Environmental Tobacco Smoke In Home Research Articles

Environmental Tobacco Smoke and Early Language Difficulties among U.S. Children.

Objective: Environmental Tobacco Smoke (ETS) is a serious public health concern with the potential to interfere with various components of healthy child development. Even so, there has been limited nationally representative research investigating these connections. The current study examines the relationship between ETS and language difficulties among toddlers and preschool-aged children in the United States. Method: Data are derived from the 2018 National Survey of Children’s Health and facilitate strategic comparisons between different forms of ETS—namely, children who live with family members who smoke vs. children whose family members smoke inside the housing unit. Results: The findings reveal a robust association between family members smoking inside the housing unit and both receptive and expressive language difficulties, but only among male children. After adjusting for covariates, smoking inside the housing unit is associated with a 182% increase in the rate of early composite language difficulties among male children. These associations persist even when compared to male children who live with smoking family members who do not smoke inside the housing unit. Conclusions: The findings suggest a need for interventions designed to reduce ETS in households with young children and increase targeted language skill training for vulnerable children in an effort to enhance child development and well-being. To maximize this effort, we advocate for interdisciplinary teams, including medical and public health practitioners, educators, and researchers, to work together to develop and implement evidence-based strategies to limit ETS in homes and facilitate healthy language development among young children.

Joint testing of genotypic and gene-environment interaction identified novel association for BMP4 with non-syndromic CL/P in an Asian population using data from an International Cleft Consortium.

BackgroundNon-syndromic cleft lip with or without cleft palate (NSCL/P) is a common disorder with complex etiology. The Bone Morphogenetic Protein 4 gene (BMP4) has been considered a prime candidate gene with evidence accumulated from animal experimental studies, human linkage studies, as well as candidate gene association studies. The aim of the current study is to test for linkage and association between BMP4 and NSCL/P that could be missed in genome-wide association studies (GWAS) when genotypic (G) main effects alone were considered.Methodology/Principal FindingsWe performed the analysis considering G and interactions with multiple maternal environmental exposures using additive conditional logistic regression models in 895 Asian and 681 European complete NSCL/P trios. Single nucleotide polymorphisms (SNPs) that passed the quality control criteria among 122 genotyped and 25 imputed single nucleotide variants in and around the gene were used in analysis. Selected maternal environmental exposures during 3 months prior to and through the first trimester of pregnancy included any personal tobacco smoking, any environmental tobacco smoke in home, work place or any nearby places, any alcohol consumption and any use of multivitamin supplements. A novel significant association held for rs7156227 among Asian NSCL/P and non-syndromic cleft lip and palate (NSCLP) trios after Bonferroni correction which was not seen when G main effects alone were considered in either allelic or genotypic transmission disequilibrium tests. Odds ratios for carrying one copy of the minor allele without maternal exposure to any of the four environmental exposures were 0.58 (95%CI = 0.44, 0.75) and 0.54 (95%CI = 0.40, 0.73) for Asian NSCL/P and NSCLP trios, respectively. The Bonferroni P values corrected for the total number of 117 tested SNPs were 0.0051 (asymptotic P = 4.39*10−5) and 0.0065 (asymptotic P = 5.54*10−5), accordingly. In European trios, no significant association was seen for any SNPs after Bonferroni corrections for the total number of 120 tested SNPs.Conclusions/SignificanceOur findings add evidence from GWAS to support the role of BMP4 in susceptibility to NSCL/P originally identified in linkage and candidate gene association studies.

Home environmental tobacco smoke exposure in Canadian children

Children living with a smoker experience increased environmental tobacco smoke (ETS) exposure, even when the smoker refrains from smoking inside the house, compared to children not living with a smoker. Given the risks of ETS in children, it was hypothesized that households with children are less likely than those without children to experience home ETS exposure. Cross-sectional analysis of the Canadian Community Health Survey 2009-2010 for the association between children aged <12 years in the household and home ETS exposure, using logistic regression and considering household education and income as confounders or effect modifiers. A subgroup analysis was conducted comparing younger child households (at least one child aged <6 years) to older child households (only children aged 6-11 years). Of 66 631 households included, home ETS exposure occurred in 25% of households without children and 22% of households with children. Households with children were less likely than those without children to experience ETS exposure (OR 0.83, 95%CI 0.80-0.87). Effect modification by education and income was observed. No difference was observed in ETS exposure between older child and younger child households (OR 0.98, 95%CI 0.91-1.05). Households with children are marginally less likely than households without children to experience home ETS exposure.

Domestic airborne pollutants and asthma and respiratory symptoms in middle age

The role of indoor air pollution as a risk factor for asthma and respiratory symptoms in middle age is unclear. We investigated associations between indoor air pollution sources and (i) asthma phenotypes and (ii) asthma-related respiratory symptoms in middle-aged adults. Subjects (n = 5729) who participated in the 2004 survey of the Tasmanian Longitudinal Health Study completed respiratory and home environment questionnaires. Associations between indoor air pollution sources, and asthma phenotypes and asthma-related respiratory symptoms were estimated. Recent mould in the home was associated with current asthma (odds ratio (OR) 1.26; 95% confidence interval 1.06-1.50), wheeze (OR 1.34; 1.17-1.54) and nocturnal chest tightness (OR 1.30; 1.12-1.51). Stratified by atopy and gender, recent mould was associated with current non-atopic asthma only in males (OR 3.73; 1.29-10.80). More rooms affected by mould were associated with significant trends for current asthma, wheeze and nocturnal chest tightness. Home environmental tobacco smoke was associated with doctor-diagnosed asthma (OR 1.25; 1.02-1.53), wheeze (OR 1.69; 1.41-2.03), nocturnal chest tightness (OR 1.54; 1.26-1.88), with current asthma only in non-smokers (OR 2.09; 95%: 1.30-3.35) and with current asthma only in males (OR 1.74; 95%: 1.25-2.42). Among heating appliances, reverse cycle air conditioning was negatively associated with doctor-diagnosed asthma (OR 0.84; 0.70-1.00). Neither electric nor gas stove use was associated with either asthma phenotype or with asthma-related respiratory symptoms. In middle age, reducing home exposure to mould and environmental tobacco smoke might reduce asthma and asthma-related respiratory symptoms.

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.

Housing characteristics and indoor environment in relation to children’s asthma, allergic diseases and pneumonia in Urumqi, China

In order to evaluate the prevalence of childhood asthma, allergic diseases and pneumonia in Urumqi City, China, as well as its associations with housing and home characteristics, a cross-sectional study was performed in 4618 children (81.7% response rate, average age 4.7±0.9 year, boys accounting for 53.7%). Questions on children’s asthma and allergic diseases were from the International Study on Asthma and Allergies in Childhood (ISAAC) and were integrated with questions on the home environment from the Dampness in Buildings and Health (DBH) study, slightly modified to account for Chinese building characteristics and life habits. The prevalences of physician diagnosed asthma, allergic rhinitis (AR) and pneumonia were 3.6%, 8.7% and 40.9%, respectively. One fourth of children reported wheezing and more than 40% AR symptoms in the last 12 months. Controlling for confounding factors, positive associations were found for home mold/dampness and wheezing (adjusted odds ratio, aOR 1.33, 95% CI 1.07–1.66), AR symptoms (1.34, 1.09–1.64) last 12 months and physician diagnosed pneumonia (1.33, 1.09–1.62). Floor material by wood, PVC or carpeting; and walls by wallpaper, painting or wood material, were positively associated with AR symptoms. Home environmental tobacco smoke (ETS) was positively associated with wheezing (1.23, 1.04–1.46) and pneumonia (1.25, 1.07–1.45). In conclusion, there was a relatively high prevalence of asthmatic and AR symptoms and diagnosed pneumonia in preschool children in Urumqi. Home signs of mold growth or dampness, windowpane condensation, as well as ETS and interior surface materials emitting chemicals were risk factors for allergic symptoms and pneumonia.

HEALTH IMPACT ASSESSMENT OF INDOOR AIR POLLUTION FROM COMBUSTION SOURCES IN HOMES

Background and Aims: In a large European study (HEIMTSA) and a local study (IAPAH) based in Ireland and Scotland, we developed and applied methods for estimating the health impact of indoor air pollution from combustion sources in homes. We considered two approaches: using a simple binary exposure (presence/absence of the indoor combustion source) or using exposure to PM2.5. Methods: Both approaches involved linking exposure estimates with demographic data, health risk functions and background rates of morbidity to estimate total health burden attributable to combustion-derived air pollution from indoor sources. IAPAH included one 24-hour measurement of PM2.5 in each of 100 homes selected for different types of biomass fuel (wood, peat, coal, gas), or environmental tobacco smoke (ETS). Information regarding household and occupant activities was also collected. These and other published data were used to derive estimates of average annual PM2.5 exposures, by exposure source. Assessment of ETS used both approaches; biomass combustion used exposure to PM2.5 only. Risk functions in PM2.5 (for ETS and biomass) were derived from relationships for outdoor air pollution, by scaling functions in background concentrations for use with personal exposures. The ETS binary approach used risks from epidemiological studies of “living with a smoker”. Results: Preliminary results suggest that (i) using binary exposures, the greatest health burden from ETS is from coronary heart disease in adults and (ii) ETS concentrations of PM2.5 greatly exceed those from biomass fuel. Health burdens from ETS and biomass, in terms of PM2.5, will be presented and, for ETS, compared with impacts using the binary approach. Conclusions: Discussion will consider strengths and weaknesses of the two approaches, for burden of disease and for evaluating impacts of policies; and the public health implications of the various domestic sources, especially ETS in homes, whose estimated impact is substantial.

The Association between Timing of Home Environmental Tobacco Smoke Exposure during Childhood and Age of Asthma Development

The Association between Timing of Home Environmental Tobacco Smoke Exposure during Childhood and Age of Asthma Development

Association between social climate for smoking and youth smoking behaviors in Taiwan: An ecological study

Background Social acceptance of smoking is associated with smoking prevalence. Higher smoking rates and ETS exposure might be considered as important indicators for pro-tobacco social norms or social climate. Among studies indicating the association between youth smoking and adult smoking behaviors, most were from individual-level study designs. Objectives An ecological study was conducted to determine the role of social climate, i.e., adult smoking behaviors and exposure to environmental tobacco smoke (ETS), on youth smoking behaviors. Methods Data on the smoking behavior and ETS of 16,688 Taiwanese adults were collected in 2004 by telephone administration of the Taiwan Adult Smoking Survey. Similar data on 22,339 junior high school students were collected in 2004 by school-based administration of the Taiwan Youth Tobacco Survey. City/county-level data were analyzed across 25 counties by descriptive statistics, Pearson's correlation, and hierarchical multiple regression. Results In both adult and youth populations, overall or gender-specific smoking prevalence and ETS varied widely across counties/cities. The current youth smoking rate within counties was significantly positively correlated with the current adult smoking prevalence as well as home ETS exposure in adults or youth. For male youth, a 1% increase in the rate of home ETS exposure reported by youth increased the current male youth smoking rate by 0.20% after controlling the female youth smoking rate and home ETS exposure reported by adults ( p = 0.0197). For female youth, male youth smoking prevalence was the only variable that contributed significantly (Beta = 0.46, p < 0.001). Conclusions Community health nurses should develop tobacco-control interventions that are tailored to support smoke-free environments by decreasing the social acceptability of smoking.

The Association Between Home and Vehicle Environmental Tobacco Smoke (ETS) and Chronic Bronchitis in a Canadian Population: The Canadian Community Health Survey, 2005

This study aimed to determine the association between home and vehicle exposure to environmental tobacco smoke (ETS), and chronic bronchitis based on data from 64,961 non-smokers aged 12 years and older who participated in the 2005 Canadian Community Health Survey (CCHS). The proportion of respondents who reported ETS exposure in the home and vehicle was 9.0% and 8.4% respectively. The prevalence of self-reported doctor diagnosed chronic bronchitis was 1.5%. When considered separately, home and vehicle ETS were both significantly associated with chronic bronchitis in children and adolescents aged 12–19 years, with adjusted odds ratios of 2.30 (95% CI 1.46–3.63) and 2.25 (95% CI 1.42–3.58), respectively. Neither home, nor vehicle ETS exposure was significantly associated with chronic bronchitis in age groups greater than 19 years. When home and vehicle ETS exposure were considered together, and sex, age, allergies, asthma, marital status, level of education, and race where controlled for, home ETS exposure was not a significant predictor of chronic bronchitis (P = 0.296), while vehicle ETS was. The correlation between exposure variables was fair, with a kappa coefficient of 0.40 (P < 0.0001). Females, older age groups, non-white individuals, asthmatic patients, as well as individuals with allergies, no high school diploma, and those who were previously married had higher odds of chronic bronchitis. In conclusion, vehicle exposure to ETS was significantly associated with chronic bronchitis, and children and adolescents exposed to ETS were more susceptible to the disease.

Smoking, environmental tobacco smoke, and risk of renal cell cancer: a population-based case-control study

BackgroundKidney and renal pelvis cancers account for 4% of all new cancer cases in the United States, among which 85% are renal cell carcinomas (RCC). While cigarette smoking is an established risk factor for RCC, little is known about the contribution of environmental tobacco smoke (ETS) to RCC incidence. This study assesses the role of smoking and ETS on RCC incidence using a population-based case-control design in Florida and Georgia.MethodsIncident cases (n = 335) were identified from hospital records and the Florida cancer registry, and population controls (n = 337) frequency-matched by age (+/- 5 years), gender, and race were identified through random-digit dialing. In-person interviews assessed smoking history and lifetime exposure to ETS at home, work, and public spaces. Home ETS was measured in both years and hours of exposure. Odds ratios and 95% confidence intervals were calculated using logistic regression, controlled for age, gender, race, and BMI.ResultsCases were more likely to have smoked 20 or more pack-years, compared with never-smokers (OR: 1.35, 95% CI: 0.93 – 1.95). A protective effect was found for smoking cessation, beginning with 11–20 years of cessation (OR: 0.39, 95% CI: 0.18–0.85) and ending with 51 or more years of cessation (OR: 0.11, 95% CI: 0.03–0.39) in comparison with those having quit for 1–10 years. Among never-smokers, cases were more likely to report home ETS exposure of greater than 20 years, compared with those never exposed to home ETS (OR: 2.18; 95% CI: 1.14–4.18). Home ETS associations were comparable when measured in lifetime hours of exposure, with cases more likely to report 30,000 or more hours of home ETS exposure (OR: 2.37; 95% CI: 1.20–4.69). Highest quartiles of combined home/work ETS exposure among never-smokers, especially with public ETS exposure, increased RCC risk by 2 to 4 times.ConclusionThese findings confirm known associations between smoking and RCC and establish a potential etiologic role for ETS, particularly in the home. Differences in methods of retrospective measurement of lifetime smoking and ETS exposure may contribute to discrepancies in measures of associations across studies, and should be addressed in future research.

Home Exposures to Environmental Tobacco Smoke and Allergic Symptoms Among Young Children in Singapore

Zuraimi MS, Tham KW, Chew FT, Ooi PL, David K. Int Arch Allergy Immunol. 2008;146(1):57–65 PURPOSE OF THE STUDY. To investigate the association of environmental tobacco smoke (ETS) exposure among preschool-aged children with allergic symptoms in homes in Singapore. STUDY POPULATION. The authors studied children between the ages of 1.5 and 6 years who were attending 687 child care centers in Singapore. METHODS. This study used a cross-sectional design, adopting an expanded and modified International Study on Asthma and Allergies in Childhood (ISAAC) questionnaire for the evaluation of asthma and allergies in 6794 children attending 120 randomly selected child care centers. Specific information on demographics and ETS exposures was obtained. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were determined by using Poisson multivariate regression with a log-link function and robust variance estimates as recommended for cross-sectional studies. RESULTS. The response rate was 70.0%, and 4759 children from 97 centers participated. After adjusting for covariates, it was found that home ETS exposure was associated with increased risks of current symptoms of rhinitis (PR: 1.23 [95% CI: 1.01–1.50]) and rhinoconjunctivitis (PR: 1.79 [95% CI: 1.26–2.54]). These associations followed dose-response trends with respect to the number of cigarettes smoked or smokers in the home. Home ETS exposures were also associated with higher PRs of wheeze, nocturnal cough, and doctor-diagnosed asthma. Compared with paternal smoking, higher risks of the above-listed outcomes were found for maternal smoking. CONCLUSIONS. Home ETS exposure is a risk factor associated with rhinitis and asthma among preschool-aged children. REVIEWER COMMENTS. This article provides additional evidence that exposure to ETS is associated with asthma and rhinitis. These findings support the continued need to discuss the risks of ETS exposure when reviewing anticipatory guidance items with families.

Community knowledge, attitudes and behaviours about environmental tobacco smoke in homes and cars

to assess knowledge, attitudes and behaviours about environmental tobacco smoke (ETS) in cars and homes in Queensland. 1,026 randomly selected Queensland residents (84% response) participated in a computer assisted telephone survey to assess knowledge, attitudes and behaviours about ETS in cars and homes; and attitudes towards restrictions on smoking in a range of contexts. Most respondents are aware of the negative health effects of ETS and have smoking bans in their cars (75.8%) and homes (76.8%), however bans are less prevalent for smokers (cars: 37.9%; homes: 51%; p=0.000). For cars/homes, most smokers who did not have smoking bans would not smoke at all around pregnant women (67.7%/53.7%); fewer would refrain for children<or=12 years (48.2%/35.1%); non-smoking adults (31.3%/17.9%); and children 13-17 years (30.9%/21.2%). Parent smokers are less likely to not smoke at all around children>or=2 years (p=0.000) compared to non-parent smokers. Most respondents support car/ home smoking bans for children<or=12 years (80.5%/66.1%); children 13-17 years (78.2%/64.7%); and pregnant women (80.5%/67%). There is strong community support for legislation targeting ETS in cars and homes, however this varies by context, smoking and parental status.

Home Exposures to Environmental Tobacco Smoke and Allergic Symptoms among Young Children in Singapore

Background: Research relating environmental tobacco smoke (ETS) exposures have focused on childhood asthma. There have been fewer studies with conflicting results performed on associations of ETS exposures with allergic symptoms. We are interested to see if ETS exposures in the homes are associated with allergic symptoms among preschool children in Singapore where public smoking is banned. Methods: A cross-sectional study adopting an expanded and modified ISAAC (International Study on Asthma and Allergies in Childhood) questionnaire for the evaluation of asthma and allergies was conducted on 6,794 children attending 120 randomly selected child care centers. Specific information on demographics and ETS exposures was obtained. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were determined using Poisson multivariate regression with a log-link function and robust variance estimates as recommended for cross-sectional studies. Results: The response proportion was 70.0%, and 4,759 children from 97 centers participated. After adjusting for covariates, it was found that home ETS exposure was associated with increased risks of current symptoms of rhinitis (PR 1.23; 95% CI 1.01–1.50) and rhinoconjunctivitis (PR 1.79; 95% CI 1.26–2.54). These associations followed dose-response trends with respect to number of cigarettes smoked or smokers in the homes. Home ETS exposures were also associated with higher PRs of wheeze, nocturnal cough and doctor-diagnosed asthma. Compared with paternal smoking, higher risks of the above outcomes were found for maternal smoking. Conclusion: Home ETS exposure is a risk factor associated with rhinitis and asthma among preschool children.

Determinants of Serum Cotinine as a Biomarker of Childhood Environmental Tobacco Smoke Exposure

ISEE-678 Objective: Environmental tobacco smoke (ETS) is a major risk factor for diseases and disability among children. We evaluated the ability of a comprehensive set of factors to predict serum cotinine, a biomarker of recent ETS exposure. Materials and Methods: We included children from the Cincinnati Asthma Prevention Study, a randomized trial of air cleaners in the homes of 223 children with asthma living with 1 or more smokers. We collected data during home visits at baseline, 6 months, and 12 months: serum cotinine, an extensive parent interview of the child's ETS exposure, an air nicotine dosimeter cassette, housing volume and other objective measures of the home. To account for the within-subject correlation in this repeated measures design, we used linear mixed models with the natural log of serum cotinine as the outcome variable, adjusting for intervention status and study visit. The Akaike Information Criteria (AIC) was used as a measure of the relative predictive ability of competing models, with a decrease >10 indicating substantially better fit. Results: The nicotine dosimeter was the single best predictive variable, outperforming (decrease in AIC > 10) a model that combined parent report of maternal smoking, number of cigarettes, and hours spent in a room with smoking. Season, home volume, and ETS exposure outside the home (vehicles and others’ homes) predicted additional variability in serum cotinine. Even after accounting for these determinants of exposure, parent sociodemographic characteristics explained additional variability in serum cotinine (decrease in AIC > 20). Conclusions: We conclude that an objective measure of home ETS exposure, air nicotine dosimeters, performed better than parent report, but that serum cotinine is preferred in epidemiologic studies because it reflects a wider variety of ETS exposure determinants. When ETS is measured by parent report, adjustment for sociodemographic characteristics may result in underestimation of the effect of ETS.

Environmental tobacco smoke of youngsters in Czech Republic, Hungary, Poland and Slovakia -- Findings from the Global Youth Tobacco Survey (GYTS)

To present data on Environmental Tobacco Smoke (ETS), Global Youth Tobacco Survey (GYTS), Czech Republic, Hungary, Poland and Slovakia. A questionnaire survey of a representative sample of 16 918 schoolchildren aged 13-15 years (2002-2003). Exposure to ETS was reported more frequently in public places than in homes and more frequently from current smokers (CS) than from never smokers (NS). ETS in homes was lower in Czech (57.6% in CS, 24.7% in NS) than in other countries (the highest in Poland: 93.0% in CS, 80.9% in NS). ETS in public places was highest in Hungary (96.9% in CS, 89.2% in NS), lowest in Czech (90.1% in CS, 57.3% in NS). Most students considered ETS as harmful and presented positive attitudes towards smoking ban. ETS in studied countries, save the Czech Republic, exceeded the global prevalence, while the situation is better than in numerous other Eastern European countries.

Screening for children's exposure to environmental tobacco smoke in a pediatric primary care setting

Context The American Academy of Pediatrics has recommended that pediatricians assess their patients' environmental tobacco smoke (ETS) exposure, but the specific questions most likely to identify children with high ETS exposure are not known. Cotinine, a nicotine metabolite present in hair, can be used to quantify months of ETS exposure. Objective To develop a brief screening tool that will accurately predict ETS exposure as defined by a child's hair cotinine level. Setting Columbus Children's Hospital Primary Care Center. Participants A convenience sample of healthy children age 2 weeks to 3 years of both self-reported smokers and nonsmokers. Interventions Screening questions regarding home ETS exposure. Main Outcome Measure Performance of the screening questions compared with child hair cotinine levels. Results Hair samples and questionnaire data were obtained from 291 children. Based on clinical applicability and statistical significance, 3 questions (Does the mother smoke?, Do others smoke?, and Do others smoke inside?) were selected as a valid screening tool to determine children's ETS exposure risk. Maternal reports of smoking outside only or smoking only a few cigarettes per day had no impact on child hair cotinine levels. Conclusions It was possible to derive a simple, specific, and valid screening tool that can be used in pediatric offices to identify children at risk for ETS exposure. Further research is needed to test this tool prospectively.

Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease

BackgroundExposure to environmental tobacco smoke (ETS), which contains potent respiratory irritants, may lead to chronic airway inflammation and obstruction. Although ETS exposure appears to cause asthma in children and adults, its role in causing COPD has received limited attention in epidemiologic studies.MethodsUsing data from a population-based sample of 2,113 U.S. adults aged 55 to 75 years, we examined the association between lifetime ETS exposure and the risk of developing COPD.Participants were recruited from all 48 contiguous U.S. states by random digit dialing. Lifetime ETS exposure was ascertained by structured telephone interview. We used a standard epidemiologic approach to define COPD based on a self-reported physician diagnosis of chronic bronchitis, emphysema, or COPD.ResultsHigher cumulative lifetime home and work exposure were associated with a greater risk of COPD. The highest quartile of lifetime home ETS exposure was associated with a greater risk of COPD, controlling for age, sex, race, personal smoking history, educational attainment, marital status, and occupational exposure to vapors, gas, dusts, or fumes during the longest held job (OR 1.55; 95% CI 1.09 to 2.21). The highest quartile of lifetime workplace ETS exposure was also related to a greater risk of COPD (OR 1.36; 95% CI 1.002 to 1.84). The population attributable fraction was 11% for the highest quartile of home ETS exposure and 7% for work exposure.ConclusionETS exposure may be an important cause of COPD. Consequently, public policies aimed at preventing public smoking may reduce the burden of COPD-related death and disability, both by reducing direct smoking and ETS exposure.

Screening for Children’s Exposure to Environmental Tobacco Smoke in a Pediatric Primary Care Setting

The American Academy of Pediatrics (Elk Grove Village, Ill) has recommended that pediatricians assess their patients' environmental tobacco smoke (ETS) exposure, but the specific questions most likely to identify children with high ETS exposure are not known. Cotinine is a nicotine metabolite, present in hair, that can be used to quantify months of ETS exposure. To develop a brief screening tool that will accurately predict ETS exposure as defined by child hair cotinine level. We compared the performance of a series of easily administered screening questions regarding home ETS exposure to child hair cotinine levels. Subjects were a convenience sample of healthy children aged 2 weeks to 3 years of both self-reported smokers and nonsmokers. Hair samples and questionnaire data were obtained from 291 children. Based on clinical applicability and statistical significance, 3 questions ("Does the mother smoke?", "Do others smoke?", and "Do others smoke inside?") were selected as a valid screening tool to determine children's ETS exposure risk. Maternal report of smoking outside only or smoking few cigarettes per day had no impact on child hair cotinine levels. It was possible to derive a simple, specific, and valid screening tool that can be used in pediatric offices to identify children at risk for ETS exposure. Further research is needed to test this tool prospectively.

Interventionen zur Prävention gesundheitlicher Risiken durch Tabakrauch für Schwangere, Frauen post partum und deren Kinder

The aim of this study was to develop recommendations for interventions aiming at reducing health risks due to tobacco smoking in pregnant women, women postpartum and their infants. Meta-Analyses and selected studies are summed up. Epidemiological findings and health risks due to smoking are summed up. Subsequently findings from intervention studies are cross-referenced and integrated as recommendations. Interventions may be divided into three categories: 1. interventions to obtain abstinence in pregnancy, 2. interventions for relapse prevention after abstinence has been attained in pregnancy, 3. interventions aimed at reducing exposure to environmental tobacco smoke in homes with children. Empirical evidence is cross-referenced to the following points: 1. Self-help materials, 2. brief counselling, 3. more time-consuming counselling, 4. interventions to reduce exposure to environmental tobacco smoke and 5. interventions by midwives. Results from meta-analyses as well as results from selected studies suggest the following recommendations: 1. use of a trusting relationship in counselling, 2. repeated counselling, 3. complementary use of self-help materials; self-help material alone is not effective enough, 4. use of state-of-the-art counselling approaches and, 5. theoretical foundation and appropriate individualized counselling.