Involuntary Smoke Research Articles

Involuntary tobacco smoke exposures from conception to 18 years increase midlife cardiometabolic disease risk: a 40-year longitudinal study.

Few population studies have sufficient follow-up period to examine early-life exposures with later life diseases. A critical question is whether involuntary exposure to tobacco smoke from conception to adulthood increases the risk of cardiometabolic diseases (CMD) in midlife. In the Collaborative Perinatal Project, serum-validated maternal smoking during pregnancy (MSP) was assessed in the 1960s. At a mean age of 39 years, 1623 offspring were followed-up for the age at first physician-diagnoses of any CMDs, including diabetes, heart disease, hypertension, or hyperlipidemia. Detailed information on their exposure to environmental tobacco smoke (ETS) in childhood and adolescence was collected with a validated questionnaire. Cox regression was used to examine associations of in utero exposure to MSP and exposure to ETS from birth to 18 years with lifetime incidence of CMD, adjusting for potential confounders. We calculated midlife cumulative incidences of hyperlipidemia (25.2%), hypertension (14.9%), diabetes (3.9%), and heart disease (1.5%). Lifetime risk of hypertension increased by the 2nd -trimester exposure to MSP (adjusted hazard ratio: 1.29, 95% confidence interval: 1.01-1.65), ETS in childhood (1.11, 0.99-1.23) and adolescence (1.22, 1.04-1.44). Lifetime risk of diabetes increased by joint exposures to MSP and ETS in childhood (1.23, 1.01-1.50) or adolescence (1.47, 1.02-2.10). These associations were stronger in males than females, in never-daily smokers than lifetime ever smokers. In conclusion, early-life involuntary exposure to tobacco smoke increases midlife risk of hypertension and diabetes in midlife.

Passive Smoking And The Health Of Children: A Primary Concern In Pakistan.

Dear Madam, Environmental tobacco smoke (ETS), also referred to as second-hand, involuntary, or passive smoke, is produced from the combustion of tobacco products or puffed out by active smokers. The smoke emitted from the tip of a cigarette contains about two times the concentration of nicotine, five times the concentration of Carbon monoxide, and 50 times the concentration of ammonia than active smoke1. Furthermore, amongst the exposed population, children are far more susceptible to complications associated with ETS due to their manner of exposure and developmental physiology. According to the 2014 Global Adult Tobacco Survey for Pakistan, 43.3% of households were exposed to ETS, with a significant amount of children included in that percentage2. Thus, children's health is more detrimentally impacted by ETS than adults. Exposure of children to ETS in domestic and public settings risks a higher occurrence of respiratory and middle-ear diseases. According to numerous studies, dose-dependent exposure to ETS directs more frequent and severe asthma attacks accompanied by wheezing. Moreover, it is observed that school-aged individuals who live in a smoking household tend to develop a range of lung diseases, including bronchitis, bronchiolitis, and pneumonia. Their lungs become weak, resulting in impaired pulmonary function3. With reference to a population-based cohort study conducted by Lovasi et al. (ref 4), it was evident that childhood ETS exposure from 2 or more smokers compared with none is linked with early emphysema in adulthood4. In addition, constant ETS exposure leads to swelling and obstruction of the eustachian tube, which interferes with pressure equalization leading to pain, fluid accumulation, and infection. Ear infections and middle ear fluid are the most common causes of hearing loss in children. Being the primary reason behind several disease, ETS is also known to cause acute effects on cardiovascular function in children. Compelling evidence demonstrates that childhood ETS exposure risks the accumulation of factors associated with cardiovascular diseases, including obesity, dyslipidemia, and imbalanced systolic and diastolic blood pressure5. [Exposure to hazardous chemicals found in ETS, for instance, benzopyrene, is known to accelerate the development of atherosclerosis]. Moreover, studies show convincing evidence that hypertension is common in children exposed to ETS at home. It is also observed that hypertension is a common risk factor for cardiovascular disease and cardiovascular stress hyperactivity in children with smoking parents. ---Continue

Critical developmental periods for effects of low-level tobacco smoke exposure on behavioral performance

Tobacco exposure during development leads to neurobehavioral dysfunction in children, even when exposure is limited to secondhand smoke. We have previously shown in rats that developmental exposure to tobacco smoke extract (TSE), at levels mimicking secondhand smoke, starting preconception and extending throughout gestation, evoked subsequent locomotor hyperactivity and cognitive impairment. These effects were greater than those caused by equivalent exposures to nicotine alone, implying that other agents in tobacco smoke contributed to the adverse behavioral effects. In the present study, we examined the critical developmental windows of vulnerability for these effects, restricting TSE administration (0.2 mg/kg/day nicotine equivalent, or DMSO vehicle, delivered by subcutaneously-implanted pumps) to three distinct 10 day periods: the 10 days preceding mating, the first 10 days of gestation (early gestation), or the second 10 days of gestation (late gestation). The principal behavioral effects revealed a critical developmental window of vulnerability, as well as sex selectivity. Late gestational TSE exposure significantly increased errors in the initial training on the radial-arm maze in female offspring, whereas no effects were seen in males exposed during late gestation, or with either sex in the other exposure windows. In attentional testing with the visual signal detection test, male offspring exposed to TSE during early or late gestation showed hypervigilance during low-motivating conditions. These results demonstrate that gestational TSE exposure causes persistent behavioral effects that are dependent on the developmental window in which exposure occurs. The fact that effects were seen at TSE levels modeling secondhand smoke, emphasizes the need for decreasing involuntary tobacco smoke exposure, particularly during pregnancy.

Smoke-Free Policies in the World's 50 Busiest Airports - August 2017.

Exposure to secondhand smoke from burning tobacco products causes premature death and disease, including coronary heart disease, stroke, and lung cancer among nonsmoking adults and sudden infant death syndrome, acute respiratory infections, middle ear disease, exacerbated asthma, respiratory symptoms, and decreased lung function in children (1,2). The U.S. Surgeon General has concluded that there is no risk-free level of exposure to secondhand smoke (1). Previous CDC reports on airport smoke-free policies found that most large-hub airports in the United States prohibit smoking (3); however, the extent of smoke-free policies at airports globally has not been assessed. CDC assessed smoke-free policies at the world's 50 busiest airports (airports with the highest number of passengers traveling through an airport in a year) as of August 2017; approximately 2.7 billion travelers pass through these 50 airports each year (4). Among these airports, 23 (46%) completely prohibit smoking indoors, including five of the 10 busiest airports. The remaining 27 airports continue to allow smoking in designated smoking areas. Designated or ventilated smoking areas can cause involuntary secondhand smoke exposure among nonsmoking travelers and airport employees. Smoke-free policies at the national, city, or airport authority levels can protect employees and travelers from secondhand smoke inside airports.

Secondhand Smoke From Multiple Sources, Thirdhand Smoke and Respiratory Symptoms in Hong Kong Adolescents.

Reports on involuntary tobacco smoke exposure in children have focused mostly on secondhand smoke (SHS) from smoking inside the home. We studied the separate and combined prevalence of SHS exposure from multiple sources and thirdhand smoke (THS) and the associations with respiratory symptoms in Hong Kong adolescents. In 2010-2011, 61 810 Secondary 1 (US Grade 7) to seven students reported their smoking status, respiratory symptoms, and exposure to four sources of tobacco smoke in the past 7 days. Weighted prevalence of exposure was calculated. Associations with respiratory symptoms were analyzed in 50 762 never smokers using logistic regression. Tobacco smoke exposure at home was 23.2% considering SHS exposure from inside the home, but increased to 33.2% including SHS from neighbors and 36.2% further including THS. Including SHS outside home (55.3%), 63.3% of adolescents were exposed to SHS anywhere or THS at home. In never smokers, SHS from each source and THS at home were linearly associated with respiratory symptoms. Exposure to more sources yielded stronger associations with respiratory symptoms (p for trend<.001). The adjusted odds ratios (95% CI) were 1.04 (0.97-1.11), 1.12 (1.03-1.22), 1.40 (1.26-1.56) and 1.99 (1.74-2.28) for 1, 2, 3, and 4 sources, respectively. Although Hong Kong's smoking prevalence is among the lowest in the developed world, over 60% of its adolescents were involuntarily exposed to tobacco smoke from one or more sources with a linear association with respiratory symptoms in never smokers. More stringent policies are needed to protect adolescents from tobacco smoke. In a high-density urban setting, involuntary exposure to tobacco smoke in adolescents can be much higher than the smoking prevalence of the general population, especially if SHS exposure from multiple sources and THS are also considered. Such exposures have important health implications as demonstrated by their linear associations with respiratory symptoms. Tobacco control measures effective in reducing smoking prevalence may have little effect in reducing adolescent exposure to tobacco smoke, especially in the private home, in which other public health strategies are urgently needed.

Tobacco Use, Secondhand Smoke, and Smoke-Free Home Rules in Multiunit Housing.

Multiunit housing (MUH) residents are particularly susceptible to involuntary secondhand smoke (SHS) exposure in their home, which can enter their living units from nearby units and shared areas where smoking occurs. To date, no study has assessed non-cigarette tobacco use among MUH residents. This study assessed the prevalence and sociodemographic correlates of tobacco use (combustible, noncombustible, any tobacco use including electronic cigarettes), smoke-free home rules, and SHS incursions among U.S. MUH residents. Data came from the 2013-2014 National Adult Tobacco Survey, a telephone survey of U.S. adults aged ≥18 years. Analyses were conducted in 2015. Prevalence of current tobacco use and smoke-free home rules were assessed overall and by sociodemographics, stratified by housing type (single family versus MUH). Prevalence and adjusted odds of SHS incursions among MUH residents with smoke-free home rules were assessed. Tobacco use was higher among adults living in MUH (24.7%) than those in single-family housing (18.9%, p<0.05). Smoke-free home rules were higher among adults living in single-family housing (86.7%) than those in MUH (80.9%, p<0.05). Among MUH residents with smoke-free homes, 34.4% experienced SHS incursions. Adjusted odds of SHS incursions were greater among women, younger adults, non-Hispanic blacks, Hispanics, and those with lower income. One quarter of MUH residents use tobacco, and one third of MUH residents with smoke-free rules experience SHS incursions. Interventions are warranted to promote tobacco cessation and smoke-free building policies to protect all MUH residents, employees, and visitors from the dangers of tobacco use and SHS.

Involuntary Tobacco Smoking Exposure Among Korean American Emerging Adults: A Qualitative Study.

High smoking prevalence among Korean American (KA) males place KA family members and co-workers at an elevated risk of involuntary tobacco smoke exposure (ITSE). KA emerging adults (EAs) face an additional risk of ITSE by their peers, as emerging adulthood is associated with increased smoking. This paper explores health behaviors, attitudes and beliefs of ITSE among KAEA. Qualitative data analysis was conducted on transcripts from ten focus groups (N=67). Themes related to attitudes and perceptions of ITSE were identified: high level of cultural tolerance, lack of knowledge/insufficient information, perceived benign health effects, and perceived hopelessness/indifference. Themes related to culturally-held beliefs include: tolerance of male family smokers, allowance of indoor smoking and misconceptions of practices perceived to minimize ITSE. The dissemination of culturally relevant ITSE information is needed in KA communities. Failure to implement indoor smoking bans in ethnic enclaves calls for increased enforcement of regulations by public health officials.

Parental Practices and Attitudes Related to Smoke-Free Rules in Homes, Cars, and Outdoor Playgrounds in US Households With Underage Children and Smokers, 2010-2011.

IntroductionA smoke-free environment protects children from exposure to involuntary smoke and also can reduce or prevent future smoking behavior. The purpose of this study was to examine levels and correlates of parental behavior and attitudes related to voluntary smoke-free rules in homes, cars, and outdoor children’s play areas among US households with underage children and 1 or more smoking parents.MethodsWe used data from the 2010–2011 Tobacco Use Supplement to the Current Population Survey and logistic regressions to model behavior and attitudes related to voluntary smoke-free rules in 3 settings.ResultsOverall, 60.1% of households with children and at least 1 smoking parent had voluntary smoke-free home rules. Approximately 84.6% and 71.5% of parents thought that smoking should not be allowed inside cars with children present and in outdoor play areas, respectively. Positive parental behavior and attitudes related to voluntary smoke-free rules were more likely among households with 2 parents, parents of higher education and household income, Hispanic parents, and parents of infants (P < .05).ConclusionTobacco control and prevention efforts are needed to promote the voluntary adoption of smoke-free rules in homes, private cars, and outdoor children’s play areas. Most parents from smoker households with underage children were supportive of smoke-free laws for cars and outdoor children’s play areas, providing evidence and encouragement to policy makers to take action to restrict smoking in these locations.

Acute secondhand smoke-induced pulmonary inflammation is diminished in RAGE knockout mice.

The receptor for advanced glycation end-products (RAGE) has increasingly been demonstrated to be an important modulator of inflammation in cases of pulmonary disease. Published reports involving tobacco smoke exposure have demonstrated increased expression of RAGE, its participation in proinflammatory signaling, and its role in irreversible pulmonary remodeling. The current research evaluated the in vivo effects of short-term secondhand smoke (SHS) exposure in RAGE knockout and control mice compared with identical animals exposed to room air only. Quantitative PCR, immunoblotting, and immunohistochemistry revealed elevated RAGE expression in controls after 4 wk of SHS exposure and an anticipated absence of RAGE expression in RAGE knockout mice regardless of smoke exposure. Ras activation, NF-κB activity, and cytokine elaboration were assessed to characterize the molecular basis of SHS-induced inflammation in the mouse lung. Furthermore, bronchoalveolar lavage fluid was procured from RAGE knockout and control animals for the assessment of inflammatory cells and molecules. As a general theme, inflammation coincident with leukocyte recruitment was induced by SHS exposure and significantly influenced by the availability of RAGE. These data reveal captivating information suggesting a role for RAGE signaling in lungs exposed to SHS. However, ongoing research is still warranted to fully explain roles for RAGE and other receptors in cells coping with involuntary smoke exposure for prolonged periods of time.

Effect of Smoke-Free Legislation on Perinatal and Child Health

Smoking kills approximately 5.7 million people each year. Although smoke-free legislation and tobacco controls are keys to reducing this death toll, most studies on their effectiveness have involved only adults. Children are known to be especially vulnerable to the adverse effects of second-hand smoke, which has been linked to many adverse outcomes during early life and the development of noncommunicable diseases in later life. This review was conducted to evaluate the effect of smoke-free legislation on perinatal and child health. The search included online databases for studies published from January 1975 to May 2013. Eligible studies investigated the association between introduction of a smoking ban in work or public places and one or more prespecified health outcomes in children. The study included children 12 years or younger to minimize potential confounding by self-smoking but accepted ages up to 20 years if most of the population met the original age criterion. Primary outcomes were preterm birth, low birth weight, and asthma. Secondary outcomes included various perinatal mortality indicators. Parental or maternal smoking was defined as the main confounder for which adjustment was recorded. Of 9228 screened titles, 20 potentially eligible studies were found and 11, reported between 2008 and 2013, were included in the analysis. Four studies described the effect on pediatric asthma; all others reported on perinatal outcomes. Three of 5 studies reported a significant reduction in preterm births after introduction of smoke-free legislation. Meta-analysis of 4 studies showed that smoke-free legislation was associated with a clinically important and statistically significant drop in preterm birth (1,366,862 participants; 10.4%; 95% confidence interval [CI], 18.8 to 2.0) with no later effect on preterm birth rate change over time. One of 6 studies reported a reduction in neonates with low birth weight (<2500 g) after smoke-free legislation. Three of 4 studies reported a significant drop in hospital attendance because of asthma after introduction of legislation. An immediate reduction was reported in 3 studies (225,753 events; 10.1%; 95% CI, 15.2 to 5.0), and an additional nonsignificant trend toward an annual rate decrease was reported in 3 studies (241,846 events; 7.5% per year; 95% CI, 16.0 to 0.9). One study reported a reduction in very preterm birth, and 1 of 2 studies found a significant effect on the rate of neonates with very low birth weight (<1500 g). Two of 3 studies showed a significant step reduction in small for gestational age. These reductions were statistically significant after pooling (1,305,965 participants; step change: 5.3%; 95% CI, 5.4 to 5.2; slope change: 0.6%; 95% CI, 0.604% to 0.596%). In a small study, no effect was noted on birth defects. This study provides evidence supporting the effectiveness of smoke-free legislation to improve perinatal and child health outcomes. Rates of preterm birth and pediatric hospital admissions for asthma were reduced by 10% along with reductions in the risk for being born very small for gestational age. The results support mandates for worldwide implementation of smoke-free legislation to improve population health. Early-life protection from involuntary second-hand smoke exposure has the potential to reduce disease burdens and associated economic losses in society.

School Absenteeism Among Children Living With Smokers

Involuntary tobacco smoke exposure causes substantial morbidity in children. We hypothesized that children exposed to tobacco smoke in the home would have increased school absenteeism with associated costs due to lost caregiver wages/time. We analyzed data on health and absenteeism among schoolchildren aged 6 to 11 years identified in the 2005 National Health Interview Survey (NHIS). We used multivariate models to assess the relationships between adult-reported household smoking and child health and school absenteeism. Analyses were adjusted for children's and parents' demographic and socioeconomic characteristics. The value of lost caregiver time was estimated by using self-reported employment and earnings data in the NHIS and publicly available time-use data. Children living with 1 or ≥ 2 adults who smoked in the home had 1.06 (95% confidence interval [CI]: 0.54-1.55) and 1.54 (95% CI: 0.95-2.12) more days absent from school per year, respectively, than children living with 0 smokers in the home. Living with ≥ 2 adults who smoked in the home was associated with increased reports of having ≥ 3 ear infections in the previous 12 months (adjusted odds ratio [aOR]: 2.65 [95% CI: 1.36-5.16]) and having a chest cold in the 2 weeks before interview (aOR: 1.77 [95% CI: 1.03-3.03]) but not with having vomiting/diarrhea in the previous 2 weeks (aOR: 0.93 [95% CI: 0.45-1.89]). Caregivers' time tending children absent from school was valued at $227 million per year. Tobacco smoke exposure has significant consequences for children and families above and beyond child morbidity, including academic disadvantage and financial burden.

A Pooled Analysis on the Associations between Involuntary Smoking and Lung Cancer Risk by Histological Types

Abstract Background: While the association between involuntary tobacco smoke exposure and lung cancer is well established, few studies with sufficient power have been conducted to evaluate the relationship between involuntary smoking (IS) and lung cancer by histological type, especially for the association between IS and small cell lung cancer among nonsmokers. Methods: We evaluated the associations between IS and lung cancer by histological type based on a pooled data of the International Lung Cancer Consortium (ILCCO). The individual-level epidemiological data from 17 participating studies were pooled, including 2,218 non-smoking lung cancer cases and 6,243 non-smoking controls. Logistic regression models were used to obtain adjusted odds ratios (OR) and 95% confidence intervals (CI), using SAS v9. Likelihood ratio tests were used to assess heterogeneity by study site. Results: Among never tobacco smokers, IS exposure was associated with lung cancer with an adjusted OR of 1.33 (95% CI 1.18, 1.50), compared to never exposure to IS, when adjusting for age, sex, ethnicity, and study site. Similar associations were observed in different histological types of lung cancer with adjusted ORs of 1.38 (95% CI 0.97, 1.98) for squamous cell carcinoma, 1.26 (95% CI 1.08, 1.46) for adenocarcinoma, 2.92 (95% CI 1.55, 5.48) for small cell lung cancer, and 1.30 (95% CI 1.14, 1.49) for non-small cell lung cancer. Similar associations with ever IS exposure were observed when the overall population including nonsmokers and smokers was included in the analysis. No apparent association was observed with IS exposure in childhood. Conclusion: This is the first study with a relatively large sample size investigating the relationship between IS exposure and small cell lung cancer among nonsmokers. Our results corroborated the association between IS and lung cancer regardless of histological types, including adenocarcinoma, and we observed the strongest association between IS and small cell lung cancer. Our study provides more precise estimates of the impact of IS on major histological types of lung cancer and suggests the importance of smoking intervention for lung cancer prevention, especially for small cell lung cancer type.

In Utero Smoke Exposure,Glutathione S-Transferase P1Haplotypes, and Respiratory Illness–Related Absence Among Schoolchildren

The GSTP1 Ile105Val variant and secondhand tobacco smoke exposure have been independently associated with acute respiratory illness; however, susceptibility to in utero and secondhand tobacco smoke has yet to be examined in relation to variation across the GSTP1 locus. The purpose of this work was to determine whether variation across the GSTP1 locus is associated with respiratory illness-related school absences and to determine whether this relationship varies by in utero and secondhand tobacco smoke exposure. Tobacco smoke exposure status, incident respiratory-related school absence records, and DNA samples was ascertained for 1132 Hispanic and non-Hispanic white elementary school children as part of the Children's Health Study. Four GSTP1 single-nucleotide polymorphisms were selected that accounted for 93% of the variation across the locus. Individual single-nucleotide polymorphism analyses showed a protective effect for the minor alleles in single-nucleotide polymorphisms 1 (rs6591255), 3 (GSTP1 Ile105Val: rs1695), and 4 (rs749174) for respiratory illness. The haplotype, which includes a minor allele for single-nucleotide polymorphisms 1, 3, and 4 (h1011), was associated with a decreased risk of respiratory illness. The protective effect of GSTP1 variants was lost among individuals exposed to in utero and secondhand tobacco smoke. A common GSTP1 haplotype, which includes the functional Ile105Val polymorphism, was associated with respiratory-related school absences. The protection afforded by this haplotype was lost in children exposed to involuntary tobacco smoke. The paradigm of loss of genetic protection among those exposed to tobacco smoke has clinical and public health implications that warrant broader consideration in research and practice.

Involuntary Tobacco Smoke Exposure and Urinary Levels of Polycyclic Aromatic Hydrocarbons in the United States, 1999 to 2002

Evidence supports active smoking as a major source of exposure to polycyclic aromatic hydrocarbons (PAH), compounds that are mutagenic and carcinogenic in humans. The influence of involuntary exposure to tobacco smoke on PAH exposure levels among nonsmokers, however, is unknown. This study evaluated the association between both active and involuntary tobacco smoke and biomarkers of PAH exposure in the general U.S. population. A cross-sectional analysis of 5,060 participants>or=6 years of age was done using data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). PAH exposure was measured by urinary concentrations of 23 monohydroxylated metabolites of nine PAH compounds. Tobacco smoke exposure was defined as no exposure, involuntary exposure, and active exposure by combining serum cotinine levels, smoking status, and presence of household smokers. PAH metabolite levels ranged from 33.9 ng/L for 9-hydroxyphenanthrene to 2,465.4 ng/L for 2-hydroxynaphthalene. After adjustment for age, sex, race/ethnicity, education, household income, and broiled/grilled food consumption, participants involuntarily and actively exposed to tobacco smoke had urinary metabolite concentrations that were increased by a factor of 1.1 to 1.4 and 1.5 to 6.9, respectively, compared with unexposed participants. Associations for involuntary smoking were stronger and statistically significant for 1-hydroxypyrene, 2-hydroxyfluorene, 3-hydroxyfluorene, 9-hydroxyfluorene, 1-hydroxyphenanthrene, 2-hydroxyphenanthrene, and 3-hydroxyphenanthrene compared with other metabolites. Involuntary exposure to tobacco smoke was associated with elevated urinary concentrations of most PAH metabolites in a representative sample of the U.S. population. Policy and educational efforts must continue to minimize PAH exposure through active and involuntary tobacco smoke exposure.

The current status of passive smoking in Chinese families and associated factors

To understand the prevalence of passive smoking in Chinese families and discuss its associated factors, as to providing scientific evidence for establishing tobacco control measures in China. Cross-sectional survey: from June to September, 2004, we randomly selected six counties in three different provinces ( Mianzhu and Xichong of Sichuan Province; Anyi and Hukou of Jiangxi Province; Xinan and Yanshi of Henan Province) and performed face-to-face questionnaire survey on citizens between 18 and 69 years old. All the data were double independently input by professional data entry company to ensure data accuracy. The prevalence of home passive smoking exposure in families with different demographic characteristics was described by using prevalence, and the possible correlated factors of home passive smoking exposure as independent variables, multiple factors were analyzed using Logistic Stepwise Regression Analysis method. The analysis on 8142 nonsmokers revealed that the rate of passive smoking was 28.42%, with 27.38% of male and 28.93% of female suffering from passive smoking. All 87.19% of the smokers would smoke in front of their families. As many as 42.14% of the nonsmokers would offer cigarettes to their guests, while about 46.82% of the nonsmokers would suggest smokers to smoke outdoor. Home restriction on tobacco was extremely rare and only 6.33% of all the families completely forbade smoking. Multivariate logistic regression analysis of non-conditions revealed that, there was a lower level of involuntary tobacco smoke exposure in female, older age group, lower education level, divorced, or widowed families. There was no difference in involuntary tobacco smoke exposure between town dwellers and county dwellers, but such difference did exist in different districts. The three provinces under investigation should have severe involuntary tobacco smoking exposure. Gender, age, literacy level, occupation and region should be all factors that influence the status of involuntary tobacco smoking exposure in different families. There is a high percentile that smokers would smoke in front of their families and kids and a relative low pressure against smoking from nonsmokers. Cigarette offering is very prevalence. The knowledge and attitude about passive smoking should be separated from the situation of passive smoking exposure.

Tobacco smoking and risk of bladder cancer

Tobacco smoking is the main known cause of urinary bladder cancer in humans. In most populations, over half of cases in men and a sizeable proportion in women are attributable to this habit. Epidemiological studies conducted in different populations have shown a linear relationship between intensity and duration of smoking and risk. Quitting smoking reduces the risk of bladder cancer. Smoking black (air-cured) cigarettes results in a higher risk than smoking blond (flue-cured) tobacco cigarettes; results on inhalation patterns and use of filter are not consistent. Cigar and pipe smoking also increases the risk of bladder cancer; data on other tobacco products are limited. The evidence for non-transitional bladder carcinoma is limited, but consistent with an increased risk. The available evidence does not point towards a different carcinogenic effect of tobacco smoking in men and women or in whites and blacks. Data on involuntary smoke and use of smokeless tobacco products are limited, but do not suggest an increased risk of bladder cancer.

Passive Smoking Exposure: A Risk Factor for Chronic Bronchitis and Asthma in Adults?

The effects of passive smoke exposure on respiratory health are still under debate. Therefore, we examined the risk of respiratory symptoms related to passive smoke exposure among German adults within the European Community Respiratory Health Survey. The questionnaire data of the population-based sample (n = 1,890) were analyzed. Multiple logistic regression models were carried out for current asthma (asthma symptoms or medication), chronic bronchitis (cough with phlegm for > or = 3 months per year), and wheezing as dependent variables, and self-reported exposure to passive smoke at home and at the workplace as independent variables after adjusting for city, age, gender, active smoking, and socioeconomic status as well as occupational exposure to dusts and/or gases. The relative odds for chronic bronchitis were significantly higher in subjects reporting involuntary tobacco smoke exposure in the workplace (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.16 to 3.11). Likewise, the adjusted OR for asthma was slightly elevated (OR, 1.51; 95% CI, 0.99 to 2.32). The risk of chronic bronchitis (OR, 3.07; 95% CI, 1.56 to 6.06), asthma (OR, 2.06; 95% CI, 1.07 to 3.97), and wheezing (OR, 2.12; 95% CI, 1.25 to 3.58) increased significantly with a daily exposure of > 8 h. The control of passive smoke exposure in the workplace might reduce the risk of respiratory symptoms independently of exposure to other airborne contaminants.

Involuntary Smoking and Asthma Severity in Children: Data From the Third National Health and Nutrition Examination Survey

We sought to determine the indicators of asthma severity among children in the United States with high and low levels of tobacco smoke exposure. Cross-sectional study. Nationally representative survey of participants in the Third National Health and Nutrition Examination Survey (from 1988 to 1994). Five hundred twenty-three children with physician-diagnosed asthma. We stratified the study participants into tertiles on the basis of serum levels of cotinine (a metabolite of nicotine that indicates tobacco smoke exposure). We used logistic and linear regression modeling, adjusting for known covariates, to determine the effect of high environmental tobacco smoke exposure on the following outcomes: asthma severity (determined using reported symptom and respiratory illness frequency); lung function; physician visits; and school absence. Among our study sample, 78.6% of children had mild asthma, 6.8% of children had moderate asthma, and 14.6% of children had severe asthma. Asthmatic children with high levels of smoke exposure, compared with those with low levels of exposure, were more likely to have moderate or severe asthma (odds ratio, 2.7 95% confidence interval [CI], 1.1 to 6.8) and decreased lung function, with a mean FEV(1) decrement of 213 mL or 8.1% (95% CI, -14.7 to -3.5). Involuntary smoke exposure is associated with increased asthma severity and worsened lung function in a nationally representative group of US children with asthma.

A smoke screen to keep the controversy alive

A smoke screen to keep the controversy alive

Fetal Exposure to Involuntary Maternal Smoking and Childhood Respiratory Disease

Several studies have now gone beyond the effects of smoking during pregnancy to examine the effects of involuntary maternal smoke exposure on fetal development. A link has also been indicated between postnatal environmental smoke exposure and long-term respiratory problems in infants. Our study examines whether an association exists between maternal exposure to environmental tobacco smoke and childhood respiratory disorders. A cross-sectional design was implemented utilizing a maternal questionnaire survey. The surveys were distributed throughout the county's health department and outlying clinic immunization sites. The county population is a diverse community of all racial and socioeconomic levels and includes a metropolitan population of approximately 300,000. The questionnaire comprised inquiries about the child's wheeze, acute respiratory illnesses, and maternal and paternal exposure to passive smoke and/or other environmental air pollutants. Chi-square and logistic regression analysis showed no statistically significant difference between passively smoke-exposed-in-utero subjects and non-smoke-exposed in-utero subjects on the outcomes of allergy and wheeze. Asthma, however, did show a statistically significant association to passive smoke exposure (chi2 = 12.4, P = .05 and Log reg = 8.7, P = .03). Passive maternal exposure to tobacco smoke during pregnancy is associated with increased incidence of asthma and supports other research findings that children born of mothers who are passively exposed to smoke during pregnancy are at risk for patterns of negative developmental outcomes.