: 0.36 per 1 unit increase of HOUSES, 95% CI, 0.12-1.04, P=0.06). CONCLUSIONS HOUSES appears to be generalisable and available as a measure of SES in asthma research in the absence of conventional SES measures.
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Affiliation(s)
- Malinda N Harris
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Dawn M Finnie
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - Timothy J Beebe
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey A Sloan
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Been JV, Nurmatov UB, Cox B, Nawrot TS, van Schayck CP, Sheikh A. Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis. Lancet 2014; 383:1549-60. [PMID: 24680633 DOI: 10.1016/s0140-6736(14)60082-9] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Smoke-free legislation has the potential to reduce the substantive disease burden associated with second-hand smoke exposure, particularly in children. We investigated the effect of smoke-free legislation on perinatal and child health. METHODS We searched 14 online databases from January, 1975 to May, 2013, with no language restrictions, for published studies, and the WHO International Clinical Trials Registry Platform for unpublished studies. Citations and reference lists of articles of interest were screened and an international expert panel was contacted to identify additional studies. We included studies undertaken with designs approved by the Cochrane Effective Practice and Organisation of Care that reported associations between smoking bans in workplaces, public places, or both, and one or more predefined early-life health indicator. The primary outcomes were preterm birth, low birthweight, and hospital attendances for asthma. Effect estimates were pooled with random-effects meta-analysis. This study is registered with PROSPERO, number CRD42013003522. FINDINGS We identified 11 eligible studies (published 2008-13), involving more than 2·5 million births and 247,168 asthma exacerbations. All studies used interrupted time-series designs. Five North American studies described local bans and six European studies described national bans. Risk of bias was high for one study, moderate for six studies, and low for four studies. Smoke-free legislation was associated with reductions in preterm birth (four studies, 1,366,862 individuals; -10·4% [95% CI -18·8 to -2·0]; p=0·016) and hospital attendances for asthma (three studies, 225,753 events: -10·1% [95% CI -15·2 to -5·0]; p=0·0001). No significant effect on low birthweight was identified (six studies, >1·9 million individuals: -1·7% [95% CI -5·1 to 1·6]; p=0·31). INTERPRETATION Smoke-free legislation is associated with substantial reductions in preterm births and hospital attendance for asthma. Together with the health benefits in adults, this study provides strong support for WHO recommendations to create smoke-free environments. FUNDING Thrasher Fund, Lung Foundation Netherlands, International Paediatric Research Foundation, Maastricht University, Commonwealth Fund.
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Affiliation(s)
- Jasper V Been
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands; Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK; Department of Paediatrics, Maastricht University Medical Centre, Maastricht, Netherlands.
| | - Ulugbek B Nurmatov
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Bianca Cox
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Department of Public Health, University of Leuven, Leuven, Belgium
| | - Constant P van Schayck
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands; Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands; Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
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Abstract
Tobacco exposure increases mortality and morbidity of the fetus, the child, the adolescent, and their children in turn. Nearly half the children in the world are exposed. Smoking is not merely personal choice or personal responsibility; those subtle phrases undermine those who have no choice in the matter. Tobacco control must take a multi-pronged attack. Smoking cessation by adults in childbearing years must take center stage of these efforts, because it is the only way to ensure a smoke-free environment for children. Smoke-free parents provide a role model for smoke-free young people, and erode the image of smoking as a desirable adult behavior to emulate. Pediatricians and pediatric pulmonologists have a key role to play here. This goal will reduce morbidity and mortality among adults and children. Legislation regarding taxation, environments, tobacco constituents, product placement and display, packaging, and media education are all key to this core goal. Smoke-free policy must be protected from attack based on trade agreements. Research is needed into more effective ways to attract and help people give up smoking, and into educating and re-deploying tobacco industry workers in emerging and developed countries.
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