High Environmental Tobacco Smoke Research Articles

Respiratory infections among junior high school students in upper northern Thailand: The role of building dampness and mould, biomass burning and outdoor relative air humidity (RH)

BackgroundFew studies exist on environmental risk factors for respiratory infections in Thai school children. AimTo study associations between home and outdoor environment and respiratory infections among school children in Northern Thailand in dry and wet season. MethodsA repeated questionnaire survey among the children (N = 1159). Data on ambient temperature and relative air humidity (RH) and PM10 and ozone was collected from nearby monitoring stations. We used logistic regression to calculate odds ratios (OR). Results14.1% had current respiratory infections (last 7 days), 32.1% had any respiratory infection last 3 months, and 26.1% had any respiratory infection last 12 months with antibiotic treatment. Students with diagnosed allergy (7.7%) and diagnosed asthma (4.7%) had more often respiratory infections (ORs 1.40–5.40; p < 0.05). Current respiratory infections were more common in dry (18.1%) than in wet season (10.4%) (p < 0.001) and was associated with indoor mould (OR 2.16; p = 0.024) and outdoor RH (OR 1.34 per 10% RH; p = 0.004.) in the total material. In wet season, mould (OR 2.32; p = 0.016), window pane condensation (OR 1.79; p = 0.050), water leakage (OR 1.82; p = 0.018), environmental tobacco smoke (ETS) (OR 2.34; p = 0.003) and outdoor RH (OR 2.70 per 10% RH; p = 0.01) were risk factors for current respiratory infections. In dry season, mould (OR 2.64; p = 0.004) and outdoor RH (OR 1.34 per 10% RH; p = 0.046) were associated with current respiratory infections. Irrespectively of season, biomass burning inside or outside the home was a risk factor for respiratory infections (ORs 1.32–2.34; p < 0.05). Living in a wooden house decreased the risk of respiratory infections (OR 0.56: p = 0.006). ConclusionsDry season, high outdoor RH, household dampness, indoor mould and ETS can increase childhood respiratory infections. Living in a traditional wooden house can reduce respiratory infections, possibly due to better natural ventilation. Smoke from biomass burning can increase childhood respiratory infections in northern Thailand.

Environmental Tobacco Smoke Exposure Estimated Using the SHSES Scale, and Feature Tracking Computed Tomography-Derived Left Ventricular Global Longitudinal Strain in Hypertensive Patients

Aim of the study was to assess the relationship between environmental tobacco smoke (ETS) and computed tomography-derived left ventricular global longitudinal strain (LV GLS) in patients with arterial hypertension. 103 non-smokers with AH were included in the study (age 67.73 ± 8.84 years). ETS exposure was assessed with the Second-Hand Smoke Exposure Scale (SHSES). LV GLS was measured on computed tomography using feature tracking technology. In accordance with SHSES scale patients were divided into subgroups: subgroup A—no ETS exposure, subgroup B—low ETS exposure, subgroup C—medium ETS exposure, and subgroup D—high ETS exposure. Peak of LV GLS was statistically significantly lower in subgroup D than in subgroup A. There was a negative correlation between the exposure to ETS expressed by the SHSES scale and peak of LV GLS (r = − 0.35, p < 0.05). Regression analysis showed that higher SHSES score, higher age, left ventricular hypertrophy, left ventricular diastolic dysfunction, and higher CAD-RADS are independent risk factors for lower peak of LV GLS values. On the contrary, the effective blood pressure control appeared to be independent protecting factor against lower peak of LV GLS values. In summary, there is an unfavorable weak relationship between ETS exposure estimated using the SHSES scale and LV GLS in hypertensive patients.

Environmental Tobacco Smoke in Occupational Settings: Effect and Susceptibility Biomarkers in Workers From Lisbon Restaurants and Bars

Environmental tobacco smoke (ETS) has been recognized as a major health hazard by environmental and public health authorities worldwide. In Portugal, smoke-free laws are in force for some years, banning smoking in most indoor public spaces. However, in hospitality venues such as restaurants and bars, owners can still choose between a total smoke-free policy or a partial smoking restriction with designated smoking areas, if adequate reinforced ventilation systems are implemented. Despite that, a previous study showed that workers remained continuously exposed to higher ETS pollution in Lisbon restaurants and bars where smoking was still allowed, comparatively to total smoke-free venues. This was assessed by measurements of indoor PM2.5 and urinary cotinine, a biomarkers of tobacco smoke exposure, demonstrating that partial smoking restrictions do not effectively protect workers from ETS. The aim of the present work was to characterize effect and susceptibility biomarkers in non-smokers from those hospitality venues occupationally exposed to ETS comparatively to non-exposed ones. A group of smokers was also included for comparison. The sister chromatid exchange (SCE), micronucleus (MN) and comet assays in whole peripheral blood lymphocytes (PBLs) and the micronucleus assay in exfoliated buccal cells, were used as biomarkers of genotoxicity. Furthermore, a comet assay after ex vivo challenge of leukocytes with an alkylating agent, ethyl methanesulfonate (EMS), was used to analyze the repair capacity of those cells. Genetic polymorphisms in genes associated with metabolism and DNA repair were also included. The results showed no clear association between occupational exposure to ETS and the induction of genotoxicity. Interestingly, the leukocytes from non-smoking ETS-exposed individuals displayed lower DNA damage levels in response to the ex vivo EMS challenge, in comparison to those from non-exposed workers, suggesting a possible adaptive response. The contribution of individual susceptibility to the effect biomarkers studied was unclear, deserving further investigation.

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.

Vitamins B-12 and C Supplementation Improves Arterial Reactivity and Structure in Passive Smokers: Implication in Prevention of Smoking-Related Atherosclerosis.

Atherosclerosis is an important medical problem of modern society. High environmental tobacco smoke in casino is associated with an accelerated atherogenic process. We have previously shown vitamin B12 and C supplementation improves vascular reactivity and may be beneficial in vascular protection. To evaluate the impact of vitamin supplementation on atherosclerosis (brachial artery reactivity FMD and carotid intima-media thickness IMT) in subjects exposed to high environmental tobacco smoke. Double-blind 2x2 factorial design fashion. Computer randomization in 4 treatment groups: placebo (n=24), vitamin B12 (n=21), vitamin C (n=23) and vitamin B12+C (n=23) groups. 91 passive-smoking casino employees (19.2% male, mean age 45.0±8.2 years). Subjects were randomized to receive vitamin B12 (500µg daily), vitamin C (200mg daily), vitamin B12+C or image-matched placebo capsules for 1 year. Brachial FMD and carotid IMT (surrogate atherosclerotic markers) were measured by ultrasound at baseline and on completion at 12 months. 91 passive smoking casino employees (19.2% male, mean age 45.0±8.2 years) were randomized to receive vitamin B12 (500µg daily), vitamin C (200mg daily), vitamin B12+C or image-matched placebo capsules in double-blind 2 x 2 factorial design fashion for 1 year. Brachial FMD and carotid IMT (surrogate atherosclerotic markers) were measured by ultrasound at baseline and 12 months. Of the 78 (85.7%) passive-smoking employees completed the study, 11.5% had hypertension, 5.1% diabetes mellitus and 15.4% hypercholesterolemia. There were no significant changes in their blood pressures, lipid profiles, glucose and body mass index after supplementation for 1 year, but mild decrease in DBP (p<0.001) and blood creatinine (p<0.01) after combined vitamin B12 and C, and significant increase in blood B12 after vitamin B12 (p<0.01) and vitamin B12+C supplementations (p<0.001). Brachial FMD and cartotid IMT improved after the 3 vitamin supplementations (p<0.001), but not after placebo, being more significant after combined vitamin supplementations (p<0.0001). No adverse effects were reported. Vitamin B12 or C supplementation in passive smokers improved vascular reactivity and structures at 1 year, with implication in long term atherosclerosis prevention.

Association of Environmental Tobacco Smoke Exposure and Infant Neurodevelopmental Achievements and Effect Modification by Maternal Overweight and Obesity: Results from the Taiwan Birth Cohort Study

Background: Environmental tobacco smoke (ETS) is a common indoor air pollutant associated with multiple adverse health effects, but it remains unclear regarding effect modifiers and susceptible groups for detrimental neurodevelopmental effect of ETS. We examine the associations between ETS exposure and infant neurodevelopmental parameters in a national-wide representative population. Methods: We extracted the information via structured questionnaires upon home interview from Taiwan Birth Cohort Study (TBCS). The associations between ETS exposure and infant neurodevelopmental milestones were evaluated with multivariate conditional logistic regression and the Cox model and with propensity score (PS) weighting and matching based upon preselected covariates. Results: In this study, 15 987 term singletons were included, and 3598 mother-infant pairs were further selected to PS-matched subpopulation. Higher ETS exposure was associated with increased likelihood of delay in caregiver-reported fine motor (adjusted odds ratio (aOR)=1.29, 95% CI=1.07-1.55; adjusted hazard ratio (aHR)=1.06, 95% CI=1.01-1.11 for clapping hands; aOR=1.21, 95% CI=1.03-1.43; aHR=1.05, 95% CI=1.00-1.10 for scribbling), language-related (aOR=1.25, 95% CI=1.03-1.50; aHR=1.08, 95% CI=1.03-1.13 for waving goodbye; aOR=1.22, 95% CI=1.01-1.47; aHR=1.08, 95% CI=1.04-1.14 for calling a parent meaningfully), and it was consistent in PS-weighted, PS-matched, and among non-smoking families. We also detected positive interaction for both maternal overweight and obesity before pregnancy and after delivery upon the association between high ETS exposure and delayed milestone achievement in scribbling. Conclusions: Maternal peripartum ETS exposure was associated with delayed neurodevelopmental milestone achievement at eighteen months among non-smoking families, and effect modification by maternal overweight and obesity status indicated possible intervention targets for pregnant women.

A translational science approach to community-based participatory research using methodological triangulation

To advance the science of translational research and triangulation through a case study of community-based participatory research (CBPR) study on children’s exposure to environmental tobacco smoke (ETS). A total of 130 African American parents and children were recruited to participate in 13 parent advisory board key informant interviews (n = 6), parent tobacco use and behavior survey (n = 63), children’s (aged 6 months to 5 years) salivary assays (n = 43), and three member check focus groups (n = 18). Data were collected and analyzed separately, and overall findings were evaluated for consistency, inconsistency, divergent data, and data saturation using a data matrix table aligned with the social ecological model. Out of 43 children, 39.5% had levels of cotinine, suggesting high ETS exposure. The findings demonstrated that extremely low knowledge on how to protect children from exposure as well as low education and poverty increase the likelihood that parents do not believe in the harms of ETS. Custodial parents cannot control noncustodial parents smoking around children and 28% of children live in homes with no or partial smoking restrictions. Children’s healthcare providers are inconsistently inquiring about ETS exposure. Children living in attached homes had a greater likelihood of being exposed to ETS by another adult outside the home. CBPR is an effective strategy for translating science into promising community-informed interventions that meet the cultural and social needs of medically underserved populations. Integrated diverse data sets were utilized in the formation of a parental intervention targeting factors identified in the matrix.

The Association of Environmental Tobacco Smoke Exposure and Inflammatory Markers in Hospitalized Children.

Background: Environmental tobacco smoke (ETS) exposure is associated with altered cytokine levels in children. We sought to examine ETS exposure prevalence and the relationship between ETS exposure and cytokine levels in a sample of hospitalized children. (2) Methods: Inflammatory markers (IL-8, IL-1β, IL-10, and TNF-α) and cotinine were measured in saliva of hospitalized, nonsmoking children (N = 112). To assess the association between ETS exposure and immune system response, we built a multivariate regression model including the four inflammatory markers as the response variables and cotinine, age, sex, and discharge diagnosis as explanatory variables while assessing possible interaction effects. (3) Results: Mean age (SD) was 5.8(5.0) years; Geometric Mean (GeoM) cotinine = 1.8 [95% CI = 1.4–2.2]. Children with non-inflammatory other diagnoses had lower IL-10 (p = 0.003) and TNF-α (p = 0.009) levels than children with inflammatory other diagnoses. Children with asthma (p = 0.01) and bacterial illnesses and/or pneumonia (p = 0.002) had higher IL-8 levels. Independent of diagnosis, there was a significant curvilinear association between cotinine and IL-1β (p = 0.002) reflecting no association for cotinine levels <5 ng/mL and a positive association for >5 ng/mL. (4) Conclusions: Children with higher ETS exposure levels have higher IL-1β levels regardless of age, sex, and diagnosis. ETS exposure may increase pro-inflammatory immune responses in children and may interfere with native immune responses and the ability to heal and fight infection.

Environmental Tobacco Smoke Exposure in Relation to Family Characteristics, Stressors and Chemical Co-Exposures in California Girls.

Childhood environmental tobacco smoke (ETS) exposure is a risk factor for adverse health outcomes and may disproportionately burden lower socioeconomic status groups, exacerbating health disparities. We explored associations of demographic factors, stressful life events, and chemical co-exposures, with cotinine levels, among girls in the CYGNET Study. Data were collected from families of girls aged 6–8 years old in Northern California, through clinic exams, questionnaires and biospecimens (n = 421). Linear regression and factor analysis were conducted to explore predictors of urinary cotinine and co-exposure body burdens, respectively. In unadjusted models, geometric mean cotinine concentrations were higher among Black (0.59 ug/g creatinine) than non-Hispanic white (0.27), Asian (0.32), or Hispanic (0.34) participants. Following adjustment, living in a rented home, lower primary caregiver education, and lack of two biologic parents in the home were associated with higher cotinine concentrations. Girls who experienced parental separation or unemployment in the family had higher unadjusted cotinine concentrations. Higher cotinine was also associated with higher polybrominated diphenyl ether and metals concentrations. Our findings have environmental justice implications as Black and socio-economically disadvantaged young girls experienced higher ETS exposure, also associated with higher exposure to other chemicals. Efforts to reduce ETS and co-exposures should account for other disparity-related factors.

Differences in Prenatal Tobacco Exposure Patterns among 13 Race/Ethnic Groups in California.

Prenatal tobacco exposure is a significant, preventable cause of childhood morbidity, yet little is known about exposure risks for many race/ethnic subpopulations. We studied active smoking and environmental tobacco smoke (ETS) exposure in a population-based cohort of 13 racially/ethnically diverse pregnant women: white, African American, Hispanic, Native American, including nine Asian/Pacific Islander subgroups: Chinese, Japanese, Korean, Filipino, Cambodian, Vietnamese, Laotian, Samoan, and Asian Indians (N = 3329). Using the major nicotine metabolite, cotinine, as an objective biomarker, we analyzed mid-pregnancy serum from prenatal screening banked in 1999–2002 from Southern California in an effort to understand differences in tobacco exposure patterns by race/ethnicity, as well as provide a baseline for future work to assess secular changes and longer-term health outcomes. Prevalence of active smoking (based on age- and race-specific cotinine cutpoints) was highest among African American, Samoan, Native Americans and whites (6.8–14.1%); and lowest among Filipinos, Chinese, Vietnamese and Asian Indians (0.3–1.0%). ETS exposure among non-smokers was highest among African Americans and Samoans, followed by Cambodians, Native Americans, Vietnamese and Koreans, and lowest among Filipinos, Japanese, whites, and Chinese. At least 75% of women had detectable cotinine. While for most groups, levels of active smoking corresponded with levels of ETS, divergent patterns were also found. For example, smoking prevalence among white women was among the highest, but the group’s ETS exposure was low among non-smokers; while Vietnamese women were unlikely to be active smokers, they experienced relatively high ETS exposure. Knowledge of race/ethnic differences may be useful in assessing disparities in health outcomes and creating successful tobacco interventions.

Environmental tobacco smoke exposure among electronic cigarette users

IntroductionExposure to environmental tobacco smoke (ETS) from combustible tobacco products causes various diseases and makes quitting smoking more difficult. However, little is known about exposure of e-cigarette users to ETS from combustible tobacco products. This study aimed to investigate e-cigarette users' exposure to ETS from tobacco smokers. MethodsThe association between ETS exposure frequency and different types of smokers including e-cigarette users was examined using ordered logistic regression analysis and nationally representative survey data on 28,765 individuals who were interviewed in the Canadian Tobacco, Alcohol and Drugs Surveys conducted during 2013 and 2015. Survey respondents were classified into one of five smoker types: smokers of tobacco only, dual users of tobacco and e-cigarettes, users of e-cigarette only, former smokers and never smokers. The analyses were conducted using the entire sample and by age group. ResultsYoung to mid-age (15–54) dual users of both regular cigarettes and e-cigarettes have higher ETS exposure than even tobacco smokers. Young to mid-age single users of e-cigarettes are less exposed to ETS than tobacco smokers, but still have higher ETS than never smokers. At older age (55+), both dual and single e-cigarette users face similar risks of ETS exposure as tobacco smokers. ConclusionsE-cigarette users are at high risk of ETS exposure. Policies that target the behaviour of e-cigarette users as well as the environments surrounding them to address their high ETS exposure risk would be beneficial.

The role of environmental tobacco exposure and Helicobacter pylori infection in the risk of chronic tonsillitis in children.

Helicobacter pylori (H. pylori) is a chronic infectious pathogen with high prevalence. This study investigated the interaction between environmental tobacco exposure and H. pylori infection on the incidence of chronic tonsillitis in Chinese children. Cross-sectional study performed in an outpatient clinic in China. Pediatric patients with chronic tonsillitis were enrolled. H. pylori infection was determined according to the presence of H. pylori CagA IgG antibodies. Serum cotinine levels and environmental tobacco smoke (ETS) exposure were determined for all participants. There was no significant difference in H. pylori infection between the children with chronic tonsillitis and children free of disease, but there was a significant difference in ETS between the two groups (P = 0.011). We next studied the association between ETS and chronic tonsillitis based on H. pylori infection status. In the patients with H. pylori infection, there was a significant difference in ETS distribution between the chronic tonsillitis and control groups (P = 0.022). Taking the participants without ETS as the reference, multivariate logistic regression analysis showed that those with high ETS had higher susceptibility to chronic tonsillitis (adjusted OR = 2.33; 95% CI: 1.67-3.25; adjusted P < 0.001). However, among those without H. pylori infection, ETS did not predispose towards chronic tonsillitis. Our findings suggest that tobacco exposure should be a putative mediator risk factor to chronic tonsillitis among children with H. pylori infection.

Influence of maternal environmental tobacco smoke exposure assessed by hair nicotine levels on birth weight.

While the perinatal outcomes of active maternal smoking are well documented, results of the effects of environmental tobacco smoke (ETS) exposure during pregnancy are inconsistent. We aimed to examine the effect of ETS exposure, assessed by maternal hair nicotine levels at 35th week of gestation, on birth weight and the risk of small for gestational age (SGA) and low birth weight (LBW). A total of 871 non-smoking healthy pregnant women were recruited by one Korean hospital between 1 October 2006 and 31 July 2007. Hair samples were collected and anthropometric questionnaires administered at 35th week of gestation. The primary outcome was birth weight and secondary outcomes were the risk of babies being SGA and LBW. Log-transformed hair nicotine concentrations were inversely related with birth weight after adjusting for confounding variables (β=-0.077, p=0.037). After stratifying hair nicotine levels by tertiles (T1, low [0.0-0.28 ng/mg]; T2, medium [0.29-0.62 ng/mg]; and T3, high [0.63-5.99 ng/mg]), the mean birth weight in each groups were 3,342 g (T1) 3,296 g (T2) and 3,290 g (T3), respectively. However the difference between groups was not statistically significant by analysis of co-variance (ANCOVA) adjusting for covariates (p=0.062). In logistic regression analysis, the risk of SGA was higher in the T3 (OR=1.59, 95%CI 1.05-2.42) than in the reference group (T1), after controlling for confounding variables. The risk of low birth weight (<2,500 g, LBW) was not significantly higher (OR=1.44, 95%CI 0.95-2.19), but the risk of babies being below 3,000g birth weight was increased in the T3 group (OR=1.53, 95%CI 1.00-2.36) compared with that in the T1 group. Maternal ETS exposure during pregnancy was inversely related with birth weight. The risk of SGA increased in the highest ETS exposure group compared with in the low exposure group. To prevent ETS exposure during pregnancy, more comprehensive tobacco control policies are needed.

Synergistic interaction between polycyclic aromatic hydrocarbons and environmental tobacco smoke on the risk of obesity in children and adolescents: The U.S. National Health and Nutrition Examination Survey 2003–2008

BackgroundPolycyclic aromatic hydrocarbons (PAHs) may be obesogens. However, the role of PAHs independent of environmental tobacco smoke (ETS) is unclear, and the interaction between PAHs and ETS remains unknown. MethodsWe performed cross-sectional analyses of urinary concentrations of PAH metabolites, body mass index (BMI), and waist circumference (WC) in 1985 people aged 6–18 years using data from the 2003–2008 U.S. National Health and Nutrition Examination Survey. ETS exposure level was measured as serum cotinine level. ResultsPAH metabolites were positively associated with BMI and WC in both the ETS-unexposed and ETS-exposed groups. The adjusted odds ratios for general obesity defined by age- and sex-specific BMI≥95th percentile across the quartiles of total PAH metabolites were 1, 4.51, 2.57, and 8.09 (Ptrend=0.003) in the ETS-unexposed group and 1, 2.02, 1.83, and 3.86 (Ptrend<0.001) in the ETS-exposed group. However, the association of PAH metabolites with obesity became stronger as serum cotinine levels increased (Pinteraction<0.05). Among those with high ETS exposure, the adjusted odds ratios for general obesity across quartiles of total PAH metabolites were 1, 2.89, 5.26, and 16.29 (Ptrend<0.001). Compared to the low PAH-exposure group without exposure to ETS, the high ETS- and high PAH-exposure group had 33.85- and 17.64-fold greater risks of general and central obesity, respectively. ConclusionEnvironmental exposure to PAHs may be associated with childhood obesity irrespective of ETS. In particular, simultaneous exposure to PAHs and ETS may substantially increase the risk of obesity.

Low birth weight and environmental tobacco smoke increases the risk of wheezing in adolescents: a retrospective cohort study

BackgroundLow birth weight (LBW) and environmental tobacco smoke (ETS) exposure are each associated with wheezing in children. This study was designed to examine the combined association of LBW and ETS with wheezing.MethodsA retrospective birth cohort analysis linked with a national survey of allergic disorders among 1,018,031 junior high school students in Taiwan (1995–1996) was analyzed. The reported incidence of wheezing (yes or no) and ETS exposure (4 categories: 0, 1–20, 21–40 and greater than or equal to 41 household cigarettes per day) were obtained from validated questionnaires. Multiple logistic regression models were used to assess the associations of interest.ResultsThere were 844,003 (83%) subjects analyzed after the exclusion criteria. LBW was associated with an increased risk of reporting ever wheezing (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.01–1.16), current wheezing (OR = 1.09, 95% CI = 1.00–1.20) and wheezing with exercise (OR = 1.11, 95% CI = 1.02–1.21) within the smoke-free cohort. Higher ETS exposure correlated to a higher risk of wheezing (ever, current and with exercise). With ETS exposure, adolescents from the lowest birth weight cohorts were more likely to report wheezing (ever, current and with exercise).ConclusionsETS and LBW each has been related to increasing public health risk for respiratory symptoms among adolescents. Furthermore, LBW may aggravate the risk among those exposed to ETS. LBW, ETS and associated respiratory impairments may deserve special attention as part of a comprehensive environmental health risk assessment directed toward prevention and intervention.

Mortality Risks Associated With Environmental Tobacco Smoke Exposure in the United States

Researchers have presented various estimates of mortality attributable to environmental tobacco smoke (ETS) exposure in the United States, but mortality risk estimates for ETS exposure from U.S. health survey data are generally unavailable. I estimated mortality hazard ratios (HRs) for ETS exposure from Third National Health and Nutrition Examination Survey (NHANES III) data from 1988 to 1994 linked for 4 and 8 years of mortality follow-up. I classified ETS exposure based on observed serum cotinine concentrations (low ETS exposure: <0.1 ng/ml, medium ETS exposure: ≥ 0.1 ng/ml, and <1 ng/ml, and high ETS exposure: ≥ 1 ng/ml and <15 ng/ml) and reported home ETS exposure information. I also estimated ETS exposure among U.S. nonsmokers over time using NHANES III data and continuous NHANES data from 1999 to 2010. High ETS exposure was associated with higher ischemic heart disease mortality risk (HR = 2.47, 95% CI = 1.04-5.86) among never-smokers during 4 years of follow-up, adjusting for age, sex, race/ethnicity, educational attainment, alcohol consumption, body mass index, high blood pressure, and serious circulatory conditions. The prevalence of medium ETS exposure among nonsmokers decreased from 53.0% (95% CI = 51.5%-54.5%) in NHANES III to 16.7% (95% CI = 15.3%-18.1%) in NHANES from 2005 to 2010. I found an association between high ETS exposure and heart disease mortality risk among never-smokers during short-term mortality follow-up using U.S. national health survey data. I also found that ETS exposure among U.S. nonsmokers has substantially decreased in recent decades.

Vitamins B12 and C Supplementation Improves Arterial Reactivity and Structure in Passive Smokers

Background: High environmental tobacco smoke in a casino is associated with accelerated atherogenic process. We have previously shown vitamin B12 or C supplementation improves vascular reactivity, which we hypothesise may be beneficial to vascular protection in passive smokers.

Excessive Cardiovascular Risk and Cardiac Investigations in Asymptomatic Population: A Study in Airline Pilots

Excessive Cardiovascular Risk andCardiac Investigations in Asymptomatic Population: A Study in Airline Pilots I.M.A. Wirawan1,2,∗, S. Aldington1, R.F. Griffiths1, C.J. Ellis 3, P.D. Larsen1 1Occupational and Aviation Medicine Unit, Department of Medicine, University of Otago Wellington, New Zealand 2 Occupational Health Department, School of Public Health, Faculty of Medicine, Udayana University, Bali, Indonesia 3 Green Lane CVS Service, Cardiology Department, Auckland City Hospital, Auckland, New Zealand Background: Accurate risk assessment for cardiovascular diseases (CVD) in airline pilots is a particular challenge as the consequence of inaccurate assessment can be either unnecessary loss of license, or sudden in-flight incapacitation. This study examined the current practice of risk assessment in airline pilots with an initial excessive CVD risk score. Methods:Across-sectional studywasperformedamong 856 pilots employed in an Oceania based airline. A retrospective review of cardiovascular investigations was conducted among pilots with an initial CVD five-year risk score of ≥10%. Results: There were 29 (3.5%) pilots found to have a five-year CVD risk score of ≥10% who underwent further investigation. In most cases (n= 26) pilots underwent an exercise stress test. Seven of these showed a positive system did identify four pilots with significant coronary lesions. http://dx.doi.org/10.1016/j.hlc.2012.03.117 Vitamins B12 and C Supplementation Improves Arterial Reactivity and Structure in Passive Smokers K.S. Woo4,∗, P. Chook4, M.L. Chiu1, X.H. Feng2, M.L. Evora1, K.V. Koon1, X.M. Zhang2, C.L. Chu3, H.C. Leong3, T.W.C. Yip4, T.Y.K. Chan4 1Hospital Central Conde de S. Januario, Macao 2 Kiang Wu Hospital, Macao 3 Macau Heart Foundation, Macao 4 The Chinese University of Hong Kong, Hong Kong SAR Background: High environmental tobacco smoke in a casino is associated with accelerated atherogenic process. We have previously shown vitamin B12 or C supplementation improves vascular reactivity, which we hypothesise may be beneficial to vascular protection in passive smokers. Methods: Seventy-eight passive smoking casino employees (19.2% male, mean age 45.0± 8.2 years) were randomised to receive vitamin B12 (500 g daily), vitamin C (200 g daily), vitamin B12 +C or double image-matched placebo capsules in double-blind 2× 2 factorial design fashion for one year. Brachial flow mediated dilation

Environmental Tobacco Smoke Exposure and Chinese Schoolchildren's Respiratory Health: A Prospective Cohort Study

Although China is the most coveted cigarette market worldwide, few studies have examined the longitudinal effects of environmental tobacco smoke (ETS) on health. To examine the relationship between exposure to ETS and respiratory health in Chinese schoolchildren. The study subjects included 1718 children, who were never-smokers, aged 10.05±0.86 years and asthma-free at baseline. The children performed spirometric tests in 2006 and 18 months later. Parents reported the children's respiratory symptoms and illnesses, ETS exposure, and other related information by self-administered survey at both assessment points. The data were analyzed in 2010. Significant exposure-response relationships were found between ETS exposure and coughing at night (p for trend<0.001); sneezing (p for trend=0.031); and sneezing with itchy, watery eyes (p for trend=0.006) in the first survey, and coughing at night (p for trend=0.019); phlegm without a cold (p for trend<0.001); and sneezing (p for trend=0.036) in the second survey. Compared with those who reported no ETS exposure in either survey, children who had a high ETS exposure level (>5 cigarettes/day) in either survey had lower growth rates in forced expiratory flow between 25% and 75% of forced vital capacity (FEF(25-75); β= -0.104, p=0.020) and forced expiratory flow at 25% of forced vital capacity (FEF(25); β= -0.077, p=0.027). A monotonic exposure-response effect was observed between ETS exposure and the deficits in the growth rate of FEF(25) and FEF(25-75.) Exposure to ETS increased the risks of respiratory symptoms in Chinese school-aged children and was associated with impaired lung function growth. A dose-response relationship was observed for the latter effect.

The Response of Children with Asthma to Ambient Particulate Is Modified by Tobacco Smoke Exposure

Ambient particulate matter concentrations have been positively associated with urinary leukotriene E(4) (LTE(4)) levels and albuterol usage in children with asthma but interactions with environmental tobacco smoke (ETS) exposure have not been demonstrated despite obvious exposure to both pollutants in an urban setting. To assess the health effects of concurrent ETS and ambient particulate matter exposure in children with asthma. Albuterol usage and LTE(4) levels were monitored in 82 urban schoolchildren with asthma over three consecutive fall to spring school periods. Concentrations of morning maximum ambient particulate matter <2.5 μm in aerodynamic diameter (mmPM(2.5)) and urine cotinine levels were also measured daily. Albuterol usage and LTE(4) were related to mmPM(2.5) concentrations on days when urine cotinine levels were low (<10 ng/ml/mg creatinine); on these days, mean albuterol usage and LTE(4) increased up to 5 or 6% per 10 μg/m(3) increase in mmPM(2.5). In contrast, no significant relationship was observed when cotinine was high, although mean albuterol usage and LTE(4) levels were greater in this case. Model fits for LTE(4) levels as a function of mmPM(2.5) concentrations were improved when mmPM(2.5) concentrations were logged, suggesting a nonlinear dose-response relationship between particulate matter exposure concentrations and airway mediators of asthma, for which the relationship tends to flatten at higher concentrations. This study suggests that ETS modifies the acute effects of low-level ambient PM(2.5) exposure on childhood asthma. This negative interaction, the smaller effect of particulate matter exposure in children exposed to higher ETS, may be related to a nonlinear dose-response relationship between asthma mediators and particulate exposures.