A cross country comparison of exposure to secondhand smoke among youth

Tobacco use, secondhand exposure and knowledge of secondhand and third-hand smoke among medical college students in Western Nepal: a cross-sectional study

OBJECTIVES

This study was conducted to assess the prevalence of tobacco use, secondhand smoke (SHS) exposure and knowledge about SHS and third-hand smoke (THS) exposure among students in a medical college in Western Nepal.

DESIGN

This is a cross-sectional study.

SETTING

Data collection was done from 8 July 2023 to 8 August 2023 in a medical college in Nepal.

PARTICIPANTS

This study was conducted on undergraduate students studying in a medical college in Western Nepal using a census (whole population) sampling technique.

MAIN OUTCOME MEASURES

Prevalence of tobacco use was assessed by asking a question, 'Did you use tobacco products within the last 30 days?'. Secondhand smoke exposure and knowledge about SHS and THS exposure were assessed by using structured questionnaires. The χ2 test was used to compare the group exposed and non-exposed to tobacco, SHS and THS by sociodemographic variables (sex, residence, year of study and academic stream).

RESULTS

The response rate was 96.43% (n=595/617). The overall prevalence of tobacco use was found to be 16.30%. A total of 88.83% of students from clinical years knew about SHS which was more than preclinical students (p <0.001). The Bachelor of Medicine and Bachelor of Surgery students have higher knowledge of SHS as compared with others (p =0.003). More than 95% of students favoured banning smoking in public places. Nearly half of the participants (45.45%) experienced SHS exposure in the last 7 days. More than half proportion of the clinical students knew about THS, which was higher than preclinical students and interns (p <0.001).

CONCLUSIONS

Tobacco use prevalence among the participants was found to be lower in comparison to other studies including medical students in several Asian countries. Despite more than three-fourths of students knowing the harmful effects of SHS exposure, almost one-half of them were exposed to SHS. The proportion of students who knew about THS exposure was comparably lower.

Mother's psychopathological conditions and parenting characteristics according to smoke exposure

The study aims to investigate the relationship between maternal smoking and smoke exposure with the mother's parenting attitude and psychopathological conditions in the absence of any health problems in the mother-child pairs. A descriptive form consisting of 27 questions, a "Parental Attitude Scale", and a "Depression, Anxiety, and Stress Scale" was applied by mothers with children aged 2 to 6 years. Of the 450 voluntary mothers included in the study, 107 (23.8%) had environmental smoke exposure and 69 (15.0%) were smokers. The highest quartile of democratic subscores was associated with maternal smoking and smoke exposure when confounding factors were controlled. Compared to non-smokers and unexposed, the adjusted odds ratio of having abnormal anxiety scale subscores was 3.90 [95% CI: 1.69-8.97] for smokers. When parenting types were included, mothers' smoking status and overprotective subscores were found to be associated with anxiety. There is an interaction among mothers' smoking, parenting types, and anxiety scores.

Associations of childhood and current secondhand smoke exposure at home with current secondhand smoke exposure at work: A cross-sectional analysis of the Singapore multi-ethnic cohort

INTRODUCTION

Relationships between secondhand smoke exposure (SHSE) in various temporal and physical settings are not fully studied despite its adverse impacts on human health, especially in multi-ethnic Asian populations. We investigated associations of childhood and current SHSE at home (SHSEhome) with current SHSE at work (SHSEwork) in Singapore and its relation to sources of daily smokers at home.

METHODS

This cross-sectional study identified 925 healthy, never smoker working adults from the Singapore Multi-Ethnic Cohort (2004-2010). Firstly, the multiple logistic regression model estimated the adjusted odds ratios (AORs) of SHSEhome. Subsequently, sources of daily smokers entered through an additional model building process using the former as a base.

RESULTS

Current adults (AOR=2.05; 95% CI: 1.28-3.29) and childhood SHSEhome (AOR=1.43; 95% CI: 0.93-2.19) had a positive and no association with current SHSEwork, respectively. These findings persisted when smoker identity-related variables entered the model: child (AOR=3.56; 95% CI: 1.19-10.64) for current daily smokers; father (AOR=2.30; 95% CI: 0.94-5.64) and sibling (AOR=2.97; 95% CI: 1.55-5.68) for childhood. Compared to no childhood SHSEhome, only those living with their fathers and siblings who smoked daily at home had significantly higher odds of reporting current SHSEwork (AOR=3.70; 95% CI: 1.88-7.30).

CONCLUSIONS

Current SHSEhome was a risk factor for current SHSEwork, with risks elevated among those who smoke daily at home and living with their children. Childhood SHSEhome becomes a risk factor when daily household smokers include fathers and siblings. Deformalizing smoking could consider interpersonal dynamics of daily smokers at home with family members in different temporal settings, to reduce SHSEwork.

Experimental study on the effect of the split-type air-conditioner on the transmission of smoking pollutants in a room

Environmental tobacco smoke (ETS) has become one of the most important sources of indoor air pollution. The study aimed to obtain the variation characteristics of typical air pollutant concentrations when people smoke in a closed room and explore the effect of the air-conditioner. A closed and air-conditioned room of 21 m² was taken as the research object. Fine particulate matter (PM_2.5) and total volatile organic compound (TVOC) were measured while 10 cigarettes were burnt in smoldering or smoking mode, with the air-conditioner on or off. The contents of nicotine in condensate samples were obtained by liquid chromatography. The impact of ETS on indoor air quality lasted for hours, causing typical pollutant concentrations to far exceed the Chinese standard. The PM_2.5 produced by smoking was 11 times higher than by smoldering, but the TVOC produced by smoldering was more than by smoking. After one hour of the cigarette burning off, the PM_2.5 concentration would be decreased by 96.1% with the air-conditioner on, in contrast to 67.9% with the air-conditioner off. Nicotine was detected in all samples of condensate from the air-conditioner. It is concluded that smoking cigarettes cannot be replaced by smoldering to evaluate the pollution of ETS. The air-conditioner has a positive effect on reducing the concentration of air pollutants produced by cigarette burning. More than 10% of the indoor nicotine may be taken away by condensate discharge, and its possible pollution should be paid attention to.Implications: This study provides new evidence of the effect of the split-type air-conditioner on ETS. The TVOC concentrations, which were less considered previously, were measured. PM_2.5 concentration in human breathing zone can be reduced more quickly with the air-conditioner on. This study shows that there is a big difference in the concentrations of typical pollutants between smoking and smoldering. And it could be a guide for the formulation of relevant research methods. This study also demonstrates that the air conditioning condensate from the smoking room may contain nicotine. Attention should be paid to the recovery and utilization of such condensate.

Smoke-free workplaces are associated with smoke-free homes in India: evidence for action

India enacted a smoke-free law in 2003. It is believed that smoke-free workplaces will lead to more smoking in private places such as homes. The national Global Adult Tobacco Survey (GATS 2) India 2016-2017 collects information on the self-reported prevalence of SHS exposure in homes and workplaces. The present study utilised the GATS 2 dataset to establish the association between working in a smoke-free workplace and living in a smoke-free home. 70.1% of respondents who worked indoors reported smoke-free workplace; 64.5% of respondents reported that they live in a smoke-free home. Respondents who reported that their workplace was smoke-free were significantly more likely to live in smoke-free homes compared with those who are exposed to SHS at the workplace (69.5% vs 45.5%, AOR = 1.8, 95% CI 1.5-2.1). Males, urban residents, family with fewer members, non-smokers and non-smokeless tobacco users were significantly more likely to live in a smoke-free home. Significant differences were also observed with respect to religion, caste, region and education levels. Our results provide conclusive evidence to support that smoke-free workplaces influence smoke-free homes in India. Thus, it highlights the importance of accelerating the implementation of existing national tobacco control legislation on smoke-free public places.

Secondhand smoke exposure at home and public places among smokers and non-smokers in India: findings from the Global Adult Tobacco Survey 2016-17

Secondhand smoke (SHS) accounts for 0.9 million deaths and 24 million disability adjusted life years (DALYs) annually. Nearly 30% of adults in India are exposed to SHS in India. To reduce SHS exposure, India enacted a smoke-free law in 2003 under which smoking in public places is banned. However, the compliance to this law has been variable in several assessments in the country. A better understanding of the nature and extent of SHS exposure can help inform better implementation of national smoke-free policies. The Global Adult Tobacco Survey (GATS) India 2016-17 collects information on the self-reported prevalence of SHS exposure in homes, workplaces, government buildings, restaurants, public transportation and health care facilities among adults (> 15 years of age).The present study utilized the GATS India 2016-17 dataset to provide estimates of SHS exposure among adults in India in homes, workplace and other public places, across gender and age groups and among the overall population and non-smokers. Weighted analysis was carried out. In the overall population, exposure to SHS in the home was 29.2%, more among young females. In workplaces, exposure to SHS was 29.2% overall, significantly higher among males (32.5%) compared to females (17.8%). In public buildings such as health care facilities and government offices, SHS exposure was less with 15.6% and 21.2% respectively. SHS exposure was high in restaurants with 39.3% overall, significantly higher among males (43.2%) compared to females (22.2%). Similar results were also seen among non-smokers. A large proportion of adults in India, both smokers and non-smokers are exposed to SHS in their homes, workplaces and other public places, especially restaurants, workplaces and public transportation. Females are more exposed to SHS at home, whereas males are more exposed in public places including workplaces. High SHS exposure among youths is also a concern. Stricter enforcement of legislation is required to ensure 100% smoke-free homes, public places and workplaces and reduce SHS exposure.

Cognizance and social attitudes regarding tobacco control laws in and around educational institutions of Nellore city, India

INTRODUCTION

Indian national law namely Cigarettes and Other Tobacco Products Act (COTPA) exists since 2003 and aims at protecting all the people in our country, but smoking is still prevalent among people. This study was aimed to assess awareness, attitudes, and practices regarding prohibition of sale of tobacco products near educational institutions of Nellore city, India.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted in degree colleges of Nellore city of Andhra Pradesh. The study population includes institutional personnel (student, teaching staff, nonteaching staff, and workers) of selected degree colleges of Nellore city. A structured questionnaire was designed for this study which was validated by Davis criteria; reliability was assessed by test-retest design. The questionnaire was divided into five parts consisting of demographic details (age and gender), smoking behavior, knowledge about tobacco control laws, attitudes toward the law and policies, and practices followed in the institution. Logistic regression analysis was used to find out the association between different independent variables to tobacco usage among institutional personnel.

RESULTS

Among the study population (n = 400 [100%]), 75.8% of the teaching staff do not know that there should be a board in the institution saying that "sale of tobacco product in an area within the radius of 100 m of educational institution is strictly prohibited," 82.2% of the study population were not aware to whom should they report, 96.3% of the study population accepted that strict execution of COTPA law saves life, the participants who answered no to strict implementation of COTPA law, and to punish the person who is violating the COTPA law are susceptible to 0.28, and 0.14 times greater odds to be a smokeless tobacco user, respectively.

CONCLUSION

The study concluded that there was lack of knowledge about smoke-free legislation among the study population and a high support for strict implementation of COTPA.

"How do you know those particles are from cigarettes?": An algorithm to help differentiate second-hand tobacco smoke from background sources of household fine particulate matter

BACKGROUND

Second-hand smoke (SHS) at home is a target for public health interventions, such as air quality feedback interventions using low-cost particle monitors. However, these monitors also detect fine particles generated from non-SHS sources. The Dylos DC1700 reports particle counts in the coarse and fine size ranges. As tobacco smoke produces far more fine particles than coarse ones, and tobacco is generally the greatest source of particulate pollution in a smoking home, the ratio of coarse to fine particles may provide a useful method to identify the presence of SHS in homes.

METHODS

An algorithm was developed to differentiate smoking from smoke-free homes. Particle concentration data from 116 smoking homes and 25 non-smoking homes were used to test this algorithm.

RESULTS

The algorithm correctly classified the smoking status of 135 of the 141 homes (96%), comparing favourably with a test of mean mass concentration.

CONCLUSIONS

Applying this algorithm to Dylos particle count measurements may help identify the presence of SHS in homes or other indoor environments. Future research should adapt it to detect individual smoking periods within a 24 h or longer measurement period.

Involuntary Smoking in Adolescents, Their Awareness of Its Harmfulness, and Attitudes towards Smoking in the Presence of Non-Smokers

The aim of the study was to examine involuntary smoking among young people, their awareness of its harmfulness and the factors associated with attitudes towards smoking in the presence of non-smokers. A cross-sectional study was conducted among 3552 students from a socially disadvantaged rural area in central Poland. Almost 40% of the participants were exposed to involuntary smoking at home and 60% outside of home on a daily or almost daily basis. More than 80% of the students felt that smoking should be banned around children at home, 59% thought it should be banned in vehicles, and 41% in the presence of non-smokers. The majority of the students were aware of the health consequences of active smoking, and 69% understood the threats of passive smoking. Females, never-smokers and current non-smokers, as well as those without smoking parents were more likely to claim that smoking should be banned at home and in vehicles (p < 0.05). Those aware of the fact that smoking was harmful to health, who discussed those issues with their parents and teachers, and who saw school tobacco control policies, were more likely to maintain that passive smoking should be banned (p < 0.05). The study results highlight the need for programs and policies to eliminate involuntary smoking among young people.

In utero and early childhood exposure to secondhand smoke in Taiwan: a population-based birth cohort study

OBJECTIVES

This study provides secondhand smoke (SHS) exposure data in utero and after birth when children were at 18 months, 36 months and 66 months old, and it identifies risk factors for the early childhood SHS among 18-month-old infants living in smoker and non-smoker households.

STUDY DESIGN

The data come from the Taiwan Birth Cohort Study, a longitudinal survey of a birth cohort born in 2005. This study used the survey wave when children were 18 months old (n=18 845) for statistical analysis of early childhood SHS exposure. Logistic regression was used to identify the risk factors of the SHS exposure.

RESULTS

Approximately 62% of the 18-month-old infants lived in a household with at least one smoker, with the father being the smoker in 84% of those households. Among these infants living in a smoker household, 70% were exposed to SHS and 36% were exposed to heavy SHS in utero, and the prevalence was approximately 66% and 17% after birth for SHS and heavy SHS, respectively. The number and the existence of smokers in the household, parents' smoking status, father's educational attainment and being a first-born baby are strong predictors of early childhood heavy SHS exposure.

CONCLUSIONS

Encouraging families to have a smoke-free home environment, empowering women to ensure their perspectives and rights are embedded into tobacco control efforts and educating families about the health risks from childhood SHS exposure, especially among people living in households with smokers, will protect non-smoking adults and children from SHS exposure.

Using air quality monitoring to reduce second-hand smoke exposure in homes: The AFRESH feasibility study

INTRODUCTION

Few interventions to reduce second-hand smoke in homes where children are present have been successful. A novel intervention was developed that included personal air-quality feedback. This study aimed to evaluate the feasibility and acceptability of delivering this theory-based intervention through small third-sector organisations in deprived areas within Scotland.

METHODS

The setting was third-sector organisations in Scotland. Support workers used air quality monitors to give information on smoke-free homes to parents. This advice was structured around computer generated reports, co-developed with workers and target-group members. Participants received a monitor then received a report, which was discussed with a support worker. Two weeks later, the monitor was reinstalled and another report produced to evaluate success. Three participants and one support worker were interviewed afterwards to explore their experiences.

RESULTS

One centre out of six that were approached agreed to deliver the intervention. Four participants took part. All participants saw a decline in average concentrations of PM_2.5 in their homes. In interviews, the participants and the support worker indicated that the intervention was acceptable and useful. The centres that declined to participate in the study cited a range of reasons, including a lack of staff time and perceived difficulties in recruiting members of the target population.

CONCLUSIONS

This intervention was acceptable for the target population tested, and may help participants to create smoke-free homes, although it is not possible to generalise the results of this small study. However, the resources required for the delivery of AFRESH do not match with the resources available in third-sector organisations, despite smoke-free homes being a policy priority.

Secondhand smoke risk perception and smoke-free rules in homes: a cross-sectional study in Barcelona (Spain)

OBJECTIVE

To describe the voluntary adoption of smoke-free homes in Spain among general population and to identify variables associated with its voluntary adoption.

METHODS

Cross-sectional study of a representative sample (n=731) of the adult population (>26 years) of Barcelona, Spain, in 2013-2014. We defined smoking rules inside the households as complete indoor rules (when smoking was not allowed inside the house), and partial or absent indoor rules (when smoking was allowed in some designated places inside the house or when smoking was allowed everywhere) and described them according to the perceived risk of the secondhand smoke (SHS) exposure. We calculated the prevalence and prevalence ratios (PR) according to sociodemographic variables.

RESULTS

57.4% of households had complete indoor smoke-free rules. The prevalence of households with complete indoor rules was higher among women (PRa: 1.15; 95% CI 1.00 to 1.33), married (PRa: 1.18; 95% CI 1.01 to 1.38), never-smokers (PRa: 2.68; 95% CI 2.06 to 3.50) and in households where a minor lived (PRa: 1.40; 95% CI: 1.20-1.65). Believe that breathing tobacco smoke from smokers is dangerous for non-smokers (PRa: 1.77; 95% CI: 1.06-2.97) is associated with the voluntary adoption of complete indoor smoke-free home.

CONCLUSIONS

Risk perceptions of SHS exposure were associated with the voluntary adoption of indoor smoke-free homes.

Prevalence of Exposure to Secondhand Smoke among Higher Secondary School Students in Ernakulam District, Kerala, Southern India

Introduction:

The association between secondhand smoke and health outcomes, such as frequent respiratory infections, ischemic heart disease, lung cancer, asthma, and stroke, has long been established. The study aimed to estimate the prevalence of secondhand smoking exposure among higher secondary school students in Ernakulam district, Kerala, Southern India.

Materials and Methods:

A structured questionnaire was administered to all students from four randomly selected higher secondary schools in Ernakulam district. Descriptive statistics was done using frequencies and percentages. Univariate and multivariate analyses were done for factors associated with household exposure to tobacco smoke generating odds ratios (ORs) and 95% confidence intervals (CIs).

Results:

A total of 629 students participated in the study. The prevalence of ever smokers was 11.9% and of current smokers was 5.2%. Among the study participants, 23.2% were exposed to secondhand smoking from a family member and 18.8% from friends. Lower educational status of father was associated with the household exposure to secondhand smoke (adjusted OR 4.51 [95% CI 1.66–12.22]). More than half of the study participants (56.3%) reported that they were exposed to cigarette smoke in past 1 week in a public place and 10.2% in closed public places. Nearly one-third of the students reported that they have seen somebody smoking inside school campus in the past 30 days.

Conclusion:

Exposure to secondhand smoke at home, schools, and public places was higher among the late adolescent higher secondary school students in Ernakulam district. The findings underscore the urgent need for increased efforts to implement the strategies to reduce secondhand smoke exposure among adolescents.

Exposure to secondhand smoke from neighbours and respiratory symptoms in never-smoking adolescents in Hong Kong: a cross-sectional study

OBJECTIVES

To investigate secondhand smoke (SHS) exposure at home from neighbours in Hong Kong adolescents and its association with respiratory symptoms in never-smokers.

DESIGN

A cross-sectional study.

SETTING

79 randomly selected secondary schools in Hong Kong.

PARTICIPANTS

61,810 secondary 1 (USA grade 7) to 7 students, in which 50,762 never-smokers were identified and included in the analysis of the association between SHS exposure at home from neighbours and respiratory symptoms.

MAIN OUTCOME MEASURES

Smoking status, family smoking status, SHS exposure at home from inside the home and from neighbours in the past 7 days, respiratory symptoms and sociodemographic characteristics were reported. Adjusted ORs (AORs) of respiratory symptoms for SHS exposure from the 2 sources in never-smokers were calculated using logistic regression.

RESULTS

In all students, 33.2% were exposed to SHS at home, including 16.2% from inside the home only, 10.0% from neighbours only and 7.0% from both. The prevalence of SHS exposure from neighbours was 17.1%, including 13.5% for 1-4 days/week and 3.6% for 5-7 days/week. In never-smokers (n=50,762), respiratory symptoms were significantly associated with SHS exposure from neighbours with AORs (95% CI) of 1.29 (1.20 to 1.39) for any exposure (p<0.001), 1.21 (1.12 to 1.31) for 1-4 days/week (p<0.001) and 1.63 (1.44 to 1.86) for 5-7 days/week (p<0.001) (P for trend <0.001). Compared with no SHS exposure at home from any source, the AORs were 1.16 (1.07 to 1.25) for SHS from inside the home only (p<0.001), 1.20 (1.11 to 1.31) from neighbours only (p<0.001), and 1.74 (1.56 to 1.94) from both (p<0.001).

CONCLUSIONS

SHS exposure at home from neighbours was prevalent in Hong Kong adolescents, and was associated with respiratory symptoms in never-smokers. SHS exposure at home may be underestimated by ignoring the neighbouring source. Smoke-free housing policy is needed to protect children and adolescents from harms of SHS.

Tobacco control in Poland-successes and challenges

For many years, tobacco smoking was the major single avoidable cause of premature mortality in Poland. In the 1970s and 1980s, Poland was a country with an extremely high prevalence of smoking and lung cancer mortality among men in the world. By 1990, over 40% of Polish men died prematurely from smoking-attributed diseases. However, the enforcement of comprehensive tobacco-control measures and programs based on the World Health Organization recommendations and the best practices from other countries, contributed to a spectacular decrease of smoking incidence, particularly in men. This led to dramatic decrease in lung cancer incidence and mortality, and to a substantial improvement in public health in Poland. This article reviews the achievements of tobacco-control in Poland over the past decades and points out current challenges in this field.

Smoking beliefs and behavior among youth in South Korea, Taiwan, and Thailand

BACKGROUND

Beliefs about smoking are important predictors of smoking behavior among adolescents, and adolescents who hold positive beliefs about the benefits of smoking are at an increased risk of smoking initiation. An alarming fact is the rising smoking prevalence in Asian countries, particularly the increasing trend in smoking during adolescence.

PURPOSE

This cross-sectional study examined smoking beliefs and behavior among a nationally representative sample of youth in South Korea, Taiwan, and Thailand.

METHODS

Descriptive statistics, linear regression, and logistic regression methods were used to analyze data from 13-15-year-old adolescents who participated in the 2005 Global Youth Tobacco Survey (GYTS) in South Korea (N = 4,765) and Thailand (N = 15,420) and the 2007 GYTS in Taiwan (N = 3,955).

RESULTS

The rate of ever smoking among youth was similar in all three countries and ranged from 26.7 to 28.0 %. The prevalence of current smoking among youth in Thailand (11.4 %) was nearly double the prevalence in South Korea (6.6 %) and Taiwan (6.5 %). Pro-tobacco advertising exposure, as well as older ages, was a positive and significant predictor of positive beliefs about smoking among youth in all three countries. Additionally, youth who reported increased positive smoking-related beliefs, greater pro-tobacco advertising exposure, and were male were more likely to be current smokers in all three countries.

CONCLUSION

Results suggest that greater attention be directed to understanding beliefs and attitudes about smoking among youth. Exploring the relationship between these factors and smoking behavior can provide a strong starting point in the development of effective smoking prevention interventions and tobacco control policies in this region.

Persistence of socioeconomic differences in adolescents' environmental tobacco smoke exposure in Finland: 1991-2009

AIMS

Socioeconomic differences in children's exposure to environmental tobacco smoke (ETS) in favour of those with higher positions are known, but research is scarce on whether differences have persisted when smoking restrictions have been tightened. We examined socioeconomic differences in adolescents' ETS exposure from 1991 to 2009 in Finland where the tobacco law has gradually restricted smoking of population.

METHODS

National cross-sectional surveys (1991-2009) in 12-18-year-olds (N=72,726, response rate 77-56%). An outcome measure was self-reported exposure to ETS (≥ 1 hour/day). Parents' socioeconomic and adolescent's individual social position (school performance/career) were used as independent variables. Across four time periods, associations were studied by logistic regression.

RESULTS

Over the study period 1991-2009, the proportion of adolescents exposed to ETS decreased from 17% to 6% (p ≤ 0.001). There were large and persistent differences between socioeconomic and parents' smoking groups. The decrease occurred in all groups but was smaller among 16-18-year-olds whose father had a low education. A steeper decline occurred among 16-18-year-olds who were not in school or were in vocational school with poor school performance compared with those with more advanced educational career. Compared with other subgroups, the decline in ETS exposure was greater among those whose parents were smokers.

CONCLUSIONS

Adolescents' ETS exposure remarkably decreased over time, when tobacco control measures were tightened, particularly among children of smoking parents. Socioeconomic differences persisted although diminishing differences were observed between educational groups at age 16-18.

Underage alcohol drinking and medical services use in Hong Kong: a cross-sectional study

OBJECTIVES

To investigate the association of underage alcohol drinking with medical consultation and hospitalisation in Hong Kong.

DESIGN

Cross-sectional study.

SETTING

Secondary schools in Hong Kong.

PARTICIPANTS

A total of 33 300 secondary 1 (US grade 7) to secondary 5 students (47.6% boys; mean age 14.6 years, SD 1.6) in 85 randomly selected schools.

OUTCOME MEASURES

An anonymous questionnaire was used to obtain information about medical consultation in the past 14 days, hospitalisation in the past 12 months, drinking alcohol, smoking, illicit drug use, physical activity, secondhand smoke exposure, feeling depressed, feeling anxious and sociodemographic characteristics. Drinking alcohol was categorised as non-drinking (reference), <1, 1-2 and 3-7 days/week. Logistic regression yielded adjusted ORs (AORs) of medical consultation and hospitalisation for drinking, adjusting for different potential confounders. Subgroup analysis was conducted among adolescents who did not report feeling anxious or depressed.

RESULTS

More than one-fourth (27.6%) of adolescents drank alcohol, 15.9% had medical consultation and 5.1% had been hospitalised. In the fully adjusted model, the AORs (95% CI) for medical consultation were 1.14 (1.06 to 1.23) for <1 day/week, 1.30 (1.13 to 1.50) for 1-2 days/week and 1.70 (1.41 to 2.06) for 3-7 days/week of drinking compared with non-drinking (p for trend <0.001). The corresponding AORs (95% CI) for hospitalisation were 1.14 (1.02 to 1.28), 1.68 (1.32 to 2.14) and 2.38 (1.90 to 2.98) (p for trend <0.001). Similar associations were observed among students who did not feel anxious or depressed.

CONCLUSIONS

Alcohol consumption was associated with medical services use in Chinese adolescents. More rigorous alcohol control policies and health promotion programmes are needed to reduce alcohol drinking and related harms in adolescents.

Secondhand smoke exposure and health services use among adolescent current smokers

Background

To investigate the associations of secondhand smoke (SHS) exposure with medical consultation and hospitalisation among adolescents in Hong Kong.

Methods

A total of 35827 secondary 1 (US grade 7) to secondary 5 students from 85 randomly selected schools completed an anonymous questionnaire on smoking, SHS at home, SHS outside home, medical consultation in the past 14 days, hospitalisation in the past 12 months, and socio-demographic characteristics. Current smoking was defined as any smoking in the past 30 days. SHS exposure was classified as none (reference), 1–4 and 5–7 days/week. Logistic regression yielded adjusted odds ratios (AORs) for medical consultation and hospitalisation in relation to SHS exposure at home and outside home in current smokers. Analyses were also done among never-smokers for comparison.

Results

Among all students, 15.9% had medical consultation and 5.2% had been hospitalised. Any SHS exposure at home was associated with AORs (95% CI) for medical consultation and hospitalisation of 1.69 (1.14–2.51) and 2.85 (1.47–5.52) in current smokers, and 1.03 (0.91–1.15) and 1.25 (1.02–1.54) in never-smokers, respectively, (P<0.01 for interaction between smoking status and SHS exposure at home). SHS exposure outside home was generally not associated with medical consultation and hospitalisation in smokers and never-smokers.

Conclusions

SHS exposure at home was associated with health services use among adolescent current smokers. Adolescent smokers should be aware of the harm of SHS in addition to that from their own smoking. The evidence helps health care professionals to advise adolescent smokers to avoid SHS exposure and stop smoking.

Tobacco control challenges in East Asia: proposals for change in the world's largest epidemic region

East Asia is one of the world's largest tobacco epidemic regions. Although several international studies have evaluated the status of tobacco control in this region, the findings have not been integrated with knowledge on domestic activities at the national and municipal levels. We analysed the current tobacco control situation in three East Asian countries, Japan, China and the Republic of Korea, using both international and domestic data sources. We collected data between 2008 and 2011 in each country according to the framework of WHO's MPOWER (Monitoring, Protect, Offer, Warn, Enforcement and Raise) approach for guiding implementation of the WHO Framework Convention on Tobacco Control. Analysis revealed that 37-53% of adult men were current smokers and that smoking prevalence among middle-aged men reached 63%. Less than 20% of male smokers plan to quit and the use of nicotine replacement drugs was 14% at maximum. Forty-six percent or more of men and 20% or more of women were exposed to passive smoking at workplaces and at home, respectively. Many tobacco industry activities remain unrestricted and prevalent. Our findings indicate an urgent need for the following set of policies: raise cigarette prices to increase the quit attempt rate, particularly among adult men; develop a multi-component quitting assistance system to provide adequate assistance for smoking cessation; implement effective smoke-free policies in workplaces and public places to reduce exposure to passive smoking; and rebuild the administrative structure to denormalise tobacco industry activities. The importance of these standard approaches should be reaffirmed by all tobacco control policymakers in East Asia.

Space and power: young mothers' management of smoking in extended families in China

Multigenerational co-residence is a widespread phenomenon in China but there is little knowledge about the impact of power dynamics on smoking behaviors among extended family residents. Using a gender lens, this ethnographic study explored how young mothers in extended families in mainland China managed the smoking of their husbands and other family members. Analysis of data resulted in a model of 'two units-three domains' to reflect gendered relationships between young mothers and other family members, and young mothers' participation in family management. Exploration of the mothers' efforts to deal with household smoking using the model provided an explanation for why the young mothers had limited control over household space and could only impose partial restrictions on home smoking in the extended family.

A cross-country comparison of secondhand smoke exposure among adults: findings from the Global Adult Tobacco Survey (GATS)

OBJECTIVE

Exposure to secondhand smoke (SHS) from burning tobacco products causes disease and premature death among non-smoking adults and children. The objective of this study was to determine the nature, extent and demographic correlates of SHS exposure among adults in low- and middle-income countries with a high burden of tobacco use.

METHODS

Data were obtained from the Global Adult Tobacco Survey (GATS), a nationally representative household survey of individuals 15 years of age or older. Interviews were conducted during 2008-2010 in Bangladesh, Brazil, China, Egypt, India, Mexico, the Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam. Descriptive statistics were used to determine the prevalence and correlates of SHS exposure in homes, workplaces, government buildings, restaurants, public transportation and healthcare facilities.

RESULTS

Exposure to SHS in the home ranged from 17.3% (Mexico) to 73.1% (Vietnam). Among those who work in an indoor area outside the home, SHS exposure in the workplace ranged from 16.5% (Uruguay) to 63.3% (China). Exposure to SHS ranged from 6.9% (Uruguay) to 72.7% (Egypt) in government buildings, 4.4% (Uruguay) to 88.5% (China) in restaurants, 5.4% (Uruguay) to 79.6% (Egypt) on public transportation, and 3.8% (Uruguay) to 49.2% (Egypt) in healthcare facilities.

CONCLUSIONS

A large proportion of adults living in low- and middle-income countries are exposed to SHS in their homes, workplaces, and other public places. Countries can enact and enforce legislation requiring 100% smoke-free public places and workplaces, and can also conduct educational initiatives to reduce SHS exposure in homes.

Smoking family, secondhand smoke exposure at home, and nicotine addiction among adolescent smokers

INTRODUCTION

Smoking family predicts adolescent smoking, but whether the level of nicotine addiction is affected by exposure to secondhand smoke (SHS) is unclear. We investigated the associations of smoking family and SHS exposure at home with morning smoking and heavier smoking among Chinese adolescent smokers.

METHODS

In a school-based anonymous survey, 2182 adolescent smokers reported their smoking behaviors, smoking status of family members and peers, and SHS exposure at home and outside home in the past 7 days. Families with one or more smoking members (excluding the subject) were classified as smoking families and otherwise as non-smoking families. Smoking or wanting to smoke first thing in the morning (morning smoking), and consuming more cigarettes (heavier smoking) denoted higher levels of nicotine addiction. Regression analysis yielded adjusted odds ratios (AORs) for morning smoking and β-coefficients for heavier smoking adjusting for potential confounders.

RESULTS

Living with siblings and other co-residing family members who smoked was significantly associated with morning smoking and heavier smoking. Compared with non-smoking families without SHS exposure at home, the AORs (95% CI) for morning smoking were 0.99 (0.76 to 1.29) for 0 day/week, 1.19 (0.95 to 1.50) for 1-3 days/week, 1.76 (1.41 to 2.21) for 4-7 days/week (p for trend <0.001) and 1.50 (1.23 to 1.83) for any days/week of SHS exposure at home in smoking families. Similarly, 4-6 days/week of SHS exposure at home significantly predicted heavier smoking.

CONCLUSION

Living with smoking family members and SHS exposure at home are associated with nicotine addiction in Chinese adolescent smokers.

Secondhand tobacco smoke: a source of lead exposure in US children and adolescents

OBJECTIVES

We evaluated the relationship between secondhand tobacco smoke (SHS) exposure and blood lead levels in US children and adolescents.

METHODS

We analyzed data from 6830 participants aged 3-19 years in the National Health and Nutrition Examination Survey (1999-2004) who were not active smokers and for whom SHS exposure information and blood lead measurements were available.

RESULTS

After multivariable adjustment, participants in the highest quartile of serum cotinine (≥ 0.44 μg/L) had 28% (95% confidence interval = 21%, 36%) higher blood lead levels than had those in the lowest quartile (< 0.03 μg/L). Similarly, blood lead levels were 14% and 24% higher in children who lived with 1 or with 2 or more smokers, respectively, than they were in children living with no smokers. Among participants for whom lead dust information was available, the associations between SHS and blood lead levels were similar before and after adjustment for lead dust concentrations.

CONCLUSIONS

SHS may contribute to increased blood lead levels in US children. Lead dust does not appear to mediate this association, suggesting inhalation as a major pathway of exposure. Eliminating SHS exposure could reduce lead exposure in children.

Socioeconomic patterning in changes in child exposure to secondhand smoke after implementation of smoke-free legislation in Wales

Introduction:

Secondhand smoke (SHS) exposure is higher among children from lower socioeconomic status (SES) households. Legislation banning smoking in public places has been linked with reduced SHS exposure in children. However, socioeconomic patterning in responses to legislation has been little explored.

Methods:

A total of 3,083 children aged 10–11 years, within 75 Welsh primary schools, completed questionnaires either before legislation or 1 year later. Saliva samples were provided by 2,787 of these children for cotinine assay. Regression analyses assessed socioeconomic differences in SHS exposure, and associations of legislation with exposure among children from low, medium, and high SES households. Changes in parental smoking in the home, car-based exposure, and perceived norms were assessed.

Results:

SHS exposure was highest among children from lower SES households. The likelihood of providing a sample containing an undetectable level of cotinine increased significantly after legislation among children from high [relative risk ratio (RRR) = 1.44, 95% CI = 1.04–2.00] and medium SES households (RRR = 1.66, 95% CI = 1.20–2.30), while exposure among children from lower SES households remained unchanged. Parental smoking in the home, car-based SHS exposure, and perceived smoking prevalence were highest among children from low SES households. Parental smoking in the home and children’s estimates of adult smoking prevalence declined only among children from higher SES households.

Conclusions:

Post-legislation reductions in SHS exposure were limited to children from higher SES households. Children from lower SES households continue to have high levels of exposure, particularly in homes and cars, and to perceive that smoking is the norm among adults.

Smoking status in parents of children hospitalized with a diagnosis of respiratory system disorders

The purpose of this study was to investigate the relationship between the statuses of hospitalized children with diagnosis of respiratory tract disease with cigarette use in the parents. This descriptive study was conducted in a Gowerment Hospital in the Sakarya city center in Turkey between June 2007 and June 2008. The inclusion criterion was willingness of families with children hospitalized due to diagnosis of respiratory disease to participate in the study. Data were collected from 345 parents using the questionnaire prepared by researchers. In our study parental smoking was observed in 42.3% of fathers, 7.8% mothers and for 20.9% both parents were smoking. It was found that the hospitalization rates were more than two times higher in children diagnosed with pneumonia and bronchitis and three times higher in children hospitalized for asthma whose parents smoke at home compared to those whose parents are non-smokers. Health care professionals who take care of children need to discuss the harmful effects of smoking and the importance of reducing childhood exposure to secondhand smoke; parents should be educated and encouraged not to smoke.

Secondhand tobacco smoke in bars and restaurants in Santiago, Chile: evaluation of partial smoking ban legislation in public places

Objective

To compare air nicotine concentrations according to the smoking policy selected by bars/restaurants in Santiago, Chile before and after the enactment of partial smoking ban legislation in 2007 (establishments could be smoke free, have segregated (mixed) smoking and non-smoking areas, or allow smoking in all areas).

Methods

The study measured air nicotine concentrations over 7 days to characterise secondhand smoke exposure in 30 bars/restaurants in 2008. Owner/manager interviews and physical inspections were conducted.

Results

Median IQR air nicotine concentrations measured in all venues were 4.38 (0.61–13.62) μg/m³. Air nicotine concentrations were higher in bars (median 7.22, IQR 2.48–15.64 μg/m³) compared to restaurants (1.12, 0.15–9.22 μg/m³). By smoking status, nicotine concentrations were higher in smoking venues (13.46, 5.31–16.87 μg/m³), followed by smoking areas in mixed venues (9.22, 5.09–14.90 μg/m³) and non-smoking areas in mixed venues (0.99, 0.19–1.27 μg/m³). Air nicotine concentrations were markedly lower in smoke-free venues (0.12, 0.11–0.46 μg/m³). After adjustment for differences in volume and ventilation, air nicotine concentrations were 3.2, 35.5 and 56.2 times higher in non-smoking areas in mixed venues, smoking areas in mixed venues and smoking venues, respectively, compared to smoke-free venues.

Conclusions

Exposure to secondhand smoke remains high in bars and restaurants in Santiago, Chile. These findings demonstrate that the partial smoking ban legislation enacted in Chile in 2007 provides no protection to employees working in those venues. Enacting a comprehensive smoke-free legislation which protects all people from exposure to secondhand smoke in all public places and workplaces is urgently needed.

Translating research evidence into practice to reduce health disparities: a social determinants approach

Translating research evidence to reduce health disparities has emerged as a global priority. The 2008 World Health Organization Commission on Social Determinants of Health recently urged that gaps in health attributable to political, social, and economic factors should be closed in a generation. Achieving this goal requires a social determinants approach to create public health systems that translate efficacy documented by research into effectiveness in the community. We review the scope, definitions, and framing of health disparities and explore local, national, and global programs that address specific health disparities. Such efforts translate research evidence into real-world settings and harness collaborative social action for broad-scale, sustainable change.

Determinants of exposure to Environmental Tobacco Smoke (ETS) among non smoking adolescents (aged 11-17 years old) in Greece: results from the 2004-2005 GYTS Study

The aim of the study is to investigate the determinants of exposure to ETS among Greek adolescents aged 11-17 years old. The GYTS questionnaire was completed by 5,179 adolescents. About 3 in 4 responders (76.8%) were exposed to ETS at home, and 38.5% were exposed to ETS outside of the home. Gender, age group, parental and close friends smoking status were significant determinants of adolescent's exposure to ETS. The results of the study could be valuable for the implementation of public health initiatives in Greece aiming to reduce the burden of adolescent's exposure to passive smoking.

Prevalence and Predictors of Environmental Tobacco Smoke Exposure among Adolescents in Cambodia

OBJECTIVE

To estimate the prevalence and predictors of environmental tobacco smoke (ETS) exposure among nonsmoking adolescents in Cambodia.

MATERIALS AND METHODS

Analysis of data from the Global Youth Tobacco Survey (GYTS) conducted in 2003 in Cambodia. Data were analysed to obtain the prevalence of ETS exposure at home and elsewhere by age and gender. Logistic regression analysis was conducted to assess the association between ETS and gender, age, smoking status of parents and friends.

RESULTS

67.1% (64.0, 70.0) males and 67.4% (64.2, 70.5) females reported being exposed to ETS either at home or elsewhere. Adolescents who had one or both smoking parents had a more than three times the odds of ETS exposure at home (OR = 3.71; 95% CI (3.02, 4.57)). Those who had smoking friends were more likely to be exposed to ETS both at home and outside home (OR = 1.74; 95% CI (1.36, 2.24)). The overall proportion of adolescents exposed to ETS outside home was higher than those exposed at home (P < 0.001), suggesting that exposure in public areas was the main form of ETS among adolescents in Cambodia.

CONCLUSIONS

Exposure to ETS is high among adolescent in Cambodia, which indicates an urgent need for specific measures, policies and regulations to protect nonsmoker Cambodian adolescents both within and outside home.

Changes in child exposure to secondhand smoke after implementation of smoke-free legislation in Wales: a repeated cross-sectional study

Background

Smoke-free legislation was introduced in Wales in April 2007. In response to concerns regarding potential displacement of smoking into the home following legislation, this study assessed changes in secondhand smoke (SHS) exposure amongst non-smoking children.

Methods

Approximately 1,750 year 6 (aged 10-11) children from 75 Welsh primary schools were included in cross-sectional surveys immediately pre-legislation and one year later. Participants completed self-report questionnaires and provided saliva samples for cotinine assay. Regression analyses assessed the impact of legislation on children's SHS exposure at the population level, and amongst subgroups defined by parental figures who smoke within the home.

Results

Geometric mean salivary cotinine concentrations were 0.17 ng/ml (95% CI 0.15,0.20) pre-legislation and 0.15 ng/ml (95% CI 0.13,0.17), post-legislation, although this change was not statistically significant. Significant movement was however observed from the middle (0.10-0.50 ng/ml) to lower tertile, though not from the higher end (>0.51 ng/ml) to the middle.

Reported exposure to SHS was greatest within the home. Home-based exposure did not change significantly post-legislation. Reported exposure in cafés or restaurants, buses and trains, and indoor leisure facilities fell significantly.

The proportion of children reporting that parent figures smoked in the home declined (P = 0.03), with children with no parent figures who smoke in the home significantly more likely to provide saliva with cotinine concentrations of <0.10 ng/ml post-legislation.

Amongst children with no parent figures who smoke in the home, the likelihood of 'not knowing' or 'never' being in a place where people were smoking increased post-legislation.

Conclusion

Smoke-free legislation in Wales did not increase SHS exposure in homes of children aged 10-11. Reported SHS exposure in public places fell significantly. The home remained the main source of children's SHS exposure. The legislation was associated with an unexpected reduction in cotinine levels among children with lower SHS exposure pre-legislation. The findings indicate positive rather than harmful effects of legislation on children's SHS exposure, but highlight the need for further action to protect those children most exposed to SHS.

Exposure to and attitudes regarding secondhand smoke among secondary students in Taiwan

The 2003 School Health Act of Taiwan stipulated that school campuses of senior high and below should be smoke free, but data from the Global Youth Tobacco Survey show that the majority of students are exposed to smoke in public and at home. More than 50% of nonsmokers indicated that they had been exposed to secondhand smoke (SHS) in public places, with the exposure rate as high as 90% among smokers. More than 40% of junior and senior high school students were exposed to SHS at home. Support for banning smoking in public places ranged from almost 60% to almost 80%. More than 60% of current smokers and almost 90% of never smokers think that smoke from others is harmful to them. With a clear body of evidence detailing the harmful effects, reduction and eventual elimination of exposure to SHS should be the goal of the tobacco control community.

At the frontier of tobacco control: a brief review of public attitudes toward smoke-free outdoor places

INTRODUCTION

Outdoor smoke-free areas have been adopted increasingly in North America, Britain, Ireland, Australasia, and elsewhere. Their use appears to be one of the frontier areas of tobacco control development. We briefly reviewed the available reports on public attitudes about smoke-free public outdoor areas.

METHODS

We included surveys of the general population or of users of public outdoor locations, reported in English language publications to September 2008.

RESULTS

We identified 16 relevant reports that used surveys from 1988 to 2007. Although the evidence remains limited, this research indicates that, in a number of jurisdictions, the majority of the public supports restricting smoking in various outdoor settings. Support for smoke-free outdoor public places appears to be increasing over time. Among respondents' reasons for support were the following: litter control, establishing positive smoke-free role models for youth, reducing youth opportunities to smoke, and avoiding exposure to secondhand smoke.

DISCUSSION

Given the recent increase in outdoor smoking restrictions in many developed countries and the growing recognition of the importance of reducing smoking role models for children, this area needs further research related to attitudes and policy evaluation. Given the levels of public support, policy makers in some jurisdictions appear to have an opportunity to establish smoke-free outdoor public places, at least in areas frequented by children.

Cigarette smoke, inflammation, and lung injury: a mechanistic perspective

Inflammation is a common feature in the pathogenesis of cigarette smoke-associated diseases. The recruitment of inflammatory cells into the lung following cigarette smoke exposure presents a risk of tissue damage through the release of toxic mediators, including proteolytic enzymes and reactive oxygen species. This review represents a toxicological approach to investigation of cigarette smoke-induced lung injury, with a focus on laboratory studies and an emphasis on inflammatory mechanisms. The studies discussed in this review analyze the role of inflammation and inflammatory mediators in the development of injury. In cases where information relating to cigarette smoke is limited, examples are taken from other models of lung injury applicable to cigarette smoke. The primary aim of the review is to summarize published work so as to permit (1) an evaluation of chronic lung injury and inflammatory responses in animal models, (2) a discussion of inflammatory mediators in the development of chronic injury, and (3) identification of immunological mechanisms of injury. These studies discuss the currently understood roles of cytokines, cell adhesion molecules, and oxidative stress in inflammatory reactions and lung injury. A role for lipocortin 1 (annexin 1), a naturally occurring defense factor against inflammation, is discussed because of the possibility that impaired synthesis and degradation of lipocortin 1 will influence immune responses in animals exposed to cigarette smoke either by augmenting T helper cell Th1 response or by shifting Th1 to Th2 response. While Th1 augmentation will increase the risk for development of emphysema, Th1 to Th2 shift will favor development of asthma.

Neonatal hair nicotine levels and fetal exposure to paternal smoking at home

Exposure to environmental tobacco smoke (ETS) is a major risk to human health, and the home is the greatest single source of ETS for children. The authors investigated fetal exposure to paternal smoking at home during pregnancy. Korean families were included as trios of fathers, mothers, and neonates identified in 2005-2007. Sixty-three trios were finally enrolled in this study after exclusion of those in which the mother was a smoker or was regularly exposed to ETS at places other than the home. Nicotine and cotinine concentrations in hair were measured by using liquid chromatography-tandem mass spectrometry to determine long-term exposure to ETS. The difference between neonatal nicotine concentrations in the smoker and nonsmoker groups was not statistically significant. However, in the indoor-smoker group, neonatal nicotine concentrations were significantly higher than in the outdoor and nonsmoker groups (P < 0.05). Furthermore, neonatal nicotine concentrations in the outdoor-smoker group were not different from those in the nonsmoker group. These findings indicate that paternal smoking inside the home leads to significant fetal and maternal exposure to ETS and may subsequently affect fetal health. Conversely, findings show that paternal smoking outside the home prevents the mother and her fetus from being exposed to ETS.

Smoking behaviors among immigrant Asian Americans: rules for smoke-free homes

BACKGROUND

Higher acculturation is associated with Asian-American smoking prevalence decreasing in men and increasing in women. Asian immigrants in California are significantly more likely than their counterparts in Asia to have quit smoking. Smoke-free environments may mediate this acculturation effect because such environments are not widespread in Asia.

METHODS

In 2006, Asian-American current and former smokers were analyzed using the 2003 California Health Interview Survey. A multivariate logistic regression analysis examined how the interaction between having a smoke-free-home rule and immigrating to the U.S. is associated with status as a former smoker and lighter smoking.

RESULTS

For recent Asian immigrants (<10 years in the U.S.) and longer-term residents (born/>or=10 years in the U.S.), having a smoke-free-home rule was associated with status as a former smoker (OR 14.19, 95% CI=4.46, 45.12; OR 3.25, 95% CI=1.79, 5.90, respectively). This association was stronger for recent immigrants (p=0.02). Having a smoke-free-home rule was associated with lighter smoking only for longer-term residents (OR 5.37, 95% CI=2.79, 10.31).

CONCLUSIONS

For Asian Americans, smoke-free-home rules are associated with status as a former smoker, particularly among recent immigrants, and lighter smoking in long-term residents. Interventions encouraging Asian Americans to adopt smoke-free-home rules should be evaluated.

Secondhand smoke exposure among women and children: evidence from 31 countries

OBJECTIVES

We sought to describe the range of exposure to secondhand smoke (SHS) among women and children living with smokers around the world and generate locally relevant data to motivate the development of tobacco control policies and interventions in developing countries.

METHODS

In 2006, we conducted a cross-sectional exposure survey to measure air nicotine concentrations in households and hair nicotine concentrations among nonsmoking women and children in convenience samples of 40 households in 31 countries.

RESULTS

Median air nicotine concentration was 17 times higher in households with smokers (0.18 mug/m(3)) compared with households without smokers (0.01 mug/m(3)). Air nicotine and hair nicotine concentrations in women and children increased with the number of smokers in the household. The dose-response relationship was steeper among children. Air nicotine concentrations increased an estimated 12.9 times (95% confidence interval=9.4, 17.6) in households allowing smoking inside compared with those prohibiting smoking inside.

CONCLUSIONS

Our results indicate that women and children living with smokers are at increased risk of premature death and disease from exposure to SHS. Interventions to protect women and children from household SHS need to be strengthened.

Smokefree environments in Latin America: on the road to real change?

Latin American countries are experiencing an increasing burden of tobacco-related diseases. Smoke free policies are cost-effective interventions to control both exposure of nonsmokers to the toxic chemicals in secondhand tobacco smoke and to reduce the prevalence of smoking and its consequent morbidity and mortality. The World Health Organization Framework Convention on Tobacco Control has created momentum in Latin America to implement meaningful tobacco control policies. As of August 2007, Uruguay, two provinces and three cities in Argentina, and one state in Venezuela, had passed, regulated, and enforced 100% smokefree legislation. The tobacco industry, working through local subsidiaries, has been the strongest obstacle in achieving this goal and has prevented progress elsewhere in the region. During the 1990s, transnational tobacco companies Philip Morris International and British American Tobacco developed voluntary initiatives ("Courtesy of Choice" and "Environmental Tobacco Smoke Consultancy" programs) to prevent effective smokefree policies. Another important barrier in the region has often been a weak and fragmented local civil society. Opportunities in the region that should be taken into account are a high public support for smokefree environments and increasing capacity building available from international collaboration on tobacco control. Policymakers and tobacco control advocates should prioritize the implementation of smokefree policies in Latin America to protect nonsmokers, reduce smoking prevalence with its economic and disease burden in the region.

"Accommodating" smoke-free policies: tobacco industry's Courtesy of Choice programme in Latin America

OBJECTIVE

To understand the implementation and effects of the Courtesy of Choice programme designed to "accommodate" smokers as an alternative to smoke-free policies developed by Philip Morris International (PMI) and supported by RJ Reynolds (RJR) and British American Tobacco (BAT) since the mid-1990s in Latin America.

METHODS

Analysis of internal tobacco industry documents, BAT "social reports", news reports and tobacco control legislation.

RESULTS

Since the mid-1990s, PMI, BAT and RJR promoted Accommodation Programs to maintain the social acceptability of smoking. As in other parts of the world, multinational tobacco companies partnered with third party allies from the hospitality industry in Latin America. The campaign was extended from the hospitality industry (bars, restaurants and hotels) to other venues such as workplaces and airport lounges. A local public relations agency, as well as a network of engineers and other experts in ventilation systems, was hired to promote the tobacco industry's programme. The most important outcome of these campaigns in several countries was the prevention of meaningful smoke-free policies, both in public places and in workplaces.

CONCLUSIONS

Courtesy of Choice remains an effective public relations campaign to undermine smoke-free policies in Latin America. The tobacco companies' accommodation campaign undermines the implementation of measures to protect people from second-hand smoke called for by the World Health Organization Framework Convention on Tobacco Control, perpetuating the exposure to tobacco smoke in indoor enclosed environments.

Prevalence and correlates of environmental tobacco smoke exposure among adolescents in Mongolia

OBJECTIVE

To estimate the prevalence and identify correlates of environmental tobacco exposure (ETS) among adolescents in Mongolia.

METHODS

A cross-sectional study was carried out in 2003 in Mongolia within the framework of the Global Youth Tobacco Survey. Information was obtained on exposure to Environmental tobacco smoke (ETS) in the home and outside home, parental and peer smoking. Demographic characteristics such as age and sex were also obtained. Data were analyzed to obtain frequencies of characteristics. Logistic regression analysis was conducted to assess the association between ETS and relevant predictor variables.

RESULTS

73.9% (71.6%-76.1%) males and 71.7% (69.7%-73.7%) females reported being exposed to ETS either in the home or elsewhere. The odds of exposure were 5.85 (3.83-8.92) if both parents were smokers, 3.65(3.10-4.30) if only father smoked and 6.54 (3.48-12.32) if only mother smoked. Older adolescents were more likely to be exposed to ETS than younger adolescents. Prevalence of exposure to ETS within the home was similar between males and females but males had a higher prevalence of exposure outside of the home than females (50.7% and 42.4% respectively (p < 0.001). Overall proportion of adolescents exposed to ETS in the home was higher than those exposed outside suggesting that domestic exposure was the main form of ETS among adolescents in Mongolia.

CONCLUSION

Exposure to environmental tobacco smoke is high among school going adolescents in Mongolia. Public health interventions aimed to reduce morbidity from tobacco among adolescents should also accord particular attention toward environmental tobacco smoke.

Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey

OBJECTIVE

To detect any change in exposure to secondhand smoke among primary schoolchildren after implementation of smoke-free legislation in Scotland in March 2006.

DESIGN

Comparison of nationally representative, cross sectional, class based surveys carried out in the same schools before and after legislation.

SETTING

Scotland.

PARTICIPANTS

2559 primary schoolchildren (primary 7; mean age 11.4 years) surveyed in January 2006 (before smoke-free legislation) and 2424 in January 2007 (after legislation).

OUTCOME MEASURES

Salivary cotinine concentrations, reports of parental smoking, and exposure to tobacco smoke in public and private places before and after legislation.

RESULTS

The geometric mean salivary cotinine concentration in non-smoking children fell from 0.36 (95% confidence interval 0.32 to 0.40) ng/ml to 0.22 (0.19 to 0.25) ng/ml after the introduction of smoke-free legislation in Scotland-a 39% reduction. The extent of the fall in cotinine concentration varied according to the number of parent figures in the home who smoked but was statistically significant only among pupils living in households in which neither parent figure smoked (51% fall, from 0.14 (0.13 to 0.16) ng/ml to 0.07 (0.06 to 0.08) ng/ml) and among pupils living in households in which only the father figure smoked (44% fall, from 0.57 (0.47 to 0.70) ng/ml to 0.32 (0.25 to 0.42) ng/ml). Little change occurred in reported exposure to secondhand smoke in pupils' own homes or in cars, but a small decrease in exposure in other people's homes was reported. Pupils reported lower exposure in cafes and restaurants and in public transport after legislation.

CONCLUSIONS

The Scottish smoke-free legislation has reduced exposure to secondhand smoke among young people in Scotland, particularly among groups with lower exposure in the home. We found no evidence of increased secondhand smoke exposure in young people associated with displacement of parental smoking into the home. The Scottish smoke-free legislation has thus had a positive short term impact on young people's health, but further efforts are needed to promote both smoke-free homes and smoking cessation.