Role of active and environmental tobacco smoke on susceptibility to osteoporosis in women undergoing dual-X-ray absorptiometry

PURPOSE

Current smoking is a risk factor for osteoporosis (Op), but few data are available regarding the passive smoke impact on Op susceptibility. This cross-sectional study aimed to evaluate the association between the smoking habits and Op in community-dwelling women undergoing dual-energy X-ray absorptiometry (DXA).

METHODS

On 01/06/2018, general practitioners from "COMEGEN" Medical Cooperative, Naples, Italy, selected the medical records from the last 10 years of women who had a measurement of bone mineral density performed and simultaneously completed a questionnaire about their smoking behaviour and their cohabiters'. The binary logistic regression analysis was used to estimate the role of passive smoke on the risk of Op, adjusting for age and body mass index (BMI).

RESULTS

Among 10,616 subjects, 3942 were currently smokers [CS; mean age 69.4 ± 10.4 years; BMI 27.0 ± 4.9 kg/m2], 873 were passive smokers (PS; mean age 67.8 ± 11.6 years; BMI 27.0 ± 4.9 kg/m2) and 5781 were never smokers (NS; mean age 67.8 ± 11.6 years; body mass index (BMI) 27.0 ± 4.9 kg/m2). Of all, 8562 women (mean age 70.3 ± 10.2 yrs; BMI 27.0 ± 4.9 kg/m2) received the Op diagnosis. PS showed an increased Op risk compared to NS [odds ratio (OR) 1.38 (1.14-1.67)] and comparable to CS [OR 1.02 (0.84-1.24)].

CONCLUSION

The study results demonstrate an association between passive smoke and Op in community-dwelling women already presenting with susceptibility to Op according to Italian essential assistance levels, suggesting that passive and active smoke are equivalent Op risk factors in women.

Environmental tobacco smoke exposure exaggerates bleomycin-induced collagen overexpression during pulmonary fibrogenesis

Environmental tobacco smoke (ETS) is known to cause lung inflammatory and injurious responses. Smoke exposure is associated with the pathobiology related to lung fibrosis, whereas the mechanism that ETS exposure augments pulmonary fibrogenesis is unclear. We hypothesized that ETS exposure could exacerbate fibrotic responses via collagen dynamic dysregulation and complement activation. C57BL/6J and p16-3MR mice were exposed to ETS followed by bleomycin administration. ETS exposure exacerbated bleomycin-induced collagen and lysyl oxidase overexpression in the fibrotic lesion. ETS exposure also led to augmented bleomycin-induced upregulation of C3 and C3AR, which are pro-fibrotic markers. Moreover, overexpressed collagens and C3 levels were highly significant in males than females. The old mice (17 months old) were exposed to ETS and treated with bleomycin to induce fibrogenesis which is considered as an aging-associated disease. Fewer gene and protein dysregulations trends were identified between ETS exposure with the bleomycin group and the bleomycin alone group in old mice. Based on our findings, we suggested that ETS exposure increases the risk of developing severe lung fibrotic responses via collagen overexpression and lysyl oxidase-mediated collagen stabilization in the fibrotic lesion, and potentially affected the complement system activation induced by bleomycin. Further, male mice were more susceptible than females during fibrogenesis exacerbation. Thus ETS and bleomycin induced lung fibrotic changes via collagen-lysyl oxidase in an age-dependent mechanism.

Systemic inflammation mediates the association between environmental tobacco smoke and depressive symptoms: A cross-sectional study of NHANES 2009-2018

BACKGROUND

Depression is associated with both environmental tobacco smoke (ETS) and inflammation. However, whether systemic inflammation mediates the ETS-depression relationship is unclear.

METHODS

We analyzed 19,612 participants from the 2009-2018 National Health and Nutrition Examination Survey (representing approximately 206,284,711 USA individuals), utilizing data of depressive symptoms (assessed by Patient Health Questionnaire-9), blood cotinine level (an ETS biomarker), dietary inflammatory index (DII, assessed by 24-h dietary recall) and inflammation, represented by immune-inflammation index (SII) and systemic inflammation response index (SIRI).

RESULTS

Weighted multivariable logistic regression showed that a higher blood cotinine level is significantly associated with a higher depressive symptoms risk (OR = 1.79, 1.35-2.38). After adjusting for covariates, the effect in smokers (OR = 1.220, 95 % CI: 1.140-1.309) is larger than that in non-smokers (OR = 1.150, 95 % CI: 1.009-1.318). Compared to the lowest level, depressive symptoms risks in participants with the highest level of SII, SIRI and DII are 19 % (OR = 1.19, 1.05-1.35), 15 % (OR = 1.15, 1.01-1.31) and 88 % (OR = 1.88, 1.48-2.39) higher, respectively. Weighted linear regression demonstrated positive correlations of SII (β = 0.004, 0.001-0.006), SIRI (β = 0.009, 0.005-0.012) and DII (β = 0.213, 0.187-0.240) with blood cotinine level. Restricted cubic splines model showed a linear dose-response relationship between blood cotinine and depressive symptoms (Pnon-linear = 0.410), with decreasing risk for lower DII. And SII and SIRI respectively mediate 0.21 % and 0.1 % of the association between blood cotinine and depressive symptoms.

LIMITATION

Cross-sectional design, and lack of medication data for depression.

CONCLUSIONS

Positive association of ETS (blood cotinine) with depressive symptoms risk is partly mediated by systemic inflammation, and anti-inflammatory diet could be beneficial.

Association between cigarette smoke exposure and urinary bladder cancer in Scottish terriers in a cohort study

Canine urothelial carcinoma (UC) initially responds favorably to treatment, but is ultimately lethal in most cases. Research to identify modifiable risk factors to prevent the cancer is essential. The high breed-associated risk for UC, e.g. 20-fold higher in Scottish terriers, can facilitate this research. The objective was to identify environmental and host factors associated with UC in a cohort of Scottish terriers. Information was obtained through dog owner questionnaires for 120 Scottish terriers ≥ 6 years old participating in a bladder cancer screening study, with comparisons made between dogs that did or did not develop UC during the 3 years of screening. Univariable models were constructed, and variables with P < 0.20 were included when building the multivariable model, and then removed using a backward stepwise procedure. P < 0.05 was considered statistically significant. Urine cotinine concentrations were measured by liquid chromatography-mass spectrometry to further investigate potential cigarette smoke exposure. Biopsy-confirmed UC which was found in 32 of 120 dogs, was significantly associated with the dogs living in a household with cigarette smokers (odds ratio [OR], 6.34; 95 % confidence intervals [CI], 1.16-34.69; P = 0.033), living within a mile of a marsh or wetland (OR, 21.23; 95 % CI, 3.64-123.69; P = 0.001), and history of previous bladder infections (OR, 3.87; 95 % CI, 1.0-14.98; P = 0.050). UC was diagnosed in 18 of 51 dogs (35.3 %) with quantifiable cotinine concentrations, and six of 40 dogs (15.0 %) without quantifiable cotinine concentrations in their urine (P = 0.0165). In conclusion, the main modifiable risk factor for UC in this cohort of dogs was exposure to second-hand tobacco smoke.

Organic toxicants and emerging contaminants in hospital interiors before and during the SARS-CoV2 pandemic: alkanes and PAHs

Indoor pollution and deposition dust (DD), in particular, are acquiring concern, due to long exposure time and importance of intake by humans through contact and ingestion. Hospitals look a special category of sites, owing to peculiar contaminants affecting them and to presence of people prone to adverse effects induced by toxicants. Four in-field campaigns aimed at understanding the chemical composition of DD were performed in five Italian hospitals. Measurements were performed before (autumn 2019), during (spring 2021), and after (winter 2022) the peak of SARS-CoV2 and when restrictions caused by pandemic were revoked (winter 2023). Parallel measurements were made outdoors (2022), as well as in a university and a dwelling. Targeted contaminants were n-alkanes and polycyclic aromatic hydrocarbons (PAHs), while iso- and anteiso-alkanes were analyzed to assess the impact of tobacco smoking. Total n-alkanes ranged from 3.9 ± 2.3 to 20.5 ± 4.2 mg/g, with higher percentages of short chain homologs in 2019. PAHs ranged from 0.24 ± 0.22 to 0.83 ± 0.50 mg/g, with light congeners (≤ 228 a.m.u.) always exceeding the heavy ones (≥ 252 a.m.u.). According to carbon preference indexes, alkanes originated overall from anthropogenic sources. Microorganisms resulted to affect a hospital, and tobacco smoke accounted for ~ 4-20‰ of DD mass. As for PAH sources, the diagnostic concentration ratios suggested the concourse of biological matter burning and vehicle emission. Benzo[a]pyrene equivalent carcinogenic and mutagenic potencies of depositions at hospitals ranged ~ 9-39 μg/g and ~ 15-76 μg/g, respectively, which seems of concern for health. DD composition in hospitals was different from that outside the premises, as well as that found at university and at dwelling.

Association between parental smoking and child exposure to environmental tobacco smoke in Israel

BACKGROUND

Environmental tobacco smoke (ETS) exposure in children can cause delayed lung development and lifelong cardiovascular damage. The aim of this study was to measure ETS exposure in children in Israel in 2020-2021 using urinary cotinine (UC) measurements and to assess correlates of ETS exposure, including parental smoking.

METHODS

In the framework of the National Human Biomonitoring Program, spot urine samples and questionnaire data were collected from 166 children aged 4-12 years, during the years 2020-2021. We collected urine samples in 233 adults, 69 of whom were parents of children included in the study. Parents of participating children were asked about parental smoking, child's exposure to ETS and smoking policy at home. Cotinine and creatinine were measured in urine. Creatinine-adjusted and unadjusted urine cotinine (UC) geometric means were calculated. Associations between potential correlates and UC concentrations were analyzed in univariate and multivariate analyses. For 69 child-parent pairs, correlation between child and parental UC was analyzed.

RESULTS

Based on urinary cotinine measurement, 65.2% of children of smokers are exposed to ETS, compared to 20.7% of children in non-smoking families. Greater numbers of smokers living in the home (beta = 1.27, p < 0.01), and low maternal education (beta = - 2.32, p < 0.01) were associated with higher levels of UC in a multivariate analysis. Spearman correlations showed a positive moderate correlation between UC in 69 child-parent pairs (r = 0.52, p < 0.01).

CONCLUSIONS

In order to reduce child exposure to ETS, smoking parents should be urgently targeted for smoking cessation and smoke-free home interventions. Further interventions are needed to protect all children from ETS.

Environmental tobacco smoke and children's health: a bibliometric and altmetric analysis of 100 most cited articles

BACKGROUND

Exposure to environmental tobacco smoke (ETS) is arguably the most ubiquitous and hazardous, even at very low levels, starting in early life. The objective of this study was to describe the state of research and future trends on ETS exposure and Children's Health (CH) topics with bibliometrics and altmetrics.

METHODS

An electronic search was performed in Scopus database on January 31, 2023. Consensus was arrived on 100 most-cited articles by two reviewers. These papers were then cross matched with citations harvested from Web of Science (WoS) and Google Scholar. Altmetric Attention Score (AAS) and Dimension counts were also collected. Analysis and network visualization of authors, countries, and keywords were generated using VOSviewer software.

RESULTS

Among a total of 1107 articles published on ETS and CH, the 100 top-cited articles appeared in 54 journals, with Pediatrics (n = 12) contributing a maximum number of articles. The time period between 2000 and 2009 accounted for 44% of all publications. With respect to the research design employed across these studies, cross-sectional design took precedence over others accounting for approximately 40%. Predominantly, articles focused on childhood asthma; however, current research trends have shifted towards emerging fields such as children's oral health and DNA methylation. Twitter, policy documents, and news outlets were the main platforms where outputs were discussed. The AAS was not associated with journal impact factor or access type. Weak correlations were observed between AAS and citation count in Scopus, WoS, and Google Scholar (r = 0.17 to 0.27) while a positive association existed between dimension count and the number of citations across all three databases (r = 0.84 to 0.98).

CONCLUSION

This study demonstrates the evolution, digital dissemination and research hotspots in the field of ETS and CH, predicting the possible future research directions. High-quality studies with more specific exposure classification are warranted to better understand the relationship between ETS and CH.

Association of environmental tobacco smoke exposure with chronic constipation: a nationwide survey (NHANES 2005-2010)

Environmental tobacco smoke (ETS) exposure has been proven to induce digestive diseases such as hepatic steatosis, cirrhosis, and gastrointestinal cancer, yet little is known about the link between ETS exposure and constipation. This study aimed to investigate the impact of ETS exposure on the risk of chronic constipation in adults aged 20 years or older. This is a cross-sectional study based on population. A total number of 7705 participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 were included. Cotinine, an alkaloid found in tobacco, serves as a reliable and precise biomarker for measuring exposure to ETS. Hence, the categorization of exposure to ETS was conducted based on serum cotinine levels, resulting in four distinct categories. The association between ETS exposure and the risk of constipation was assessed using multivariable restricted cubic spline and logistic regression with odds ratio (OR) and 95% confidence interval (CI). The weighted prevalence of constipation in this study was estimated to be 7.51% based on stool consistency, or 3.11% based on stool frequency. The fully adjusted models indicated a positive correlation between exposure to ETS and constipation as measured by stool frequency, among adults with poor dietary quality (OR (95% CI): moderate exposure: 2.49 (1.05, 5.94); high exposure: 2.36(1.13, 4.95), P for trend = 0.03), while no significant difference was observed in the subgroup with a higher healthy eating index. Furthermore, the log10-transformed serum cotinine level exhibited a non-linear inverted U-shaped association with constipation in individuals with poor dietary quality (P overall = 0.0207, P non-linear = 0.0427). Conversely, a J-shaped non-linear relationship was observed in the subgroup with a higher healthy eating index (P overall = 0.0028, P non-linear = 0.0036). Our results show that ETS exposure appears to be positively associated with stool frequency-related chronic constipation in adults with poor dietary quality.

Environmental tobacco smoke exposure is associated with increased levels of metals in children's saliva

BACKGROUND

Exposure to environmental tobacco smoke (ETS) has been associated with detectable levels of cotinine (a nicotine metabolite) in children's saliva. However, tobacco smoke also contains toxic and essential trace metals, including chromium (Cr), copper (Cu), lead (Pb), manganese (Mn), nickel (Ni) and zinc (Zn).

OBJECTIVE

The current study examines whether there is a relationship between ETS exposure, as gauged by salivary cotinine, and salivary levels of these metals in a subset (n = 238) of children from the Family Life Project.

METHODS

Using inductively-coupled-plasma optical emission spectrophotometry, we measured levels of metals in saliva from children at ~90 months of age. Salivary cotinine was measured using a commercial immunoassay.

RESULTS

We found that Cr, Cu, Mn, and Zn were detected in most samples (85-99%) with lower levels of detection for Pb and Ni (9.3% and 13.9% respectively). There were no significant differences in any of the metal concentrations between males and females, nor were levels associated with body mass index, although significant differences in salivary Cr and Mn by race, state and income-to-needs ratio were observed. Children with cotinine levels >1 ng/ml had higher levels of Zn (b = 0.401, 95% CI: 0.183 to 0.619; p = 0.0003) and Cu (b = 0.655, 95% CI: 0.206 to 1.104; p = 0.004) compared to children with levels <1 ng/ml, after controlling for multiple confounders, including sex, race, BMI and income-to-needs ratio. Further, we show that children whose cotinine levels were >1 μg/L were more likely to have detectable levels of Pb in their saliva (b = 1.40, 95% CI: 0.424 to 2.459; p = 0.006) compared to children with cotinine levels <1 ng/ml, also considering confounders.

IMPACT STATEMENT

This is the first study to demonstrate significant associations between salivary cotinine and salivary levels of Cu, Zn and Pb, suggesting that environmental tobacco smoke exposure my be one source of increased children's exposure to heavy metals. This study also demonstrates that saliva samples can be used to measure heavy metal exposure, and thus serve as a non-invasive tool for assessing a broader range of risk indicators.

Association of exposure to environmental vanadium and manganese with lung function among young children: A population-based study

Exposure to environmental metals has been associated with health outcomes including respiratory health. Little is known about the impact of exposure to environmental metals on lung function among young children in general population. This study aimed to investigate the associations of exposure to metals with lung function among young children in a population-based cohort. A total of 1488 children aged 5-8 years attended a follow-up visit as part of the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort. We measured urinary samples of vanadium (median: 1.21 ng/mL; interquartile range (IQR): 0.73-1.98), manganese (median: 0.23 ng/mL; IQR: 0.13-0.47), arsenic (median: 40.51 ng/mL; IQR: 21.66-70.49), nickel (median: 1.09 ng/mL; IQR: 0.31-3.60), and cadmium (median: 0.26 ng/mL; IQR: 0.11-0.43) and performed lung function tests. Urinary vanadium concentrations were inversely associated with FVC (β coefficient for the highest quartile versus the other quartiles: -33.40, p = 0.001), FEV1 (β: -41.31, p < 0.001), FEV1/FVC ratio (β: -1.00, p = 0.009), PEF (β: -92.12, p = 0.004), and FEF25-75 (β: -82.85, p < 0.001), after adjusting for relevant confounders. Urinary manganese concentrations were inversely associated with FVC (β: -26.60, p = 0.007), FEV1 (β: -31.62, p = 0.001), PEF (β: -84.86, p = 0.009), and FEF25-75 (β: -69.21, p = 0.002). Stratification analyses found inverse associations of urinary vanadium and manganese concentrations with lung function parameters predominantly among children exposed to environmental tobacco smoke. We did not find significant associations of urinary arsenic, nickel, and cadmium concentrations with lung function parameters. In conclusion, this study adds new evidence showing inverse associations of vanadium and manganese exposure with lung function among young children in the general population. Children with environmental tobacco smoke exposure are particularly vulnerable to adverse impact of vanadium and manganese exposure on lung function.

Gender differences in the association between biomarkers of environmental smoke exposure and developmental disorders in children and adolescents

Effects of environmental tobacco smoke (ETS) exposure on children and adolescent health outcomes have been attracted more and more attention. In the present study, we seek to examine the gender-specific difference association of environmental smoke exposure biomarkers and developmental disorders in children and adolescents aged 6-15 years. US nationally representative sample collected from the National Health and Nutrition Examination Survey (NHANES) 2007-2014 was enrolled (N = 4428). Developmental disorders (DDs) are defined as a positive answer to the question, "Does your child receive special education or early intervention services?" Serum cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) were utilized as acute and chronic exposure biomarkers of ETS, respectively. Participants with serum cotinine >0.015 ng/mL were considered as with acute ETS exposure, and participants with creatinine-adjusted NNAL >0.0006 ng/mL were considered as with chronic ETS exposure. A survey logistic regression model was used to estimate the association between ETS exposure biomarkers and DDs. Additive interaction was utilized to examine the interaction of gender and biomarkers of ETS. Overall, approximately 9% of children were defined as DDs, and 65% of children had serum cotinine and urinary NNAL levels above the limit of detection. In the adjusted models, the association of ETS exposure biomarkers with DDs was only observed in girls. Girls with low cotinine levels and high urinary NNAL levels had 2.074 (95% CI: 1.012-4.247) and 1.851 (95% CI: 1.049-3.265) times higher odds of being DDs than those without ETS exposure, respectively. However, the effects of boys and NNAL exposure on DDs have additively interacted. Our findings first provided strong evidence for gender differences in the association between two tobacco metabolites and DDs in children, disclosing the public health implications and economic burdens of environmental tobacco smoke exposure.

Association of exposure to environmental tobacco smoke at home and risk of mortality among US never smokers by race/ethnicity, education, and income

Environmental tobacco smoke (ETS) increases the risk of mortality among nonsmokers. Yet, few studies have examined this association among racial/ethnic minorities or among people with less education or income. We assessed self-reported ETS exposure at home among never smoking participants (n = 110,945) of the 1991-2010 National Health Interview Surveys. Deaths through 2015 were identified by the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality were estimated using Cox proportional hazards regression models with age as the underlying time metric and adjusted for sex, race/ethnicity, education, household income, body mass index, region of residence, and survey year. We further stratified all-cause mortality analyses by race/ethnicity, household income, and education. Relative to no ETS at home, every day exposure was associated with higher risk of all-cause mortality (HR = 1.33, 95%CI: 1.23, 1.45), with similar HRs observed across strata of education and income. HRs were similar among non-Hispanic Black (HR = 1.28, 95%CI: 1.08, 1.53) and non-Hispanic White adults (HR = 1.34, 95%CI: 1.21, 1.48) although somewhat higher among Hispanic adults (HR = 1.65, 95%CI: 1.29, 2.10; P for pairwise comparison = 0.04). ETS exposure at home is an important contributor to mortality across strata of race/ethnicity, education, and income in the US.

Investigation of exposure biomarkers in human plasma following differing levels of tobacco-specific N-nitrosamines and nicotine in cigarette smoke

Tobacco-specific N-nitrosamines (TSNAs) are strong carcinogens widely found in tobacco products, environmental tobacco smoke, lake, and wastewater. The main objective of this study was to investigate the effects of cigarette smoke with different yields of TSNAs (NNK, NNN, NAT, NAB) and nicotine on the levels of biomarkers of exposure in smokers' plasma. Three hundred healthy volunteers were recruited comprising 60 smokers of each of 3 mg, 8 mg and 10 mg ISO tar yield cigarettes and 60 smokers who smoked 10 mg, 8 mg, and 3 mg for 14 days sequentially and 60 non-smokers. All study participants were male, aged from 21 to 45 years old, and were recruited from a same unit in Hebei, China. We measured the levels of NNAL, NAT, NNN, NAB and cotinine in plasma from 240 smokers and 60 non-smokers using a novel method established by online two-dimensional solid phase extraction-liquid chromatography-tandem mass spectrometry. The results showed that NNAL, NAT, NNN, NAB and cotinine in the plasma of smokers smoking cigarette with low TSNAs and nicotine were lower than that with high TSNAs and nicotine. When smokers switched from higher to lower TSNA yields of cigarettes, their plasma NNAL, NAT, NNN, NAB levels significantly decreased. The plasma concentrations of NNAL were significantly correlated with those of cotinine, NNN, NAT and NAB for smokers (p < 0.001). Similarly, the plasma concentrations of cotinine were significantly correlated with those of NNN, NAT and NAB for smokers (p < 0.001). The plasma NNAL, NAT, NNN, NAB and cotinine levels for smokers were significantly higher than those for non-smokers. These findings suggested that the total NNAL, NNN, NAT, NAB and cotinine in plasma were valid and reliable biomarkers for human exposure to TSNAs and nicotine.

Knowledge about the Harmful Effects of Environmental Tobacco Smoke, Perceptions toward Initiation of Smoking and Factors Influencing Smoking in Adolescents: A Cross-sectional Study

Background

The main hope of a nation lies in the proper education of its adolescents because the youths of today are the leaders of tomorrow. About 15% of children of ages 13-15 years are ingesting tobacco in certain forms and are getting addicted to tobacco. Hence, tobacco has become a burden in our society. Similarly, environmental tobacco smoking (ETS) is more dangerous than smoking and is common among young adolescents.

Aim

This study is aimed to explore the knowledge about the hazards of ETS and the factors which are responsible for adolescents to initiate tobacco smoking among parents visiting the pediatric dental clinic.

Materials and methods

A cross-sectional survey on the knowledge about the harmful effects of ETS and factors influencing the initiation of tobacco use among adolescents was assessed using a self-administered questionnaire. A sample size of 400 parents of adolescents aged between 10 and 16 years visiting the pediatric clinics was included in the study; data thus obtained was subjected to statistical analysis.

Results

The effect of ETS in increasing the risk of cancer was known to be 64.4%. But the effect on premature babies was least known by 37% of the parent population, which is statistically significant. About 14% of parents perceive that children initiate smoking to experiment or relax, which is statistically significant.

Conclusion

Parents have very little knowledge regarding the effects of ETS on children. They can be counseled regarding types of smoking and smokeless tobacco products, health hazards, the deleterious health effects of ETS, and passive smoking, particularly in children with respiratory diseases.

How to cite this article

Thimmegowda U, Kattimani S, Krishnamurthy NH. Knowledge about the Harmful Effects of Environmental Tobacco Smoke, Perceptions toward Initiation of Smoking and Factors Influencing Smoking in Adolescents: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(6):667-671.

Association of advanced paternal age with lung function at school age

BACKGROUND

Epidemiological studies suggest that advanced paternal age impact offspring health, but its impact on respiratory health is unclear. This study aimed to investigate the association of paternal age with lung function and fraction of exhaled nitric oxide (FeNO) in children.

METHODS

We analyzed data from 1330 single-born children (576 girls, 43.3%; mean age, 6.4 years), who participated in the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort and received measurements of lung function and FeNO at 6-year follow-up visits. Covariate-adjusted regression analyses were applied.

RESULTS

Every 5-year increase in paternal age at birth was associated with 0.51% decrease in FEV1/FVC ratio (95% CI - 0.86 to - 0.15; p = 0.005) and 19.86 mL/s decrease in FEF75 (95% CI: - 34.07 to - 5.65; p = 0.006). Stratified analyses revealed that increasing paternal age at birth was associated with decreasing FEV1/FVC ratio and FEF75 only among children with prenatal exposure to environmental tobacco smoke (ETS) or not being breastfed. Sensitivity analyses using paternal age as a categorical variable found decreasing FEV1/FVC ratio and FEF75 in the groups of paternal age 35-39 and ≥ 40 years. There was no association of paternal age at birth with FeNO.

CONCLUSION

Our findings provide novel evidence linking advanced paternal age at birth with decreasing lung function in children at school age. Children with prenatal exposure to ETS or not being breastfed are more vulnerable to the adverse effect of advanced paternal age on childhood lung function. Further studies are warranted to confirm this novel adverse effect of advanced paternal age.

Critical window for the association between prenatal environmental tobacco smoke exposure and preterm birth

Although environmental tobacco smoke (ETS) exposure is considered to be a severe public health problem and a modifiable risk factor for preterm birth (PTB), we still lack a comprehensive understanding of the PTB risk associated with trimester-specific prenatal ETS exposure. This study aimed to examine the accumulation of risk across trimester ETS exposure and the critical window of the association between maternal ETS exposure during pregnancy and PTB. A total of 63,038 mother-child pairs were involved in the analysis of the 2017 survey of Longhua Child Cohort Study. Information about socio-demographic characteristics, prenatal ETS exposure, and birth outcomes were collected using a self-report questionnaire. A series of logistic regression models were employed to assess the associations between prenatal ETS exposure and PTB. We found that maternal ETS exposure during pregnancy significantly increased the risk of PTB and this association increased with both the average level of daily ETS exposure and the number of trimesters of ETS exposure. Moreover, mothers who were initially exposed to ETS in the 1st trimester of pregnancy had significant higher risk of PTB (OR = 1.34, 95% CI: 1.25-1.44). Furthermore, mothers exposed to ETS in the 1st trimester only (OR = 1.26, 95%CI: 1.04-1.50), in both 1st and 2nd trimester (OR = 1.35, 95%CI: 1.08-1.67) and throughout pregnancy (OR = 1.35, 95%CI: 1.24-1.46) experienced a significantly high risk of PTB. Prenatal maternal ETS exposure during only the 2nd trimester also resulted in a high risk of PTB with marginal significance (OR = 1.33, 95% CI:0.78-2.13). To conclude, the 1st and early 2nd trimester might be the critical window for prenatal ETS exposure causing PTB.

TAPaC-tobacco-associated particulate matter emissions inside a car cabin: establishment of a new measuring platform

Background

Particulate matter (PM) emission caused by tobacco combustion leads to severe health burdens worldwide. Second-hand smoke exposure is extraordinarily high in enclosed spaces (e.g., indoor rooms, car cabins) and poses a particular threat to the health of vulnerable individuals (e.g., children, elderly, etc.). This study aimed to establish a new measuring platform and investigate PM emissions under four different ventilation conditions inside a car cabin without exposing any person to harmful tobacco smoke.

Methods

PM concentrations were measured during the smoking of 3R4F reference cigarettes in a Mitsubishi Space Runner (interior volume 3.709 m³). The cigarettes were smoked with a machine, eliminating exposure of the researchers. Cigarettes were extinguished 4.5 min after ignition, and PM measurements continued until 10 min after ignition.

Results

High mean PM concentrations were measured for cigarettes without ventilation after 4.5 min (PM₁₀: 1150 µg/m³, PM_2.5: 1132 µg/m³, PM₁: 861.6 µg/m³) and after 10 min (PM₁₀: 1608 µg/m³, PM_2.5: 1583 µg/m³, PM₁: 1133 µg/m³). 3R4F smoked under conditions with turned on ventilation resulted in reduction of PM compared to those smoked without ventilation after 4.5 min (PM₁₀:-47.5 to -58.4%, PM_2.5:-47.2 to -58%, PM₁:-39.6 to -50.2%) and after 10 min (PM₁₀:-70.8 to -74.4%, PM_2.5:-70.6 to -74.3%, PM₁:-64.0 to -68.0%). Cigarettes smoked without ventilation generated high PM peaks at 4.5 min (PM₁₀: 2207 µg/m³, PM_2.5: 2166 µg/m³, PM₁: 1421 µg/m³) and at 10 min (PM₁₀: 1989 µg/m³, PM_2.5: 1959 µg/m³, PM₁: 1375 µg/m³). PM peaks of cigarettes smoked under different ventilation modes varied at 4.5 min (PM₁₀: 630-845 µg/m³, PM_2.5: 625-836 µg/m³, PM₁: 543 - 693 µg/m³) and 10 min (PM₁₀: 124 - 130 µg/m³, PM_2.5: 124 - 129 µg/m³, PM₁: 118 - 124 µg/m³).

Conclusion

The new measuring platform provides a safer way for researchers to investigate PM emissions of cigarettes. These data are comparable to published research and show that smoking in a parked vehicle with the windows closed generates harmful PM emissions even when the vehicle ventilation is in operation. Future studies should be carried out using the new measuring platform investigating PM exposure and PM distribution of in-vehicle smoking under a wide range of conditions.

Assessment of passive human exposure to tobacco smoke by environmental and biological monitoring in different public places in Wuhan, central China

Passive exposure to tobacco smoke is a global public health problem, while there are few data on public place monitoring and general population exposure assessment in central China. This study aimed to examine the levels of airborne nicotine (n = 256) in ten kinds of different public places in Wuhan, central China, and assess short-term and long-term smoke exposure in 340 non-smokers aged 18-67 who worked in these public places using tobacco biomarkers [i.e., cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), respectively]. The highest median concentration of airborne nicotine (17.0 μg/m³) was observed in internet cafes, approximately 304-fold of the lowest value found in nurseries (55.9 ng/m³). Among the other studied public places, restaurants had the highest median concentrations (ng/m³) of airborne nicotine (3,120), followed by subway stations (810), hotels (624), government officess (286), middle schools (269), health institutions (268), public institutions (190), and primary schools (140). Urinary cotinine and NNAL were found in almost all the participants, and the highest concentrations were found in non-smokers from the internet cafes [specific gravity (SG)-corrected urinary median concentrations: 23.1 ng/mL, geometric mean (GM): 24.1 ng/mL, range: 0.62-1679 ng/mL] for cotinine and 104 pg/mL (GM: 97.6 pg/mL, range: 32.3-236 pg/mL) for NNAL, respectively]. Urinary cotinine concentrations in male non-smokers (median: 2.02 ng/mL) were significantly higher than those in female non-smokers (1.44) (P < 0.01). Participants aged 18-27 were detected with the highest urinary cotinine and NNAL concentrations. Urinary cotinine and NNAL concentrations were significantly correlated with daily and monthly working hours, respectively. Besides, a positive correlation was observed between log-transformed urinary concentrations of cotinine and NNAL (r = 0.32, P < 0.001). This is the first time to report matched data on airborne nicotine and urinary cotinine/NNAL among employees in different public places. This study demonstrated ubiquitous exposure to environmental tobacco smoke in the studied public places.

Effects of life-stage and passive tobacco smoke exposure on pulmonary innate immunity and influenza infection in mice

Limited data are available on the effects of perinatal environmental tobacco smoke (ETS) exposure for early childhood influenza infection. The aim of the present study was to examine whether perinatal versus adult ETS exposure might provoke more severe systemic and pulmonary innate immune responses in mice inoculated with influenza A/Puerto Rico/8/34 virus (IAV) compared to phosphate-buffered saline (PBS). BALB/c mice were exposed to filtered air (FA) or ETS for 6 weeks during the perinatal or adult period of life. Immediately following the final exposure, mice were intranasally inoculated with IAV or PBS. Significant inflammatory effects were observed in bronchoalveolar lavage fluid of neonates inoculated with IAV (FA+IAV or ETS+IAV) compared to PBS (ETS+PBS or FA+PBS), and in the lung parenchyma of neonates administered ETS+IAV versus FA+IAV. Type I and III interferons were also elevated in the spleens of neonates, but not adults with ETS+IAV versus FA+IAV exposure. Both IAV-inoculated neonate groups exhibited significantly more CD4 T cells and increasing numbers of CD8 and CD25 T cells in lungs relative to their adult counterparts. Taken together, these results suggest perinatal ETS exposure induces an exaggerated innate immune response, which may overwhelm protective anti-inflammatory defenses against IAV, and enhances severity of infection at early life stages (e.g., in infants and young children).

Association between secondhand smoke and peripheral arterial disease: a meta-analysis of cross-sectional studies

PURPOSE

The association between secondhand smoke (SHS) and peripheral arterial disease (PAD) was inconsistent and the studies were relatively scarce, hence, we conducted a meta-analysis of the association between SHS and PAD.

MATERIALS AND METHODS

We systematically searched three electronic databases (PubMed, EMBASE, and Web of Science), and calculated the pooled prevalence risk ratio (RR) and estimated standard error by random effect model from the meta-analysis. Furthermore, we performed a subgroup meta-analysis according to the location of SHS exposure.

RESULTS

We initially identified 502 articles from the electronic database, and 6 articles, cross-sectional data from 4 cross-sectional studies and 2 prospective cohort studies, were included in the meta-analysis. Among these six articles, two studies showed a significant correlation between SHS exposure and PAD, whereas no study showed a negative correlation between SHS exposure and PAD. In the meta-analysis, pooled prevalence showed a significant association between SHS exposure and PAD (RR = 1.23; 95% confidence interval [CI] 1.08-1.41; z = 3.02, p = 0.003). In the subgroup analysis based on location of SHS exposure, the prevalence RR of PAD at home was 1.30 (95% CI 1.14-1.49, Z-3.99, p < 0.0001). The prevalence RR in the subgroup of SHS exposure at work was not significant (RR = 0.89; 95% CI 0.55-1.44; z = 0.48, p = 0.63).

CONCLUSION

Exposure to SHS was significantly and positively associated with PAD. Moreover, we found a significant association between exposure to SHS and PAD at home, but the association was not significant at work.

Smoking habit in parents and exposure to environmental tobacco smoke in elementary school children of Milan

INTRODUCTION

Children with smoking parents are potentially exposed to Environmental Tobacco Smoke (ETS). The aims of this study were: 1) to assess ETS exposure in Milan schoolchildren, by measuring urinary cotinine (COT-U), 2) to compare the parents' perception of children ETS exposure, with the actual ETS exposure measured by COT-U, 3) to explore the factors influencing COT-U, including smoking bans at home, the season, and children characteristics.

METHODS

One-hundred school children (7-11 years) and their parents were recruited for the study in Spring 2018 (n = 81) and in Winter 2019 (n = 94), 75 children participated to both campaigns, for a sum of 175 observations. A questionnaire was submitted to parents to collect information about smoking habits in the house. COT-U was measured by LC-MS/MS in spot urine sample collected in the morning from children.

RESULTS

Detectable COT-U levels were found in 42% and 57% of children, in spring and winter, in contrast with 17% and 13% of parents acknowledging ETS exposure. Children living with smokers or e-cigarette users (vapers) (30% of the participants) had higher COT-U levels than children not living with smokers or vapers (median 0.67, 0.46, and <0.1 μg/L in spring, and 0.98, 0.85, and 0.11 μg/L in winter, respectively). Increasingly higher COT-U levels were observed in children living in homes where smoking was completely banned, allowed in the external parts of the home, or allowed in some rooms. The multiple regression analysis confirmed the positive significant effect of living with smokers, a partial smoking ban and absence of smoking ban at home, the winter season, and BMI as determinants of COT-U.

CONCLUSION

ETS exposure resulted in measurable urinary cotinine in children. Smoking parents underestimate exposure to ETS of their children. Living with smokers is a determinant of COT-U, only slightly mitigated by adopting partial smoking ban.

Association between environmental tobacco smoke exposure in early life and autistic-like behaviors in Chinese preschoolers

OBJECTIVE

Few studies have evaluated the association between children's exposure to environmental tobacco smoke (ETS) in early life (during pregnancy, from birth to one year and from one to three years) and autistic-like behaviors. This study aimed to explore this association.

METHODS

This cross-sectional study analyzed data collected in 2017 as part of the Longhua Child Cohort Study. Autistic-like behaviors were measured using the Autism Behavior Checklist (ABC). Data on ETS exposure and autistic-like behaviors of children were collected via self-administered questionnaires completed by the mothers. Multivariate logistic regression models were undertaken to assess the associations.

RESULTS

Of the 65,243 participants included in this study, 1958 children met criteria for having autistic-like behaviors. The results showed that children were more likely to exhibit autistic-like behaviors when they were exposed to ETS in early life (AOR = 1.38; 95% CI = 1.26-1.52), compared to preschoolers without ETS exposure at any period of their early life. Compared with their unexposed counterparts, children who were exposed to ETS during gestation (AOR = 1.42; 95% CI = 1.29-1.57), or from birth to one year old (AOR = 1.42; 95% CI = 1.19-1.69) had significantly increased risk of autistic-like behaviors. In addition, with the increase in duration of exposure and average number of cigarettes smoked in the child's immediate environment, the risk of autistic-like behaviors increased.

CONCLUSION

Our study indicated that children's ETS exposure in early life was significantly associated with autistic-like behaviors. When children's exposure to cigarettes in early life increased in duration and number, the likelihood of the presence of autistic-like behaviors was higher.

Differential associations of hand nicotine and urinary cotinine with children's exposure to tobacco smoke and clinical outcomes

BACKGROUND

Children's overall tobacco smoke exposure (TSE) consists of both inhalation of secondhand smoke (SHS) and ingestion, dermal uptake, and inhalation of thirdhand smoke (THS) residue from dust and surfaces in their environments.

OBJECTIVES

Our objective was to compare the different roles of urinary cotinine as a biomarker of recent overall TSE and hand nicotine as a marker of children's contact with nicotine pollution in their environments. We explored the differential associations of these markers with sociodemographics, parental smoking, child TSE, and clinical diagnoses.

METHODS

Data were collected from 276 pediatric emergency department patients (Median age = 4.0 years) who lived with a cigarette smoker. Children's hand nicotine and urinary cotinine levels were determined using LC-MS/MS. Parents reported tobacco use and child TSE. Medical records were reviewed to assess discharge diagnoses.

RESULTS

All children had detectable hand nicotine (GeoM = 89.7ng/wipe; 95 % CI = [78.9; 102.0]) and detectable urinary cotinine (GeoM = 10.4 ng/ml; 95%CI = [8.5; 12.6]). Although hand nicotine and urinary cotinine were highly correlated (r = 0.62, p < 0.001), urinary cotinine geometric means differed between racial groups and were higher for children with lower family income (p < 0.05), unlike hand nicotine. Independent of urinary cotinine, age, race, and ethnicity, children with higher hand nicotine levels were at increased risk to have discharge diagnoses of viral/other infectious illness (aOR = 7.49; 95%CI = [2.06; 27.24], p = 0.002), pulmonary illness (aOR = 6.56; 95%CI = [1.76; 24.43], p = 0.005), and bacterial infection (aOR = 5.45; 95%CI = [1.50; 19.85], p = 0.03). In contrast, urinary cotinine levels showed no associations with diagnosis independent of child hand nicotine levels and demographics.

DISCUSSION

The distinct associations of hand nicotine and urinary cotinine suggest the two markers reflect different exposure profiles that contribute differentially to pediatric illness. Because THS in a child's environment directly contributes to hand nicotine, additional studies of children of smokers and nonsmokers are warranted to determine the role of hand nicotine as a marker of THS exposure and its potential role in the development of tobacco-related pediatric illnesses.

Prenatal environmental tobacco smoke exposure alters children's cognitive control circuitry: A preliminary study

BACKGROUND AND OBJECTIVES

Prenatal exposure to environmental tobacco smoke (ETS) is associated with increased attention problems in children, however, the effects of such exposure on children's brain structure and function have not been studied. Herein, we probed effects of prenatal ETS on children's cognitive control circuitry and behavior.

METHODS

Forty-one children (7-9 years) recruited from a prospective longitudinal birth cohort of non-smoking mothers completed structural and task-functional magnetic resonance imaging to evaluate effects of maternal ETS exposure, measured by maternal prenatal urinary cotinine. Attention problems and externalizing behaviors were measured by parent report on the Child Behavior Checklist.

RESULTS

Compared to non-exposed children, exposed children had smaller left and right thalamic and inferior frontal gyrus (IFG) volumes, with large effect sizes (p-FDR < .05, Cohen's D range from 0.79 to 1.07), and increased activation in IFG during the resolution of cognitive conflict measured with the Simon Spatial Incompatibility Task (38 voxels; peak t(25) = 5.25, p-FWE = .005). Reduced thalamic volume was associated with increased IFG activation and attention problems, reflecting poor cognitive control. Mediation analyses showed a trend toward left thalamic volume mediating the association between exposure and attention problems (p = .05).

CONCLUSIONS

Our findings suggest that maternal ETS exposure during pregnancy has deleterious effects on the structure and function of cognitive control circuitry which in turn affects attentional capacity in school-age children. These findings are consistent with prior findings documenting the effects of active maternal smoking on chidlren's neurodevleoment, pointing to the neurotixicity of nicotine regardless of exposure pathway.

Aortic Valve Calcification Score in Patients with Arterial Hypertension Environmentally Exposed to Tobacco Smoke

The objective of our study was to determine the relationship between exposure to environmental tobacco smoke (ETS) and the value of the aortic valve calcification score (AVCS) in people suffering from arterial hypertension (AH). 107 non-smokers with AH (mean age 67.16 ± 8.48 years) were qualified for the study. The degree of exposure to ETS was assessed using the Second-hand Smoke Exposure Scale (SHSES) questionnaire. Study group was divided depending on ETS exposure: A—no exposure, B—low, C—medium and D—high. AVCS was measured based on the aortic valve plane multiplanar reconstruction from the non-contrast phase of the cardiac computed tomography. The Agatston algorithm was used, in which calcifications were considered changes with a density exceeding 130 HU. The mean AVCS value in the study group of patients was 213.59 ± 304.86. The AVCS was significantly lower in subgroup A than in subgroups C and D. In subgroup A, the lack of aortic valve calcification (AVCS = 0) was observed significantly more frequently than in subgroups C and D. There was a positive correlation between the number of SHSES points and the AVCS value (r = 0.37, p < 0.05). Based on the ROC curve, the SHSES value was determined as the optimal cut-off point for the prediction of AVCS = 0, amounting to 3 points. The accuracy of SHSES < 3 as the predictor of AVCS = 0 was set at 62.18%. Hypertensive patients have an unfavourable relationship between the amount of exposure to ETS, determined on the SHSES scale, and the AVCS value.

The effect of active smoking, passive smoking, and e-cigarettes on the tear film: An updated comprehensive review

Active tobacco smoking, passive smoking, and e-cigarette smoking have been associated with different systemic and ocular diseases. The precorneal tear film plays an important role in eye health and its analysis can provide useful information on ocular status. This review investigates the effects of different types of smoking on the precorneal tear film, by analyzing the peer-reviewed literature on this topic. Specifically, tear evaporation rate, stability, volume, ferning, osmolarity, and physical composition (lipids and proteins) of tear film are detailed. Most of the reported works show that cigarette smoking reduces tear film stability and quality by affecting its components. This review highlights that smoking severely affects the tear film, but a single test is not sufficient to determine these effects because smoking can impact different parts of the eye.

Association between environmental tobacco smoke before and during pregnancy and the risk of adverse birth outcomes: a birth cohort study in Wuhan, China

Associations between environmental tobacco smoke (ETS) and the risk of adverse birth outcomes may be confounded. We aimed to clarify the associations of ETS before and during pregnancy with the risk of adverse birth outcomes and determine whether the associations were modified by key potential confounders. A total of 7147 non-smoking mothers from the Tongji Maternal and Child Health Cohort (TMCHC) in Wuhan, China, were included in the final analyses. ETS status was self-reported by pregnant women at their first antenatal care visit before 16 gestational weeks. Information on birth outcomes was extracted from delivery records. Poisson regression was used to identify the association between ETS before and during pregnancy and the risk of adverse birth outcomes. Exposures to ETS before and during pregnancy were reported by 645 (9.0%) and 464 (6.5%) mothers, respectively. Compared with no ETS, continued ETS during pregnancy was associated with an increased risk of preterm birth (PTB) (RR: 1.55, 95% CI: 1.07, 2.25) after adjustment for potential confounders. The association remained consistent in medically indicated PTB and late PTB. The risk of PTB associated with continued ETS during pregnancy was significantly increased in mothers more educated (P for interaction < 0.05). However, the increased risk of low birth weight (LBW) or small for gestational age (SGA) births by ETS during pregnancy was not observed. Exposure to ETS during pregnancy was associated with a higher risk of PTB, but not LBW or SGA births in a Chinese birth cohort.

The oxidative capacity of indoor source combustion derived particulate matter and resulting respiratory toxicity

Indoor air pollution sources with emissions of fine particles (PM_2.5), including environmental tobacco smoke (ETS) and incense smoke (IS) deteriorate indoor air quality and may cause respiratory diseases in humans. This study characterized the emission factors (EFs) of five types of tobacco and incense in Hong Kong using an environmental chamber. Human alveolar epithelial cells (A549) were exposed to PM_2.5 collected from different indoor sources to determine their cytotoxicity. The PM_2.5 EF of ETS (109.7±36.5 mg/g) was higher than IS (97.1±87.3 mg/g). The EFs of total polycyclic aromatic hydrocarbons (PAHs) and carbonyls for IS were higher than ETS, and these two combustion sources showed similar distributions of individual PAHs and carbonyls. Oxidative damage and inflammatory responses (i.e. DNA damage, 8-hydroxy-desoxyguanosine (8-OHdG), tumor necrosis factor-α (TNF-α) and interlukin-6 (IL-6)) of A549 cells was triggered by exposure to PM_2.5 generated from ETS and IS. Different indoor sources showed different responses to oxidative stress and inflammations due to the accumulation effects of mixed organic compounds. High molecular weight PAHs from incense combustion showed higher correlations with DNA damage markers, and most of the PAHs from indoor sources demonstrated significant correlations with inflammation. Exposure to anthropogenic produced combustion emissions such as ETS and IS results in significant risks (e.g. lung cancer) to the alveolar epithelium within the distal human respiratory tract, of which incense emissions posed a higher cytotoxicity.

Secondhand smoke presence in outdoor areas in 12 European countries

INTRODUCTION

Secondhand smoke (SHS) causes morbidity and mortality among non-smokers.

OBJECTIVES

To investigate SHS presence in outdoor areas from 12 European countries and its association with country-level characteristics.

METHODS

Cross-sectional study performed in 2017-2018 within the TackSHS project. We conducted a face-to-face survey on a representative sample of the population aged 15 years and older from 12 European countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain. Out of 11,902 participants, 8,562 were non-smokers. SHS presence was assessed in selected outdoor areas and defined as respondents viewing someone smoking the last time they visited each setting within the last 6 months. A ranking score for outdoor SHS presence was assigned to each country based on the SHS presence in each setting. We used Spearman's correlation (r) and the Chi-squared tests to assess the relationship between SHS presence and country-level characteristics.

RESULTS

Except for children's playgrounds (39.5%; 95% confidence interval, CI: 37.6%-41.3%), more than half of non-smokers reported SHS presence in outdoor areas: schools (52.0%; 95%CI: 50.2%-53.7%), stadia (57.4%; 95%CI: 55.4%-59.4%), parks (67.3%; 95%CI: 66.0%-68.5%), hospitals (67.3%; 95%CI: 65.8%-68.7%), public transport stops (69.9%; 95%CI: 68.6%-71.2%), bar/restaurant terraces (71.4%; 95%CI: 70.2%-72.6%), and beaches (72.8%; 95%CI: 71.4%-74.1%). Residents in Latvia showed the highest overall outdoor SHS presence rank, followed by Greece, and Portugal. Outdoor SHS presence was directly correlated to the country's smoking prevalence (r = 0.64), and inversely correlated to the Tobacco Control Scale 2016 overall score (r = -0.62), the socio-demographic index 2017 (r = -0.56), and Gross Domestic Product per capita 2018 (r = -0.47) (p < 0.001).

CONCLUSIONS

SHS presence is high in most outdoor areas in Europe, especially in countries with higher smoking prevalence and lower tobacco control performance. To address outdoor SHS exposure, our findings require considering smoking bans along with other strategies to reduce smoking prevalence.

Comparative analysis of the concentrations of serum cotinine and hydroxycotinine for US children, adolescents, and adults: impact of exposure to environmental tobacco smoke at home and other indoor environments

This study was carried out to investigate how serum cotinine and hydroxycotinine concentrations compare and vary by age, gender, race/ethnicity, smoking, and exposure to environmental tobacco smoke (ETS) at home and other indoor environments. Data from NHANES for 2013-2018 for US children aged 3-11 years (N = 3834), nonsmoker (N = 1963) and smoker (N = 247) adolescents aged 12-19 years, and nonsmoker (N = 10,334) and smoker (N = 3264) adults aged ≥ 20 years were analyzed by fitting regression models with log10 transformed values of serum cotinine and hydroxycotinine as dependent variables. Models stratified by age and smoking status were fitted. Those reporting using tobacco products during the last 5 days were classified as smokers. For cotinine, males had higher cotinine concentrations than females for children, adolescent smokers, and nonsmoker adults. Non-Hispanic Blacks were found to have lower concentrations of both cotinine and hydroxycotinine than non-Hispanic Whites for adult smokers (p < 0.01) only. The ratio of concentrations of those exposed to ETS at home to those not exposed to ETS at home for hydroxycotinine was 6.3 for nonsmoker adults and as low as 1.39 for adult smokers.

The Effect of Passive Exposure to Tobacco Smoke on the Immune Response in Children with Asthma

Introduction: There are a few publications about the impact of tobacco smoke on the children's immune system. Material and Methods: The study group consisted of 43 children with asthma. The control group consisted of 37 healthy children. The exposure to tobacco smoke was assessed by the presence of the cotinine in the urine (metabolit of nicotine). Results: The group of children with asthma exposed to tobacco smoke had significantly higher levels of the IL-1 and lower levels IL-4 than children not exposed to the passive smoking. The children from the control group exposed to tobacco smoke had a significantly higher concentration of IL-4 than unexposed children. In the whole analyzed population, there was a significant positive correlation between cotinine-IL1 and cotinine-CRP. Conclusion: In this study we found that the passive exposure to tobacco smoke has the immunomodulatory effects on the immune system.

[Smoking cessation in asthmatic patients and its impact]

INTRODUCTION

The prevalence of smoking in asthmatic patients is similar to, or even higher than in the general population.

OBJECTIVES

This systematic review addresses (1) the effects of smoking on asthma, (2) smoking cessation strategies in asthmatic patients, and (3) the consequences of smoking cessation for people with asthma.

RESULTS

Active or passive smoking can promote the development of asthma. The few studies on smoking cessation in asthma confirm the efficacy of validated smoking cessation strategies in these patients (nicotine replacement therapy, varenicline, bupropion, cognitive and behavioural therapies). Smoking cessation in parents with asthmatic children is essential and is based on the same strategies. Electronic cigarettes may be a useful help to quit smoking in some patients. Smoking cessation is beneficial in asthmatic smokers and associated with (1) a reduction of asthma symptoms, acute exacerbations, bronchial hyperresponsiveness, and bronchial inflammation, (2) decreased use of rescue medications and in doses of inhaled corticosteroids, (3) improved asthma control, quality of life, and lung function.

CONCLUSION

In asthmatic patients, it is essential to assess smoking status and health professionals must assist them to quit smoking.

A prospective study on the role of smoking, environmental tobacco smoke, indoor painting and living in old or new buildings on asthma, rhinitis and respiratory symptoms

We studied associations between tobacco smoke, home environment and respiratory health in a 10 year follow up of a cohort of 11,506 adults in Northern Europe. Multilevel logistic regression models were applied to estimate onset and remission of symptoms. Current smokers at baseline developed more respiratory symptoms (OR = 1.39-4.43) and rhinitis symptoms (OR = 1.35). Starting smoking during follow up increased the risk of new respiratory symptoms (OR = 1.54-1.97) and quitting smoking decreased the risk (OR = 0.34-0.60). ETS at baseline increased the risk of wheeze (OR = 1.26). Combined ETS at baseline or follow up increased the risk of wheeze (OR = 1.27) and nocturnal cough (OR = 1.22). Wood painting at baseline reduced remission of asthma (OR 95%CI: 0.61, 0.38-0.99). Floor painting at home increased productive cough (OR 95%CI: 1.64, 1.15-2.34) and decreased remission of wheeze (OR 95%CI: 0.63, 0.40-0.996). Indoor painting (OR 95%CI: 1.43, 1.16-1.75) and floor painting (OR 95%CI: 1.77, 1.11-2.82) increased remission of allergic rhinitis. Living in the oldest buildings (constructed before 1960) was associated with higher onset of nocturnal cough and doctor diagnosed asthma. Living in the newest buildings (constructed 1986-2001) was associated with higher onset of nocturnal breathlessness (OR = 1.39) and rhinitis (OR = 1.34). In conclusion, smoking, ETS and painting indoor can be risk factors for respiratory symptoms. Wood painting and floor painting can reduce remission of respiratory symptoms. Smoking can increase rhinitis. Living in older buildings can be a risk factor for nocturnal cough and doctor diagnosed asthma. Living in new buildings can increase nocturnal dyspnoea and rhinitis.

Tobacco smoke is a likely source of lead and cadmium in settled house dust

INTRODUCTION

Environmental exposure to lead (Pb) and cadmium (Cd) are risk factors for adverse health outcomes in children and adults. This study examined whether thirdhand smoke residue contributes to Pb and Cd in settled house dust.

METHODS

Participants were 60 multiunit housing residents in San Diego, California. All had indoor smoking bans during the study period, and 55 were nonsmokers. Wipe samples from different surfaces and vacuum floor dust samples were analyzed for nicotine, a marker of thirdhand smoke, and for Pb and Cd using liquid chromatography-triple quadrupole mass spectrometry and inductively coupled plasma-mass spectrometry, respectively.

RESULTS

Examined in each sample type separately, Pb and Cd loadings were significantly correlated (r = 0.73, vacuum floor dust; 0.52, floor wipes; 0.72, window sill/trough wipes; all p < 0.0025). Pb and Cd loadings from different sample types were not correlated (all p > 0.30). Nicotine loading in dust was significantly correlated with Pb and Cd loading in dust (r = 0.49 for Pb; r = 0.39 for Cd, all p < 0.0025). Pb and Cd loadings on floor or window surfaces, showed no association with nicotine loading in dust, on floors, or on furniture (all p < 0.30).

CONCLUSIONS

Tobacco smoke is a likely source of Pb and Cd that accumulates in settled house dust in multiunit housing, suggesting that Pb and Cd are constituents of thirdhand smoke that lingers long after smoking has ended.

Prenatal and early life exposure to particulate matter, environmental tobacco smoke and respiratory symptoms in Mexican children

BACKGROUND

Exposure to particulate matter <2.5 μm in diameter (PM2.5) and environmental tobacco smoke (ETS) are associated with respiratory morbidity starting in utero. However, their potential synergistic effects have not been completely elucidated. Here, we examined the joint effects of prenatal and early life PM2.5 and prenatal ETS exposure on respiratory outcomes in children.

MATERIAL AND METHODS

We studied 536 mother-child dyads in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) study in Mexico City. Exposure to PM2.5 was estimated using residence in pregnancy and child's first year of life with a satellite-based spatio-temporal model. ETS exposure was assessed by caregiver's report of any smoker in the household during the second or third trimester. Outcomes included report of ever wheeze and wheeze in the past 12 months (current wheeze) assessed when children were 6-8 years old considered in separate models. Associations were modeled using distributed lag models (DLM) with daily PM2.5 averages for pregnancy and the first year of life, adjusting for child's sex, birth weight z-score, mother's age and education at enrollment, maternal asthma, season of conception and stratified by prenatal ETS exposure (yes/no).

RESULTS

We identified a sensitive window from gestational week 14 through postnatal week 18 during which PM2.5 was associated with higher risk of ever wheeze at age 6-8 years. We also observed a critical window of PM2.5 exposure between postnatal weeks 6-39 and higher risk of current wheeze. We found significant associations between higher prenatal and early life PM2.5 exposure and higher cumulative risk ratios of ever wheeze (RR:3.76, 95%CI [1.41, 10.0] per 5 μg/m3) and current wheeze in the past year (RR:7.91, 95%CI [1.5, 41.6] per 5 μg/m3) only among children born to mothers exposed to ETS in pregnancy when compared to mothers who were not exposed.

CONCLUSIONS

Exposure to prenatal ETS modified the association between prenatal and early life PM2.5 exposure and respiratory outcomes at age 6-8 years. It is important to consider concurrent chemical exposures to more comprehensively characterize children's environmental risk. Interventions aimed at decreasing passive smoking might mitigate the effects of ambient air pollution.

Acute Exposure to Environmental Tobacco Smoke: A Controlled Study in Adults with Asthma

BACKGROUND

Short-term, indoor exposure to environmental tobacco smoke (ETS) is still highly prevalent; however, little is known about the acute lung response in adult asthma.

OBJECTIVES

We investigated whether acute, experimental ETS exposure influences symptoms, lung function, and inflammatory parameters.

METHODS

Human subjects with asthma (n = 23) were exposed for 180 min to either room air or ETS at 250, 450, or 850 µg/m3. Respiratory symptoms, lung function, and exhaled nitric oxide (FeNO) were measured. Additionally, blood samples were analyzed for pro- and anti-inflammatory cytokines.

RESULTS

Humans with asthma demonstrate an increase in respiratory symptoms at all levels of ETS exposure, while the forced expiratory volume in 1 s (FEV1) and FeNO decrease with increasing ETS. The anti-inflammatory cytokine interleukin (IL)-10 increases at intermediate ETS concentrations, whereas tumor necrosis factor (TNF)-α and IL-8 increase only at the highest ETS concentration.

CONCLUSION

Following 180 min of acute, experimental ETS exposure, we observed a significant increase in respiratory symptoms, a decrease in lung function, and an increase in inflammatory cytokines, indicating an acute lung response in asthma.

Environmental tobacco smoke and cancer risk, a prospective cohort study in a Chinese population

Few prospective cohort studies have investigated associations between environmental tobacco smoke (ETS) and other cancer sites, in addition to lung cancer. We assessed these associations in a population-based prospective cohort study started from 2008 to 2011 with average of 9.1 years of follow-up, in Minhang district, Shanghai, China. The study included a total of 23,415 participants (8388 men, 15,027 women) and 205,515 person-years. Epidemiological data were collected by a standardized questionnaire including ETS exposure. Newly diagnosed patients with primary cancers and deaths were identified by record linkage system with the Shanghai Cancer Registry and Shanghai Vital Statistics. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models, adjusting for potential confounders. During the study period, a total of 1462 patients with diagnoses of primary cancers were identified. Among all participants and non-smokers, ETS was associated with an increased risk of all smoking-related cancers (all: adjusted HR: 1.23, 95% CI: 1.05-1.43 and non-smokers: 1.24, 1.02-1.49), lung cancer (1.29, 0.98-1.71 and 1.27, 0.91-1.77), and stomach cancer (1.86, 1.21-2.85 and 1.75, 1.05-2.91), respectively. Furthermore, associations for lung and stomach cancers were the strongest among non-smoking females. The joint effects of both ETS and active smoking were strongest for all cancers, all smoking-related cancers, lung cancer, and stomach cancer. No clear interactions were observed. These results suggest that ETS exposure may increase the risk of smoking-related cancers in a Chinese population. Further studies on the relationship between ETS exposure and specific cancer sites are warranted to replicate our findings.

Gluten intake and risk of thyroid peroxidase autoantibodies in the Diabetes Autoimmunity Study In the Young (DAISY)

PURPOSE

Autoimmune diseases co-occur, perhaps due to common risk factors. The age at gluten introduction and gluten intake in early childhood has been associated with the autoimmunity preceding celiac disease (CD) and type-1 diabetes (T1D). We explored their associations with the development of thyroid autoimmunity.

METHODS

DAISY has prospectively followed children at increased risk for T1D and CD since 1993. During follow-up, 107 children developed thyroid autoimmunity, defined as positivity for autoantibodies against thyroid peroxidase on at least two study visits. Age at gluten introduction was ascertained from food history interviews every 3 months until 15 months of age. Gluten intake (g/day) at age 1-2 years was estimated using a food frequency questionnaire.

RESULTS

From multivariable Cox regression, there was no association between the age of gluten introduction nor the amount of gluten intake and development of thyroid autoimmunity. However, females (hazard ratio = 2.19, 95% CI: 1.46, 3.27) and cases of islet autoimmunity (HR = 2.20, 95% CI: 1.39, 3.50) were significantly more likely to develop thyroid autoimmunity, while exposure to environmental tobacco smoke decreased the risk (HR = 0.46, 95% CI: 0.30, 0.71).

CONCLUSIONS

Neither the age of gluten introduction nor the amount of gluten consumed in early childhood is associated with risk of thyroid autoimmunity.

Early postnatal tobacco smoke exposure aggravates experimental autoimmune encephalomyelitis in adult rats

Although substantial evidence supports smoking as a risk factor for the development of multiple sclerosis (MS) in adulthood, it remains controversial whether early-life exposure to environmental tobacco smoke (ETS) increases the risk of MS later in life. Here, using experimental autoimmune encephalomyelitis (EAE) as an animal model for MS, we show that exposing neonatal rats during the first week (ETS1-EAE), but not the second week (ETS2-EAE) and the third week (ETS3-EAE) after birth, increased the severity of EAE in adulthood in comparison to pups exposed to filtered compressed air (AIR-EAE). The ETS1-EAE rats showed a worse neurological deficit score and a significant increase in CD4⁺ cell infiltration, demyelination, and axonal injury in the spinal cord compared to AIR-EAE, ETS2-EAE, and ETS3-EAE groups. Flow cytometry analysis showed that the ETS1 group had decreased numbers of regulatory T (Treg) cells and increased effector T (Teff) cells in the brain and spinal cord. The expressions of Treg upstream regulator Foxp3 and downstream cytokines such as IL-10 were also altered accordingly. Together, these findings demonstrate that neonatal ETS exposure suppresses Treg functions and aggravates the severity of EAE, confirming early-life exposure to ETS as a potential risk factor for multiple sclerosis in adulthood.

Development of a novel method to measure material surface staining by cigarette, e-cigarette or tobacco heating product aerosols

Tobacco smoke (CS) may visually stain indoor surfaces including ceilings, walls and soft furnishings over time. Potentially reduced risk products (PRRPs) such as e-cigarettes (EC) and tobacco heating products (THP) produce chemically less complex aerosols with significantly reduced levels of toxicants, particles and odour. However, the potential effects of EC and THP aerosols on the staining of indoor surfaces are currently unknown. In this study, an exposure chamber was developed as a model system to enable the accelerated staining of wallpaper and cotton samples by a scientific reference cigarette (3R4F), three THP (glo™, glo™ pro, glo™ sens) and an e-cigarette (iSwitch Maxx).

Exposure to 3R4F reference cigarettes caused the greatest level of staining, which was significantly higher than glo™, glo™ pro, glo™ sens or iSwitch Maxx aerosols, all of which showed relatively little colour change. Exposure to 200–1000 puffs of 3R4F cigarette smoke resulted in a visible dose response effect to wallpaper and cotton samples which was not observed following exposure to glo™, glo™ pro, glo™ sens or iSwitch Maxx aerosols. Aging of the samples for 4 weeks post-exposure resulted in changes to the staining levels, however PRRP staining levels were minimal and significantly lower than 3R4F exposed samples.

For the first time, diverse PRRPs across the tobacco and nicotine products risk continuum have been assessed in vitro for their impact on surface staining. CS exposure significantly increased the level of wallpaper and cotton staining, whereas exposure to glo™, glo™ pro, glo™ sens or iSwitch Maxx aerosols resulted in significantly reduced levels of staining, staining levels were also comparable to untreated control samples.

Environmental Tobacco Smoke Exposure Estimated Using the SHSES Scale and Epicardial Adipose Tissue Thickness in Hypertensive Patients

The aim of the study was to assess the relationship between environmental tobacco smoke exposure (ETS) and epicardial adipose tissue thickness (EATT) in hypertensive patients. A total of 96 patients with essential hypertension were recruited for this study. The group consisted of 48 females and 48 males with the mean age of 69.32 ± 9.54 years. ETS was assessed with The Secondhand Smoke Exposure Scale (SHSES). EATT was assessed in 128-slice dual source coronary computed tomography angiography. In accordance to SHSES scale patients were divided into subgroups: subgroup A-no ETS exposure (SHSES = 0 points, n = 48), subgroup B-low ETS exposure (SHSES = 1-3 points, n = 11), subgroup C-medium ETS exposure (SHSES = 4-7 points, n = 20) and subgroup D-high ETS exposure (SHSES = 8-11 points, n = 17). Within the study group the mean EATT was 5.75 ± 1.85 mm and the mean SHSES score was 3.05 ± 3.74. EATT was statistically significantly higher in subgroup D than in subgroups A and B (A: 5.28 ± 1.64 mm, B: 5.04 ± 2.64 mm, D: 7.04 ± 2.64 mm, p_A-D and p_B-D < 0.05). There was a positive linear correlation between the exposure to ETS expressed by the SHSES scale and EATT (r = 0.44, p < 0.05). Regression analysis showed that higher SHSES score, higher BMI, and higher systolic and diastolic blood pressure are independent risk factors for higher EATT values. Contrary, the use of ACE inhibitors and β-blockers appeared to be independent protecting factor against higher EATT values. There is an unfavorable positive relationship between ETS exposure estimated using the SHSES scale and EATT in hypertensive patients.

Exposure to environmental tobacco smoke and prevalence of asthma among adolescents in a middle eastern country

Background

There is increasing evidence linking environmental tobacco smoke (ETS) exposure at homes to the development of asthma among adolescents. Few studies have addressed this issue in the Middle Eastern countries including Kuwait. Therefore, this cross-sectional study assessed the prevalence of ETS exposure at home, prevalence of asthma and other respiratory conditions and examined the ETS exposure at home and personal tobacco smoking as risk factors for self-reported asthma among high-school students in Kuwait.

Methods

In this cross-sectional study, we enrolled participants from nine high-schools of Hawally Governorate of Kuwait during October 2015. We adapted a previously validated self-administered questionnaire for data collection. Prevalence of self-reported asthma and ETS exposure (≥ 1 smoker at home vs. none) were computed. The association between exposures of interest and self-reported asthma status was examined using a multivariable log-binomial regression model.

Results

Of 800 enrolled participants, 746 (92.2%) consented and completed the questionnaire. The participants with mean (SD) age of 16.8 (0.68) years were predominantly Kuwaiti (74.8%) and female (50.1%). The prevalence of ETS exposure at home and personal current smoking was 54 and 12.4% respectively. Self-reported asthma prevalence was 20.5%. Furthermore, the prevalence of physician-diagnosed asthma, wheezing during the last 12 months and wheezing ‘ever’ was 16.4, 20.1 and 26.2%, respectively. Fitted multivariable log-binomial regression model revealed that compared with the non-asthmatic, participants with self-reported asthma tended to be current smokers (adjusted prevalence ratio (adjusted PR) = 1.82; 95% CI: 1.30–2.56; p = 0.001) or have had ETS exposure at home (adjusted PR = 1.64; 95% CI: 1.21–2.23; p = 0.002).

Conclusions

We recorded a high prevalence of ETS exposure at home, high prevalence of self-reported asthma and identified ETS exposure at home and being a current smoker as strong risk factors for self-reported asthma among adolescents. Voluntary household smoking bans may substantially minimize the ETS exposure among adolescents. Additionally, such restriction may inculcate an antismoking attitude and prevent smoking initiation among adolescents. Such efforts may bring about reduction in ETS exposure and associated asthma risk and other smoking-related morbidities in this and other similar settings.

Environmental Tobacco Smoke and Educational Self-Regulation and Achievement in First Grade High School Students

Environmental tobacco smoke, containing many toxic gases, suggests inevitable contact of humans with the damaging factors of cigarettes. On average, approximately 40% of children, 35% of women and 32% of men worldwide are exposed to environmental tobacco smoke. This study aims at investigating the relationship between environmental tobacco smoke in adolescents and their educational self-regulation and achievement. In this study, 770 students aged between 13 and 15 were selected and studied using the multistage sampling method. The tools used in this study consisted of four questionnaires, demographic characteristics, environmental tobacco smoke, educational self-regulation, and educational achievement. The validity and reliability of tools have been approved, and the data were analyzed using SPSS v22. The results indicated a significant inverse relationship between environmental tobacco smoke and students' educational self-regulation and achievement (p-value > 0.001). Given the relationship between exposure to environmental tobacco smoke and educational self-regulation and achievement, it is essential to keep children away from tobacco smoke. Family health and education policy-makers are recommended to design and operate fundamental schemes in order to deal with environmental tobacco smoke.

[Passive Smoking and Pregnancy - CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy]

OBJECTIVE

The objective of this chapter is to evaluate the risks of second-hand-smoke during pregnancy and to assess the benefits of antenatal care.

METHODS

Bibliographical research in French and English using the Medline and Cochrane databases and the recommendations of international societies.

RESULTS

Exposure to second-hand smoke appears to be higher at home and in the car, with potential consequences for pregnancy, especially prematurity (NP3). Complete avoidance of smoking at home significantly reduces exposure to passive smoking compared to incomplete avoidance (NP4). The more numerous the sources, the higher the intoxication is (NP4). The major risk factor associated with passive smoking is the presence of a spouse who smokes. Other associated factors are the presence of a smoker at home or in the car, young population (<25 years), low level of education, old smoking (NP4). Passive smoking is associated with an increased risk of fetal death in utero, fetal malformations, prematurity and birth weight under 2500g (NP2). No specific management is recommended for all pregnant women. Nevertheless, in a specific population of pregnant women with vulnerabilities, a behavioral approach aimed at teaching them to negotiate with their entourage may be beneficial in order to reduce the effects of passive smoking on pregnancy (NP2).

CONCLUSION

It is recommended to advise women and their family (especially spouses) to create a smoke-free environment, especially at home and in the car (professional consensus). It is recommended to provide a minimum amount of smoking cessation advice to pregnant women's entourage (professional consensus).

Measuring for change: A multi-centre pre-post trial of an air quality feedback intervention to promote smoke-free homes

INTRODUCTION

Second-hand smoke exposure in the home is a serious cause of ill-health for children. Behaviour change interventions have been developed to encourage parents to keep homes smoke-free. This study evaluates a novel air quality feedback intervention using remote air quality monitoring with SMS and email messaging to promote smoke-free homes among families from deprived areas.

METHODS

This paper presents a pre-post study of this intervention. Using internet connected monitors developed with the Dylos DC1700, daily SMS and weekly email feedback provided for 16 days to participants recruited in four European countries. Participants were recruited based on their stage of change, in order to target those most able to achieve smoke-free homes. The primary outcome measure was median change in mean fine particulate matter (PM_2.5) concentration between baseline and follow-up periods, while secondary outcome measures included change in time over the World Health Organisation (WHO) guideline limit for PM_2.5 exposure over 24 h (25 µg/m³) in those periods and the number of homes where PM_2.5 concentrations reduced. Telephone interviews were conducted with participants in Scotland post-intervention to explore intervention experience and perceived effectiveness.

RESULTS

Of 86 homes that completed the intervention study, 57 (66%) experienced pre-post reductions in measured PM_2.5. The median reduction experienced was 4.1 µg/m³ (a reduction of 19% from baseline, p = 0.008). Eight homes where concentrations were higher than the WHO guideline limit at baseline fell below that level at follow-up. In follow-up interviews, participants expressed positive views on the usefulness of air quality feedback.

DISCUSSION

Household air quality monitoring with SMS and email feedback can lead to behaviour change and consequent reductions in SHS in homes, but within the context of our study few homes became totally smoke-free.

Associations between observed concentrations of ethylene oxide in whole blood and smoking, exposure to environmental tobacco smoke, and cancers including breast cancer: data for US children, adolescents, and adults

For the first time, National Health and Nutrition Examination Survey released data on ethylene oxide (ETO) into public domain for US children aged 6-11 years, adolescents aged 12-19 years, and adults aged ≥ 20 years for 2013-2016. This study was undertaken to evaluate the associations between concentrations of ETO in whole blood and smoking, exposure to environmental tobacco smoke (ETS), and self-reported diagnosis of cancers including breast cancer. Both adolescent (29.6 vs. 49.6 pmol/g Hb, p < 0.01) and adult smokers (31.5 vs. 142.7 pmol/g Hb, p < 0.01) were found to have substantially higher adjusted levels of ethylene oxide than nonsmokers. Non-Hispanic blacks had higher levels of ethylene oxide than other race/ethnicities for children and adolescents. Non-Hispanic Asians had higher levels of ethylene oxide than other race/ethnicities for adults. Exposure to ETO measured by the number of smokers smoking inside the home (p < 0.01) and number of days smokers smoked inside the home (p = 0.03) during the prior week was found to be associated with elevated levels of ETO (p < 0.01) among US adults. Increased age was associated with elevated levels of ETO among adolescents (p = 0.02) and adults (p < 0.01) but the reverse was true for children (p = 0.04). For the general US population, levels of ETO were not found to be associated with cancers including breast cancer.

Environmental tobacco smoke exposure during pregnancy affects complications and birth outcomes in women with and without asthma

Background

It is known that environmental tobacco smoke (ETS) has adverse effects on pregnancy and birth outcomes. We aimed to assess the impact of ETS in pregnant women with and without asthma.

Methods

A cohort study was conducted from August 2014 to June 2015 enrolling 1603 pregnant women during their 2nd trimester. Data on tobacco exposure were collected at first visit and women were followed through pregnancy till postpartum.

Results

Of the 1603 women, 231 reported passive smoking, 223 non-asthmatics and 8 asthmatics. Women exposed to ETS during pregnancy were more likely to have an infant admitted to the pediatric ward (10.8% vs. 6.5%, p = 0.026) and to have low one- and five-minute Apgar scores (1 min: 6.1% vs. 2.6%, p = 0.011; 5 min: 2.2% vs. 0.7%, p = 0.039). Complications of pregnancy were also elevated in women exposed to ETS (53.7% vs. 42.3%, p = 0.002). Asthma had no additional effect beyond the impact of ETS except for cesarean sections that were more frequent in women with asthma exposed to ETS.

Conclusions

Due to the small number of women with asthma exposed to ETS, combined effects of asthma and ETS were only found for cesarean sections. Still counseling of pregnant women about adverse effects of ETS should consider women’s asthma as an additional reason to avoid ETS.

Suppressive effect of environmental tobacco smoke on murine Th2 cell-mediated nasal eosinophilic inflammation

Background

Environmental tobacco smoke (ETS) exposure is recognized as a risk factor for the development of various respiratory diseases.

Objective

In this study, the effect of ETS on allergen-immunized and allergen-specific Th2 cell-transferred murine eosinophilic inflammation models and that of cigarette smoke extract (CSE) and nicotine on allergen-induced Th2 cell proliferation and interleukin (IL)-4 production were investigated.

Methods

Ovalbumin (OVA)-immunized and OVA-specific Th2 cell-transferred BALB/c mice were exposed to ETS and were challenged with OVA. Then, the number of inflammatory cells in the nasal mucosa and nasal hyperresponsiveness (NHR) were assessed. The effects of CSE and nicotine on the allergen-induced proliferative response of and IL-4 production by Th2 cells were determined in vitro.

Results

In OVA-immunized and Th2 cell-transferred mice, allergen-induced NHR and nasal eosinophil infiltration were significantly suppressed by ETS exposure, whereas the accumulation of neutrophils was rather enhanced. Allergen-specific Th2 cell proliferation and IL-4 production were inhibited by coculture with CSE. The same effects were induced by nicotine, though the effect on proliferation was relatively weak.

Conclusion

Regardless of its harmful effect, ETS suppresses NHR, probably through the inhibition of Th2 cell responses.

Pet ownership in utero and in childhood decreases the effects of environmental tobacco smoke exposure on hypertension in children: A large population based cohort study

BACKGROUND

Little is known about whether exposure to pets influences the association between hypertension and environmental tobacco smoke (ETS). The current study aims to examine the interaction of pet ownership on ETS exposure and the development of hypertension in children.

METHODS

From 2012 to 2013, a total of 9354 children, 5 to 17 years of age, were recruited from 62 schools in seven northeastern cities. BP in children was measured and hypertension was defined as an average diastolic blood pressure (DBP) or systolic blood pressure (SBP) at or above the 95th percentile for that child's age, sex, and height. Pet ownership in three different time periods (in utero, past 2 years, and currently) and ETS exposure data were collected from parents via a questionnaire. Two-level regressions were used for the data analyses.

RESULTS

The data show consistent, significant interactions between exposure to pets and effects from ETS. Children who were not exposed to pets experienced stronger effects from ETS on hypertension when compared to those exposed to pets, and the protective effect of pet ownership became stronger with a greater number of pets in the home. Exposure to in utero ETS was associated with hypertension [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI): 1.13-1.54] only for those children without pet exposure in utero but not for those with pets (aOR = 0.75; 95% CI: 0.49-1.15) (p_interaction < 0.05). Moreover, household dog ownership was related to significantly lower effects of current ETS on hypertension (aOR = 0.80, 95% CI: 0.61-1.05) compared with children without dogs (aOR = 1.26, 95% CI: 1.11-1.44) (p_interaction = 0.001). Interaction associations between ETS and pet ownership were more robust for girls than for boys and for younger than older children.

CONCLUSION

This study indicates an inverse relationship between pet ownership and ETS, potentially pointing to pet ownership as protecting against the development of hypertension in children.

The time window of pet ownership exposure modifies the relationship of Environmental Tobacco Smoke with lung function: A large population-based cohort study

There is a large body of evidence linking Environmental Tobacco Smoke (ETS) exposure with impaired lung function. However, it is not known whether exposure to pets modifies this relationship. To investigate if pet ownership changes the association between ETS exposure and lung function, a population-based sample of 7326 children, 7-14 years old, were randomly recruited from 24 districts in northeast China. Lung function including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF) was measured by spirometry, while pet ownership time periods and ETS exposure were collected by questionnaire. Two-level regression analysis was done, with covariates controlled for. The results showed pet exposure in certain early lifetime windows modified the associations of ETS exposure on decreased lung function in children. Among children exposed to current ETS, those exposed to pets in utero had greater reductions in lung function (for instance: OR for reduced FVC (<85% predicted) = 10.86; 95% CI: 3.80-30.97) than those not exposed to pets in utero (OR = 2.32; 95% CI: 1.76-3.05) (p_interaction = 0.005). While, children exposed to current pet ownership reduced the lung function impairment induced by ETS exposure during the first 2 years of life and/or ETS exposure during pregnancy, especially for FVC impairment. For instance, OR (95%CI) for reduced FVC (<85% predicted) was 0.81 (0.56, 1.18) and 1.42 (1.15, 1.74), respectively, for children with or without current pet ownership exposed to ETS during the first 2 years of life (p_interaction = 0.010). Furthermore, pet type or number of pets did not significantly modify associations between ETS exposure and lung function. In conclusion, the timing of pet ownership modified associations between ETS exposure and lung function, pet ownership in utero and during the first 2 years of life significantly worsened the adverse impacts of passive smoking on lung function.