Reduce Secondhand Smoke Exposure Research Articles

The crossroads of work and home: linkages between smoke-free policies at work and household environments

BackgroundTobacco use causes over eight million global deaths annually, with seven million directly attributed to tobacco use and 1.2 million to second hand smoke (SHS). Smoke-free environments are crucial to counter SHS. Although India banned smoking in public places in 2008, SHS exposure remains high. Studies have noted that limiting smoking in workplaces, restaurants, etc., helps to reduce overall smoking and reduce SHS exposure. Under this background, the study explores the linkages between smoke-free workplaces and living in smoke-free homes in India.MethodsThe two rounds of the GATS India (2009-10 and 2016-17) have been used for the study. The study focuses on male tobacco smokers working indoors or outdoors or both indoors and outdoors. The sample for the study was 2,969 for GATS 1 and 2,801 for GATS 2. Dependent variables include living in a smoke-free home, while the independent variables were adherence to a smoke-free office policy and socio-demographic variables. The two rounds of the GATS data were pooled for analysis. Statistical analysis involves bivariate and multivariate analysis.ResultsFindings reveal that 41% of respondents worked in smoke-free workplaces in GATS 2. Nationally, smoke-free homes increased from 35% in 2009–2010 to 44% in 2016-17. Individuals with smoke-free workplaces were more likely to have smoke-free homes. The Southern region consistently exhibited the highest proportion of smoke-free homes. Urban areas and higher education correlated with increased smoke-free homes. Logistic regression analysis confirmed that workplace smoke-free status is a significant predictor of smoke-free homes. In GATS 2, respondents aged 30 years and above were less likely to have smoke-free homes, while education and Southern region residence positively influenced smoke-free homes.ConclusionsThe correlation between smoke-free workplaces and smoke-free homes is linked to stringent workplace no-smoking policies, potentially deterring individuals from smoking at home. Opportunities exist for the expansion and stringent implementation of the smoke-free policies among Indian working adults, leveraging the workplace as a key setting for evidence-based tobacco control. The study highlights positive trends in India’s smoke-free homes, crediting workplace policies. Effective policies, education, and regional strategies can advance smoke-free homes, stressing the pivotal role of workplace policies and advocating broader implementation.

Tobacco control interventions for populations living in subsidised, low-income housing: a scoping review.

People living in subsidised low-income housing are more likely to smoke and experience secondhand smoke exposure compared to the general population. While tobacco control interventions have yielded substantial population health benefits, people living in subsidised housing experience a greater burden of tobacco-related harms. We synthesised existing peer-reviewed and grey literature to determine tobacco control interventions that have been implemented in subsidised housing globally, and to understand their impact on smoking and secondhand smoke exposure. We searched five databases for peer-reviewed research, and Google Advanced for grey literature. We adhered to the JBI Scoping Review Methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Fifty-seven sources met the eligibility criteria. The most common type of intervention was mandatory smoking bans covering all indoor spaces (n = 32), followed by cessation-focused interventions (n = 19). Interventions that indirectly addressed smoking were the least common (n = 6). Our findings suggest smoking bans can increase smoking cessation and reduce secondhand smoke exposure, especially if implemented alongside cessation support strategies. Tobacco control interventions targeting subsidised housing demonstrate positive effects on tobacco-related outcomes for residents and provide an important opportunity to address health disparities. Future research should examine the long-term impacts of the interventions, including potential unintended consequences, in varied subsidised housing contexts.

A Comparison of Measured Airborne and Self-Reported Secondhand Smoke Exposure in the MADRES Pregnancy Cohort Study.

Secondhand smoke (SHS) exposure during pregnancy is linked to adverse birth outcomes, such as low birth weight and preterm birth. While questionnaires are commonly used to assess SHS exposure, their ability to capture true exposure can vary, making it difficult for researchers to harmonize SHS measures. This study aimed to compare self-reported SHS exposure with measurements of airborne SHS in personal samples of pregnant women. SHS was measured on 48-hour integrated personal PM2.5 Teflon filters collected from 204 pregnant women, and self-reported SHS exposure measures were obtained via questionnaires. Descriptive statistics were calculated for airborne SHS measures, and analysis of variance tests assessed group differences in airborne SHS concentrations by self-reported SHS exposure. Participants were 81% Hispanic, with a mean (SD) age of 28.2 (6.0) years. Geometric mean (SD) personal airborne SHS concentrations were 0.14 (9.41) µg/m3. Participants reporting lower education have significantly higher airborne SHS exposure (p=0.015). Mean airborne SHS concentrations were greater in those reporting longer duration with windows open in the home. There was no association between airborne SHS and self-reported SHS exposure; however, asking about the number of smokers nearby in the 48-hour monitoring period was most correlated with measured airborne SHS (Two+ smokers: 0.30µg/m3 vs. One: 0.12µg/m3 and Zero: 0.15µg/m3; p=0.230). Self-reported SHS exposure was not associated with measured airborne SHS in personal PM2.5 samples. This suggests exposure misclassification using SHS questionnaires and the need for harmonized and validated questions to characterize this exposure in health studies. This study adds to the growing body of evidence that measurement error is a major concern in pregnancy research, particularly in studies that rely on self-report questionnaires to measure secondhand smoke (SHS) exposure. The study introduces an alternative method of SHS exposure assessment using objective optical measurements, which can help improve the accuracy of exposure assessment. The findings emphasize the importance of using harmonized and validated SHS questionnaires in pregnancy health research to avoid biased effect estimates. This study can inform future research, practice, and policy development to reduce SHS exposure and its adverse health effects.

Influence of socioeconomics and social marketing on smoking in Thailand: A National Survey in 2017.

Smoking is one of the risk factors for noncommunicable diseases and is harmful to both active and passive smokers. This study aimed to identify the influence of socioeconomic and environmental issues on smoking in Thailand. The study is a secondary dataset analysis of cross-sectional data using data from the 2017 Smoking and Drinking Behaviors Survey of the National Statistical Office of Thailand. The survey collected the data among 88689 participants using a structured questionnaire. The multi-level analysis was used to identify the association between socioeconomics, environmental factors, social marketing, and smoking while controlling for the effects of covariates and presenting the adjusted odds ratio (AOR) and its 95% confidence interval (CI). Among 88689 respondents, the prevalence of smoking was 18.2% (95% CI: 18.00-18.51). Factors that were associated with smoking were: exposure to secondhand smoke in residential settings (AOR=15.31; 95% CI: 14.47-16.20) and alcohol regular drinking (AOR=4.44; 95% CI: 4.14-4.76). In addition, social marketing factors include: disagreeing or being unsure of the opinions that cigarettes should be categorized as harmful goods (AOR=3.15; 95% CI: 2.94-3.37); not having been exposed to the disadvantages of smoking in social media (AOR=1.51; 95% CI: 1.43-1.61); not having been exposed to the disadvantages of smoking in newspapers, television, radio, advertisements, or other sources (AOR=1.46; 95% CI: 1.37-1.62); having never seen the warning cautions or having seen them but ignored the hazardous effect (AOR=4.81; 95% CI: 4.5-4.9); and having ever seen the warning cautions/ever seen but ignore the hazardous effect (AOR=4.81; 95% CI: 4.54-5.09), and ever seen advertisements or billboards which motivate smoking in various places (AOR=1.33; 95% CI: 1.24-1.42). Smoking and secondhand smoke are crucial problems that affect health. In addition, related sectors should help to develop a policy recommendation to reduce the smoking rate through social marketing. Strict and comprehensive policies and laws on non-smoking in work places, public spaces, and homes, will help to reduce secondhand smoke exposure among non-smokers.

Barriers and Enablers to Implementing a Smoke-free Home and Car During Pregnancy: A Qualitative Study Among Expectant Israeli Fathers.

Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. This study aims to identify barriers and facilitators for implementing a smoke-free home and car among expectant Israeli fathers. Twenty-four qualitative semistructured telephone interviews were audio-recorded, transcribed, and analyzed according to a reflexive and collaborative thematic approach. Inclusion criteria were being male, Hebrew speaker, age ≥18 years, smoking at least one cigarette a day, and living with their nonsmoking pregnant spouse. The Capability, Opportunity and Motivation for Behavior (COM-B) model was used as a theoretical model for analysis. Participants reported feeling a strong responsibility for their pregnant spouse's comfort and health, stating that they are doing the best they can to reduce their spouse's secondhand smoke exposure (Motivation). Participants had a low level of knowledge about specific secondhand smoke health consequences, effective strategies to reduce secondhand smoke exposure, with incorrect perceptions about what constitutes exposure (Capability). Couple relationships were not affected by the husband's smoking habits, and participants expressed mutual consideration and understanding (Opportunity). Participants also expressed positive attitudes regarding smoke-free home and car implementation but emphasized that any changes have to be their own decision (Motivation). The present study identified principal Capability, Opportunity and Motivation barriers and facilitators that influence Israeli expectant fathers' decision to implement a smoke-free home and car. Those findings will inform the development of a digital behavioral intervention targeting expectant fathers to reduce prenatal secondhand smoke exposure. Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. Interventions among expectant fathers that focus on creating a smoke-free home and car may be effective because pregnancy has been identified as a "window of opportunity" that generates a strong motivation and creates a sense of urgency to change smoking behavior, while being considered more achievable than smoking cessation. Interventions might be effective if they focus on strengthening the parental responsibility among expectant fathers and emphasize the benefits of a smoke-free home and car, while maintaining male autonomy and increasing skills to effectively implement a smoke-free home and car.

Smoke-free home restrictions in Armenia and Georgia: motives, barriers and secondhand smoke reduction behaviors.

Promoting smoke-free homes (SFHs) in Armenia and Georgia is timely given high smoking and secondhand smoke exposure (SHSe) rates and recent national smoke-free policy implementation. This study examined theoretical predictors (e.g. motives, barriers) of SFH status, and among those without SFHs, past 3-month SFH attempts and intent to establish SFHs in the next 3 months. Multilevel logistic regression analyzed these outcomes using 2022 survey data from 1467 adults (31.6% past-month smokers) in Armenia (n = 762) and Georgia (n = 705). Correlates of interest included SHSe reduction behaviors and SFH motives and barriers; models controlled for country, community, age, sex, smoking status and other smokers in the home. In this sample, 53.6% had SFHs (Armenia: 39.2%; Georgia: 69.2%). Among those without SFHs, one-fourth had partial restrictions, no smokers in the home and/or recent SFH attempts; 35.5% intended to establish SFHs; and ∼70% of multiunit housing residents supported smoke-free buildings. We documented common SHSe reduction behaviors (opening windows, limiting smoking areas), SFH motives (prevent smell, protect children/nonsmokers) and barriers (smokers' resistance). Correlates of SFHs were being from Georgia, other smokers in the home, fewer SHSe reduction behaviors, greater motives and fewer barriers. Among participants without SFHs, correlates of recent SFH attempts were other smokers in the home, greater SHSe reduction behaviors and SFH motives, and fewer barriers; correlates of SFH intentions were being female, greater SHSe reduction behaviors, greater motives, and fewer barriers. SFH interventions should address motives, barriers and misperceptions regarding SHSe reduction behaviors. Moreover, smoke-free multiunit housing could have a great population impact.

Chronic secondhand smoke exposure on cardiovascular regulation and the role of soluble epoxide hydrolase in mice

Background: Secondhand smoke (SHS) is a significant risk factor for cardiovascular morbidity and mortality. About 80% of SHS-related deaths are due to cardiovascular causes. Reducing SHS exposure with smoking bans is associated with improved cardiovascular outcomes in non-smokers. Soluble epoxide hydrolase (sEH) inhibitors have been shown to attenuate tobacco exposure-induced lung inflammatory responses, making them a great candidate for combating SHS exposure-induced cardiovascular outcomes. The goals of this study were to determine 1) the time course of environmentally relevant SHS exposure effects on cardiac autonomic function and blood pressure (BP) regulation and 2) whether prophylactic administration of a soluble epoxide hydrolase inhibitor (TPPU) can protect against SHS-induced autonomic and cardiovascular dysregulation. Methods: Male C57BL/6J mice (11 wk) implanted with BP/electrocardiogram (ECG) telemetry devices were exposed to 12 wks of either filtered air (FA, n=19) or 3 mg/m3 of SHS (6 hr/d, 5 d/wk, n=18), followed by 4 weeks recovery window (SHS substituted with FA). Separate mice were randomly assigned to one of the 3 groups: FA (n=12), FA+TPPU (n=12), and SHS+TPPU (n=22). TPPU (15 mg/l) was given by drinking water during the 12 weeks of exposure period (estimated dose = 3.75 ug/g/day). BP and ECG were recorded continuously for 36 hours every month when mice were not exposed. Data were stratified by 12-hour circadian window: The dark cycle (dark 1) immediately after the 5th day of exposure and the following light and dark (dark 2) cycles. Baroreflex sensitivity (BRS) was determined with the sequence method. Standard time domain heart rate variability (HRV) parameters were obtained from normal-to-normal R-R intervals. Results: SHS-exposed mice had significantly higher physical activity levels (~ 50% higher, p<0.05), an effect that persisted 4 wks after cessation of SHS exposure. SHS exposure significantly decreased 1) short-term HRV (RMSSD) by ~20% as early as after 4 wks of exposure; 2) overall HRV (SDNN) with maximum effect at 12 wks (-15%, p<0.05); 3) pulse pressure (-8%, p<0.05) as early as week 4; and 4) BRS with maximum effect at 12 wks (-11%, p<0.05). All SHS-induced changes in cardiovascular regulation were ameliorated by 4 weeks of recovery. Treatment with TPPU in drinking water eliminated SHS exposure-induced decreases in HRV, PP and BRS. However, SHS-induced increase in activity persisted (30% higher, p<0.05) even with TPPU treatment. Conclusions: These data suggest that 1) Three months of environmentally relevant SHS significantly reduces cardiac autonomic function and BP regulation; 2) cardiovascular consequences from SHS can be rescued by removing from SHS exposure; and 3) oral TPPU can prevent SHS-induced cardiovascular dysregulation. R01 ES025229, T32 HL086350, T32 ES007059, R35ES030443 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Preventive Interventions to Reduce Second-Hand Smoke Exposure Among Non-Smoking Pregnant Women: A Systematic Review

The alarming number of smokers have increased public health concerns regarding the effects of second-hand smoke (SHS) on non-smokers, especially amongst pregnant women and unborn babies. This paper aims to review the existing interventions used to reduce SHS exposure amongst non-smoking pregnant women. This review was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) review method. Published articles were identified through three databases: ProQuest, Science Direct, and Scopus within the 2010–2021 timeframe. Articles related to the intervention to reduce SHS exposure among non-smoking pregnant women were included. Nine studies were identified and reviewed. Most of the preventive interventions primarily focused on pregnant women as the target group, whereas a few interventions directly focused on changing the smoking behaviour of their spouses. This review suggests that using theories as a foundation in designing the intervention effectively reduces exposure to SHS among non-smoking pregnant women. The main limitation as reported by most studies was the lack of biochemical verification. Thus, future intervention should consider both pregnant women and their smoking spouses as the target group and include relevant theories in clinical intervention.

Effects of municipal smoke-free ordinances on secondhand smoke exposure in the Republic of Korea.

To reduce premature deaths due to secondhand smoke (SHS) exposure among non-smokers, the Republic of Korea (ROK) adopted changes to the National Health Promotion Act, which allowed local governments to enact municipal ordinances to strengthen their authority to designate smoke-free areas and levy penalty fines. In this study, we examined national trends in SHS exposure after the introduction of these municipal ordinances at the city level in 2010. We used interrupted time series analysis to assess whether the trends of SHS exposure in the workplace and at home, and the primary cigarette smoking rate changed following the policy adjustment in the national legislation in ROK. Population-standardized data for selected variables were retrieved from a nationally representative survey dataset and used to study the policy action's effectiveness. Following the change in the legislation, SHS exposure in the workplace reversed course from an increasing (18% per year) trend prior to the introduction of these smoke-free ordinances to a decreasing (-10% per year) trend after adoption and enforcement of these laws (β 2 = 0.18, p-value = 0.07; β 3 = -0.10, p-value = 0.02). SHS exposure at home (β 2 = 0.10, p-value = 0.09; β 3 = -0.03, p-value = 0.14) and the primary cigarette smoking rate (β 2 = 0.03, p-value = 0.10; β 3 = 0.008, p-value = 0.15) showed no significant changes in the sampled period. Although analyses stratified by sex showed that the allowance of municipal ordinances resulted in reduced SHS exposure in the workplace for both males and females, they did not affect the primary cigarette smoking rate as much, especially among females. Strengthening the role of local governments by giving them the authority to enact and enforce penalties on SHS exposure violation helped ROK to reduce SHS exposure in the workplace. However, smoking behaviors and related activities seemed to shift to less restrictive areas such as on the streets and in apartment hallways, negating some of the effects due to these ordinances. Future studies should investigate how smoke-free policies beyond public places can further reduce the SHS exposure in ROK.

Secondhand smoke exposure is associated with the risk of hypertensive disorders of pregnancy: the Japan Environment and Children’s Study

Hypertensive disorders of pregnancy (HDP) are associated with poor maternal and neonatal prognoses. Although several studies have indicated an effect of secondhand smoke (SHS) exposure on HDP, such evidence is lacking in Japan. Therefore, we analyzed data from the Japan Environment and Children’s Study, a large-scale epidemiological investigation, to elucidate a possible link between SHS exposure and HDP risk. Data were obtained from the all-birth fixed datasets and included information on 104,062 fetuses and their parents. SHS exposure was assessed in terms of the frequency (rarely, 1–3, or 4–7 days/week) and the daily duration of exposure (<1, 1–2, or ≥2 h(s)/day). Modified Poisson regression model analyses were performed with adjustment for known risk factors for HDP. Additionally, the population attributable fractions (PAFs) of SHS exposure and maternal smoking to HDP prevalence were estimated. The relative risks of developing HDP among individuals with SHS exposures of 4–7 days/week and ≥2 h/day were 1.18 and 1.27 (95% confidence interval: 1.02–1.36 and 0.96–1.67), respectively, compared to the reference groups (rare exposure and <1 h/day). The PAFs for the risk of HDP due to SHS exposure and perinatal smoking were 3.8% and 1.8%, respectively. Japanese women with greater exposure to SHS have a higher risk of HDP after adjustment for possible confounding factors; thus, relevant measures are required to reduce SHS exposure to alleviate HDP risk.The association between second-hand smoking exposure and hypertensive disorders of pregnancy risk was analyzed using the JECS data. The relative risks in 4–7 days/week and ≥2 h/day of SHS exposures were 1.18 and 1.27, respectively. The PAFs due to SHS exposure and maternal smoking were 3.80% and 1.81%, respectively.

Effects of chronic secondhand smoke exposure on cardiovascular regulation and the role of soluble epoxide hydrolase in mice.

Background: Secondhand smoke (SHS) is a significant risk factor for cardiovascular morbidity and mortality with an estimated 80% of SHS-related deaths attributed to cardiovascular causes. Public health measures and smoking bans have been successful both in reducing SHS exposure and improving cardiovascular outcomes in non-smokers. Soluble epoxide hydrolase (sEH) inhibitors have been shown to attenuate tobacco exposure-induced lung inflammatory responses, making them a promising target for mitigating SHS exposure-induced cardiovascular outcomes. Objectives: The objectives of this study were to determine 1) effects of environmentally relevant SHS exposure on cardiac autonomic function and blood pressure (BP) regulation and 2) whether prophylactic administration of an sEH inhibitor (TPPU) can reduce the adverse cardiovascular effects of SHS exposure. Methods: Male C57BL/6J mice (11weeks old) implanted with BP/electrocardiogram (ECG) telemetry devices were exposed to filtered air or 3mg/m3 of SHS (6hr/d, 5d/wk) for 12weeks, followed by 4weeks of recovery in filtered air. Some mice received TPPU in drinking water (15mg/L) throughout SHS exposure. BP, heart rate (HR), HR variability (HRV), baroreflex sensitivity (BRS), and BP variability were determined monthly. Results: SHS exposure significantly decreased 1) short-term HRV by ∼20% (p < 0.05) within 4weeks; 2) overall HRV with maximum effect at 12weeks (-15%, p < 0.05); 3) pulse pressure (-8%, p < 0.05) as early as week 4; and 4) BRS with maximum effect at 12weeks (-11%, p < 0.05). Four weeks of recovery following 12weeks of SHS ameliorated all SHS-induced cardiovascular detriments. Importantly, mice exposed to TPPU in drinking water during SHS-related exposure were protected from SHS cardiovascular consequences. Discussion: The data suggest that 1) environmental relevant SHS exposure significantly alters cardiac autonomic function and BP regulation; 2) cardiovascular consequences from SHS can be reversed by discontinuing SHS exposure; and 3) inhibiting sEH can prevent SHS-induced cardiovascular consequences.

Family matters: the influence of partner and familial encouragement on home and car smoking bans

Background: Secondhand smoke exposure (SHSe) poses health risks to neonatal intensive care unit (NICU) infants after they are discharged; these risks can be mitigated by the implementation of parent-enforced total home and car smoking bans. Understanding the influence that various family members have on household smoking policies may inform interventions to reduce SHSe among vulnerable infants.Methods: In a cross-sectional, secondary analysis of data collected between 2013 and 2015, mothers of NICU infants who reported smoking or living with a smoker (N=242) were asked about whether members of 9 separate relationship types (e.g., partner, mother, father) encouraged or discouraged smoking in the home and car. The influence of perceived encouragement from each relationship type on the odds of having a total smoking ban in place was estimated.Results: Participants reported that partners (47%) and siblings (32%) were most likely to encourage smoking in the home/car. In a multivariate model, both partner (p=0.0002) and sibling (p=0.004) encouragement of indoor smoking decreased the likelihood of having a total smoking home and car ban in place.Conclusions: Family members have significant influence on SHSe reduction practices. Innovative family-based interventions may be needed in order to reduce SHSe in this particularly vulnerable group of infants.

Factors associated with secondhand smoke exposure among non-smoking employees in the workplace: A cross-sectional study in Qingdao, China.

ObjectiveThis study was conducted to describe secondhand smoke (SHS) exposure among non-smoking employees in the workplace, and identify factors related to SHS exposure in Qingdao.MethodsThe study participants covered key non-smoking places stipulated in the “Qingdao City Smoking Control Regulations,” which included three categories: restaurants, bars, and office buildings. Airborne nicotine concentration in the workplace and saliva cotinine concentration of employees were measured. The questionnaire included employees’ demographic factors, smoke-free measures in the workplace, employers’ tobacco hazard knowledge, and attitudes towards smoke-free policy.ResultsA total of 222 non-smoking employees and 46 non-smoking employers were included in the study. The median concentrations of airborne nicotine and salivary cotinine were 0.389 μg/m3 and 0.575 ng/mL, respectively. Educational status, average number of workplace smokers per day, exposure time to SHS in the workplace, and whether smoking and non-smoking areas were divided significantly related to airborne nicotine concentration. Age, educational status, exposure time to SHS in the workplace, tobacco control training and publicity, and whether the employers support the “Qingdao Tobacco Control Regulation” were significantly related to salivary cotinine concentration.ConclusionsDespite the implementation of the “Qingdao Smoking Control Regulations” in 2013, the workplace remains an important location for SHS exposure. Interventions such as raising workers’ awareness of the risks associated with SHS exposure through health education and developing smoking prevention and cessation programs to reduce SHS exposure in the workplace are urgently needed.

Secondhand smoke exposure among never-smoking adolescents in Wuhan, China

Without smoke-free legislation in Wuhan, China, we investigated secondhand smoke (SHS) exposure at home, school, and public places for never-smoking school-going adolescents in 2019. A cross-sectional study was carried out within the Global Youth Tobacco Survey (GYTS) framework. Weighted univariate, bivariate and multivariable analyses were conducted. The prevalence of SHS exposure among never-smoking adolescents at home, school and public places was 25.7%, 31.9% and 48.9%, respectively. Multivariable logistic regression analysis showed that parents smoking, peers smoking and observing teachers smoking in school were all significantly related to a higher probability of SHS exposure at home, school, and public places. Never-smoking adolescents who had smoking parents had 14 times (adjusted odds ratio [aOR], 14.00; 95% confidence interval [CI], 11.37–17.24) higher odds of SHS exposure at home; Never-smoking adolescents who observed teachers smoking in school had about 10 (aOR = 9.76; 95% CI = 7.13–13.36) and four times (aOR = 3.55; 95% CI = 2.77–4.55) higher odds of SHS exposure in school and public places, respectively. Adopting comprehensive smoke-free legislation in public places and smoke-free home rules and implementing and supervising smoke-free school policies may further reduce SHS exposure among adolescents.

Designing Spouse-based Educational Intervention to Reduce Second-hand Smoke For Pregnant Women: A Study Protocol For Randomized Control Trial

Introduction: Secondhand smoke (SHS) exposure affects not only the maternal wellbeing but also unborn baby. This study aims to develop a spouse-based educational intervention to reduce SHS exposure by examining the understanding and perception of both pregnant women and their smoking spouses. Methods: Using a sequential exploratory mixed-method research design, this study will be conducted through four phases. In the first phase, a qualitative study will be conducted to examine the understanding and perception of pregnant women and their smoking spouses regarding secondhand smoke exposure. In the second phase, the content of the educational intervention will be designed based on the outcomes of the first phase and from the literature review. Validation of the designed intervention will be conducted by experts to assess the accuracy of the contents in phase 3. After the validation, a pilot study will be conducted to measure the comprehensiveness of the module. The feasibility and effectiveness of the intervention will be measured in phase four by a pre-test and post-test study design. Expected outcome and conclusion: The designed educational intervention module of SHS exposure can be used as a breakthrough point to empower non-smoking pregnant women to protect themselves from secondhand smoke exposure, and also to facilitate the smoking spouse to change their smoking behavior, and thus promote the smoke-free home.

Changes in the salivary cotinine cut-offs to discriminate smokers and non-smokers before and after Spanish smoke-free legislation

IntroductionHigh levels of cotinine in non-smokers indicate passive exposure to tobacco smoke. This study aims to evaluate variations in salivary cotinine cut-offs to discriminate smokers and non-smokers before and after the implementation of smoke-free legislation (Law 28/2005 and Law 42/2010) in a sample of the adult population of Barcelona, Spain. MethodsThis longitudinal study analyzes salivary cotinine samples and self-reported information from a representative sample (n = 676) of the adult population from Barcelona before and after the approval of smoke-free legislation. We calculated the receiver operating characteristic (ROC) curves, to obtain optimal cotinine cut-off points to discriminate between smokers and non-smokers overall, by sex and age, and their corresponding sensitivity, specificity, and area under the curve. We used linear mixed-effects models, with individuals as random effects, to model the percentage change of cotinine concentration before and after the implementation of both laws. ResultsThe mean salivary cotinine concentration was significantly lower post-2010 law (−85.8%, p < 0.001). The ROC curves determined that the optimal cotinine cut-off points for discriminating non-smokers and smokers were 10.8 ng/mL (pre-2005 law) and 5.6 ng/mL (post-2010 law), with a post-2010 law sensitivity of 92.6%, specificity of 98.4%, and an area under the curve of 97.0%. The post-2010 law cotinine cut-off points were 5.6 ng/mL for males and 1.9 ng/mL for females. ConclusionThe implementation of Spanish smoke-free legislation was effective in reducing secondhand smoke exposure and, therefore, also in reducing the cut-off point for salivary cotinine concentration. This value should be used to better assess tobacco smoke exposure in this population.

Exposure to second-hand smoke is an independent risk factor of small airway dysfunction in non-smokers with chronic cough: A retrospective case-control study.

ObjectivesThis study aimed to identify the potential risk factors for small airway dysfunction (SAD) in non-smokers with chronic cough.MethodsNon-smokers with chronic cough who underwent lung function tests at Xiangya Hospital from May 2019 to May 2020 were enrolled, and divided into the derivation and validation cohorts based on their hospital admission time. SAD was determined based on the presence of at least two of the following three indicators of lung function being less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow at 50% of forced vital capacity (FVC), and forced expiratory flow at 75% of FVC. Clinical data of these patients were collected. Risk factors for SAD were identified by logistic regression analysis in the derivation cohort and further confirmed in the validation cohort.ResultsIn total, 316 patients (152 in the non-SAD group and 164 in the SAD group) were included in the derivation cohort. Compared with the non-SAD group, the SAD group had a higher proportion of female patients (82.3 vs. 59.2%, P < 0.001), was more commonly exposed to second-hand smoke (SHS) (61.6 vs. 27.6%, P < 0.001), and tended to be older (median age, 45.5 vs. 40.0 years old, P = 0.004). The median FVC, forced expiratory volume in one second (FEV1) % pred, FEV1/FVC ratio, and peak expiratory flow (PEF) % pred were slightly lower in the SAD group. Multivariable logistic analysis showed that exposure to SHS was an independent risk factor (OR 4.166 [95% CI 2.090–8.302], P < 0.001) for SAD in non-smokers with chronic cough after adjusting for related variables. In the validation cohort (n = 146), patients with SHS exposure had a relative risk of 1.976 (95% CI 1.246–3.135, P = 0.004) for SAD compared to those without SHS exposure. Multivariable logistic analysis consistently confirmed that exposure to SHS was an independent risk factor (OR 3.041 [95% CI 1.458–6.344], P = 0.003) for SAD in non-smokers.ConclusionsExposure to SHS is independently associated with a higher risk of SAD in non-smokers with chronic cough. Reduction in SHS exposure may ameliorate lung function, thus lowering the risk of irreversible airway obstruction.

Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASS II): a combined evidence and theory-based plus partnership intervention development approach

IntroductionDeaths from second-hand smoke (SHS) exposure are increasing, but there is not sufficient evidence to recommend a particular SHS intervention or intervention development approach. Despite the available guidance on intervention reporting, and on the role and nature of pilot and feasibility studies, partial reporting of SHS interventions is common. The decision-making whilst developing such interventions is often under-reported. This paper describes the processes and decisions employed during transitioning from the aim of adapting an existing mosque-based intervention focused on public health messages, to the development of the content of novel community-based Smoke-Free Home (SFH) intervention. The intervention aims to promote smoke-free homes to reduce non-smokers’ exposure to SHS in the home via faith-based messages.MethodsThe development of the SFH intervention had four sequential phases: in-depth interviews with adults in households in Dhaka, identification of an intervention programme theory and content with Islamic scholars from the Bangladesh Islamic Foundation (BIF), user testing of candidate intervention content with adults, and iterative intervention development workshops with Imams and khatibs who trained at the BIF.ResultsIt was judged inappropriately to take an intervention adaptation approach. Following the identification of an intervention programme theory and collaborating with stakeholders in an iterative and collaborative process to identify barriers, six potentially modifiable constructs were identified. These were targeted with a series of behaviour change techniques operationalised as Quranic verses with associated health messages to be used as the basis for Khutbahs. Following iterative user testing, acceptable intervention content was generated.ConclusionThe potential of this community-based intervention to reduce SHS exposure at home and improve lung health among non-smokers in Bangladesh is the result of an iterative and collaborative process. It is the result of the integration of behaviour change evidence and theory and community stakeholder contributions to the production of the intervention content. This novel combination of intervention development frameworks demonstrates a flexible approach that could provide insights for intervention development in related contexts.

Real-time feedback of air quality in children's bedrooms reduces exposure to secondhand smoke.

INTRODUCTIONSecondhand smoke (SHS) exposure creates health risks for non-smokers and is especially detrimental to children. This study evaluated whether immediate feedback in response to poor indoor air quality in children’s bedrooms can reduce the potential for SHS exposure, as measured by adherence to a World Health Organization (WHO) indoor air standard.METHODSHomes that contained children and an adult who regularly smoked inside (n=298) had an air particle monitor installed in the child’s bedroom. These devices measured the concentration of particulate matter (PM2.5) for approximately three months and, for half of the participants, immediately provided aversive feedback in response to elevated PM2.5. Hierarchical linear models were fit to the data to assess whether the intervention increased the probability that: 1) a given day was below the WHO guideline for daily exposure, and 2) a household established and maintained a smoke-free home (SFH), operationalized as achieving 30 consecutive days below the WHO guideline. The intervention’s impact was calculated as group-by-time effects.RESULTSThe likelihood that a child’s bedroom met the WHO indoor air quality standard on a given day increased such that the baseline versus post-baseline odds ratio (OR) of maintaining indoor PM2.5 levels below the WHO guideline was 2.38 times larger for participants who received the intervention. Similarly, the baseline versus post-baseline OR associated with achieving an SFH was 3.49 times larger for participants in the intervention group.CONCLUSIONSThe real-time intervention successfully drove clinically meaningful changes in smoking behavior that mitigated indoor PM2.5 levels in children’s bedrooms and thereby reduced SHS exposure. These results demonstrate the effectiveness of targeting sensitive microenvironments by giving caregivers actionable information about children’s SHS risks. Future extensions should examine additional microenvironments and focus on identifying the potential for SHS exposure before it occurs.

The Effect of Couple's Motivational Interviewing on Exposure to Secondhand Smoke Among Pregnant Women at Home.

Objective: Secondhand smoke (SHS) during pregnancy is associated with many maternal-fetal complications. Iran has a high male smoking prevalence rate. This study aimed to determine the effect of motivational interviewing with couples on exposure to SHS at home in pregnant women referring to health centers in Urmia in 2019. Materials and methods : A randomized control trial was performed on 112 non-smoking pregnant women with smoking husbands, randomly allocated into two groups (each with 56 members). The participants were asked to specify the daily average times and duration of exposure during the last week. Five motivational interviewing sessions were held for the members of the intervention group. Each session lasted90 minutes and two sessions were held per week. The data were collected before and four weeks after the intervention. The data were analyzed using the repeated-measures analysis of variance (ANOVA) by SPSS-20 at a significance level of 0.05. Results: Of 112 couples who were randomized, 102 (91.07%) completed the trial. There was a significant reduction in terms of the daily frequency and duration of SHS exposure of the husband one week and one month after the intervention in the intervention group. The daily frequency and duration of SHS exposure of people other than the spouse at home did not decrease over time. Conclusion: Following the results of the study, the couple-based motivational interviewing approach can be used to reduce SHS exposure in women at home.