Pulmonary effects of active smoking and secondhand smoke exposure among adolescent students in Juárez, Mexico

Sex and Racial/Ethnic Patterns of Tobacco Product Use Among Students at a U.S. University in 2021-2023

Background: Although the prevalence of conventional tobacco product use among U.S. college students has declined, an increasing number of students use various novel tobacco products. Objectives: This study aims to examine up-to-date sex and racial/ethnic patterns of tobacco use among students at a U.S. university in 2021-2023. Methods: Data of 2,732 students at an urban university in the Southeast of the U.S. were collected in 2021-2023 as part of the National College Health Assessment of the American College Health Association. Self-reported past 3-month use of five tobacco products (cigarette, electronic vapor products, water pipe/hookah, smokeless tobacco, and cigars) was dichotomized. We conducted multinomial logistic regression analysis to examine sex (male or female) and racial/ethnic (non-Hispanic White, non-Hispanic Black, Hispanic, or non-Hispanic Other) differences in single and dual/poly (con-current use of two or more tobacco products) tobacco use compared to nonuse, adjusting for age, student status, parent education level, obese status, psychological distress level, and survey year. Results: Male students had higher odds of being dual/poly tobacco user than female students, adjusting for covariates (adjusted odds ratio [AOR] = 2.00, 95% confidence interval [CI] = 1.42, 2.82). Non-Hispanic Black students had lower odds of being single (AOR = 0.43, 95% CI = 0.26, 0.69) and dual/poly (AOR = 0.09, 95% CI = 0.02, 0.37) tobacco user compared to non-Hispanic White students, adjusting for covariates. Conclusions: Considering higher health risk of con-current use of multiple tobacco products, dual/poly tobacco use prevention strategies targeting male and non-Hispanic White students may be considered.

Pulmonary function in children post -SARS-CoV-2 infection: a systematic review and meta-analysis

OBJECTIVE

There are some concerns regarding long-term complications of COVID-19 in children. A systematic review and meta-analysis was performed evaluating the respiratory symptoms and pulmonary function, post-SARS-CoV-2 infection.

METHODS

A systematic search was performed in databases up to 30 March 2023. Studies evaluating respiratory symptoms and pulmonary function after COVID-19 infection in children were selected. The major outcomes were the frequency of respiratory symptoms and the mean of spirometry parameters. A pooled mean with 95% confidence intervals (CIs) was calculated.

RESULTS

A total of 8 articles with 386 patients were included in meta-analysis. Dyspnea, cough, exercise intolerance, and fatigue were the most common symptoms. The meta-mean of forced expiratory volume (FEV1) and forced vital capacity (FVC) was 101.72%, 95% CI= (98.72, 104.73) and 101.31%, 95% CI= (95.44, 107.18) respectively. The meta-mean of FEV1/FVC and Forced expiratory flow at 25 and 75% was 96.16%, 95% CI= (90.47, 101.85) and 105.05%, 95% CI= (101.74, 108.36) respectively. The meta-mean of diffusing capacity for carbon monoxide was 105.30%, 95%CI= (88.12, 122.49). There was no significant difference in spirometry parameters before and after bronchodilator inhalation.

CONCLUSIONS

Despite some clinical respiratory symptoms, meta-results showed no abnormality in pulmonary function in follow-up of children with SARS-CoV-2 infection. Disease severity and asthma background had not confounded this outcome.

Current situation and factors influencing physical fitness among adolescents aged 12 ∼ 15 in Shandong Province, China: A cross-sectional study

Adolescent physical fitness serves not merely as a current barometer of well-being but as a significant prognosticator of future health trajectories. Amidst the tumult of socioeconomic metamorphoses and pronounced lifestyle transitions enveloping China-mirroring global trends-the imperative to elucidate the present landscape of adolescent physical fitness intensifies. Moreover, discerning the myriad determinants underpinning it becomes paramount. In this context, our research endeavored to meticulously delineate the physical fitness milieu of adolescents residing in Shandong Province, systematically unpacking the multifarious influencers thereof. The insights garnered herein furnish an empirical foundation, primed to guide the sculpting of calibrated interventions, targeting the enhancement of health in this pivotal population cohort. In an extensive evaluative survey conducted in 2023 concerning the physical fitness of Shandong's student populace, a cohort of 33,211 adolescents aged 12 to 15 years was delineated utilizing a stratified random cluster sampling technique. This exercise meticulously quantified the physical fitness indices across diverse gender, age, and household registration classifications, subsequently computing the concomitant qualified rates. Employing multivariable logistic regression analysis, this investigation delved into the determinants modulating the adolescents' physical fitness qualified rate. For 2023, the aggregate fitness qualified rate stood at 91.94 % for the adolescents aged 12 ∼ 15 in Shandong Province. Gender-wise, female adolescents registered a qualified rate of 92.25 %, marginally eclipsing their male peers at 91.63 % (P < 0.05). An age-related trend in qualified rates was discernible, with marked variations across different age bands (P < 0.05): 91.37 % for 12-year-olds, 91.79 % for 13-year-olds, 91.81 % for 14-year-olds, and a zenith of 92.87 % for 15-year-olds. A geographical dichotomy emerged wherein rural adolescents distinctly outperformed their urban counterparts, notching up a 92.28 % qualified rate versus 91.64 % in urban settings (P < 0.05). The multivariable logistic regression analysis showed that after adjusting for gender, age, and household registration characteristics, adolescents had a lower odds of failing the physical fitness tests whose parents both liked physical exercises, whose parents supported children's participation in physical exercise, who participated in physical exercise sessions 3 ∼ 5 times per week or more than 5 times per week, who exercised for 0.5 ∼ 1 h each time or more than 1 h each time, who engaged in moderate intensity physical exercise, who slept 6 ∼ 8 h per day or more than 8 h per day, who consumed breakfast 3 ∼ 6 times per week or daily. On the other hand, adolescents had a higher odds of failing the physical fitness tests who always exposed to passive smoking, who spent 1 ∼ 3 h on screen per day or more than 3 h on screen per day, who spent more than 3 h doing homework per day, who consumed fast food 2 ∼ 3 times per week or more than 3 times per week. The physical fitness trajectory of adolescents residing within Shandong Province is tethered to a mosaic of determinants. This underscores the imperative for a synergistic strategy, harmonizing parental, scholastic, and societal vectors, to cultivate the salubrious maturation of this pivotal cohort.

Secondhand and thirdhand smoke: a review on chemical contents, exposure routes, and protective strategies

Secondhand smoke (SHS: a mixture of sidestream and mainstream smoke) and thirdhand smoke (THS: made up of the pollutants that settle indoors after smoking in closed environments) are a significant public health concern. SHS and THS contain various chemicals which can be released into the air or settle on surfaces. At present, the hazards of SHS and THS are not as well documented. In this review, we describe the chemical contents of THS and SHS, exposure routes, vulnerable groups, health effects, and protective strategies. The literature search was conducted for published papers on September 2022 in Scopus, Web of Science, PubMed, and Google Scholar databases. This review could provide a comprehensive understanding of the chemical contents of THS and SHS, exposure routes, vulnerable groups, health effects, protective strategies, and future researches on environmental tobacco smoke.

Proportion and trend in the age of cigarette smoking initiation among adolescent smoking experiencers aged 13-15 years in 148 countries/territories

Background

Limited studies have assessed the recent proportion and trend in the age of cigarette smoking initiation among adolescent smoking experiencers globally. We aimed to assess the recent global proportion, associated factors and the long-term trend of the initiated age of cigarette smoking among adolescent smoking experiencers.

Methods

We used data from the most recent Global Youth Tobacco Survey on 99,728 adolescent smoking experiencers aged 13-15 years from 144 countries/territories (hereafter "countries") that had conducted at least one survey in 2010-20, to assess the recent proportion of the age of cigarette smoking initiation. Additionally, we used data from 148 countries that had conducted ≥2 surveys between 1999 and 2020, to assess the trend in the average age of cigarette smoking initiation.

Results

Among 99,728 adolescent smoking experiencers aged 13-15 years, the proportions of initiating cigarette smoking when aged ≤ 9 years, 10-11 years, 12-13 years, and 14-15 years were 22.8% (95%CI 21.3-24.4), 18.8% (17.3-20.2), 36.8% (34.5-39.2), and 21.6% (19.9-23.2), respectively. The average age of cigarette smoking initiation decreased by 0.44 years per 5 calendar-years averagely in 17 (11.5%) of 148 countries, was unchanged in 95 (64.2%) countries, and increased by 0.38 years per 5 calendar-years averagely in 36 (24.3%) countries. Higher income category (reference group: low-income countries; lower-middle-income: OR = 0.44, 95%CI = 0.28-0.70; upper-middle-income: OR = 0.56, 95%CI = 0.38-0.83; high-income: OR = 0.35, 95%CI = 0.22-0.53) and Framework Convention on Tobacco Control ratification (OR = 0.51, 95%CI = 0.42-0.63) were inversely associated with early cigarette smoking initiation.

Conclusions

A substantial proportion (~80%) of adolescent smoking experiencers aged 13-15 years initiated cigarette smoking before 13 years, and the average age of cigarette smoking initiation decreased or remained unchanged in nearly three quarters of the countries surveyed. These findings emphasize that national governments around the world need to strengthen intervention strategies and measures aimed at children and adolescents to prevent smoking up-take.

Assessing secondhand and thirdhand tobacco smoke exposure in Canadian infants using questionnaires, biomarkers, and machine learning

BACKGROUND

As smoking prevalence has decreased in Canada, particularly during pregnancy and around children, and technological improvements have lowered detection limits, the use of traditional tobacco smoke biomarkers in infant populations requires re-evaluation.

OBJECTIVE

We evaluated concentrations of urinary nicotine biomarkers, cotinine and trans-3'-hydroxycotinine (3HC), and questionnaire responses. We used machine learning and prediction modeling to understand sources of tobacco smoke exposure for infants from the CHILD Cohort Study.

METHODS

Multivariable linear regression models, chosen through a combination of conceptual and data-driven strategies including random forest regression, assessed the ability of questionnaires to predict variation in urinary cotinine and 3HC concentrations of 2017 3-month-old infants.

RESULTS

Although only 2% of mothers reported smoking prior to and throughout their pregnancy, cotinine and 3HC were detected in 76 and 89% of the infants' urine (n = 2017). Questionnaire-based models explained 31 and 41% of the variance in cotinine and 3HC levels, respectively. Observed concentrations suggest 0.25 and 0.50 ng/mL as cut-points in cotinine and 3HC to characterize SHS exposure. This cut-point suggests that 23.5% of infants had moderate or regular smoke exposure.

SIGNIFICANCE

Though most people make efforts to reduce exposure to their infants, parents do not appear to consider the pervasiveness and persistence of secondhand and thirdhand smoke. More than half of the variation in urinary cotinine and 3HC in infants could not be predicted with modeling. The pervasiveness of thirdhand smoke, the potential for dermal and oral routes of nicotine exposure, along with changes in public perceptions of smoking exposure and risk warrant further exploration.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

The Association between Secondhand Smoke and Stress, Depression, and Suicidal Ideation in Adolescents

Background: Secondhand smoke (SHS) is an important risk factor for adolescents’ health. Several studies have reported that SHS is as dangerous as active smoking. Therefore, this study aimed to investigate the association between exposure to SHS and mental health, including stress, depression, and suicidal ideation, in adolescents. Methods: Using raw data from the 2018 14th Korea Youth Risk Behavior Web-Based Survey, we analyzed the effects of sociodemographic characteristics on stress, depression, suicidal ideation in 51,500 students, including 85.8% of all sampled students (n = 60,040), after excluding students with a history of smoking, and then we performed logistic regression analysis to determine the level of exposure to SHS and its impact on stress, depression, and suicidal ideation. Results: The increased level of exposure to SHS was positively associated with stress, depression, and suicidal ideation. Furthermore, stress, depression, and suicidal ideation increased as the level of SHS increased, after adjusting for variables such as age, gender, education level of the father and mother, school achievement, economic status, inhabitation, and drinking. Conclusions: This study demonstrates that SHS is positively associated with risk of mental health problems, including stress, depression, and suicidal ideation, in adolescents. Further research and policy strategies and systems to prevent and manage exposure to SHS in adolescents are required.

Early diagnosis of COPD: myth or a true perspective

The early stages of COPD have recently become a hot topic as many new risk factors have been proposed, but substantial knowledge gaps remain in explaining the natural history of the disease. If we are to modify the outcomes of COPD, early detection needs to play a critical role. However, we need to sort out the barriers to early detection and have a better understanding of the definition of COPD and its diagnosis and therapeutic strategies to identify and treat patients with COPD before structural changes progress. In this review, we aim to clarify the differences between early COPD, mild COPD and early detection of COPD, with an emphasis on the clinical burden and how different outcomes (quality of life, exacerbation, cost and mortality) are modified depending on which definition is used. We will summarise the evidence for the new multidimensional diagnostic approaches to detecting early pathophysiologic changes that potentially allow for future studies on COPD management strategies to halt or prevent disease development.

FEF25-75% Values in Patients with Normal Lung Function Can Predict the Development of Chronic Obstructive Pulmonary Disease

Purpose

The forced mid-expiratory flow (FEF_25-75%) value is a potentially sensitive marker of obstructive peripheral airflow. We aimed to assess whether FEF_25-75% can be an early predictor of chronic obstructive pulmonary disease (COPD).

Patients and Methods

Between July 1, 2007 and June 31, 2009, we identified 3624 patients who underwent a pulmonary function test (PFT) in Gangnam Severance Hospital. We selected 307 patients aged over 40 years without COPD who had normal PFT results at baseline and who had follow-up PFT records more than 1 year later. A FEF_25-75% z-score less than −0.8435 was considered low. We defined COPD as a forced expiratory volume in one second/forced vital capacity value of less than 0.7 before July 31, 2019.

Results

Among 307 patients, 91 (29.6%) had low FEF_25-75% at baseline. After 10 years, the incidence rate of COPD in the low FEF_25-75% group was significantly higher than that in the normal FEF_25-75% group (41.8% vs 7.4%; P-value<0.001). The Cox proportional hazard model showed that age (hazard ratio [HR] 1.09; P-value<0.001), smoking status (occasional smoker HR, 4.59; P-value<0.001 and long-term smoker HR, 2.18; P-value=0.023), and low FEF_25-75% (HR, 3.31; P-value<0.001) were predictive factors for the development of COPD.

Conclusion

The FEF_25-75% value in patients with normal lung function is a useful predictor for the development of COPD. We should carefully monitor patients who present with low FEF_25-75% values, even if they have normal lung function.

Spirometric indices of early airflow impairment in individuals at risk of developing COPD: Spirometry beyond FEV1/FVC

Spirometry is the current gold standard for diagnosing and monitoring the progression of Chronic Obstructive Pulmonary Disease (COPD). However, many current and former smokers who do not meet established spirometric criteria for the diagnosis of this disease have symptoms and clinical courses similar to those with diagnosed COPD. Large longitudinal observational studies following individuals at risk of developing COPD offer us additional insight into spirometric patterns of disease development and progression. Analysis of forced expiratory maneuver changes over time may allow us to better understand early changes predictive of progressive disease. This review discusses the theoretical ability of spirometry to capture fine pathophysiologic changes in early airway disease, highlights the shortcomings of current diagnostic criteria, and reviews existing evidence for spirometric measures which may be used to better detect early airflow impairment.

Effects of Smoking and Physical Activity on the Pulmonary Function of Young University Nursing Students in Cáceres (Spain)

Background:

The simultaneous effect of physical activity (PA) and smoking on pulmonary function in young people remains unclear.

Propose:

The aim of this study was to determine the influence of smoking and PA on pulmonary function in young university students in Cáceres, Spain.

Methods:

A sample of 120 young nursing students was studied (60 smokers and 60 nonsmokers). All subjects underwent spirometry with a COPD-6 portable device, and their level of PA was quantified using the International Physical Activity Questionnaire. The influence of PA and smoking on pulmonary function was determined by comparing hypotheses.

Results:

Significant differences were observed between smokers and nonsmokers in terms of percent forced expiratory volume in 1 second, percent forced expiratory volume in 6 seconds, lung age, and the difference between lung age and chronological age (LA–CA) in those who practiced mild PA. In the subjects who performed moderate and vigorous PA, these differences were not noted. In the intragroup analysis, significant differences were observed in smokers in terms of percent forced expiratory volume in 1 second, percent forced expiratory volume in 6 seconds, lung age, and LA–CA; however, in the control group, differences were only observed in terms of lung age and LA–CA. These findings were confirmed in the multivariate analysis.

Conclusions/Implications for Practice:

Our findings confirmed a deterioration in pulmonary function in smokers who did not perform moderate or vigorous PA. The level of PA performed was positively related to pulmonary function in smokers, whereas in nonsmokers, improvements were only significant in LA–CA.

Lung Function Decline after 24 Weeks of Moxa Smoke Exposure in Rats

OBJECTIVE

Moxibustion is a complementary therapy that has been used for thousands of years. Burning moxa produces smoke and inhalable particulates. Recent research has indicated that smoke inhalation is associated with negative lung effects. This study aimed to evaluate the lung function of rats after moxa smoke exposure at different concentrations.

METHODS

Using a randomised block experiment design, 28 male Wistar rats were randomly divided into three moxa smoke groups (opacity) (n=7): low concentration (27.45 mg/m3), medium concentration (168.76 mg/m3), and high concentration (384.67 mg/m3) with a control group. Rats in the moxa smoke groups were exposed in an automatic dynamic exposure device separately with different concentrations for 20 min/d, 6d/week, for 24 weeks. Rats in the control group were exposed in the same space without moxa smoke. Lung function was evaluated by the AniRes 2005 animal pulmonary function analysing system. Statistical Product and Service Solutions 18.0 software was used for data analysis.

RESULTS

In the study, no deaths were found in any group. There was no difference of forced expiratory volume in one second/forced vital capacity percentage (FEV1/FVC%), inspiratory resistance (Ri), and expiratory resistance (Re) among each group after 24 weeks of moxa smoke exposure (P>0.05). Compared with the control group (0.33 ml/cmH20), dynamic compliance (Cdyn) was reduced in the medium (0.29 ml/cmH20) and high (0.25 ml/cmH20) concentration groups (P<0.05); however, Cdyn in the low concentration group (0.29 ml/cmH20) was not significantly affected.

CONCLUSION

Moxa smoke exposure at low concentrations did not affect the rat's lung function. Moxa smoke of medium and high concentrations destroyed the lung function represented by decreased Cdyn. However, moxa smoke of low concentrations (27.45 mg/m3) is much higher than the concentration in a regular moxibustion clinic (3.54 mg/m3). Moxa smoke at higher concentrations might destroy the lung function. The safety evaluation of moxa smoke requires further research.

Tobacco smoke exposure in early life and adolescence in relation to lung function

Maternal smoking during pregnancy is associated with impaired lung function among young children, but less is known about long-term effects and the impact of adolescents' own smoking. We investigated the influence of maternal smoking during pregnancy, secondhand smoke exposure and adolescent smoking on lung function at age 16 years.

The BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology) birth cohort collected information on participants' tobacco smoke exposure through repeated questionnaires, and measured saliva cotinine concentrations at age 16 years. Participants performed spirometry and impulse oscillometry (IOS) at age 16 years (n=2295).

Exposure to maternal smoking during pregnancy was associated with reduced forced expiratory volume in 1 s (FEV₁)/forced vital capacity (FVC) ratio of −1.1% (95% CI −2.0 to −0.2%). IOS demonstrated greater resistance at 5–20 Hz (R_5–20) in participants exposed to maternal smoking during pregnancy. Adolescents who smoked had reduced FEV₁/FVC ratios of −0.9% (95% CI −1.8 to −0.1%) and increased resistance of 6.5 Pa·L^–1·s (95% CI 0.7 to 12.2 Pa·L^–1·s) in R_5–20. Comparable associations for FEV₁/FVC ratio were observed for cotinine concentrations, using ≥12 ng·mL⁻¹ as a cut-off for adolescent smoking.

Maternal smoking during pregnancy was associated with lower FEV₁/FVC ratios and increased airway resistance. In addition, adolescent smoking appears to be associated with reduced FEV₁/FVC ratios and increased peripheral airway resistance.

Maternal smoking in utero and teenage smoking are associated with indices of airway obstruction at age 16 yearshttp://ow.ly/NwF030jFS2W

Behavior of Lung Health Parameters among Smokers and Secondhand Smokers

A cross-sectional study on a pool of undergraduate smokers and nonsmokers (n = 200) was randomly selected from Notre Dame University, Lebanon. The study design is based on a questionnaire about the students' smoking record exposure, cotinine saliva levels, and ventilatory lung function parameters. Despite the nonsmoking policies that have been recently established by universities, diffused smoking stations in proximity to classes and offices still exist, at least in the MENA region. Such an environment still imposes a remarkable effect on certain lung health parameters of nonsmokers exhibiting similar exhaled air per second (FEV1) to smokers with a P value = 0.558 and normal flow of air (TV) with a P value = 0.153. However, the maximum amount of air held in the lungs remained different with respect to sex and smoking status. These results imply a poor performance of nonsmokers mimicking partially the lung health parameters of smokers. It remains a pressing issue to increase awareness concerning the debilitating effects of secondhand smoking.

Review of biomarkers to assess the effects of switching from cigarettes to modified risk tobacco products

Context: One approach to reducing the harm caused by cigarette smoking, at both individual and population level, is to develop, assess and commercialize modified risk alternatives that adult smokers can switch to. Studies to demonstrate the exposure and risk reduction potential of such products generally involve the measuring of biomarkers, of both exposure and effect, sampled in various biological matrices.Objective: In this review, we detail the pros and cons for using several biomarkers as indicators of effects of changing from conventional cigarettes to modified risk products.Materials and methods: English language publications between 2008 and 2017 were retrieved from PubMed using the same search criteria for each of the 25 assessed biomarkers. Nine exclusion criteria were applied to exclude non-relevant publications.Results: A total of 8876 articles were retrieved (of which 7476 were excluded according to the exclusion criteria). The literature indicates that not all assessed biomarkers return to baseline levels following smoking cessation during the study periods but that nine had potential for use in medium to long-term studies.Discussion and conclusion: In clinical studies, it is important to choose biomarkers that show the biological effect of cessation within the duration of the study.