Environmental Smoke Research Articles

Unraveling the Environmental, Meteorological, and Lifestyle Determinants of Hypertension Mortality in Türkiye

Hypertension is a leading risk factor for cardiovascular diseases and a significant cause of mortality worldwide. This study investigates the association of environmental, meteorological, and lifestyle factors with hypertension mortality in Türkiye from 2010 to 2019. This study analyzed province-level hypertension mortality data for 81 provinces in Türkiye from 2010 to 2019. Predictors included air quality indicators (particulate matter 10, sulfur dioxide, carbon monoxide, nitrogen dioxide, ozone), meteorological variables (air pressure, humidity, temperature, wind speed), and lifestyle factors (smoking, alcohol consumption, exposure to second-hand smoke). An ordinal logistic regression approach was employed to model the likelihood of hypertension mortality, with adjustments for multiple testing using the Benjamini-Hochberg False Discovery Rate technique. In this study, it was found that significant associations are between hypertension mortality and several predictors. Air pressure, in terms of coefficient of variation and median levels, was significantly associated with hypertension mortality. Temperature and humidity showed strong associations, with median levels and variability impacting mortality rates. Lifestyle factors, notably smoking and alcohol consumption, were also significantly associated with increased hypertension mortality. Surprisingly, exposure to smoke at home showed a slight protective effect. The study highlights the complex interplay of environmental, meteorological, and lifestyle factors in terms of influencing hypertension mortality in Türkiye. These findings emphasize the need for multifaceted public health strategies that consider these diverse influences to manage and prevent hypertension-related mortality effectively.

Association of Sleep Quality and General, Mental, and Oral Health with Lifestyle Traits (Dietary Intake, Smoking Status) in Arthritis: A Cross-Sectional Study from the Canadian Community Health Survey (CCHS).

Arthritis is associated with health challenges. Lifestyle traits are believed to influence arthritis development and progression; however, data to support personalized treatment regimens based on holistic lifestyle factors are missing. This study aims to provide a comprehensive list of associations between lifestyle traits and the health status of individuals with arthritis in the Canadian population, using binary logistic regression analysis on data from the Canadian Community Health Survey, which includes 104,359 respondents. Firstly, we explored the association between arthritis and various aspects of health status including self-reported lifestyle factors. Secondly, we examined the associations between self-reported dietary intake and smoking status with general, mental, and oral health, and sleep disturbance among individuals both with and without arthritis. Our analysis revealed that individuals with arthritis reported considerably poorer general, mental, and oral health, and poorer sleep quality compared to those without arthritis. Associations were also found between self-reported dietary intake and various measures of health status in individuals with arthritis. Smoking and exposure to passive smoking were associated not only with arthritis but also with compromised sleep quality and poorer general, mental, and oral health in people with and without arthritis. This study highlights the need for personalized and holistic approaches that may include a combination of dietary interventions, oral health improvements, sleep therapies, and smoking cessation for improved arthritis prevention and care.

Exposure to second-hand smoke and breast cancer risk in non-smoking women: a comprehensive systematic review and meta-analysis.

Through the use of an innovative method to identify original publications, we conducted ameta-analysis of all epidemiological studies evaluating the association between second-hand smoke (SHS) exposure and breast cancer risk among female non-smokers published in English up to October 2022. Pooled relative risks (RR) were obtained through the use of random-effects models. Dose-response relationships were derived using log-linear functions. Out of 73 identified eligible studies, 63 original articles were included in the meta-analysis. The pooled RR for breast cancer for overall exposure to SHS was 1.24 (95% confidence interval, CI, 1.15-1.34, number of articles, n = 52). Regarding the setting of exposure, RRs were 1.17 (95% CI 1.08-1.27, n = 37) for SHS exposure at home, 1.03 (95% CI 0.98-1.08, n = 15) at the workplace, 1.24 (95% CI 1.11-1.37, n = 16) at home or workplace, and 1.45 (95% CI 1.16-1.80, n = 13) for non-specified settings. The risk of breast cancer increased linearly with higher duration (RR 1.29;95% CI 1.04-1.59 for 40 years of SHS exposure, n = 12), intensity (RR 1.38;95% CI 1.14-1.67 for 20 cigarettes of SHS exposure per day, n = 6), and pack-years (RR 1.50;95% CI 0.92-2.45 for 40 SHS pack-years, n = 6) of SHS exposure. This meta-analysis shows a statistically significant excess risk of breast cancer in women exposed to SHS.

Risk factors for respiratory syncytial virus-associated acute lower respiratory infection in children under 5 years: An updated systematic review and meta-analysis

ObjectivesRespiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infection (ALRI) in young children. With substantial advances in RSV research, we aimed to conduct an updated systematic review of risk factors for RSV-ALRI in children under 5 years. MethodsWe updated our previously published literature search to November 2022 among three English databases and additionally searched three Chinese databases (from January 1995) to identify all relevant publications. We performed random-effects meta-analyses to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) for each risk factor and each outcome (RSV-ALRI in the community and RSV-ALRI hospitalization). ResultsA total of 47 studies were included (26 from the updated search). Indoor air pollution was identified as a possible risk factor for RSV-ALRI in the community (OR 1.45, 95% CI: 1.10-1.90). The identified risk factors for RSV-ALRI hospitalization fall into four categories: demographic (male sex, Māori and Pacific ethnicities vs European or other ethnicities), pre- and post-neonatal (prematurity, low birth weight, small for gestational age, maternal smoking during pregnancy or lactation, maternal age <30 years vs 30-34 years, multiparity, caesarean section vs vaginal), household and environmental (having siblings, passive smoking, maternal asthma, daycare centre attendance) and health and medical conditions (any chronic diseases, bronchopulmonary dysplasia, HIV infections, congenital heart disease, Down syndrome, cystic fibrosis, previous asthma). The pooled ORs ranged from 1.14 to 4.55. ConclusionOur findings on the risk factors for RSV-ALRI help identify RSV high-risk groups, which has important implications for RSV prevention at both individual and population levels.

Expert panel opinion on adult pneumococcal vaccination in the post-COVID era (NAP- EXPO Recommendations-2024).

Pneumococcal diseases pose a significant public health concern in India, with substantial morbidity and mortality, with the elderly and those with coexisting medical conditions being most at risk. Pneumococcus was also seen to be one of the main reasons for co-infection, pneumonia and complications in COVID. Current guidelines recommend vaccination for specific adult populations, but there is a lack of uniformity and guidance on risk stratification, prioritisation and optimal timing. Nation Against Pneumococcal Infections - Expert Panel Opinion (NAP-EXPO) is a panel convened to review and update recommendations for adult pneumococcal vaccination in India. The panel of 23 experts from various medical specialties engaged in discussions and evidence-based reviews, discussed appropriate age for vaccination, risk stratification for COPD and asthma patients, vaccination strategies for post-COVID patients, smokers and diabetics, as well as methods to improve vaccine awareness and uptake. The NAP-EXPO recommends the following for adults: All healthy individuals 60 years of age and above should receive the pneumococcal vaccine; all COPD patients, regardless of severity, high-risk asthma patients, post-COVID cases with lung fibrosis or significant lung damage, should be vaccinated with the pneumococcal vaccine; all current smokers and passive smokers should be educated and offered the pneumococcal vaccine, regardless of their age or health condition; all diabetic individuals should receive the pneumococcal vaccine, irrespective of their diabetes control. Strategies to improve vaccine awareness and uptake should involve general practitioners (GPs), primary health physicians (PHPs) and physicians treating patients at high risk of pneumococcal disease. Advocacy campaigns should involve media, including social media platforms. These recommendations aim to enhance pneumococcal vaccination coverage among high-risk populations in India in order to ensure a reduction in the burden of pneumococcal diseases, in the post-COVID era. There is a need to create more evidence and data to support the recommendations that the vaccine will be useful to a wider range of populations, as suggested in our consensus.

Influence of educational level on the prevalence of risk behaviors during the perinatal period.

The objective of this work was to assess changes during pregnancy and after childbirth in diet, consumption of tobacco, electronic cigarettes, cannabis, alcohol use and exposure to environmental tobacco smoke depending on the mother's educational level.A cross-sectional study was carried out whose target population was 18,822 Galician women aged 18-49 who gave birth between September 2015 and August 2016, and their 19,204 live-born children. A descriptive analysis was performed, and the prevalence of different behaviors was estimated at three time points - pre-pregnancy, pregnancy and after childbirth - depending on the mother's educational level. Percentages of change were calculated.Information was obtained from 6,436 women. Regardless of the educational level, during pregnancy there was an improvement in the different lifestyles. In the first months after childbirth, lifestyles worsened, except for exposure to environmental tobacco smoke and the use of electronic cigarettes. Most of the risk behaviors showed a gradient depending on the educational level; thus, the lower the educational level, the higher the prevalence of risk behaviors.In general, during pregnancy all women adopted healthier lifestyles that they abandoned in the months following childbirth. Women with a lower level of education showed a higher prevalence of risk behaviors, both in the period prior to pregnancy, as well as during pregnancy and after childbirth.

The economic impact of tobacco smoking and secondhand smoke exposure in Jordan: estimating the direct and indirect costs

Aim To quantify the economic burden associated with tobacco smoking among smokers aged 30-69 years, and second-hand smokers (SHS) aged 15-69 years in Jordan. Materials and methods A prevalence-based analysis was conducted in alignment with the Economics of Tobacco Toolkit developed by the WHO. The time-horizon of the analysis was one year (2019). Direct and indirect costs were estimated using data from the 2019 Global Burden of Diseases study. The analysis targeted the Jordanian population of smokers aged 30–69 years, and SHS aged 15-69 years. Adjustments were applied for age, gender, and smoking-related diseases. Direct costs were estimated using the smoking-attributable fraction (SAF) and national health expenditures. Indirect costs were divided into morbidity and mortality components. A discount rate of 3.0% and an annual productivity growth rate of 1.0% were assumed in modelling future economic losses. A sensitivity analysis was conducted on the lower and upper estimates of data used in this study. Results The cost of tobacco smoking and SHS exposure was estimated at US$2,108 million (95% confidence interval [CI] = US$2,003 million-US$2,245 million). This represents 4.7% (95%CI = 4.5%–5.0%) of national gross domestic product (GDP). Direct costs accounted for 3.1% of national GDP. Tobacco smoking accounted for 85.0% of total cost and SHS exposure accounted for 15.0% of total cost. Direct costs accounted for 67.0% of total cost, while indirect morbidity and mortality costs accounted for 9.0% and 24.0% of total cost, respectively. Non-communicable diseases accounted for 96.0% of total direct costs compared to communicable diseases (4.0% of total direct costs). Conclusions Smoking cessation interventions such as raising taxes on cigarettes, protecting people from tobacco smoke, warning labels, plain packaging, and bans on advertising, are crucial for controlling national expenditures for treating smoking-related diseases and for averting future economic losses.

Assessment of the occupational exposures within homes for home healthcare workers in the United Kingdom

Many of the tasks being conducted by home healthcare workers are associated with significant complex demands. Each home is a unique work environment with potentially different exposures. The purpose of this study was to investigate the plethora of exposures for home healthcare workers in the United Kingdom. The study was a cross-sectional study that utilized a trained supervisor to complete the direct observation of the healthcare worker (nursing aide and nurse). Environmental hazards that were captured included mold/mildew (8.7%) and dogs (14.5%), and secondhand smoking (15.9% with smell in home and 8.7% with active smoking). Verbal abuse was prominent for nurse aides (31% experiencing it). Ergonomic hazards were observed through various tasks such as repositioning in bed (34.8%), transfer from bed to chair (30.4%), transfer from bed to chair (26.1%), and transfer from chair to chair (26.1%) and particularly for nursing aides. The results of the current observations indicated that home healthcare workers faced a multitude of exposures that could lead to injuries. This provides a rigid platform for occupational safety and ergonomics specialists to appreciate the occupational exposures and challenges that home health care workers face in the unique home care environment and proactively identify mitigation measures of the respective occupational hazards.

Maternal Smoking Prevalence in Brazil in 2013 and 2019: Not What We Expected When They Were Expecting!

Monitoring tobacco use during pregnancy is critical for achieving the United Nations Sustainable Development Goals. We examined changes between 2013 and 2019 in the relative differences in smoking prevalence rates between pregnant and nonpregnant women aged 18-49 years. We used data from a nationally representative health survey conducted in Brazil in 2013 and 2019. A generalized linear model with binomial family and logarithmic link function was used to estimate, for each year of analysis, the crude and adjusted (by age group, educational attainment, place of residence, and status of protection from passive smoking at home) relative differences. In 2013, the proportion point estimate of tobacco use among pregnant women was lower than that observed among nonpregnant women (4.7% vs. 9.6%). However, in 2019 proportion point estimates were virtually the same (8.5% vs. 8.4%). After adjustment for selected variables, in 2013, smoking prevalence among pregnant women was 42% (p-value ≤ .05) lower than that observed among nonpregnant women. On the other hand, in 2019, maternal smoking prevalence was 13% (p-value > .05) higher than that found among nonpregnant women. Ongoing tobacco industry interference and the marketing of tobacco products to vulnerable populations pose serious threats to public health and likely contribute to increasing maternal smoking prevalence. The fact that women smoke in such an important phase of their and their unborn children's lives reinforces the need to strengthen the implementation of concurrent tobacco control actions, including tobacco excise tax policy and prenatal tobacco prevention and cessation interventions as part of health professionals' routine consultation. The decline in smoking prevalence among nonpregnant women between 2013 and 2019 was accompanied by an increase in maternal smoking prevalence. Monitoring tobacco use during pregnancy is critical for achieving the United Nations Sustainable Development Goals. Ongoing tobacco industry interference and the marketing of tobacco products to vulnerable populations in Brazil pose serious threats to public health. The fact that women smoke in such an important phase of their and their unborn children's lives reinforces the need to strengthen the implementation of concurrent tobacco control actions, including tobacco excise tax policy and primary healthcare professionals´ tobacco-related assistance during interaction with their patients.

Identification of Urine Cotinine in Secondhand Smoke and its Association with Socio-Environmental

Background: Exposure to cigarette smoke not only affects active smokers but also endangers passive smokers, leading to various health problems. However, research on passive smokers is still very limited, particularly regarding the relationship with socio-environmental factors. Cotinine is the primary metabolite of nicotine consumption and can serve as a biomarker for tobacco use and its derivatives; moreover, its presence is associated with poor health risks. Socio-environmental conditions are influential factors in smoking behavior, but the relationship between these factors and cotinine identification in passive smokers has not been fully studied. This study aimed to identify cotinine in passive smokers and their relationship with socio-environmental conditions. Methods: This study utilized an analytical survey with a cross-sectional approach. The sample size consisted of 53 passive smokers who had never actively smoked and were over 15 years old. Urine cotinine was identified using a competitive immunochromatography method, and profile of passive smokers was obtained through questionnaires. The collected data were then statistically analyzed. Results: The results showed that 36 samples tested positive for cotinine (67.90%), with the majority being females (28 individuals; 77.80%). Statistical tests indicated a significant relationship between urine cotinine identification and exposure location (p&lt;0.001) and exposure frequency (p&lt;0.001). In contrast, factors such as sex (p=0.570) and occupation (p=0.861) did not show a significant relationship with the identification of cotinine in passive smoker’s urine. Conclusion: Factors such as exposure location and exposure frequency are related to cotinine identification, whereas sex and occupation are not related to cotinine identification in passive smoker’s urine.

A Qualitative Evaluation of Smoke-Free Policy Implementation among the Hospitality Industry in Yogyakarta, Indonesia

Background: The Indonesian government has implemented various regulations, including smoke-free policies (SFPs) aimed at reducing exposure to second-hand smoke and improving public health. However, the implementation of these policies has encountered challenges. Objective: This study aimed to investigate the implementation of SFP in the hospitality industry in Yogyakarta, Indonesia. Methods: Three focus group discussions with the managers of hotels, restaurants, and coffee shops (n=19) were conducted in November 2021. Thematic analysis was used to analyse the data. Results: Three themes were identified: 1) Efforts to implement SFPs at hospitality premises; 2) Reasons for adopting SFPs; and 3) Challenges for policy implementation. Many hospitalities industry have undertaken efforts to implement SFPs, though they are not comprehensive. The reasons for implementing SFPs include protecting second-hand smokers, meeting guest preferences, and creating a fresher environment. Resistance from customers has become a significant challenge, as some view SFPs as an infringement on personal freedom. Furthermore, unclear sanctions and enforcement from the government also highlighted by participant as the main barriers of SFPs implementation. Conclusion: Overall, while there is significant effort to implement SFPs in hospitality venues, challenges such as customer resistance and unclear government guidance persist. This condition underscores the need for clearer policies and support mechanisms for successful implementation.

Second Hand Tobacco Smoke Exposure among Adults in an Urbanized Village in Delhi

Abstract Background: India contributes to the maximum of the world’s health burdens attributable to tobacco use. Exposure to secondhand smoke (SHS) is also associated with adverse health effects, causing 1.2 million deaths worldwide each year. In Delhi, 28.0% had SHS exposure at public places. About one-fifth experienced exposure to SHS at workplace. This study aimed to determine the prevalence of SHS exposure among adults in an urbanized village in Delhi. Materials and Method: It was a community-based cross-sectional house-to-house survey conducted between January 2020 and June 2021 in Aliganj, an urbanized village in Delhi. A total of 490 residents ≥15 years were included using simple random sampling. The interview was conducted by the primary author using the Global Adult Tobacco Survey (GATS). Each subject enrolled in the study was explicitly informed of the purpose of the study by the investigator and provided written informed consent before enrolment. Data were checked for errors, entered in Microsoft Excel, and analyzed in Statistical Package for the Social Sciences (SPSS). Results: Of the 490 participants, 14.7% were exposed to SHS in their house and 16.1% were exposed to SHS outside the house in the last 1 month. The majority (85.3%) believed secondhand smoking is harmful, 6.5% disagreed, and the rest were unaware. Conclusion: Though most participants knew that exposure to SHS can cause serious illness, further awareness sessions need to be conducted to improve knowledge and understanding and reduce exposure to secondhand tobacco smoke in homes. Strict adherence to no-smoking policies should be implemented as per law to reduce exposure to SHS in public areas.

Prevalence and Associated Factors of Chronic Respiratory Symptoms among Street Sweepers in Bangkok, Thailand: A Cross-sectional Study.

Chronic respiratory diseases are becoming a more prominent cause of morbidity and mortality worldwide. Street sweepers are commonly found in low- and middle-income countries. This job involves outdoor work that exposes workers to various health hazards and air pollution, particularly affecting respiratory health. There is still limited research focusing specifically on street sweepers. The study aims to examine the prevalence of chronic respiratory symptoms and the associated factors in street sweepers in Bangkok, Thailand. We undertook a cross-sectional survey between February and April 2023. A multi-stage sampling technique was employed, stratifying the sample according to district locations within Bangkok, Thailand. Data were collected through a questionnaire assessing demographic characteristics, occupational and environmental factors, and respiratory symptoms using a modified version of the Medical Research Council questionnaire. Data analysis included bivariate analysis and multiple logistic regression. The response rate was 98.0% (n = 341). The prevalence of chronic respiratory symptoms among street sweepers in Bangkok, Thailand, with at least one respiratory symptom was reported by 33.7% of the participants, specifically cough (22%), phlegm (20.2%), dyspnea (17.6%), and wheeze (7.0%). The average age of the sample group was 43.2 years, with a majority being female (85.9%). Among the participants, 88.3% were non-smokers, while 37.2% reported exposure to secondhand smoke. All participants reported the use of respiratory protective equipment, with face masks used at 78.9%. 7.3% of the participants lived near sources of pollution, and 12.0% were involved in household pollution activities. An average annual air quality index in the workplace area was categorized as 'good' at 57.8%. Multiple logistic regression analysis revealed significant associations of chronic respiratory symptoms with the following factors: exposure to secondhand smoke [odds ratio (OR) =2.3, 95% confidence interval (CI) 1.3-4.2] and household activities (OR = 3.0, 95% CI 1.3-6.6). Exposure to secondhand smoke and indoor air pollutants in household environments are significant factors associated with the symptoms. Raising awareness about secondhand smoke hazards in household and environmental settings and promoting self-care practices related to various activities with potential exposure to indoor air pollution is crucial.

Association between metal exposures and periodontitis among U.S. adults: the potential mediating role of biological aging

BackgroundThis study aimed to investigate the associations between metal exposures and periodontitis among U.S. adults, as well as the mediated effect of biological aging.MethodsUsing data from the National Health and Nutrition Examination Survey (NHANES) 2009–2014, we explored the single and mixed impacts of metal exposures on periodontitis through adjusted weighted logistic regression, robust Poisson regression, restricted cubic spline regression, and Bayesian kernel machine regression models. This study included 2,393 participants, with 46.9% experiencing periodontitis. Concentrations of nine urinary metals, including barium (Ba), cadmium (Cd), cobalt (Co), cesium (Cs), molybdenum (Mo), lead (Pb), thallium (Tl), tungsten (Tu), and uranium (Ur), were measured using inductively coupled plasma-mass spectrometry. In addition, we analyzed the association between metals and periodontitis, stratified by age, body mass index, gender, and smoking status. Mediation models were also applied to investigate the mediated effects of biological aging between metal exposures and periodontitis.ResultsWeighted logistic and robust Poisson regression identified positive associations between Cd, Pb and periodontitis (P < 0.05). BKMR analyses indicated that mixed metal exposures were significantly associated with periodontitis, particularly among smokers, second-hand smokers, and males, with Cd, Pb, Tl, and Ba contributing the most. Furthermore, subgroup analyses observed a modifying effect on the associations between urinary Cd, Pb and periodontitis in stratified gender and BMI subgroups in robust Poisson regression. Phenotype age was found to mediate the association between metals and periodontitis.ConclusionsThis study identified significant positive associations between metal exposures and periodontitis in the U.S. adults. In addition, the association between metal exposures and periodontitis could vary in different gender, BMI and smoking subgroups. These associations were likely partly mediated by biological aging, suggesting that metals may potentially increase the risk of periodontitis by promoting cell senescence and overall aging of the body.Graphical

The research on infrared radiation affected by smoke or fog in different environmental temperatures

Infrared thermal imaging camera as a non-contact monitoring of the object to be measured is widely used in fire detection, driving assistance and so on. Although there are many related studies, there is a lack of research on the influence of fog or smoke on infrared imaging under different environmental temperatures. To address this shortcoming, The temperature of both the environment and the target in this experiment is controlled by PID technology. The smoke or fog environment is generated using a smoke cake or an ultrasonic fog machine. The temperature of the target was measured by infrared thermal imaging camera. It was observed that as the temperature of the environment increases, the measured temperature of the target also increases. However, the change in temperature is more pronounced in the fog environment compared to either the smoke environment or the normal environment. It has been found through research that environmental radiation causes temperature changes in fog droplets. Therefore, Infrared radiation is less affected in the smoke environment and more affected in the fog environment. Additionally, when the environmental temperature is close to the target's temperature, the infrared image becomes blurred.

Associations between urinary hydroxylated polycyclic aromatic hydrocarbon biomarker concentrations and measures of timing of delivery and infant size at birth

Preterm birth is a leading cause of neonatal mortality and presents significant public health concerns. Environmental chemical exposures during pregnancy may be partially to blame for disrupted delivery timing. Polycyclic aromatic hydrocarbons (PAHs) are products of incomplete combustion, exposure to which occurs via inhalation of cigarette smoke and automobile exhaust, and ingestion of charred meats. Exposure to PAHs in the US population is widespread, and pregnant women represent a susceptible population to adverse effects of PAHs. We aimed to investigate associations between gestational exposure to PAHs and birth outcomes, including timing of delivery and infant birth size. We utilized data from the PROTECT birth cohort where pregnant women provided spot urine samples at up to three study visits (median 16, 20, and 24 weeks gestation). Urine samples were assayed for eight hydroxylated PAH concentrations. Associations between PAHs and birth outcomes were calculated using linear/logistic regression models, with adjustment for maternal age, education, pre-pregnancy BMI, and daily exposure to environmental tobacco smoke. Models accounted for urine dilution using specific gravity. We also explored effect modification by infant sex. Interquartile range (IQR) increases in all averaged PAH exposures during the second trimester were associated with reduced gestational age at delivery and increased odds of overall PTB, although these associations were not statistically significant (p > 0.05). Most PAHs at the second study visit were most strongly associated with earlier delivery and increased odds of overall and spontaneous PTB, with visit 2 2-hydroxynapthalene (2-NAP) being significantly associated with increased odds of overall PTB (OR:1.55; 95 %CI: 1.05,2.29). Some PAHs resulted in earlier timing of delivery among only female fetuses, specifically 2-NAP on overall PTB (female OR:1.52 95 %CI: 1.02,2.27; male OR:0.78, 95 %CI: 0.53,1.15). Future work should more deeply investigate differential physiological impacts of PAH exposure between pregnancies with male and female fetuses, and on varying developmental processes occurring at different points through pregnancy.

Associations between noticing public health education campaigns about cannabis and risk perceptions in the northern Canadian territories: a cross-sectional study.

This study investigated whether noticing cannabis education campaigns was associated with increased cannabis risk perceptions in Canada's three territories following non-medical cannabis legalization. Data were from the Cannabis Policy Study in the Territories, including 2452 participants, age ≥16years residing in Yukon, Northwest Territories and Nunavut. Poisson regression with robust standard errors were used to estimate associations between noticing cannabis education campaigns and moderate to very high risk perceptions of daily cannabis smoking, vaping, edible use and exposure to second-hand cannabis smoke, adjusting for sociodemographic characteristics and cannabis-use frequency. Results were compared with associations with risk perceptions of daily alcohol consumption and cigarette smoking, not included in cannabis education campaigns. Interactions were examined between noticing education campaigns and age group and cannabis-use frequency. Cannabis education campaigns were noticed by 40.4% of respondents, with lower awareness among those with lower education and income. Noticing campaigns was associated with higher risk perceptions of daily cannabis smoking [adjusted risk ratio (RRadj) = 1.09, 95% confidence interval (CI): 1.02-1.16] and vaping (RRadj = 1.09, 95%CI: 1.02-1.16). Significant interactions were not found with age group or cannabis-use frequency. Findings are consistent with modest effects of cannabis education campaigns. Approaches are needed to increase reach of cannabis education campaigns, including among groups with lower education and income.

Influence of smoking on changes in indicators of bronchitis, asthma and lung cancer - comparison on the example of Poland, Malta and other European Union countries

Introduction. Smoking is associated with respiratory diseases. Despite declining smoking rates, asthma and chronic bronchitis cases rose between 2014 and 2019. Quitting smoking is vital for managing asthma and reducing the risks of bronchitis and lung cancer. Aim. A correlational study of smoking prevalence and its association with asthma, bronchitis and lung cancer in people from Malta, Poland and the EU in 2008/2014/2019. Materials and methods. Integration and comparison of statistical data from EUROSTAT – (EHIS) 2008/2014/2019, ISAAC; ESPAD, 2014/2015, ECIS 2020. Results. Smoking habits exhibit notable gender disparities, with 24% of Polish men and 23% of Maltese men being regular smokers, compared to women (Poland – 15%, Malta – 16%). While male smoking rates have declined, especially in Poland, female rates persist. In 2019, asthma affected 5.6% of the EU adult population, with Poland at 4.1% and Malta at 6%. Chronic bronchitis is more prevalent in Poland (3%) than Malta (1%). In 2020, lung cancer rates among men varied slightly between Poland and Malta (120.0; 100.3 per 100.000). However, the incidence among women is twice as high in Poland (53.1; 23.9 per 100.000). Conclusions. Malta’s elevated asthma rate, despite comparable smoking rates, hints at additional risk factors like traffic. Poland’s increased bronchitis rate likely stems from higher historical smoking. The doubled lung cancer incidence in Polish women suggests a passive smoking connection. The burden of bronchitis intensifies due to high smoking rates in men over 50. Addressing smoking rates can potentially address respiratory disease rates, but other risk factors should also be identified and managed. Keywords: tobacco smoking, asthma, bronchitis, lung cancer.

Voice Disorder Prevalence and Vocal Health Characteristics in Children

Voice disorders impede communication and limit quality of life for many children. However, research demonstrating the prevalence of pediatric voice problems and associated voice use patterns is scarce. This investigation examined the prevalence of voice problems and vocal health characteristics of school-aged children. To examine the prevalence of voice problems in school-aged children throughout the US with reference to lifestyle, demographic characteristics, and voice use patterns. This study used a cross-sectional design to survey a probability sample of caregivers of children aged 4 to 12 years living throughout the US in 2023. Caregivers were surveyed regarding their children's voice use, voice symptoms, voice problems, extracurricular activities, and demographic information. Caregivers also competed the Pediatric Voice-Related Quality of Life questionnaire. The Fisher exact test, χ2 tests, and logistic regression were used to compare children with and without voice problems. Overall, 6293 panelists were invited to complete screening questions for the survey, and 1789 individuals were screened for eligibility between March and April 2023. Of these, 1175 parents (65.7%) completed the survey. Twenty-one (1.8%) were excluded for a combination of either high refusal rates (n = 16), speeding (n = 2), or straight lining (n = 12). The final number of participants included in analysis was 1154 caregivers of children aged 4 to 12 years (559 female children [48.4%]; 595 male children [51.6%]; mean [SD] age, 8.02 [2.49] years). The prevalence of voice problems in children was 6.7% (n = 78), and the lifetime prevalence was 12% (n = 138). Benign vocal fold lesions was the most common diagnosis underlying voice complaints, and other causes included respiratory illness, allergies, autism-related voice issues, and other neurological conditions. Risk factors for pediatric voice problems included being male (odds ratio [OR], 1.47; 95% CI, 1.0-2.1), having more than 4 individuals living in the household (OR, 2.30; 95% CI, 1.2-4.4), poor speech intelligibility (OR, 2.26; 95% CI, 1.2-4.3), maternal history of voice problems (OR, 4.54; 95% CI, 1.2-16.4), participating in online gaming (OR, 1.56; 95% CI, 1.0-2.3), and secondhand smoke exposure (OR, 1.7; 95% CI, 1.1-2.6). Voice use-related risk factors included frequent talking, coughing, throat clearing, tantrums/crying, and vocal strain. Voice problems were associated with substantially detracted quality of life as measured by the Pediatric Voice-Related Quality of Life questionnaire, limited social/extracurricular interactions, increased school absences, and negative attention from adults. The results of this survey study suggest that pediatric voice problems are relatively common and detract from quality of life. Specific environmental and behaviorial factors are associated with increased risk for voice disorders.

Ambiguity in the Policy Implementation of the No-Smoking Area: Evidence from Indonesia

The ambiguity in the implementation of the No-Smoking Area (NOSAR) public policy is a topic of discussion among people occasionally, along with the underlying perspective of its users (smokers). This article explains the implementation of the NOSAR policy. Qualitative research methods with a phenomenological approach were used to reveal the meaning behind the facts of implementer and smoker behavior. The data collection technique is through observation at the locus where markers or writing are placed that inform about the prohibition of smoking. Apart from that, in-depth interview techniques were used with informants, both policy implementers and active smokers and passive smokers, while exploring documents regarding regulations regarding NOSAR in Bekasi City Government agencies, Indonesia. The data analysis follows an interactive model: data collection, condensation, data presentation, and verification/conclusion. The results of the research found that the implementation of the NOSAR policy in the City of Bekasi has been implemented effectively. However, there are still various obstacles found in the context of its implementation, including a lack of proportional human resources and funds for implementing regional regulations, a lack of coordination between agency leaders and employees, the implementation of trials Justice for NOSAR violators is limited to giving verbal warnings and no administrative sanctions have been given, so that violations of the rules in the NOSAR are still often found.