Immediate and short-term consequences of secondhand smoke exposure on the respiratory system

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association Between Second-Hand Smoke Exposure and Respiratory Symptoms Among the General Population of Non-smoker Adults in Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Second-hand smoke (SHS) exposure is associated with respiratory symptoms such as cough, dyspnea, and wheezing. However, data on this association in Saudi Arabia is limited.

OBJECTIVES

The objective of this study is to investigate the prevalence of SHS exposure and its association with respiratory symptoms among non-smoker adults in Saudi Arabia.

METHODS

Data collection was carried out over the course of two months by distributing an online questionnaire among adults living in Saudi Arabia. The survey consisted of questions assessing sociodemographic factors, SHS exposure, and the presence of respiratory symptoms. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Data was considered significant if p<0.05.

RESULTS

The questionnaire was completed by 1360 participants. Most were females (n=845, 72.1%) and individuals aged 18 to 30 years (n=838, 71.5%). From the analyzed records, 67.3% (n=789) reported SHS exposure. Among them, 40.3% (n=472) reported SHS exposure from household sources, 32.6% (n=382) from work colleagues, and 30.5% (n=357) from friends. The majority (n=306, 76.9%) of those exposed at home reported daily SHS exposure. The main source of home exposure was male family members, particularly the father (n=201, 42.6%). The majority (n=985, 84.0%) of participants reported not having any kind of mold or damage at their place of residence. Individuals with SHS exposure were more likely to report asthma (p=0.043), chest whistling or wheezing (p=0.021), chronic cough (p<0.001), productive cough (p<0.001), and nasal symptoms without a cold (p<0.001). These individuals also demonstrated a higher average symptom score than those not exposed to SHS.  Conclusion: The study reveals that a significant percentage of the Saudi population is exposed to SHS daily, mainly from household sources, especially male family members. A significant association was found between SHS exposure and the presence of respiratory symptoms. Public awareness regarding the prevalence and dangers of SHS exposure is essential in order to alleviate the impact of SHS on the health of the general Saudi population. Additionally, further research is required in this field and demographic group to develop appropriate interventions.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Trends in smoking-related diseases by socioeconomic position following a national smoking ban in 2007: a nationwide study in the Danish population

BACKGROUND

National comprehensive smoke-free legislation has been found to decrease the incidence of several smoking-related diseases. In 2007, Denmark introduced a national smoking ban, which banned smoking indoor in workplaces and public places, although only partial restrictions were applied in certain settings. We examined the impact of the smoking ban on smoking-related diseases and whether this differed across socioeconomic groups.

METHODS

Interrupted time series analyses of nationwide register data were performed using Poisson regression models to examine the differential impact of the smoking ban on monthly incidence rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers from 2002 to 2015. Immediate changes in incidence rates after the smoking ban and long-term changes in disease trends were estimated by comparing data from the pre- and post-ban period. Models were stratified by socioeconomic position.

RESULTS

Overall, we found neither immediate changes in rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers following the smoking ban nor long-term post-ban changes in disease trends as compared to before the ban. Results did not differ across socioeconomic groups. A pronounced socioeconomic gradient in incidence rates was observed for all outcomes both before and after the smoking ban.

CONCLUSION

The national smoking ban was not associated with a lower incidence of smoking-related diseases in the post-ban period compared to pre-ban levels and no differences between socioeconomic groups were observed. Future tobacco control in Denmark should consider which measures most effectively target the low socioeconomic groups to decrease the current strong socioeconomic inequality in health.

Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case-control study

Introduction

Exposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities.

Methodology

Multicentric case-control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA).

Results

A total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29-4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43-3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home.

Discussion

The results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed.

Particle Exposure Hazards of Visiting Outdoor Smoking Areas for Patients with Asthma or COPD Even in EU Countries with Comprehensive Smokefree Laws

Smokefree laws are intended to protect against second-hand smoke (SHS) in outdoor areas. We examined if exposure to PM2.5 particles in outdoor smoking areas changed breathing rates in 60 patients with asthma (n = 30) or with COPD (n = 30), in an open, non-randomised, interventional study model in Czechia, Ireland and Spain. The patients wore a PM2.5 particle monitor (AirSpeck) and a breath monitor (RESpeck) for 24 h to determine changes in breathing rates (Br) at rest and during a visit to an outside smoking area. Spirometry and breath CO were measured before and the day after visiting an outdoor smoking area. The PM2.5 levels at the 60 venues were highly variable, ranging from ≥2000 µg/m3 (in 4 premises) to ≤10 µg/m3 (in 3 premises, which had only a single wall in the structure). At 39 venues, the mean PM 2.5 levels were ≥25 µg/m3. The breathing rate changed significantly in 57 of the 60 patients, resulting in an increase in some patients and a decrease in others. Comprehensive smokefree laws were ineffective in protecting asthma and COPD patients from exposure to high levels of SHS in outside areas of pubs and terraces, which should be avoided by these patients. These findings also support the extension of smokefree laws to outside areas.

Second-hand smoke and fine particulate matter exposures among multi-unit housing residents in Singapore: A pilot study

Globally, approximately 1.2 million deaths among non-smokers are attributed to second-hand smoke (SHS) per year. Multi-unit housing is becoming the common type of residential dwelling in developed cities and the issue of neighbour SHS is of rising concern especially as 'Work From Home' became the norm during and post COVID-19 pandemic. To measure and compare the air quality of households that are exposed to SHS and unexposed households among smoking and non-smoking households in Singapore. A total of 27 households were recruited from April to August 2021. Households were categorized into smoking households with neighbour SHS, smoking households without neighbour SHS, non-smoking households with neighbour SHS, and non-smoking household without neighbour SHS. Air quality of the households was measured using calibrated particulate matter (PM_2.5) sensors for 7-16 days. Socio-demographic information and self-reported respiratory health were collected. Regression models were used to identify predictors associated with household PM_2.5 concentrations and respiratory health. Mean PM_2.5 concentration was significantly higher among non-smoking households with neighbour SHS (n = 5, mean = 22.2, IQR = 12.7) than in non-smoking household without neighbour SHS (n = 2, mean = 4.1, IQR = 5.8). Smoking activity at enclosed areas in homes had the lowest PM_2.5 concentration (n = 7 mean = 15.9, IQR = 11.0) among the three smoking locations. Exposure to higher household PM_2.5 concentration was found to be associated with poorer respiratory health. This is the first study to measure real-time PM_2.5 concentrations in households. Mean PM_2.5 concentrations was significantly higher in non-smoking households with neighbour SHS. Exposure to higher PM_2.5 concentration was associated with poorer respiratory health. A 'smoke-free residential building' policy is recommended to tackle the issue of rising neighbour SHS complaints and health concerns in densely populated multi-unit housing in Singapore. Public education campaigns should educate smokers to smoke away from the home to sufficiently protect household members from SHS.

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

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

Outdoor smoking as a nuisance to non-smokers: The case for smoke-free outdoor public spaces in dense urban areas

INTRODUCTION

Despite the growing number of smoke-free spaces, many non-smokers continue to be involuntarily exposed to secondhand smoke outdoors and on public streets. Both theory and research suggest that people living in densely populated urban areas are more likely to smoke than those living in less densely populated areas. Consequently, non-smokers in densely populated urban areas might be more likely to be exposed and feel annoyed by secondhand smoke outdoors. We investigated whether the extent to which non-smokers feel annoyed by secondhand smoke exposure in outdoor public spaces is related to urban population density.

METHODS

We used cross-sectional survey data from the Netherlands 'Module Substance Use' survey (2020 data, n=9375). This is a nationally representative sample of the adult population in the Netherlands. Using logistic regression models, we investigated whether urban population density predicts both smoking and non-smokers' annoyance to secondhand smoke exposure outdoors.

RESULTS

We found that smoking rates were associated with urban population density. In the Netherlands, people living in extremely population-dense urban areas were more likely to smoke than those living in non-urban areas (AOR=1.59; 95% CI: 1.25-2.02, p<0.001). Feeling annoyed by secondhand smoke outdoors was also associated with urban population density: non-smokers living in extremely population-dense urban areas were more likely to be annoyed than respondents living in non-urban areas (AOR=1.65; 95% CI: 1.34-2.02, p<0.001).

CONCLUSIONS

These cross-sectional data highlight the importance of comprehensive local tobacco control policy programs that include creating smoke-free outdoor public spaces. This need for such smoke-free outdoor public spaces might be particularly strong in densely populated areas.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

The limits of single-group interrupted time series analysis in assessing the impact of smoke-free laws on short-term mortality

BACKGROUND

Decreases in circulatory/respiratory morbimortality after the January-2006 Spanish partial smoke-free law have been found using designs without control groups, such as single-group interrupted time series (ITS), which are prone to biases. The aim was to reassess the law's impact on mortality using ITS designs with robustness checks.

METHODS

A comprehensive cohort of people aged ≥25 in each calendar-year of 2002-2007, living in 13 of 18 Spanish regions, was followed up between 01/2002 and 12/2007. The law included a smoking ban in indoor public and workplaces, allowing exceptions in catering, hospitality and leisure venues, and other interventions. Post-law changes in monthly coronary/respiratory mortality were estimated using segmented regression, adjusting for relevant covariates, including seasonality, extreme temperatures, influenza incidence and air pollution. The validity of results was assessed using control outcomes, hypothetical law dates, and non-equivalent control groups, analysing their results as difference-in-differences (DID) designs.

RESULTS

Significant immediate post-law decreases in coronary, respiratory and non-tobacco-related mortality were observed among people aged ≥70. A significant immediate post-law decrease in respiratory mortality (-12.7%) was also observed among people age 25-69, although this was neutralized by a subsequent upward trend before 1.5 years. More favourable post-law changes in coronary/respiratory mortality among the target (people aged 25-69) than control groups (people aged ≥70 or women aged ≥80) were not identified in DID designs. Establishing hypothetical law dates, immediate decreases began in February/March 2005 with maxima between April and July 2005.

CONCLUSIONS

After robustness checks, the results do not support a clear positive impact of the 2006 Spanish smoke-free law on short-term coronary/respiratory mortality. The favourable immediate changes observed pre- and post-law could derive mainly from the harvesting effect of the January-2005 cold wave. This highlights the risks of assessing the impact of health interventions using both morbimortality outcomes and designs without a control group and adequate robustness checks.

Effect of tobacco on periodontal disease and oral cancer

INTRODUCTION

Periodontal disease and oral cancer are common health hazards. Epidemiological investigations show that smoking, periodontal disease and oral cancer are closely related. Tobacco is one of the major risk factors for periodontitis and oral cancer.

METHODS

A systematic literature review was performed. To identify relevant studies, the following online databases were searched using specific keywords: PubMed, Web of Science and CNKI.

RESULTS

Tobacco not only possesses an addictive effect, but it aggravates periodontal disease by promoting the invasion of pathogenic bacteria, inhibiting autoimmune defense, aggravating the inflammatory reaction, and aggravating the loss of alveolar bone. According to current evidence, tobacco significantly aggravates the development and progression of periodontal disease and oral cancer, and periodontal disease may be related to the prevalence of oral cancer.

CONCLUSIONS

Clinicians should strongly recommend that smokers undertake a strategy to stop smoking to avoid the exacerbation of nicotine-related periodontal disease and to reduce the incidence of oral cancer.

Second-hand smoke exposure in outdoor hospitality venues: Smoking visibility and assessment of airborne markers

INTRODUCTION

After the implementation of smoke-free policies in indoor hospitality venues (including bars, cafeterias, restaurants, and pubs), smokers may have been displaced to their outdoor areas. We aimed to study smoking visibility and second-hand smoke exposure in outdoor hospitality venues.

METHODS

We collected information on signs of tobacco consumption on entrances and terraces of hospitality venues in 2016 in the city of Madrid, Spain. We further measured airborne nicotine concentrations and particulate matter of less than 2.5 µm in diameter (PM2.5) in terraces with monitors by active sampling during 30 min. We calculated the medians and the interquartile ranges (IQR) of nicotine and PM2.5 concentrations, and fitted multivariate models to characterize their determinants.

RESULTS

We found 202 hospitality venues between May and September (summer), and 83 between October and December 2016 (fall) that were opened at the time of observation. We found signs of tobacco consumption on 78.2% of the outdoor main entrances and on 95.1% of outdoor terraces. We measured nicotine and PM2.5 concentrations in 92 outdoor terraces (out of the 123 terraces observed). Overall median nicotine concentration was 0.42 (IQR: 0.14-1.59) μg/m³, and overall PM2.5 concentration was 10.40 (IQR: 6.76-15.47) μg/m³ (statistically significantly higher than the background levels). Multivariable analyses showed that nicotine and PM2.5 concentrations increased when the terraces were completely closed, and when tobacco smell was noticed. Nicotine concentrations increased with the presence of cigarette butts, and when there were more than eight lit cigarettes at a time.

CONCLUSIONS

Outdoor hospitality venues are areas where non-smokers, both employees and patrons, continue to be exposed to second-hand smoke. These spaces should be further studied and considered in future tobacco control interventions.

Changes in hospitalizations for chronic respiratory diseases after two successive smoking bans in Spain

Background

Existing evidence on the effects of smoke-free policies on respiratory diseases is scarce and inconclusive. Spain enacted two consecutive smoke-free regulations: a partial ban in 2006 and a comprehensive ban in 2011. We estimated their impact on hospital admissions via emergency departments for chronic obstructive pulmonary disease (COPD) and asthma.

Methods

Data for COPD (ICD-9 490–492, 494–496) came from 2003–2012 hospital admission records from the fourteen largest provinces of Spain and from five provinces for asthma (ICD-9 493). We estimated changes in hospital admission rates within provinces using Poisson additive models adjusted for long-term linear trends and seasonality, day of the week, temperature, influenza, acute respiratory infections, and pollen counts (asthma models). We estimated immediate and gradual effects through segmented-linear models. The coefficients within each province were combined through random-effects multivariate meta-analytic models.

Results

The partial ban was associated with a strong significant pooled immediate decline in COPD-related admission rates (14.7%, 95%CI: 5.0, 23.4), sustained over time with a one-year decrease of 13.6% (95%CI: 2.9, 23.1). The association was consistent across age and sex groups but stronger in less economically developed Spanish provinces. Asthma-related admission rates decreased by 7.4% (95%CI: 0.2, 14.2) immediately after the comprehensive ban was implemented, although the one-year decrease was sustained only among men (9.9%, 95%CI: 3.9, 15.6).

Conclusions

The partial ban was associated with an immediate and sustained strong decline in COPD-related admissions, especially in less economically developed provinces. The comprehensive ban was related to an immediate decrease in asthma, sustained for the medium-term only among men.

Cardiorespiratory response to exercise of nonsmokers occupationally exposed to second hand smoke (SHS)

INTRODUCTION

Occupational exposure to Second Hand Smoke (SHS) continues to be an issue, even in countries with strong tobacco control legislation. The current study assessed the effect of chronic occupational exposure to SHS on cardiorespiratory exercise response among healthy adult non-smokers.

METHODS

60 healthy non-smokers; 38 men, 22 women, aged 18-58 years with body mass index (BMI)<30 were separated into exposed to occupational SHS (exposed, n=30) and those non-exposed (controls, n=30) to occupational SHS in the hospitality sector. All individuals underwent baseline spirometry and ergospirometry testing. Non-smoking status was confirmed with exhaled CO, SHS exposure with urine cotinine measurement and indoor environmental pollution with PM2.5 concentration. Statistical differences among groups were determined with an independent t-test and p-value set to <0.05.

RESULTS

The exposed group had an average range of 6.9% to 14% lower exercise performance against their % predicted compared to controls. Significant mean differences ±standard deviation found between groups for ergospirometry were: oxygen uptake (VO₂, mL/minute) 11.8 ±3.9 (p=0.004) and 11.7 ±4.8 (p=0.019); carbon dioxide output (VCO₂) 14.0 ±3.7 (p<0.001) and 13.4 ±5.0 (p=0.009); metabolic equivalents (METS) 11.9 ±3.9 (p=0.003) and 11.7 ±4.9 (p=0.018) and for oxygen pulse (VO₂/HR) 16.6 ±7.551 (p=0.032) and 11.9 ±4.554 (p=0.011) at points of maximum oxygen uptake (VO₂max) and recovery (RC) against % predicted values, respectively.

CONCLUSION

Chronic occupational SHS exposure among non-smokers deteriorates CR exercise performance. Its impact on chronic disease development should be further explored. These results add to the evidence of the importance of enforcing clean indoor air legislations..

Factors associated with the annual change in forced expiratory volume in 1 second of officially acknowledged victims of pollution-related illness in improved environments: a longitudinal study

[Purpose] We examined factors affecting annual change in pulmonary function in residents previously exposed to air pollution in an area where pollution has been reduced and a long time period has elapsed. [Subjects and Methods] Data of 730 officially acknowledged victims of pollution-related illness from an annual survey during 2000 to 2009 were analyzed. The primary outcome was forced expiratory volume in 1 second (FEV₁), along with factors such as age, body composition, smoking habits, respiratory symptoms, and classification of medical management (an index of the need for treatment). Multiple regression analyses were used to identify factors associated with the annual change in FEV₁. [Results] Three significant factors were identified: smoking habit, classification of medical management, and gender. Smoking habits and classification of medical management had stronger effects on the annual change in FEV₁ than gender. [Conclusion] With an improved environment, continuation of smoking accelerates the decline in FEV₁.

Secondhand smoke in outdoor settings: smokers' consumption, non-smokers' perceptions, and attitudes towards smoke-free legislation in Spain

OBJECTIVE

To describe where smokers smoke outdoors, where non-smokers are exposed outdoors to secondhand smoke (SHS), and attitudes towards smoke-free outdoor areas after the implementation of national smoke-free legislation.

DESIGN

This cross-sectional study was conducted between June 2011 and March 2012 (n=1307 participants).

SETTING

Barcelona, Spain.

PARTICIPANTS

Representative, random sample of the adult (≥16 years) population.

PRIMARY AND SECONDARY OUTCOMES

Proportion of smoking and prevalence of exposure to SHS in the various settings according to type of enclosure. Percentages of support for outdoor smoke-free policies according to smoking status.

RESULTS

Smokers reported smoking outdoors most in bars and restaurants (54.8%), followed by outdoor places at work (46.8%). According to non-smokers, outdoor SHS exposure was highest at home (42.5%) and in bars and restaurants (33.5%). Among non-smoking adult students, 90% claimed exposure to SHS on university campuses. There was great support for banning smoking in the majority of outdoor areas, which was stronger among non-smokers than smokers. Over 70% of participants supported smoke-free playgrounds, school and high school courtyards, and the grounds of healthcare centres.

CONCLUSIONS

Extending smoking bans to selected outdoor settings should be considered in further tobacco control interventions to protect non-smokers from SHS exposure and to establish a positive model for youth. The majority of public support for some outdoor smoke-free areas suggests that it is feasible to extend smoking bans to additional outdoor settings.

Current perspective of the impact of smoking on the progression and treatment of periodontitis

This literature review provides an overview of the current scenario regarding the impact of smoking on the progression and treatment of periodontitis; clinical, microbiological and immunological data from studies from our and other groups are presented. In general, preclinical and clinical data are unanimous in demonstrating that smokers present increased susceptibility, greater severity and faster progression of periodontal disease compared with nonsmokers. The evidence further demonstrates that smokers lose more teeth and have a less favorable response to therapy than do nonsmokers. Although it is well established that smoking significantly impacts on the onset, progression and outcome of periodontal disease, the mechanisms involved remain unclear. More importantly, some of the reported deleterious effects of smoking on periodontal tissues have been reported to be reversible upon participation in smoking-cessation programs. Therefore, clinicians should strongly advise smokers to enroll in cessation strategies, even temporarily, in order to improve the overall outcome.

Smoking bans linked to lower hospitalizations for heart attacks and lung disease among medicare beneficiaries

Policies limiting exposure to cigarette smoke have been associated with reduced hospitalizations for heart attacks, but little is known about the impact of smoking bans on other health conditions and whether findings from individual communities generalize to other areas. We investigated the association between smoking bans targeting workplaces, restaurants, and bars passed throughout the United States during 1991-2008 and hospital admissions for smoking-related illnesses-acute myocardial infarction and chronic obstructive pulmonary disease-among Medicare beneficiaries age sixty-five or older. Risk-adjusted hospital admission rates for acute myocardial infarction fell 20-21 percent thirty-six months following implementation of new restaurant, bar, and workplace smoking bans. Admission rates for chronic obstructive pulmonary disease fell 11 percent where workplace smoking bans were in place and 15 percent where bar smoking bans were present. By contrast, very little effect was found for hospitalization for gastrointestinal hemorrhage and hip fracture-two conditions largely unrelated to smoking and examined as points of comparison. These findings provide further support for the public health benefits of laws that limit exposure to tobacco smoke.

Secondhand tobacco smoke exposure in open and semi-open settings: a systematic review

BACKGROUND

Some countries have recently extended smoke-free policies to particular outdoor settings; however, there is controversy regarding whether this is scientifically and ethically justifiable.

OBJECTIVES

The objective of the present study was to review research on secondhand smoke (SHS) exposure in outdoor settings.

DATA SOURCES

We conducted different searches in PubMed for the period prior to September 2012. We checked the references of the identified papers, and conducted a similar search in Google Scholar.

STUDY SELECTION

Our search terms included combinations of "secondhand smoke," "environmental tobacco smoke," "passive smoking" OR "tobacco smoke pollution" AND "outdoors" AND "PM" (particulate matter), "PM(2.5)" (PM with diameter ≤ 2.5 µm), "respirable suspended particles," "particulate matter," "nicotine," "CO" (carbon monoxide), "cotinine," "marker," "biomarker" OR "airborne marker." In total, 18 articles and reports met the inclusion criteria.

RESULTS

Almost all studies used PM(2.5) concentration as an SHS marker. Mean PM(2.5) concentrations reported for outdoor smoking areas when smokers were present ranged from 8.32 to 124 µg/m(3) at hospitality venues, and 4.60 to 17.80 µg/m(3) at other locations. Mean PM(2.5) concentrations in smoke-free indoor settings near outdoor smoking areas ranged from 4 to 120.51 µg/m(3). SHS levels increased when smokers were present, and outdoor and indoor SHS levels were related. Most studies reported a positive association between SHS measures and smoker density, enclosure of outdoor locations, wind conditions, and proximity to smokers.

CONCLUSIONS

The available evidence indicates high SHS levels at some outdoor smoking areas and at adjacent smoke-free indoor areas. Further research and standardization of methodology is needed to determine whether smoke-free legislation should be extended to outdoor settings.

Secondhand smoke exposure levels in outdoor hospitality venues: a qualitative and quantitative review of the research literature

OBJECTIVE

This paper considers the evidence on whether outdoor secondhand smoke (SHS) is present in hospitality venues at high levels enough to potentially pose health risks, particularly among employees.

DATA SOURCES

Searches in PubMed and Web of Science included combinations of environmental tobacco smoke, secondhand smoke, or passive smoke AND outdoor, yielding 217 and 5,199 results, respectively through June, 2012.

STUDY SELECTION

Sixteen studies were selected that reported measuring any outdoor SHS exposures (particulate matter (PM) or other SHS indicators).

DATA EXTRACTION

The SHS measurement methods were assessed for inclusion of extraneous variables that may affect levels or the corroboration of measurements with known standards.

DATA SYNTHESIS

The magnitude of SHS exposure (PM2.5) depends on the number of smokers present, measurement proximity, outdoor enclosures, and wind. Annual excess PM2.5 exposure of full-time waitstaff at outdoor smoking environments could average 4.0 to 12.2 μg/m3 under variable smoking conditions.

CONCLUSIONS

Although highly transitory, outdoor SHS exposures could occasionally exceed annual ambient air quality exposure guidelines. Personal monitoring studies of waitstaff are warranted to corroborate these modeled estimates.