Environmental Smoke Research Articles

The Cardiovascular Disease Burden Associated with secondhand smoke, 1990-2019: an age-period-cohort analysis of the Global Burden of Disease study

Abstract Background Over the past three decades, global regions have shown significant differences in the burden of cardiovascular disease (CVD), and secondhand smoke is a major risk factor contributing to this burden. Nevertheless, a comprehensive understanding of the global trends and associations between second-hand smoke and cardiovascular disease is lacking. Methods Using data from the Global Burden of Disease (GBD) study 1990-2019, an age-period-cohort (APC) analysis was conducted to investigate trends in cardiovascular disease-related mortality in populations affected by secondhand smoke globally over the past 30 years and its association with age, period, and birth cohort. Results Over the past 30 years, the number of cardiovascular deaths caused by secondhand smoke has increased significantly worldwide, from 432.6 thousand in 1990 (95% UI: 357.4-508.3) to 598.5 thousand in 2019 (95% UI: 489.7-713.5), an increase of 38.4% (95% UI: 26.8%-49.5%). In 2019, cardiovascular disease accounted for 45.9% of all deaths attributable to secondhand smoke in both men and women globally. Among cardiovascular diseases, ischemic heart disease became the main component, accounting for 66.4% compared with stroke. The gender composition of cardiovascular deaths due to secondhand smoke is slightly lower in men (46.5%) than in women (53.5%). Longitudinal analyses using age-time-cohort models show that global CVD-related mortality from secondhand smoke has improved overall over the past three decades, but there are differences between regions, genders, and CVD subtypes. It is worth noting that the higher the socio-demographic index (SDI) level, the greater the reduction in mortality, with a staggering 39.1% reduction in high SDI areas (95% UI: 35.6%-42.3%), in sharp contrast to virtually no change in mortality in low SDI areas (0.1% (95% UI: -52.4%-62.2%)). During the period 2003-2007, cardiovascular disease-related mortality decreased significantly, with an average annual percentage change of -1.48%. Conclusion The study highlights the importance of using secondhand smoke as a modifiable risk factor for the global burden of cardiovascular disease. Further research is vital to understand the factors that lead to differences in countries and regions at different levels of development, gender differences and differences in cardiovascular disease subtypes.

Healthy air for healthy minds

Abstract Background The adverse health effects from exposure to air pollution is increasingly known. A recent report shows that at least 95% of the world’s population breathe air containing dangerous levels of pollutants. According to estimates from the World Health Organization (WHO), ambient air pollution is related to 4.2 million deaths every year. Less is known about the association between indoor air (especially particulate matter 2.5 and volatile organic compounds (VOC) pollution and mental health conditions. Many sources of indoor air pollution exist, such as pressed wood products, pesticides, secondhand smoke, stoves, heaters, overcrowding and fireplaces. Aims We aim to synthesize knowledge on the effects of particulate matter 2.5 in indoor air and mental health conditions. Methods We systematically reviewed the association of indoor air pollution with mental health conditions using the databases Pubmed and EMBASE. Results Exposure to indoor air pollutants is associated with increased anxiety and depression and less cognitive performance. These results are robust; however, the impact of PM2.5 is larger for less-educated and female respondents. Females cook with solid fuels and biomass more often. Physical exposure and gender factors overlap in the exposure to indoor air pollutants. Discussion Poor indoor air quality should be part of a comprehensive assessment of factors influencing mental health and cognition. Neuroinflammation might explain the effects of poor air on mental health and cognition. Further research is needed to combine research on the social determinants of mental health and the effects of indoor air. Studies in different settings such as home, work, and hospitals are needed to better understand the specific exposures of indoor air pollution and mental health conditions in different population groups.

Assessing cancer prevention literacy among European population: a cross-sectional study

Abstract Background Cancer prevention literacy (CPL) is essential for empowering individuals to make health-informed decisions and adopt preventive measures to reduce their cancer risk. This study aims to measure CPL among the European population. Methods A cross-sectional population-based study was conducted from February to March 2024 among European residents over 18 years old (N = 2312) in the context of BUMPER Project (https://bumper.cancer.eu/). An online self-administered questionnaire was developed including: sociodemographic characteristics (age, gender, country of residence, educational level), and CPL (general and by European Code Against Cancer -ECAC- topics). A descriptive analysis was performed and the chi-square and Kruskal-Wallis test were calculated to examine the relationship between CPL and sociodemographic variables. Results 44.2% showed a high level of CPL, followed by 39.5% with medium, and 16.3% with low level. 61.1% of participants are not aware of ECAC. ECAC topics with higher levels of knowledge are: UV exposure (88.3%), pollution (81.6%), tobacco (78.7%), second-hand smoking (60.9%). ECAC topics with lower levels are: hormone replacement therapy (47.9%), breastfeeding (41.6%), and vaccination (32.9%). Statistically significant differences (p < 0.05) are observed in CPL level by gender, country of residence, and educational level. Those with a higher % of low CPL levels are men (22.8%), people from West and South Europe (20.8% and 18.1%), and primary education level (34.7%). Conclusions CPL level is medium-high among the European population, with social and gender inequalities. Further studies are needed to delve into these inequalities. Key messages • The cancer prevention literacy level is medium-high among the European population, with social and gender inequalities. • There is a need of tailored interventions to address social inequalities in cancer prevention literacy among European population.

The protective effects of medicinal plants against cigarette smoking: A comprehensive review

BackgroundsCigarette smoking remains a pervasive and harmful habit, and it poses a significant public health concern globally. Tobacco smoke contains numerous toxicants and carcinogens that contribute to the incidence of various diseases, including respiratory ailments, cancer, and cardiovascular disorders. Over the past decade, there has been a growing interest in exploring natural remedies to mitigate the harmful effects of cigarette smoke (CS). Medicinal plants, with their rich phytochemical compositions, have emerged as potential sources of protective agents against CS-induced damage. ObjectivesThe current review attempts to comprehensively review and provide a thorough analysis of the protective effects of medicinal plants, including ginseng, Aloe vera, Olea europaea, Zea mays, green tea, etc. against CS-related toxicities. Materials and methodsA comprehensive research and compilation of existing literature were conducted. We conducted a literature search using the Web of Science, PubMed, Scopus, and Google Scholar. We selected articles published in English between 1987 and 2025. The search was performed using keywords including cigarette smoking, cigarette smokers, second-hand smokers, natural compounds, plant extracts, naturally derived products, natural resources, phytochemicals, and medicinal plants. ResultsThis review critically investigated recent literature focusing on the effects of medicinal plant extracts, essential oils, and isolated compounds on reducing the adverse consequences of CS exposure. These investigations encompassed several in vivo, in vitro, and clinical trials, clarifying the mechanisms underlying the protective effects of these plants. The notable antioxidant, anti-inflammatory, and detoxifying properties of these botanical interventions were also highlighted. ConclusionCollectively, this review emphasizes the potential of medicinal plants in alleviating the harmful effects of CS. The rich active constituents present in these plants offer various mechanisms that counteract oxidative stress, inflammation, and carcinogenesis induced by CS exposure. Further research is warranted to reveal the precise molecular mechanisms, derive dosing recommendations, and explore the efficacy of botanical interventions in large-scale clinical trials, ultimately improving public health outcomes and providing valuable insights for the smoking population worldwide.

Changes of lifestyle and mental health among COVID-19 situation: resident-centered health promotion

Abstract Background Yuzawa town, located in the Niigata prefecture of Japan, is famous for its hot springs and ski resorts. A sustainable action plan for resident-centered regional health promotion (Yuzawa family health plan) was initiated in 2002. Surveys have been conducted every five years. This study aims to evaluate changes of their habits and mental health status between in 2017 and in 2022. Methods The survey of Yuzawa family health plan was conducted in 2017 and in 2022. Questionnaires were composed with living alone, living with marriage partner, living with son or daughter, living with grandchildren, living with brother or sister, health consciousness, attention to health, health concern, awakening in a morning, clockwork life, fitness habits, smoking, taking alcohol, anxiety, loneliness, consultation, resolve suffering, economic problem, handle stress, taking a rest, risk breaching, communication, life satisfaction, talking with family, job at home, intercommunion with friends, greeting with neighbors, relationship with neighbors, occupations, good sleep, taking breakfast, nutritional balance, mastication status, confirmation of food compositions, exercise habits, yearly health check-up, dental check-up, brushing teeth habits, and sleep satisfactions. Chi square tests were used to evaluate changes between in 2017 and in 2022. This study was approved by the ethics committee of Tokyo Women’s Medical University. Results Passive smoking, intercommunions with neighborhood and friends, exercises, and Salt reduction awareness reduced in 2022. Talking with family, taking a rest, attention to health, clockwork life, and sleep satisfactions increased. Conclusions Many changes were shown between in 2017 and in 2022. Because elderly has been able to use a mobile phone, loneliness was not increased. But numbers of elderly living alone have been increased from 2002. Health promotion programs giving health information for elderly is needed. Key messages • Many lifestyle changes were shown between in 2017 and in 2022. • Passive smoking reduced. Taking a rest and attention to health increased.

How does a Smoke-Free campus initiative generates changes in smoking? A theory-based evaluation

Abstract Background Smoke-free campuses (SFC) prohibit smoking and vaping on all university grounds and for all users. Despite their effectiveness in reducing smoking prevalence, passive smoking, and denormalizing tobacco use, the complex interplay between the programme activities and their impact on users and campus environments remain unclear. This study aims to improve our understanding of the transformation processes associated with SFC expected outcomes. Methods We conducted a retrospective qualitative study on the first SFC implemented in France by the EHESP School of Public Health. Guided by Mayne’s theory of change framework that includes ten dimensions of an impact pathway (e.g. activities, reach/reaction, capacity, behaviour changes, etc.), the research examined the chain of effects and hypotheses driving this SFC. Our dataset included internal documents (e.g. minutes of meetings, administrative documents) and semi-structured interviews with stakeholders (n = 16) involved in the development and implementation of the analysed SFC. Data is currently being analysed. Results Initial results suggest that the EHESP’s SFC activities included communication initiatives, student ambassadors, cessation support for smokers, installation of smoking shelters on campus periphery, etc. These activities were geared on capacity change (e.g. securing support and compliance among campus users, reduce smoking opportunities, promoting the use of cessation aids) and were intended to drive behaviour change (reducing smoking and facilitating cessation among students and staff). The goal of this SFC was not only to impact behaviors but also to educate future health service managers at EHESP to implement SFC policies and set an example for other institutions in France. Conclusions This study identifies some of the transformations that activities of the EHESP’s SFC can generate in students and staff in order to fulfil its outcomes. It also highlighted its expected impact on other institutions. Key messages • Understanding how a smoke-free campus generates its changes is essential in facilitating transferability of experiences to other universities. • Smoke-free campus policies can also generate a broader impact on other institutions.

Protecting Young Lives: A Systematic Review of the Impact of Secondhand Smoke Exposure and Legislative Measures on Children's Health

Protecting Young Lives: A Systematic Review of the Impact of Secondhand Smoke Exposure and Legislative Measures on Children's Health

Exposure to secondhand smoke among school-going adolescents in Malaysia: Results from the National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey (AHS).

The adverse effects of secondhand smoke (SHS) exposure on health have been well established. Using the NHMS 2002: Adolescent Health Survey (AHS), this study attempts to evaluate the extent and factors associated with SHS exposure among Malaysian school-going adolescents. We conducted the NHMS 2022: AHS to gather a representative sample of school-age teenagers. We employed a cross-sectional study design and a multi-stage sampling procedure. We utilized a pre-validated self-administered questionnaire to collect data from the selected respondents. The data analysis included adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs). Additionally, we investigated the possible two-way interactions between the independent variables. The SHS prevalence was 42.0%. Exposure to secondhand smoke (SHS) was associated with male gender (AOR=1.28; 95 CI: 1.20-1.38), older age (AOR=1.46; 95% CI: 1.33-1.60), Malay (AOR=1.88; 95% CI: 1.49-2.37), Bumiputra Sabah (AOR=2.23; 95% CI: 1.67-2.99), Bumiputra Sarawak (AOR=2.43; 95% CI: 1.80-3.28), and Chinese ethnicity (AOR=2.89; 95 CI: % 2.30-3.64), as well as current smoking (AOR=2.78; 95% CI: 2.50-3.09), having separated or divorced parents (AOR=1.12; 95% CI: 1.02-1.23), and parental tobacco product use (AOR=4.75; 95% CI: 4.44-5.08). We found significant interactions between: 1) Age group with gender and ethnicity; 2) Gender and ethnicity; and 3) Parental smoking status with gender, response to tobacco use, parents' marital status, and ethnicity. Parental characteristics, sociodemographic characteristics, and SHS exposure are strongly correlated. In addition, there is evidence of smoking displacement to the house from other areas by parents/guardians. This study offers a fresh perspective on how these variables influence the likelihood of SHS exposure for Malaysian school-age teenagers. More efforts should focus on parental variables and sociodemographic traits, especially parental smoking cessation support.

Protocol for a cluster randomised controlled trial to evaluate effectiveness of a self-help group intervention to encourage smoke-free homes in slums of Kochi(Kochi Intervention for tobacco smoke free homes-KIFT)

Background Exposure to second hand smoke (SHS) is a cause for heart disease and lung cancer among non- smokers. This cluster randomized control trial will evaluate the effectiveness of a tobacco smoke free home intervention in reducing exposure to second hand smoke. Protocol The intervention will be conducted among 30 clusters in urban and peri-urban areas of Kochi, India. The sample size is 300 per arm and 15 clusters to detect a minimal difference of 0.03ng/ml in cotinine levels between groups, at 80% power with a two-sided alfa of 0.05 considering variable cluster size. A baseline survey will be undertaken to identify smokers. Data related to smoking, indoor smoking, nicotine dependence, blood pressure (BP) of smokers, morbidity experienced, and lung volume Fev1/Fev6 of smokers will be measured. Urine cotinine, morbidity, BP of spouse and child will be assessed. Air quality monitors measuring PM2.5 will be placed in homes. Trained self-help group women and frontline health workers will implement the intervention. The intervention will consist of monthly home visits to educate the smoker on the harms of second-hand smoke using 3 A’s. The circle of influencers around the smoking men will also be contacted by the members of self-help group to provide support to stop smoking within homes and to quit. They will then organize two-three meetings of community leaders and heads of women’s groups, present data on harms of SHS, and explain the rationale for establishing smoke free homes in their community for a duration of six months. After the intervention a post assessment will be conducted and this will be repeated after six months. Ethics and dissemination The trial protocol was approved by the Institutional Ethical Committee of Amrita Institute of Medical Sciences. Results will be submitted to open access peer reviewed journals and shared with other stakeholders. Trial registration CTRI/2021/06/034478

Effect of polyunsaturated fatty acids intake on the occurrence of current asthma among children and adolescents exposed to tobacco smoke: NHANES 2007–2018

BackgroundAsthma is an airway inflammatory disease driven by multiple factors with a high incidence in children and adolescents. Environmental tobacco smoke exposure (TSE) and diet are inducing factors for asthma. The potential of omega-3 polyunsaturated fatty acids (PUFAs) to alleviate asthma symptoms by their anti-inflammatory effects has been explored. However, to date, no studies have explored the effect of dietary PUFAs intake on the asthma in children and adolescents exposed to tobacco smoke.ObjectiveWe aimed to examine the effect of dietary PUFAs intake on the current asthma in children and adolescents exposed to tobacco smoke.MethodsData of this cross-sectional were extracted from the National Health and Nutrition Examination Survey (NHANES) 2007–2018. Children and adolescents with serum cotinine concentration ≥ 0.05 ng/mL were defined to exposed to tobacco smoke. Dietary PUFAs intake information were obtained from 24 h recall interview. The weighted univariate and multivariate were utilized to explore the effect of PUFAs on the association of asthma and TSE, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs). These moderating effects were further explored based on the age, gender and body mass index (BMI) and sedentary time.ResultsTotally, 7981 eligible children and adolescents were included, with the mean age of 11.96 ± 0.06 years old. Of whom, 1.024 (12.83%) had current asthma. After adjusted all covariates, we found children and adolescents with TSE had high occurrence of current asthma (AOR = 1.2, 95% CI 1.03–1.63); We also found omega-3 PUFAs intake (P for interaction = 0.010), not omega-6 PUFAs (P for interaction = 0.546), has a moderating effect on the association of TSE and current asthma. Moreover, we further observed that children and adolescents with TSE and low omega-3 PUFAs intake had high occurrence of current asthma (AOR = 1.58, 95% CI 1.19–2.10), while no significant association was found in children and adolescents with high omega-3 PUFAs intake (all P > 0.05). This moderating effect was more prominent in children and adolescents aged ≤ 12 years old (AOR = 1.62, 95% CI 1.06–2.47), girls (AOR = 2.14, 95% CI 1.15–3.98), overweight (AOR = 1.87, 95% CI 1.01–3.47) and sedentary time > 6 h (AOR = 1.96, 95% CI 1.00–3.86).ConclusionWe found dietary omega-3 PUFAs plays a moderating effect on the association of asthma and TSE in children and adolescents, especially in children and adolescents aged ≤ 12 years, girls, overweight or sedentary time > 6 h. This moderating effect suggested higher omega-3 intake has potential benefits in decreasing the occurrence of asthma in children and adolescents who exposed to tobacco smoke.

Secondhand smoking increased the possibility of hypertension with a significant time and frequency dose-response relationship

In this research, we investigated whether secondhand smoking (SHS) increases the possibility of hypertension. We used data from the Shaanxi baseline survey of the Regional Ethnic Cohort Study in Northwest China (RECS). Active smoking and SHS were determined by questionnaires. Hypertension was defined as self-reported or objectively measured. Multivariable logistic regression model was performed to estimate the risk of hypertension under active smoking and SHS. Compared to never-smokers, exposure to SHS had a 9% (P = 0.005) higher possibility of hypertension. The adjusted OR for exposure time of ≤ 3 h/week, 3–12 h/week, and > 12 h/week were 1.03 (P = 0.545), 1.10 ( P = 0.040), and 1.15 (P = 0.015), respectively. The adjusted OR for frequency of SHS of 1–2 times/week, 3–5 times/week, and nearly every day were 0.94 (P = 0.421), 1.01 (P = 0.846), and 1.14 (P < 0.001), respectively. Compared to smokers, additional exposure to SHS had a more than threefold increased possibility of having hypertension. The adjusted OR for hypertension was 1.07 (P = 0.254), and 1.23 (P = 0.007) in only smokers and smokers with SHS, respectively. Our study provided evidence that SHS could be a risk factor for hypertension, and additional exposure of active smokers to SHS significantly increases the possibility of hypertension. Reducing the frequency or time of SHS may be effective in preventing hypertension.

Research on visual features and identification of coal and gangue in simulated underground mine environments

ABSTRACT In underground mine environments, factors such as low light intensity, diffusion of dust particles, and coal slurry coverage interfere with coal gangue identification. To further realize coal-gangue sorting underground, we analyzed the coal-gangue visual characteristics coupled with the above factors. The analysis reveals that both smoke environments and coal slurry coverage tend to make the coal-gangue visual features more consistent. There are still differences in coal-gangue visual features under smoke environments, while coal slurry coverage leads to gangue exhibiting coal-related feature information. To improve the detection capability of coal gangue in underground environments, this study adopts a coal gangue recognition method based on the DG module and YOLOX-PSB network: Utilize the DG module to achieve dehazing and then use the YOLOX-PSB model for object detection. The proposed method was validated through ablation experiments, and the results showed that the detection accuracy reached 99.6%, with an FPS of 98. The proposed method enables real-time detection and exhibits the best robustness in complex environments, realizing reliable and efficient performance.

The Impact of Microparticulate Air Pollution in Polycystic Ovary Syndrome: A Narrative Review

Objective: The aim of this narrative review is to summarize studies examining the relationship between microparticulate air pollution (MAP) and polycystic ovary syndrome (PCOS). Mechanism: PCOS is increasingly regarded as an evolutionary mismatch disorder that manifests in women due to exposure to a range of lifestyle and environmental factors. Although the underlying causes of PCOS remain debated, environmental factors such as endocrine-disrupting chemicals (EDC), may contribute to its pathogenesis due to their well-documented hormonal and metabolic effects. MAP is another significant environmental exposure that has been associated with a variety of chronic diseases, as well as adverse hormonal and metabolic effects, including PCOS. Chronic low-grade inflammation and insulin resistance (IR) are key pathophysiological features of PCOS that have been associated with inhalation and ingestion of MAP. Findings in Brief: Our search identified four studies that systematically examined the relationship between MAP and PCOS. One population-based cohort study showed an increased risk of PCOS with increased exposure to various air pollutants, including MAP. A second population-based study showed a decreased risk of PCOS with increasing levels of exposure, while a longer duration of exposure was associated with an increased risk of PCOS. A third study found that conception rates were lower in women with PCOS exposed to second-hand smoke (SHS) compared to non-exposed women. In contrast, a fourth study reported that exposure to air pollutants was not associated with reduced pregnancy outcomes. These data suggest that both the concentration and duration of exposure to MAP may be important factors, and that reproductive outcomes could be affected by exposure to MAP through second-hand cigarette smoke. Conclusions: Preliminary data suggest that MAP may contribute to an increased risk of PCOS, although the available evidence remains inconsistent. Nevertheless, the current evidence supports advising women to avoid exposure to SHS and MAP whenever possible. This review highlights the need for further research on the effects of MAP in women with PCOS.

Prevalence and predictors of indoor secondhand tobacco smoke exposure among Senegalese household population

ABSTRACT Indoor secondhand tobacco smoke (SHS) exposure imposes substantial health risks among all household members, including children. Earlier studies reported high tobacco use in West African country Senegal. Despite the high health risks, no recent study has presented the situation of indoor SHS exposure in Senegal. Using cross-sectional design, we assessed the prevalence and predictors of indoor SHS exposure in Senegal. We used recent demographic and health survey (DHS) 2023 data of 75,080 household members of all ages. Analyzing these data, the prevalence of indoor SHS was assessed, and binomial logistic regression was used to identify predictors of indoor SHS exposure. The prevalence of indoor SHS exposure in Senegal was 24% (95% CI 23.5–24.2). Females, compared to males, were less likely to get indoor SHS exposure (aOR 0.9; 95% CI 0.8–0.9). Compared to the urban population, rural residents were less likely to get indoor SHS exposure (aOR 0.8; 95% CI 0.7–0.8). Individuals lived in households where members experienced shock events (aOR 1.2; 95% CI 1.1–1.2) and had members with psychological issues (aOR 1.5; 95% CI 1.4–1.6) were more susceptible to indoor SHS exposure. We conclude that indoor SHS exposure is high, particularly among Senegalese males, urban residents, and the poorest wealth quintiles. Additionally, susceptibility to indoor SHS increases with the presence of stressors like past adverse shock events and mental health issues. Both of these stressors encourage indoor smoking and intensify the risk of indoor SHS exposure among all household members. Community-based interventions providing behavior change communication on quitting tobacco and preventing indoor smoking are recommended.

Spirometric Values of Healthy School Children in Three Rural Schools of Bangladesh

Background: The prevalence of asthma in Bangladesh is about 7%. The spirometric values in healthy children were obtained in a single urban school more than a decade ago. No rural data is available till date. The objective of this study is to determine the spirometric values of healthy school going children in three rural schools of Bangladesh. Materials and Methods: This cross-sectional study was carried out from July 2019 to June 2020 among 300 healthy children among both boys and girls aged 11 to 15 years in three rural schools. Among 350 approached students 332 students responded to the study, 18 students did not meet inclusion criteria and 14 students could not follow spirometry procedure. Informed written consent was taken from guardians. History regarding socio-demographic profile, passive smoking, concurrent or past respiratory illness and medication were taken and weight, height and BMI were measured of the children. Spirometry was done with spirometer and reports were generated by software installed in a laptop. Results: Boys showed higher FVC, FEV1 and PEFR but lower FEV1/FVC ratio than those of girls. Regression equations for lung function values were determined for boys and girls considering height as independent variable. Conclusions: Spirometric indices were higher in boys than those of girls and they tended to increase with height, except FEV1/FVC ratio that was higher in girls with a negative correlation with height. BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 17-23

Best practices for expansion of smoke-free and aerosol-free environments in Europe: Protocol for the consultation to experts.

Smoke-free legislation has been shown to positively impact reducing secondhand smoke (SHS) exposure, especially in countries that have implemented comprehensive legislation rather than partial bans. Also, secondhand aerosols (SHA) that come from the heating of tobacco or liquids, with or without nicotine, in electronic nicotine delivery systems (ENDS) have been proven to increase levels of harmful substances in the air. Therefore, protection against SHS and SHA exposure and expansion of smoke- and aerosol-free environments (SAFE) should be taken into account when creating or trying to expand or enforce clean air policies. This article aims to present the protocol for a consultation with experts on tobacco and nicotine control in order to identify best practices, barriers, and opportunities for the expansion of SAFE in Europe. We identified experts among policymakers, researchers, and tobacco regulators in European countries and invited them to participate in the consultation by completing an online survey designed, programmed, and pilot-tested using Survey Monkey. The responses to the questionnaire contained quantitative and qualitative information that was thematically analyzed. The experts' consultation allowed us to produce a report on barriers and opportunities for SAFE, a report and a position paper on SAFE best practices, a web-based repository of best practices, and a weight of evidence paper that assembles evidence supporting the expansion of SAFE on indoor and outdoor spaces.

Secondhand Smoke Exposure and Its Impact on Pediatric Lung Function, Aerobic Fitness, and Body Mass: Evidence from a Cross-Sectional Study.

Several studies have documented the detrimental impacts of secondhand smoke (SHS) exposure to a range of pediatric respiratory conditions, including asthma, bronchitis, and reduced lung function. The aim of the study was to investigate the influence of SHS exposure on lung function, physical fitness, and body mass index (BMI) in children aged 10 to 14 years. This cross-sectional study included children aged 10 to 14 years at the Elementary School "Trilj" in Trilj, Croatia. Data on SHS exposure were collected using a questionnaire. Antropometric and spirometry measurements were performed. Physical fitness was assessed using the shuttle run (BEEP) test. This study included 157 children, 89 (56.69%) boys and 68 (43.31%) girls. Children exposed to every day SHS in households had significantly lower values of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, peak expiratory flow (PEF) (p < 0.001) and higher z-score BMI levels (p = 0.018) in comparison to unexposed children. Logistic regression showed that children unexposed to SHS had higher odds for better results in the BEEP test (OR 62.45, 95% CI 21.26-179.24, p < 0.001). Children with poorer physical fitness, expressed by lower BEEP score levels, had significantly lower FVC, FEV1, FEV1/FVC, and PEF (p < 0.001). Every day SHS exposure in children was associated with poorer lung function, higher BMI, and poorer physical fitness.

Secondhand smoke exposure in public outdoor spaces in The Netherlands: The stronger the smell, the more exposure to nicotine

Secondhand smoke exposure in public outdoor spaces in The Netherlands: The stronger the smell, the more exposure to nicotine

Macronutrients in Human Milk and Early Childhood Growth-Is Protein the Main Driver?

Infant growth trajectories reflect current health status and may predict future obesity and metabolic diseases. Human milk is tailored to support optimal infant growth. However, nutrient intake rather than milk composition more accurately predicts growth outcomes. Although the role of protein leverage in infant growth is unclear, protein intake is important for early infancy growth. This study of exclusively breastfeeding mothers with allergies (n = 161) from the Infant Fish Oil Supplementation Study assessed relationships between intake of human milk macronutrients and infant growth. Human milk fat, protein and lactose concentrations were measured at 3 months postpartum, and infant daily intakes were estimated using an average milk intake of 800 mL/day. Higher human milk protein:energy ratio was associated with higher weight-for-age z-score at 2.5 years compared to 3 months and higher body mass index-for-age z-score change (6 months to 1 year compared to 3-6 months). Maternal atopy and birth season (summer) were negatively associated with human milk lactose concentration. Passive smoke exposure was associated with reduced energy and fat concentrations and increased lactose:energy ratio. Our results indicate that intake of human milk macronutrients may impact early childhood growth.

A case-control study on the associations of parental smoking and alcohol consumption during the periconceptional period and their interactions with risk of congenital heart disease in offspring

To explore the associations of parental smoking and alcohol consumption during the periconceptional period and their interactions with risk of congenital heart disease (CHD) in offspring. The parents of children with simple CHD aged 0 to 1 year (n=683) were recruited as the case group, while the parents of healthy children aged 0 to 1 year (n=740) served as the control group. A case-control study was conducted, and a questionnaire was used to collect information on perinatal exposures. After controlling for relevant confounding factors using multivariate logistic regression analysis and propensity score matching, the associations of parental smoking and alcohol consumption during the periconceptional period and their interactions with CHD were examined, as well as the cumulative effects of smoking and drinking on CHD risk. Maternal active smoking (OR=2.91, 95%CI: 1.60-5.30), passive smoking (OR=1.94, 95%CI: 1.56-2.42), and alcohol consumption (OR=2.59, 95%CI: 1.89-3.54), as well as paternal smoking (OR=1.52; 95%CI: 1.22-1.90) and drinking (OR=1.48, 95%CI: 1.19-1.84), were associated with an increased risk of CHD in offspring. There was no interaction between parental smoking and drinking behaviors during the periconceptional period concerning the risk of CHD in offspring (P>0.05). The more parents' smoking and drinking behaviors during the perinatal pregnancy, the higher the risk of CHD in their offspring (OR=1.50, 95%CI: 1.36-1.65). Parental smoking and alcohol consumption during the periconceptional period are associated with the occurrence of CHD in offspring, and there is a cumulative effect on CHD risk, suggesting that reducing tobacco and alcohol exposure during the periconceptional period may lower the incidence of CHD.