Household Environmental Tobacco Smoke Research Articles

Demographic and Clinical Characteristics of COVID-19 in Children and the Effect of Household Tobacco Smoke Exposure on COVID-19.

Objective:Environmental tobacco smoke (ETS) exposure is associated with many diseases, including lower respiratory tract infections, in pediatric age groups. In this study, we aimed to assess the effect of household ETS exposure on symptom frequency and clinical severity in children and adolescents with COVID-19.Materials and Methods:This retrospective study included pediatric cases (<18 years old) with a positive SARS-CoV-2 test, who were admitted to our hospital between 20.03.2020 and 01.05.2020. Patients with respiratory diseases and active smokers were excluded. Demographic characteristics, symptoms, and clinical severity of COVID-19 were obtained from parents and children using a questionnaire and from patients’ files. Household ETS exposure was assessed by questionnaire.Results:A total of 167 patients (median age 145 months, 50.7 % male) were included in the study. The frequency of household ETS exposure was 50.9%, and the frequency of cough was significantly higher in exposed children than non-exposed children (71.4% vs 50.8% respectively, p=0.02). The frequency of both fever and cough was significantly higher ETS-exposed in the subgroup of cases with a mild clinical course (69.5% vs 48.1% respectively, p= 0.02 for fever and 67.8% vs 44.4% respectively, p=0.01 for cough). There was no relationship between clinical severity and household ETS exposure. Conclusion:Household ETS exposure may impact COVID-19 pediatric cases as demonstrated by the increased frequency of cough and fever in ETS-exposed children. As new lockdown measures are implemented, increasing public awareness about the effect of household ETS exposure on COVID-19as well as encouraging a decrease in ETS exposure are essential.

Household environmental tobacco smoke exposure in healthy young children in Hong Kong: Prevalence and risk factors.

BackgroundEnvironmental tobacco smoke (ETS) exposure attributable respiratory illness burden is huge in paediatric population. Understanding the epidemiology of ETS exposure is important to guide health promotion planning. Therefore, we designed this study to determine the prevalence of household ETS exposure in healthy young children under 2 years of age in Hong Kong, and to explore risk factors associated with the exposure. Our secondary goal was to characterise children’s exposure profile to maternal smoking.MethodsA secondary analysis was performed based on the data collected from our 2013–2014 territory-wide cross-sectional pneumococcal carriage surveillance study, with a sample size of 1541. We conducted descriptive analysis for exposure prevalence, univariate and multivariate analysis for identification of risk factors.Results1541 children (mean age: 11.2 ± 6.4 months, male: 50.7%) were included in the analysis. The overall prevalence of current household ETS exposure was 31.5%, prevalence of prenatal and postnatal maternal smoking was 3.5% and 1.6% respectively. Independent factors associated with children’s ETS exposure were: never breastfed (AOR: 1.48, 95% CI: 1.13–1.93, p = 0.004); prenatal maternal smoking (AOR: 7.46, 95% CI: 2.73–20.39, p< 0.001); overcrowding of household living place (AOR: 3.17, 95% CI: 2.02–4.96, P< 0.001); lower household income (AOR: 1.34, 95% CI: 1.04–1.72, p = 0.02). Interestingly, children residing in Kowloon (AOR: 1.66, 95% CI: 1.19–2.33, p = 0.003) and New Territories West (AOR: 1.54, 95% CI: 1.11–2.15, p = 0.01) were associated with exposure compared with children residing in Hong Kong Island.ConclusionExposure to household ETS is prevalent among Hong Kong young children, particularly in children with maternal unfavourable behaviour and lower socioeconomic status. The identified risk factors should be considered while tobacco control interventions and legislations are planned.

Associations of household environmental tobacco smoke exposure with respiratory symptoms and utilisation of medical services in healthy young children in Hong Kong.

INTRODUCTIONYoung children are especially vulnerable to environmental tobacco smoke (ETS) exposure. This study was carried out to determine whether household ETS exposure was associated with respiratory symptoms and medical service utilisation among Hong Kong healthy children in their first eighteen months of age.METHODSA secondary analysis was done on the data obtained from our previous cross-sectional territory-wide pneumococcal carriage surveillance study in Hong Kong in 2013–2014. All measures were reported by caregivers. Univariable and multivariable analyses were performed to examine the associations between ETS exposure and outcome measures. Covariates included children’s sex, age, body mass index z score, history of breastfeeding, gestational age at birth, birthweight, maternal age, living region, overcrowding of living area, household income, child care attendance, and presence of siblings. Additional adjustment for season and households’ respiratory symptoms were made to ascertain the association between ETS and children’s respiratory symptoms.RESULTSThe analysis included 1541 children (mean age: 11.2 ± 6.4 months; males: 50.7%). Current household ETS exposure (AOR=1.30; 95% CI: 1.00– 1.66; p=0.050) and postnatal maternal smoking (AOR=2.21; 95% CI: 1.06–4.64; p=0.035) were independently and significantly associated with all-cause doctor consultation in the past 3 months. Children living with more than one household smoker were more likely to have all-cause doctor consultation compared with the non-exposed children (AOR=1.70; 95% CI: 1.04–2.77, p=0.028). Postnatal maternal smoking was associated with all-cause hospitalisation in the past 3 months (AOR=2.48; 95% CI: 1.05–5.86; p=0.039). Children living in a household, where the daily consumption by household smokers was more than 20 cigarettes, were more likely to have respiratory symptoms compared with non-exposed children (AOR=1.99; 95% CI: 1.12–3.52; p=0.016).CONCLUSIONSHousehold ETS exposure in young children was associated with respiratory symptoms and all-cause outpatient or inpatient medical service utilisation. The associations were potentially dose-dependent.

The moderating effect of childhood disadvantage on the associations between smoking and occupational exposure and lung function; a cross sectional analysis of the UK Household Longitudinal Study (UKHLS)

BackgroundLung function is lower in people with disadvantaged socio-economic position (SEP) and is associated with hazardous health behaviours and exposures. The associations are likely to be interactive, for example, exposure to socially patterned environmental tobacco smoke (ETS) in childhood is associated with an increased effect of smoking in adulthood. We hypothesise that disadvantaged childhood SEP increases susceptibility to the effects of hazards in adulthood for lung function. We test whether disadvantaged childhood SEP moderates smoking, physical activity, obesity, occupational exposures, ETS and air pollution’s associations with lung function.MethodsData are from the Nurse Health Assessment (NHA) in waves two and three of the United Kingdom Household Longitudinal Study (UKHLS). Analysis is restricted to English residents aged at least 20 for women and 25 for men, producing a study population of 16,339. Lung function is measured with forced expiratory volume in the first second (FEV1) and standardised to the percentage of expected FEV1 for a healthy non-smoker of equivalent age, gender, height and ethnicity (FEV1%). Using STATA 14, a mixed linear model was fitted with interaction terms between childhood SEP and health behaviours and occupational exposures. Cross level interactions tested whether childhood SEP moderated household ETS and neighbourhood air pollution’s associations with FEV1%.ResultsSEP, smoking, physical activity, obesity, occupational exposures and air pollution were associated with lung function. Interaction terms indicated a significantly stronger negative association between disadvantaged childhood SEP and currently smoking (coefficient -6.47 %, 95% confidence intervals (CI): 9.51 %, 3.42 %) as well as with formerly smoking and occupational exposures. Significant interactions were not found with physical activity, obesity, ETS and air pollution.ConclusionThe findings suggest that disadvantaged SEP in childhood may make people’s lung function more susceptible to the negative effects of smoking and occupational exposures in adulthood. This is important as those most likely to encounter these exposures are at greater risk to their effects. Policy to alleviate this inequality requires intervention in health behaviours through public health campaigns and in occupational health via health and safety legislation.

Environmental Tobacco Exposure and Urinary Cotinine Levels in Smoking and Nonsmoking Adolescents.

We aimed to evaluate the association between environmental tobacco smoke (ETS) exposure and urinary cotinine levels in current adolescent smokers and nonsmokers. The secondary objective was to explore the association between ETS exposure and nicotine dependence in adolescent smokers. Using the results from a validation study for the 2012 Global Youth Tobacco Survey in Mexico, we quantified urinary cotinine levels in adolescent smokers and nonsmokers. We fitted a multivariate regression model to assess the association between household exposure to ETS and cotinine levels in adolescent smokers and nonsmokers. In addition, using the questionnaire's answers for morning cravings, we fitted a multivariate Poisson regression model to explore the association between household ETS exposure and nicotine dependence in adolescent smokers. For each day of household ETS exposure, cotinine levels increase by 5% in adolescent smokers compared to a 2% increase in nonsmokers, adjusting for the number of cigarettes smoked per week, age and sex (exp(β) 1.05; 95% confidence interval [CI] [1.00, 1.10]; p = .041). Morning cravings increase 11% for each day of household ETS exposure adjusting for the number of cigarettes smoked per week, age and sex (prevalence ratio [PR] 1.11; 95% CI [0.99, 1.25]; p = .064). There is an association between ETS exposure and cotinine levels, and ETS may contribute to nicotine dependence in adolescent smokers. If confirmed, avoiding ETS exposure could prove helpful for addiction control and quitting in adolescents. Evidence suggests that ETS increases cotinine levels in nonsmokers and adult smokers. However, no study has explored the association between ETS exposure and cotinine levels and addiction in adolescent smokers. This paper provides evidence of an association between ETS exposure and cotinine levels in adolescent smokers: each day of environmental tobacco smoke exposure at home increased cotinine levels by 5% among smokers. In addition, morning cravings in adolescent smokers increased 11% for every day of ETS exposure. ETS exposure is a significant source of nicotine for adolescent smokers and could play an important role in addiction.

Active smoking, environmental tobacco smoke and bronchitic symptoms among adolescents in Taiwan: A prospective cohort study

ObjectiveThe study investigates the association between active smoking, exposure to environmental tobacco smoke (ETS) and the development of bronchitis and bronchitic symptoms among adolescents. MethodsA prospective cohort study was conducted with 4134 adolescents aged 12–14 from the Taiwan Children Health Study in 14 communities in Taiwan since 2007. Parents or guardians completed written questionnaires regarding demographic information, household ETS and respiratory symptoms at baseline. The adolescents themselves completed identical questionnaires on respiratory outcomes in the 2009 survey. Associations between active smoking, exposure to ETS and the 2-year incidence of respiratory outcomes were analyzed by multiple Poisson regression models, taking overdispersion into account. ResultsActive smoking was associated with an increased risk of developing chronic cough and chronic phlegm. We found significant dose–response associations between the duration of smoking, the numbers of cigarettes and the onset of bronchitic symptoms. Exposure to ETS was a significant risk factor for the development of chronic cough. Among asthmatic adolescents, exposure to ETS was associated with an additional risk for the onset of chronic phlegm. ConclusionThis study demonstrates that active smoking and exposure to ETS are associated with higher risks for developing bronchitic symptoms among adolescents.

Family socioeconomic status, household tobacco smoke, and asthma attack among children below 12 years of age

Studies have demonstrated the negative impact of environmental tobacco smoke (ETS) or parental cigarette smoking on pediatric asthma. Little is known, however, regarding whether there is a gender difference in the effect of household ETS on pediatric asthma. Using a nationwide survey in Taiwan, we examined the relationship between asthma prevalence in the past year and household ETS among children below 12 years of age (N = 3761). We used multivariate regression models to assess odds ratios (ORs) and 95% confidence intervals (CIs) for the association of household ETS and asthma attacks by gender. In about 3% of the sample, parents reported that their children had an asthma attack in the past year, confirmed by physicians. Multivariate logistic regression revealed that household ETS predicted asthma attacks for girls (OR = 3.11, 95%CI = 1.24-7.76) but not for boys. Father's education was significantly associated with asthma attack for both girls (OR = 1.24, 95%CI = 1.04-1.47) and boys (OR = 1.15, 95%CI = 1.05-1.26). Girls with lower family income were more likely to have had an asthma attack in the last year (OR = .48, 95%CI = .27-.87). The impact of household ETS and family socioeconomic status on asthma attacks differs by gender among children below 12 years.

Association of time–location patterns with urinary cotinine among asthmatic children under household environmental tobacco smoke exposure

IntroductionEnvironmental tobacco smoke (ETS) is a hazardous component of indoor air, and may increase the risk of respiratory diseases, atherosclerosis and otitis media in children. In this study, we explored the relationship between time inside the house, ETS exposure and urinary cotinine level, and also determined the association of time inside the house on asthma phenotypes when children exposed to ETS. MethodsA total of 222 asthmatic children and 205 non-asthmatic controls were recruited in the Genetic and Biomarker study for Childhood Asthma (GBCA). Structured questionnaires and time–location pattern questionnaires were administered by face-to-face interview. Urinary cotinine was measured by liquid chromatography tandem mass spectrometry (LC/MS/MS). The level of household ETS exposure was assessed using the cotinine/creatinine ratio (CCR). ResultsIn general, urinary cotinine and CCR were higher in subjects exposed to household ETS than those who never had ETS at home. A significant positive relationship was found between average time inside the house and urinary CCR in asthmatic children with current ETS at home (β=0.278, p=0.02). After adjustment for age and gender, average time inside the house was positively related to severe wheeze in asthmatic children with household ETS within 1 month (OR: 1.26, 95%: 1.02–1.64). ConclusionsOur study suggests that the major source of ETS exposure for children is due to longer period of exposures among children living with adult smokers at home. Home-smoking restrictions that effectively prevent children from being exposed to ETS would be worthwhile.

Household Environmental Tobacco Smoke and Risk of Allergic Sensitization Among Children with Asthma

Abstract Background: Exposure to cigarette smoke is causing health problems, its components are known to possess carcinogenic, mutagenic, cytotoxic or irritant properties. Prevalence of smoking in pregnant women is between 17% and 35% worldwide. Passive smoking is identified as a factor with negative impact on health, and children are especially vulnerable. Children raised in families with smokers have a higher incidence of respiratory infections, recurrent wheezing, bronchitis, nocturnal cough and asthma. The aim of this study was determination of sensitization to various allergens in children exposed to cigarette smoke compared with children not exposed to cigarette smoke. Material and method: One-hundred eighty children treated in Pediatric Clinic 1 of Tîrgu Mureș were included in the study between 2008- 2011. The patients were divided into two groups: 50 children exposed to cigarette smoke and 130 children not exposed. Measurement of lung function was performed in children over 4 years using a spirometer. Serum specific IgE was analyzed to inhalatory and food allergens. Wheezing phenotype was determined in children younger than 4 years and exposure to cigarette smoke was evaluated based on parents' responses to questionnaires. Results: There was a significantly greater likelihood of developing sensitivity in children exposed to tobacco smoke than in those not exposed to dermatophagoides pteronissimus, dermatophagoides farinae, milk and grass pollen. Conclusions: During early childhood both pre- and postnatal tobacco smoke exposure has an adjuvant effect on allergic sensitization inhalatory and food allergens.

Burden of Household Environmental Tobacco Smoke on Medical Expenditure for Japanese Women: A Population-Based Cohort Study

BackgroundThe economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women.MethodsThis population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors.ResultsWe analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum.ConclusionsWe calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS.

Household Environmental Tobacco Smoke Exposure and Respiratory Health in School Age Children

SUMMARY In the recent years the exposure to environmental tobacco smoke (ETS) has been an important public health hazard, especially in Serbia, a country with too many smokers. A common component of tobacco smoke is particulate matter less than 10μm in aerodynamic diameter (PM10), which is considered to be the most dangerous air pollutant for health. The aim of this paper was to investigate the association between respiratory symptoms and illnesses in schoolchildren in relation to their environmental tobacco smoke exposure. We conducted an epidemiological study that included 708 participants (49.15 % male) aged 11-14 years from Niš, Serbia. The children were surveyed by original structured questionnaire, based on the instrument developed for similar investigations. Data about the prevalence of respiratory symptoms in the last 12-month period of life and lifetime prevalence of respiratory illnesses were obtained. The questionnaire also included items about other indoor environmental determinants. Tobacco smoke was the most prevalent source of indoor air pollution at children’s home (60.73%). We found a significant association between ETS exposure and increased prevalence of dyspnea, wheezing, bronchitis and asthma among children. It is necessary to inform parents in Serbia on the health effects of ETS exposure during childhood and to encourage them to change smoking habits in order to protect their children from ETS exposure at home.

Environmental Factors Associated with Overweight and Obesity in Taiwanese Children

We explored the relationship among sociodemographic, behavioural, household environmental and perinatal factors, and risks of childhood overweight and obesity in Taiwan. A total of 7930 children aged 9 to 14 years were recruited from 14 randomly selected Taiwanese communities in 2007 and 2010. Height and weight were measured using standard protocols during school visits. Questionnaires that contained children's family information, birth conditions, exercise habits and household environmental factors were answered by the parents. Associations between risk factors and childhood overweight and obesity were estimated through odds ratio and 95% confidence interval from mixed models. In this cohort, 32.3% of the children were overweight and 17.5% were obese. Male gender, high birthweight, exposure to in utero maternal smoking and current exposure to household environmental tobacco smoke (stronger effect of maternal than paternal smoking) were positively associated with childhood overweight/obesity. In contrast, higher parental education level, number of siblings, active exercise habits and taking vitamins were associated with reduced risks of childhood obesity. Birthweight revealed a J-shaped relationship with the probability of childhood overweight/obesity. This study uncovers several modifiable risk factors for childhood overweight and obesity, and parents are encouraged to provide an anti-obesity environment such as quitting smoking, controlling birthweight of child during pregnancy and building up exercise habits.

Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in adults (INSEARCH)

Field sites in 12 districts in different parts of India. To determine the nationwide population prevalence of and risk factors for asthma and chronic bronchitis (CB) in adults. A standardised validated questionnaire based on the International Union Against Tuberculosis and Lung Disease's 1984 questionnaire was used to assess asthma and CB prevalence. Multivariate logistic regression analyses were performed to determine the risk factor associations. Estimates standardised to the 2011 population projection estimates for India were used to calculate the national disease burden. A total of 85,105 men and 84,470 women from 12 urban and 11 rural sites were interviewed. One or more respiratory symptoms were present in 8.5% of individuals. The overall prevalence of asthma and CB was respectively 2.05% (adults aged ≥15 years) and 3.49% (adults aged ≥35 years). Advancing age, smoking, household environmental tobacco smoke exposure, asthma in a first-degree relative, and use of unclean cooking fuels were associated with increased odds of asthma and CB. The national burden of asthma and CB was estimated at respectively 17.23 and 14.84 million. Asthma and CB in adults pose an enormous health care burden in India. Most of the associated risk factors are preventable.

Household Environmental Tobacco Smoke and Respiratory Diseases among Children in Niš (Serbia)

The authors investigated the relationship between household environmental tobacco smoke (ETS) exposure and prevalence of respiratory symptoms and diseases as well as absenteeism related to respiratory illness in schoolchildren. The study sample consisted of 1,074 children aged 7-11 years from three primary schools in Nis (Serbia). ETS exposure was associated with wheezing (OR-1.48; 1.09-2.01), bronchitis (OR-1.66; 1.23-2.23), headache (OR-1.45; 1.08-1.95), and fatigue (OR-1.38; 1.02-1.85) in exposed children. The other risk factors with possible influences weren't assessed. There was no statistically significant difference in the number of physicians' visits as well as in absenteeism from school due to illness in children exposed to ETS in comparison to non exposed children. The tobacco smoke effect on children is an essential and urgent problem with life lasting negative health effects which are preventable.

Environmental tobacco smoke exposure increases Mycobacterium tuberculosis infection risk in children.

Data on the association between exposure to environmental tobacco smoke (ETS) and Mycobacterium tuberculosis infection in children are limited. To examine the dose-response effect of ETS exposure on the risk of M. tuberculosis infection in children in a high tuberculosis (TB) burden setting. This cross-sectional study included healthy South African children from impoverished urban communities. Data were collected on household ETS and M. tuberculosis exposure, demographics, socio-economic and anthropometric data, M. tuberculosis infection, human immunodeficiency virus and TB disease status. Among 196 children (median age 6.8 years, range 0.3-15.9), 97 (49.5%) were M. tuberculosis - i nfected (tuberculin skin test [TST] ≥ 10 mm) and 128 (65.3%) reported ETS exposure; of these, 81/128 (63.3%) were exposed to ≥ 2 household smokers. The presence of ≥ 2 household smokers was associated with M. tuberculosis infection in univariate analysis, irrespective of TST cut-off point. In analysis adjusting for M. tuberculosis exposure, socio-economic status, age and previous TB treatment, ETS exposure remained associated with M. tuberculosis infection. In univariate and multivariate analysis, pack-years of exposure were associated with risk of TB infection. Exposure to ETS is associated with M. tuberculosis infection in children after adjustment for multiple variables, with a dose-response relationship between the degree of ETS exposure and risk of infection. Public health interventions to reduce exposure to tobacco smoke among children in high TB burden settings are urgently needed.

Relationships Between Self-Reported Smoking, Household Environmental Tobacco Smoke Exposure and Depressive Symptoms in a Pregnant Minority Population

This study sought to examine relationships between depressive symptoms and prenatal smoking and/or household environmental tobacco smoke exposure (HH-ETSE) among urban minority women. We analyzed private, audio computer-assisted self interview data from a clinic-based sample of 929 minority pregnant women in Washington, DC. Depressive symptoms were assessed via the Beck Depression Inventory Fast Screen. HH-ETSE, current smoking, and former smoking were assessed via self-report. Depression levels and demographic characteristics were compared: (1) among nonsmokers, for those reporting HH-ETSE versus no HH-ETSE; and (2) among smokers, for those reporting current smoking (in last 7 days) versus former smokers. Measures associated with HH-ETSE/current smoking in bivariate analysis at P < 0.20 were included in adjusted logistic regression models. HH-ETSE, as a possible indicator of a social smoking network, was assessed as a mediator for the relationship between depression and current smoking. Non-smokers reporting moderate-to-severe depressive symptoms showed significantly higher adjusted odds of prenatal HH-ETSE (AOR 2.5, 95% CI [1.2, 5.2]). Smokers reporting moderate-to-severe or mild depressive symptoms showed significantly higher adjusted odds of current smoking (AOR 1.9, 95% CI [1.1, 3.5] and AOR 1.8, 95% CI [1.1, 3.1], respectively). Among smokers, HH-ETSE was a significant mediator for the association between moderate-to-severe symptoms and current smoking. In conclusion, health care providers should be aware that depressed urban minority women are at risk of continued smoking/HH-ETSE during pregnancy. Interventions designed to encourage behavior change should include screening for depression, and build skills so that women are better able to address the social environment.

TIME-LOCATION PATTERN, HOUSEHOLD ENVIRONMENTAL TOBACCO SMOKE EXPOSURE AND URINARY COTININE IN NON-SMOKING CHILDREN

Background and Aims:Environmental tobacco smoke (ETS) is an important exposure of indoor air, and may increase the risk of respiratory disease in children. The level of household ETS exposure may be associated with the time-location pattern for children. In this study, we will explore the association between the indoor time, household ETS exposure and urinary cotinine level in non-smoking children. Methods :Total of 429 children were recruited in Genetic and Biomarker for Childhood Asthma (GBCA). We will utilize parental report method to measure household ETS exposure in children using structure questionnaires. Indoor and outdoor time for non-smoking children was administrated by the time-location pattern questionnaires. The urinary cotinine level was measured using a sensitive high-performance liquid chromatographic (HPLC) technique and the level of household ETS exposure will be assessed using the cotinine/creatinine ratio (CCR). Results:Children exposed to ETS in household had higher cotinine level and CCR when compared with those children expose to ETS in outdoor environment. The CCR also showed a significant trend when children exposed to different amount of ETS in household. When the time-location pattern were considered in our analysis, we have found a significant trend of average CCR increased with indoor time for children in the groups of currently household ETS exposure, amount of household ETS exposure per day and number of smokers at home. Conclusions:We found a dose-response relationship between urinary cotinine level and indoor time for non-smoking children. Our study suggested that the major source of ETS exposure for Taiwanese children was from family members in the household.

Levels of household particulate matter and environmental tobacco smoke exposure in the first year of life for a cohort at risk for asthma in urban Syracuse, NY

The Syracuse, NY, AUDIT (Assessment of Urban Dwellings for Indoor Toxics) study was designed to quantify asthma agent levels in the inner-city homes of a birth cohort whose mothers had a diagnosis of asthma. Risk of exposure to particulate matter (PM), particle number and tobacco smoke was assessed in 103 infants' homes. Repeat measurements were made in 44% of the homes. Infants also were examined on a quarterly basis during the first year of life to monitor their respiratory health and urine cotinine levels. Overall geometric mean (GM) values for PM 2.5 of 21.2 μg/m 3 and for PM 10 of 31.8 μg/m 3 were recorded in homes at visit 1. GM values for PM 2.5 and PM 10 in smoking homes were higher at 26.3 and 37.7 μg/m 3, while values in non-smoking homes were 12.7 and 21.2 μg/m 3 respectively. Fifty-four percent of mothers (55/103) smoked at some point in pregnancy (39% smoked throughout pregnancy). Environmental tobacco smoke (ETS) exposure occurred in 68% of homes during the infants' first year. Significant to this study was the size- and time-resolved monitoring of PM at 140 home visits and the classification of PM count data. PM number counts ranged from continuously low levels (little indoor activity) to continuously high counts (constant indoor activity), and recorded apparent instances of prolonged repeated cigarette smoking. Wheezing in the first year of life was recorded for 38% of the infants (39/103). Adjusted logistic regression modeling demonstrated that elevated levels of indoor PM 2.5 (≥ 15 μg/m 3) were a significant risk factor for infant wheezing after controlling for infant gender, mothers' age and education level, season of home visit and presence of carpeting (OR 4.21; 95% CI 1.36–13.03; p = 0.013). An elevated level of the nicotine metabolite cotinine in infant urine also was associated with infant wheezing after adjusting for infant gender, mothers' age and education level (OR 5.10; 95% CI 0.96–27.24; p = 0.057). ETS exposure was pervasive in the AUDIT cohort and a risk for developing infants in this urban population.

Household environmental tobacco smoke and risks of asthma, wheeze and bronchitic symptoms among children in Taiwan

BackgroundAlthough studies show that maternal smoking during pregnancy increases the risks of respiratory outcomes in childhood, evidence concerning the effects of household environmental tobacco smoke (ETS) exposure remains inconsistent.MethodsWe conducted a population-based study comprised of 5,019 seventh and eighth-grade children in 14 Taiwanese communities. Questionnaire responses by parents were used to ascertain children's exposure and disease status. Logistic regression models were fitted to estimate the effects of ETS exposures on the prevalence of asthma, wheeze, and bronchitic symptoms.ResultsThe lifetime prevalence of wheeze was 11.6% and physician-diagnosed asthma was 7.5% in our population. After adjustment for potential confounders, in utero exposure showed the strongest effect on all respiratory outcomes. Current household ETS exposure was significantly associated with increased prevalence of active asthma, ever wheeze, wheeze with nighttime awakening, and bronchitis. Maternal smoking was associated with the increased prevalence of a wide range of wheeze subcategories, serious asthma, and chronic cough, but paternal smoking had no significant effects. Although maternal smoking alone and paternal smoking alone were not independently associated with respiratory outcomes, joint exposure appeared to increase the effects. Furthermore, joint exposure to parental smoking showed a significant effect on early-onset asthma (OR, 2.01; 95% CI, 1.00-4.02), but did not show a significant effect on late-onset asthma (OR, 1.17; 95% CI, 0.36-3.87).ConclusionWe concluded that prenatal and household ETS exposure had significant adverse effects on respiratory health in Taiwanese children.

Impact of Environmental Tobacco Smoke on the Incidence of Mutations in Epidermal Growth Factor Receptor Gene in Never-Smoker Patients With Non–Small-Cell Lung Cancer

Active tobacco smoking has been associated with the incidence of epidermal growth factor receptor (EGFR) mutations. However, the impact of environmental tobacco smoke (ETS) on EGFR mutations has been unknown. We investigated an association between ETS exposure and EGFR mutations in never smokers with non-small-cell lung cancer (NSCLC). We enrolled 179 consecutive never smokers who were newly diagnosed with NSCLC. The history of ETS exposure was obtained with a standardized questionnaire that included exposure period, place, and duration. The nucleotide sequences of exons 18 to 21 on EGFR gene were determined using nested polymerase chain reaction amplification. The incidence of EGFR mutations was significantly lower in patients with ETS exposure than in those without (38.5% v 61.4%; P = .008). In a logistic regression model that adjusted for sex and histology, an adjusted odds ratio (AOR) for the risk of EGFR mutations with exposure to ETS was 0.40 (95% CI, 0.20 to 0.81; P = .011). In quartile groups based on total smoker-year, the AORs for the lowest- to highest-quartile groups were 0.59 (95% CI, 0.23 to 1.49), 0.50 (95% CI, 0.17 to 1.50), 0.48 (95% CI, 0.20 to 1.18), and 0.22 (95% CI, 0.08 to 0.62; P(trend) = .028). Among the types of ETS exposure, adulthood ETS and household ETS were significantly associated with the incidence of EGFR mutations. Patients with ETS exposure showed a lower response rate to EGFR tyrosine kinase inhibitors than did patients without ETS exposure (24.6% v 44.8%; P = .053). ETS exposure is negatively associated with EGFR mutations in never smokers with NSCLC.