Second-hand smoke exposure in Canada: prevalence, risk factors, and association with respiratory and cardiovascular diseases. Can Respir J. 2008;15:263-269. [PMID: 18716689 DOI: 10.1155/2008/912354]

Effects of the grade/price and thickness of cigarette on the PM2.5 concentration of smoke

In an attempt to promote sales of high-grade/price and slim cigarettes with lower tar and nicotine content, the State Tobacco Monopoly Administration (STMA) also known as the China National Tobacco Corporation (CNTC), whose monopoly controls all aspects of tobacco production, marketing, and distribution in China, have advertised them as safe cigarettes that cause less tobacco smoke pollution (TSP). However, cigarette smoke contains thousands of harmful components, and the effects of only tar and nicotine cannot be used to represent TSP. This study aimed to evaluate the impact of cigarette grade/price and size on TSP by measuring PM2.5 concentrations for three different grades/prices and two sizes of popular cigarettes in China. The results showed that cigarette grade/price did not significantly affect PM2.5 levels in regular (R) or slim (S) cigarettes in either sidestream or mainstream smoke. However, cigarette size had a significant effect on PM2.5 levels, with R cigarette PM2.5 being 116% higher than S cigarette PM2.5 in sidestream smoke. In mainstream smoke, this difference decreased to 31%, although R-cigarette PM2.5 levels remained higher. While S cigarette PM2.5 levels were lower than those of R cigarettes, this did not necessarily mean that S cigarettes were less harmful. The harmfulness of smoke is not only manifested in PM2.5 but also in other particulate matter such as PM10 and PM1.0. At the same time, it is also affected by smoking habits. Therefore, further experiments are required to evaluate the potential harmfulness of S cigarettes.

Second-hand smoking, hypertension and cardiovascular risk: findings from Peru

Background

Second-hand smoking has not been detailedly studied in Peru, where smoking is prohibited in all indoor workplaces, public places, and public transportation. Second-hand smoke exposure may occur at home or any other places. This study aimed to estimate the prevalence of second-hand smoking and assess its association with hypertension and cardiovascular risk in Peru.

Materials and methods

Secondary analysis of a nationally-representative population-based survey including individuals aged 18–59 years. There were two outcomes: hypertension and 10-year cardiovascular risk using the Framingham and the 2019 World Health Organization (WHO) risk scores. The exposure was self-reported second-hand smoking during the 7 days before the survey. The association between second-hand smoking and hypertension was quantified with Poisson models reporting prevalence ratio (PR) and 95% confidence interval (95% CI); the association between second-hand smoking and cardiovascular risk was quantified with linear regressions reporting coefficients and their 95% CI.

Results

Data from 897 individuals, mean age: 38.2 (SD: 11.8) years, and 499 (55.7%) females, were analyzed, with 8.7% subjects reporting second-hand smoking at home and 8.3% at work or any other place. Thus, 144 (15.5%; 95% CI: 12.8%-18.6%) subjects reported any second-hand smoking. In multivariable model second-hand smoking was associated with hypertension (PR = 2.42; 95% CI: 1.25–4.67), and with 1.2% higher Framingham cardiovascular risk, and 0.2% higher 2019 WHO risk score.

Conclusions

There is an association between second-hand smoking and hypertension as well as with cardiovascular risk, and 15% of adults reported second-hand smoke exposure overall with half of them exposed at home. There is a need to guarantee smoking-free places to reduce cardiovascular risk.

Socioeconomic inequalities in secondhand smoke exposure before, during and after implementation of Quebec's 2015 'An Act to Bolster Tobacco Control'

BACKGROUND

To better understand whether tobacco control policies are associated with changes in secondhand smoke (SHS) exposure across socioeconomic groups, we monitored differences in socioeconomic inequalities in SHS exposure in households and private vehicles among youth and adults before, during and after adoption of Quebec's 2015 An Act to Bolster Tobacco Control.

METHODS

Using data from the Canadian Community Health Survey, we examined the prevalence of daily exposure to SHS in households and private vehicles among youth (ages 12 to 17) and adults (ages 18+) across levels of household education and income (separately) in 2013/2014, 2015/2016 and 2017/2018. We tested differences in the magnitude of differences in outcomes over time across education and income categories using logistic models with interaction terms, controlling for age and sex.

RESULTS

We detected inequalities in SHS exposure outcomes at each time point, most markedly at home among youth (OR of SHS exposure among youth living in the 20% poorest households vs the 20% richest=4.9, 95% CI 2.7 to 6.2). There were decreases in SHS exposure in homes and cars in each education/income group over time. The magnitude of inequalities in SHS exposure in homes and cars, however, did not change during this period.

CONCLUSIONS

The persistence of socioeconomic inequalities in SHS exposure despite implementation of new tobacco control laws represents an increasingly worrisome public health challenge, particularly among youth. Policymakers should prioritise the reduction of socioeconomic inequalities in SHS exposure and consider the specific needs of socioeconomically disadvantaged populations in the design of future legislation.

Urban-rural differences in related factors of second-hand smoke exposure: a cross-sectional study of adult non-smokers in Northeast China

BACKGROUND

this study aims to examine the different factors associated with exposure to second-hand smoke (SHS) between urban and rural areas and to facilitate a reduction in SHS exposure in Northeast China.

METHODS

a multistage stratified random cluster sampling design was used in this 2012 cross-sectional survey in Jilin Province, Northeast China. A total of 13 056 non-smokers were included in this study. The Rao-Scott χ2 test, multiple regression analysis and discriminant function analysis were used.

RESULTS

the SHS prevalence among adult non-smokers was 60.2% in urban areas and 61.8% in rural areas. In urban areas, males were more likely to be exposed to SHS, while in rural areas, females were more likely to be exposed to SHS (P < 0.05). Increasing age was a protective factor against SHS exposure both in urban and rural areas (P < 0.05). Tobacco-relevant knowledge was positively associated with SHS exposure. Among urban non-smokers, high education level and engagement in manual work were risk factors for SHS exposure, and retired subjects were less likely to be exposed to SHS (P < 0.01).

CONCLUSIONS

non-smokers from urban and rural areas differ in the factors associated with SHS exposure, and urban-rural differentials, especially with regard to gender, should be considered in tobacco control.

Inadequate Knowledge, Attitude and Practices about Second-Hand Smoke among Non-Smoking Pregnant Women in Urban Vietnam: The Need for Health Literacy Reinforcement

The rate of exposure to second-hand smoke (SHS) is relatively high in several countries, including Vietnam, and health issues related to SHS have worsened in recent years, especially for pregnant women and their infants. Enhancement of knowledge, attitude, and practice (KAP) scores of pregnant women in Vietnam could raise practical interventions to protect their health and reduce complications of SHS. A cross-sectional study of 432 pregnant women who came to the Obstetrics Department of Bach Mai Hospital, Hanoi, Vietnam for antenatal care was conducted in 2016 to collect information about their KAP related to SHS. Composite mean scores from survey questions assessing their KAP were calculated on a 10-point scale, finding mean scores of 4.19, 7.45, and 4.30, respectively. Higher scores indicated better knowledge, attitude, and practice. Generalized linear models identified that age, occupation, living place, and sources of information were associated with SHS-related KAP. Findings from this study indicate that suitable programs related to SHS should be implemented to improve and reinforce health literacy to both mothers and smokers to reduce the harmfulness of smoking on women and their infants' health.

Associations of Smoke-Free Policies in Restaurants, Bars, and Workplaces With Blood Pressure Changes in the CARDIA Study

Background

Smoke‐free legislation has been associated with reductions in secondhand smoke exposure and cardiovascular disease. However, it remains unknown whether smoke‐free policies are associated with reductions in blood pressure (BP).

Methods and Results

Longitudinal data from 2606 nonsmoking adult participants of the CARDIA (Coronary Artery Risk Development in Young Adults) Study (1995–2011) were linked to state, county, and local‐level 100% smoke‐free policies in bars, restaurants, and/or nonhospitality workplaces based on participants’ census tract of residence. Mixed‐effects models estimated associations of policies with BP and hypertension trajectories over 15 years of follow‐up. Fixed‐effects regression estimated associations of smoke‐free policies with within‐person changes in systolic and diastolic BP and hypertension. Models were adjusted for sociodemographic, health‐related, and policy/geographic covariates. Smoke‐free policies were associated with between‐person differences and within‐person changes in systolic BP. Participants living in areas with smoke‐free policies had lower systolic BP on average at the end of follow‐up compared with those in areas without policies (adjusted predicted mean differences [in mm Hg]: restaurant: −1.14 [95% confidence interval: −2.15, −0.12]; bar: −1.52 [−2.48, −0.57]; workplace: −1.41 [−2.32, −0.50]). Smoke‐free policies in restaurants and bars were associated with mean within‐person reductions in systolic BP of −0.85 (−1.61, −0.09) and −1.08 (−1.82, −0.34), respectively. Only restaurant policies were associated with a significant within‐person reduction in diastolic BP, of −0.58 (−1.15, −0.01).

Conclusions

While the magnitude of associations was small at the individual level, results suggest a potential mechanism through which reductions in secondhand smoke because of smoke‐free policies may improve population‐level cardiovascular health.

See Editorial by https://10.1161/JAHA.118.011120

Exposure to second-hand smoke in the context of tobacco policy changes in Estonia, 1996-2016

BACKGROUND

Exposure to second-hand smoke (SHS) is a preventable cause of disease and disability that can effectively be tackled by tobacco legislation. The aim of the study was to analyse the trends of SHS exposure and its sociodemographic patterning during 1996-2016 in the context of tobacco policy changes in Estonia.

METHODS

Nationally representative data from biennial health surveys in 1996-2016 (n = 14 629) were used to present prevalence ratios for SHS exposure among non-smokers in Estonia. Joinpoint regression and multivariable logistic regression were used to study the sociodemographic and socio-economic differences in SHS exposure and its changes during the period.

RESULTS

Exposure to SHS among non-smoking men and women has declined 3.6 and 5 times, respectively, during 1996-2016. While the rate of change was constant among men throughout the period, the decline in SHS exposure among women became significantly faster after 2006 compared with the previous period. However, 15.6% [95% confidence interval (CI) 13.1-18.3%] of men and 8.8% (95% CI 7.1-10.6%) of women were still exposed to SHS in 2016 with higher odds found for younger age groups, non-Estonians and those with lower education and income.

CONCLUSIONS

The consistently declining prevalence of SHS exposure among non-smoking population can be at least partially attributed to implementation of tobacco legislations in 2000s. However, the existing sociodemographic and socio-economic differences in SHS exposure require further attention as those in more vulnerable positions are also more exposed to SHS-related health harms.

Exposure to second hand smoke and 10-year (2002-2012) incidence of cardiovascular disease in never smokers: The ATTICA cohort study

BACKGROUND

Despite WHO Framework Convention of Tobacco Control (FCTC) adoption, effective implementation of national smoking bans remains pending in several countries. This study quantified the association of second hand smoke (SHS) exposure and 10-year cardiovascular disease (CVD) among never smokers in such settings.

METHODS

In 2001-2002, a sample of 1514 males and 1528 females (range: 18-89 years old) were randomly selected in Greece. Frequency and duration of SHS exposure (i.e. exposure extending >30 min/day) within the home and/or workplace were assessed by interview. Following a 10-year follow-up period (2002-2012), incidence of non-fatal and fatal CVD (ICD-10) was evaluated among n = 2020 participants. The analytic study sample consisted of all never smokers (n = 910).

RESULTS

Despite national smoking ban implementation (2009), 44.6% (n = 406) of never smokers reported SHS exposure. While SHS exposed never smokers exhibited a more favorable profile of CVD-related risk factors at baseline, they subsequently developed similar 10-year CVD incidence rates, at a younger mean age (p = 0.001), than their non-exposed counterparts. Following adjustment for several lifestyle and clinical factors, SHS exposed never smokers exhibited a two-fold elevated 10-year CVD risk (adj. HR: 2.04, 95% CI: 1.43-2.92), particularly among women (adj. HR: 2.45, 95% CI: 1.45-4.06). SHS exposure accounted for 32% excess Population Attributable Risk (PAR) for 10-year CVD events in never smokers, with highest rates (PAR: 52%) being among those exposed in the workplace.

CONCLUSION

The prevention of SHS associated CVD and related healthcare costs mandates additional strategies for securing the effective implementation of comprehensive WHO FCTC based national smoking bans.

Awareness of health effects of exposure to secondhand smoke from cigarettes: A cross-sectional study of never-smoked adult primary care patients in Eastern Nigeria

Background:

Cigarette smoking whether actively or passively is a growing public health problem. Despite the wealth of information on the hazards of active cigarette smoking, awareness of the health effects of passive smoking on human population is often neglected in Nigeria.

Aim:

The study was aimed at describing the awareness of health effects of exposure to secondhand smoke from cigarettes among never-smoked adult primary care patients in Eastern Nigeria.

Materials and Methods:

A hospital-based study carried out on a cross-section of 500 adult patients in a primary care clinic in Nigeria. Data were collected using pretested, structured, and interviewer-administered questionnaire. Exposure to secondhand smoke was defined as exposure to cigarette smoke in a never-smoked adult patient in the previous 1 year. Data were analyzed using Statistical Package for Social Sciences version 21 for the calculation of percentages for categorical variables. Bivariate analysis involving Chi-square test was used to test for significance of association between categorical variables at P < 0.05.

Results:

The age of the respondents ranged from 18 to 74 years, with a mean age of 36 ± 12.4 years. There were 180 (36.0%) males with 320 (64%) females, with a sex ratio of 1.8. Awareness of general health effects of secondhand smoke on adults, children, and pregnant women was 95.6%, 92.8%, and 65.2%, respectively. The most common specific health effects the respondents were aware for adults, children, and obstetric population were lung cancer (95.6%), precipitation of asthmatic condition (92.8%), and delivery of small babies (65.2%), respectively. The predominant source of awareness of information was radio (93.6%). Awareness of general health effects of exposure to secondhand smoke on adults (P = 0.041), children (P = 0.031), and obstetrics population (P = 0.02) was significantly associated with exposure status.

Conclusion:

The most common health effects of secondhand smoke the respondents had highest awareness were lung cancer, precipitation of asthmatic attacks, and delivery of small babies in adults, children, and obstetric population, respectively. Awareness of general health effects on adults, children, and obstetrics population was significantly associated with exposure status. The current level of awareness should be improved while effort should be intensified to address identified areas of low level of awareness.

Prevalence and associated risk factors of chronic bronchitis in First Nations people

Background

Inadequate housing, low family income, household smoking, personal smoking status, and poor schooling are some of the conditions that have been significantly associated with the prevalence and incidence of chronic bronchitis. The aim of the current study was to determine the prevalence of chronic bronchitis (CB) and associated risk factors among First Nations people.

Methods

An interviewer-administered survey was conducted as part of the First Nations Lung Health Project in 2012 and 2013 with 874 individuals from 406 households in two First Nations communities located in the province of Saskatchewan, Canada. The questionnaire collected information on individual and contextual determinants of health and a history of ever diagnosed with CB (outcome variable) from the two communities participating in the First Nations Lung Health Project. Clustering effect within households was adjusted using Generalized Estimating Equations.

Results

The prevalence of CB was 8.9% and 6.8% among residents (18 years and older) of community A and community B respectively and was not significantly different. CB prevalence was positively associated with odour or musty smell of mildew/mould in the house [OR_adj (95% CI) = 2.33 (1.21, 4.50)], allergy to house dust [3.49 (1.75, 6.97)], an air conditioner in home [2.33 (1.18, 4.24)], and increasing age [0.99 (0.33, 2.95), 4.26 (1.74, 10.41), 6.08 (2.58, 14.33)]. An interaction exposure to environmental tobacco smoke in the house*body mass index showed that exposure to household smoke increased the risk of CB for overweight and obese participants (borderline). Some of the variables of interest were not significantly associated with the prevalence of CB in multivariable analysis, possibly due to small numbers.

Conclusions

Our results suggest that significant determinants of CB were: increasing age; odour or musty smell of mildew/mould in the house; allergy to house dust; and, body mass index. Modifiable risk factors identified were: (i) community level-housing conditions (such as mould or mildew in home, exposure to environmental tobacco smoke in house); and, (ii) policy level-remediation of mould, and obesity.

Trial registration

Not applicable.

Environmental tobacco smoke exposure and heart disease: A systematic review

AIM

To review evidence relating passive smoking to heart disease risk in never smokers.

METHODS

Epidemiological studies were identified providing estimates of relative risk (RR) of ischaemic heart disease and 95%CI for never smokers for various indices of exposure to environmental tobacco smoke (ETS). “Never smokers” could include those with a minimal smoking experience. The database set up included the RRs and other study details. Unadjusted and confounder-adjusted RRs were entered, derived where necessary using standard methods. The fixed-effect and random-effects meta-analyses conducted for each exposure index included tests for heterogeneity and publication bias. For the main index (ever smoking by the spouse or nearest equivalent, and preferring adjusted to unadjusted data), analyses investigated variation in the RR by sex, continent, period of publication, number of cases, study design, extent of confounder adjustment, availability of dose-response results and biomarker data, use of proxy respondents, definitions of exposure and of never smoker, and aspects of disease definition. Sensitivity analyses were also run, preferring current to ever smoking, or unadjusted to adjusted estimates, or excluding certain studies.

RESULTS

Fifty-eight studies were identified, 20 in North America, 19 in Europe, 11 in Asia, seven in other countries, and one in 52 countries. Twenty-six were prospective, 22 case-control and 10 cross-sectional. Thirteen included 100 cases or fewer, and 11 more than 1000. For the main index, 75 heterogeneous (P < 0.001) RR estimates gave a combined random-effects RR of 1.18 (95%CI: 1.12-1.24), which was little affected by preferring unadjusted to adjusted RRs, or RRs for current ETS exposure to those for ever exposure. Estimates for each level of each factor considered consistently exceeded 1.00. However, univariate analyses revealed significant (P < 0.001) variation for some factors. Thus RRs were lower for males, and in North American, larger and prospective studies, and also where the RR was for spousal smoking, fatal cases, or specifically for IHD. For case-control studies RRs were lower if hospital/diseased controls were used. RRs were higher when diagnosis was based on medical data rather than death certificates or self-report, and where the never smoker definition allowed subjects to smoke products other than cigarettes or have a limited smoking history. The association with spousal smoking specifically (1.06, 1.01-1.12, n = 34) was less clear in analyses restricted to married subjects (1.03, 0.99-1.07, n = 23). In stepwise regression analyses only those associations with source of diagnosis, study size, and whether the spouse was the index, were independently predictive (at P < 0.05) of heart disease risk. A significant association was also evident with household exposure (1.19, 1.13-1.25, n = 37). For those 23 studies providing dose-response results for spouse or household exposure, 11 showed a significant (P < 0.05) positive trend including the unexposed group, and two excluding it. Based on fewer studies, a positive, but non-significant (P > 0.05) association was found for workplace exposure (RR = 1.08, 95%CI: 0.99-1.19), childhood exposure (1.12, 0.95-1.31), and biomarker based exposure indices (1.15, 0.94-1.40). However, there was a significant association with total exposure (1.23, 1.12-1.35). Some significant positive dose-response trends were also seen for these exposure indices, particularly total exposure, with no significant negative trends seen. The evidence suffers from various weaknesses and biases. Publication bias may explain the large RR (1.66, 1.30-2.11) for the main exposure index for smaller studies (1-99 cases), while recall bias may explain the higher RRs seen in case-control and cross-sectional than in prospective studies. Some bias may also derive from including occasional smokers among the “never smokers”, and from misreporting smoking status. Errors in determining ETS exposure, and failing to update exposure data in long term prospective studies, also contribute to the uncertainty. The tendency for RRs to increase as more factors are adjusted for, argues against the association being due to uncontrolled confounding.

CONCLUSION

The increased risk and dose-response for various exposure indices suggests ETS slightly increases heart disease risk. However heterogeneity, study limitations and possible biases preclude definitive conclusions.

Support for smoke-free multi-unit housing policies among racially and ethnically diverse, low-income seniors in South Florida

Previous studies have gauged support for implementing smoke-free multi-unit housing (MUH) policies in the United States, but none have specifically examined attitudes among racially and ethnically diverse elders living in low-income MUH. We surveyed a convenience sample of elders 62 years of age and older (n = 807) across 24 low-income housing properties in Broward County, Florida in order to assess residents' smoking behaviors, exposure to second-hand smoke, and support for smoke-free policies. The study sample was ethnically and racially diverse with Hispanics comprising more than 61 % of the population, and 22 % identifying as Black or other races. Although close to 22 % of the sample were former smokers, only 9 % of residents reported being current smokers. The majority of residents surveyed supported no-smoking policies: 75 % support no-smoking policies for individual units; 77 % supported no-smoking policies in common areas; and, 68 % supported no-smoking policies in outdoor areas. Over 29 % of residents surveyed reported being exposed to secondhand smoke entering their units from elsewhere in their building. Residents who reported having a home smoking rule were more than twice as likely to support an indoor policy compared to residents who allowed smoking anywhere in their home (OR = 2.36; 95%CI 1.25-4.43; p ≤ 0.01), and nonsmoking residents were nearly three times as likely to support an indoor policy compared to smokers (OR = 2.89; 95%CI 1.44-5.79; p ≤ 0.01). Support for an indoor policy was not modified by age, gender, ethnicity or race. . This study demonstrates that elders living in low-income MUH properties overwhelmingly supported the implementation of smoke-free policies.

An examination of exposure and avoidance behavior related to second-hand cigarette smoke among adolescent girls in Canada

BACKGROUND

Although rates of tobacco use and exposure to second-hand smoke (SHS) are declining in Canada, SHS exposure among non-smoking adolescents remains high. This study aimed to describe frequency, locations, and avoidance behavior related to SHS exposure among adolescent girls in British Columbia, Canada.

METHODS

Data were analyzed from 841 adolescent girls aged 13 to 15 years old who completed an internet-delivered survey as part of a cohort study examining SHS exposure and substance use. Measures assessed demographics, smoking behavior and intentions, frequency and locations of SHS exposure, and avoidance behavior related to SHS.

RESULTS

Excluding their own smoking, 27% of girls reported exposure at least once a week and an additional 17% reported daily or almost daily exposure over the past month. Among girls who reported daily or almost daily exposure, the locations of most frequent levels of high exposure were in the home, at or near school, inside a vehicle, and outdoor public places. Avoidance behavior related to SHS exposure significantly differed by overall SHS exposure in the past month.

CONCLUSIONS

Despite historically low smoking rates, many adolescent girls continue to report regular SHS exposure in multiple locations in British Columbia. Girls with the most frequent exposure were significantly less likely to report habitual avoidance behavior related to SHS compared to those less frequently exposed. This study elucidates settings of high SHS exposure among adolescent girls that could be targeted in future policy interventions. Additionally, future interventions could target adolescent girls who are frequently exposed to SHS and report infrequent avoidance behavior around their SHS exposure.

Correlates of COPD and chronic bronchitis in nonsmokers: data from a cross-sectional study

Purpose

Our objective was to assess the prevalence of chronic bronchitis and chronic obstructive pulmonary disease (COPD) and their correlates among a Lebanese nonsmoker group.

Material and methods

A cross-sectional study was conducted between October 2009 and September 2010, using a multistage cluster sample throughout Lebanon including Lebanese residents aged 40 years and above with no exclusion criteria. Pre- and postbronchodilator spirometry measurements were performed and carbon monoxide level was measured in exhaled air. COPD was defined and classified according to the Global Initiative for Chronic Obstructive Lung Disease guidelines or according to the lower limit of normal (forced expiratory volume in 1 second/forced vital capacity postbronchodilator < 5th percentile of the healthy population having the same age and sex). Chronic bronchitis was defined by the declaration of morning cough and expectorations for more than 3 months a year over more than 2 years in individuals with normal spirometry.

Results

Out of 2201 individuals, 732 were never-smokers: 25 (3.4%) of them had COPD, and 86 (11.75%) fulfilled the definition of chronic bronchitis. Correlates of COPD included a childhood respiratory disease, house heated by diesel, and older age. On the other hand, correlates of chronic bronchitis included childhood respiratory diseases, living in southern Lebanon versus other regions, heating home by gas, older age, number of smokers at work, and lower height.

Conclusion

A substantial percentage of the nonsmoking population may exhibit chronic bronchitis or COPD. The significant correlates mentioned above should be taken into consideration in order to reduce the risk of developing such chronic and debilitating respiratory diseases.

Cigarette Smoking and Lung Cancer: Pediatric Roots

A vast array of data suggests that early age of smoking onset enhances the risk for development of lung cancer in adulthood. Initiation of smoking at a young age may influence the development of lung cancer because of its effect on duration of smoking. Early onset of smoking also may serve as an independent risk factor. It may increase the likelihood that smoking occurs during a critical period of development that enhances susceptibility to the adverse effects of cancer causing agents in cigarette smoke, thereby facilitating the initiation of the carcinogenic process. While evidence for the latter hypothesis derives from a variety of sources, definitive proof has proven elusive. Whether or not early age of smoking serves as an independent risk factor for lung carcinogenesis, the consensus of the public health community is that prevention of smoking onset at a young age and early cessation are keys to stemming the current lung cancer pandemic. Population approaches to tobacco prevention and control, such as measures contained in the World Health Organization Framework Convention Tobacco Control Treaty, offer the best opportunity, on the scale needed, to create a smoke-free world and bring an end to the pandemic of tobacco-related disease.

Epidemiology of chronic obstructive pulmonary disease: a literature review

The aim of this study is to quantify the burden of chronic obstructive pulmonary disease (COPD) – incidence, prevalence, and mortality – and identify trends in Australia, Canada, France, Germany, Italy, Japan, The Netherlands, Spain, Sweden, the United Kingdom, and the United States of America. A structured literature search was performed (January 2000 to September 2010) of PubMed and EMBASE, identifying English-language articles reporting COPD prevalence, incidence, or mortality. Of 2838 articles identified, 299 full-text articles were reviewed, and data were extracted from 133 publications. Prevalence data were extracted from 80 articles, incidence data from 15 articles, and mortality data from 58 articles. Prevalence ranged from 0.2%–37%, but varied widely across countries and populations, and by COPD diagnosis and classification methods. Prevalence and incidence were greatest in men and those aged 75 years and older. Mortality ranged from 3–111 deaths per 100,000 population. Mortality increased in the last 30–40 years; more recently, mortality decreased in men in several countries, while increasing or stabilizing in women. Although COPD mortality increased over time, rates declined more recently, likely indicating improvements in COPD management. In many countries, COPD mortality has increased in women but decreased in men. This may be explained by differences in smoking patterns and a greater vulnerability in women to the adverse effects of smoking.

Awareness of risk factors among persons at risk for lung cancer, chronic obstructive pulmonary disease and sleep apnea: a Canadian population-based study

OBJECTIVE

To assess awareness among persons at risk for lung cancer, chronic obstructive pulmonary disease (COPD) and sleep apnea regarding symptoms and risk factors of the disease, and their attitudes regarding the disease and toward those who are affected.

METHODS

A quantitative hybrid telephone and Internet survey of a representative population of Canadian adults at risk for at least one of the three diseases was conducted. To measure the awareness and attitudes of First Nations, Inuit and Métis people to these diseases, a proportionate number were also surveyed.&nbsp;

RESULTS

A total of 3626 individuals were contacted. Of these, 3036 (84%) were eligible to participate. Of those at risk for lung cancer and COPD, 65% and 69%, respectively, were due to tobacco smoke exposure. Among those at risk, 72% believed that they were informed about lung cancer compared with 36% for COPD and 56% for sleep apnea. Most respondents were knowledgeable about the common symptoms of lung cancer, COPD and sleep apnea, but were less aware of the impact lifestyle choices could have on the development of these disorders and the availability of treatment. Most of the participants (77%) believed that smoking was an addiction rather than a habit (19%). There were no significant differences in the awareness of risk factors, symptoms and attitudes toward all three lung diseases between First Nations, Inuit and Métis people and the general population.

CONCLUSIONS

Canadians are reasonably aware of risk factors and symptoms for lung cancer and sleep apnea. However, there is poor awareness of COPD as a disease entity. There is a lack of appreciation for the impact lifestyle choices and changes can have on lung diseases.