Environmental Tobacco Smoke Exposure Risk Research Articles

Determinants of environmental tobacco smoke at work and at home: analysis of baseline data from the Kong Cohort Study, Southern Iran

ABSTRACT Objective This study aimed to investigate the association between demographic and socio-economic determinants of environmental tobacco smoke (ETS) at work and at home. Methods Using baseline data from the Kong Cohort Study (KCS), the present prospective research was conducted among subjects between 40 and 70 years of age in Kong County of Hormozgan Province to calculate adjusted and crude odds ratios (ORs) at 95% confidence intervals (CIs) to test the independent association of ETS with determinants. Results multivariate analysis showed that men were exposed to ETS 12.5 times as much as women; rural residents were exposed to ETS at work 5 times as much as urban residents. Holding a university degree decreased the chances of exposure for 52% at work. Women were exposed to ETS 2 times as much as men at home. Rural residents were exposed to ETS at home 2 times as much as urban residents. The elderly (above 65 years) were exposed to ETS 60% less than the young (<45 years) at home. Conclusion In the light of the present findings, it can be concluded that ETS determinants at home and at work differ significantly. In the Kong County, compared to the urban areas, people in the rural areas are at a higher risk of ETS exposure.

Perspectives about Environmental Tobacco Smoke Exposure from Mothers of Premature Infants.

The study aimed to better understand the perceptions of mothers of preterm infants regarding smoking behaviors and environmental tobacco smoke (ETS) exposure using qualitative methodology. Using a Grounded Theory approach, we conducted in-depth, semi-structured interviews with mothers of preterm infants, both smokers and nonsmokers. Using the Theory of Planned Behavior (TPB) as a conceptual framework for our questions, we conducted and analyzed interviews until theoretical saturation was reached. Analysis included an iterative coding process resulting in theme development. Our key themes aligned with the TPB domains of attitudes, perceived control, and social norms. Regarding attitudes, mothers expressed that smoking was bad for their infants and that preterm infants were more vulnerable than term infants. Regarding perceived control, mothers commented on their perceived ability to avoid ETS exposure with subthemes including strategies utilized to mitigate ETS exposure risk. Some mothers expressed difficulty avoiding ETS exposure, for example, when residing in high-density housing. Regarding perceived social norms, mothers whose family and friends were nonsmokers expressed ease avoiding ETS, while mothers whose family and friends were smokers expressed more difficulty avoiding ETS. Mothers used a variety of behaviors within the domains of the TPB to reduce ETS exposures in their preterm infants which can inform future neonatal intensive care unit-based interventional strategies. · Mothers felt ETS is harmful for preterm infants.. · Mothers reported strategies for ETS avoidance.. · Mothers reported barriers to ETS avoidance.. · TPB can frame mothers' ETS-related behaviors..

Further Insights on Predictors of Environmental Tobacco Smoke Exposure during the Pediatric Age.

Background: The smoking ban in public places has reduced Environmental Tobacco Smoke (ETS) exposure for non-smokers, but despite this, domestic environments still remain places at high risk of exposure, and, today, about 40% of children worldwide are exposed to ETS at home. The aims of the study are to investigate the contribution of several factors on ETS exposure among a group of Italian children and to evaluate the changes in smoking precautions adopted at home when the smoker is the mother, the father, or both parents, respectively. Methods: A cross-sectional study was performed on a sample of 519 Italian schoolchildren. Information was collected via a questionnaire. Results: 41.4% of the participants lived with at least one smoker. Almost half of the children exposed to ETS lived with one or more smokers who do not observe any home smoking ban. Lower maternal or paternal educational levels significantly increase the risk of ETS exposure at home and the “worst case” is represented by both parents who smoke. Conclusions: More effective preventive interventions are needed to protect children from ETS exposure. Some interventions should be specifically dedicated to smokers with a low educational level and to mothers that smoke.

Environmental tobacco smoke exposure among electronic cigarette users

IntroductionExposure to environmental tobacco smoke (ETS) from combustible tobacco products causes various diseases and makes quitting smoking more difficult. However, little is known about exposure of e-cigarette users to ETS from combustible tobacco products. This study aimed to investigate e-cigarette users' exposure to ETS from tobacco smokers. MethodsThe association between ETS exposure frequency and different types of smokers including e-cigarette users was examined using ordered logistic regression analysis and nationally representative survey data on 28,765 individuals who were interviewed in the Canadian Tobacco, Alcohol and Drugs Surveys conducted during 2013 and 2015. Survey respondents were classified into one of five smoker types: smokers of tobacco only, dual users of tobacco and e-cigarettes, users of e-cigarette only, former smokers and never smokers. The analyses were conducted using the entire sample and by age group. ResultsYoung to mid-age (15–54) dual users of both regular cigarettes and e-cigarettes have higher ETS exposure than even tobacco smokers. Young to mid-age single users of e-cigarettes are less exposed to ETS than tobacco smokers, but still have higher ETS than never smokers. At older age (55+), both dual and single e-cigarette users face similar risks of ETS exposure as tobacco smokers. ConclusionsE-cigarette users are at high risk of ETS exposure. Policies that target the behaviour of e-cigarette users as well as the environments surrounding them to address their high ETS exposure risk would be beneficial.

Discrepancy between Self-Reported and Urine Cotinine-Verified Environmental Tobacco Smoke Exposure among Rural Pregnant Women in China.

Prenatal exposure to environmental tobacco smoke (ETS) is the most modifiable risk factor associated with adverse child-health outcomes. However, few longitudinal studies are implemented to compare the rates of discrepancy between self-reported (SR) and urinary cotinine (UC)-verified ETS exposure during the three trimesters of pregnancy, especially in rural areas. The objectives of this study were to assess the discrepancy between SR and UC-verified ETS exposure among rural women employing three measures throughout pregnancy, and to explore predictors related to these differences. This study used a prospective prenatal cohort consisting of 420 pregnant women whose ETS exposure was entirely evaluated by both SR and UC verification across three trimesters of pregnancy. Environmental tobacco exposure was assessed via SR verification, and was validated using the limit of detection for UC. The discrepancy rates were determined for each trimester. Multivariate logistic regression was used to assess the predictors associated with these differences. The discrepancy rates between SR and UC verification were 25.2%, 17.1%, and 20.5% (first, second, and third trimester, respectively). The highest inconsistency occurred in the first trimester. After adjusting for confounding factors, the following variables were found to have statistically significant associations with the discrepancy rate between SR and UC-verified ETS exposure: the number of smokers in the family and household income for all three trimesters, township site for the second and third trimester, and gravidity for the last trimester. The SR rate of ETS exposure among rural pregnant women is underreported, while the UC-verified rate is higher. More smokers in the family and gravidity may increase the risk of ETS exposure for pregnant women. Biochemical validation is warranted throughout pregnancy for the adoption of home-smoking bans and the promotion of community-based smoke-free programs.

Monitoring an outdoor smoking area by means of PM2.5 measurement and vegetal biomonitoring.

The extension of pollutant accumulation in plant leaves associated with its genotoxicity is a common approach to predict the quality of outdoor environments. However, this approach has not been used to evaluate the environmental quality of outdoor smoking areas. This study aims to evaluate the effects of environmental tobacco smoke (ETS) by assessing particulate matter 2.5μm (PM2.5) levels, the pollen abortion assay, and trace elements accumulated in plant leaves in an outdoor smoking area of a hospital. For this, PM2.5 was measured by active monitoring with a real time aerosol monitor for 10days. Eugenia uniflora trees were used for pollen abortion and accumulated element assays. Accumulated elements were also assessed in Tradescantia pallida leaves. The median concentration of PM2.5 in the smoking area in all days of monitoring was 66 versus 34μg/m3 in the control area (P < 0.001). In addition, the elements Al, Cd, Cu, Ni, Pb, Rb, Sb, Se, and V in Tradescantia pallida and Al, Ba, Cr, Cu, Fe, Mg, Pb, and Zn in Eugenia uniflora were in higher concentration in the smoking area when compared to control area. Smoking area also showed higher rate of aborted grains (26.1 ± 10.7%) compared with control (17.6 ± 4.5%) (P = 0.003). Under the study conditions, vegetal biomonitoring proved to be an effective tool for assessing ETS exposure in outdoor areas. Therefore, vegetal biomonitoring of ETS could be a complement to conventional analyses and also proved to be a cheap and easy-handling tool to assess the risk of ETS exposure in outdoor areas.

The Risk of Exposure to Cigarette Smoke in Anemia During Pregnancy

ABSTRACTAnemia is a state of hemoglobin levels in the RBC (Red Blood Cells) are lower than normal according to age and gender. The prevalence of anemia during pregnancy according Riskesdas 2007,2010, and 2013 tend to increase. One of risk factor isenvironmental tobacco smoke (ETS). This research was study the comparative risk of ETS exposure of anemia in pregnant woman. This study used case control design. Research sample consisted of two groups, case and control sample with the comparative at 1:2. Sample cases were pregnant women anemia (n=18) who control in Puskesmas Mojo Surabaya on 2015 while samplescontrol were pregnant woman who did not anemia (n=36), collected by simple random sampling. to determine the influence of risk by calculating the value on OR 95% CI with Statcalc in Epi Info. The independent variables were age, education level, employement status, family income, gestational age, gestational spacing, history of pregnant double, parity, antenatal care (ANC), LILA, Fe tablets. Results showed the risk exposure to ETS on the incidence of anemia in pregnant woma to the OR = 4.09 (1.07 &lt; OR &lt; 16.26), time of beginning the exposure 1st trimester OR = 5.43 (1.12&lt; OR &lt; 34.41), the number of active smokers 1-2 OR = 5.54 (1.20 &lt; OR &lt; 34.28), exposure duration ≤ 15 minute/day OR = 6.33 (1.28 &lt; OR &lt; 40.53).The conclusion is the exposure to cigarette smoke can causeanemia in pregnant woman. It is recommended for pregnant woman to avoid ETS exposure during pregnancy.Keywords: anemia, pregnant woman, environmental tobacco smoke (ETS), number of smoker, exposure duration

The Risk of Exposure to Cigarette Smoke in Anemia During Pregnancy

Anemia is a state of hemoglobin levels in the RBC (Red Blood Cells) are lower than normal according to age and gender. The prevalence of anemia during pregnancy according Riskesdas 2007,2010, and 2013 tend to increase. One of risk factor isenvironmental tobacco smoke (ETS). This research was study the comparative risk of ETS exposure of anemia in pregnant woman. This study used case control design. Research sample consisted of two groups, case and control sample with the comparative at 1:2. Sample cases were pregnant women anemia (n=18) who control in Puskesmas Mojo Surabaya on 2015 while samplescontrol were pregnant woman who did not anemia (n=36), collected by simple random sampling. to determine the influence of risk by calculating the value on OR 95% CI with Statcalc in Epi Info. The independent variables were age, education level, employement status, family income, gestational age, gestational spacing, history of pregnant double, parity, antenatal care (ANC), LILA, Fe tablets. Results showed the risk exposure to ETS on the incidence of anemia in pregnant woma to the OR = 4.09 (1.07 &lt; OR &lt; 16.26), time of beginning the exposure 1st trimester OR = 5.43 (1.12&lt; OR &lt; 34.41), the number of active smokers 1-2 OR = 5.54 (1.20 &lt; OR &lt; 34.28), exposure duration ≤ 15 minute/day OR = 6.33 (1.28 &lt; OR &lt; 40.53).The conclusion is the exposure to cigarette smoke can causeanemia in pregnant woman. It is recommended for pregnant woman to avoid ETS exposure during pregnancy.Keywords: anemia, pregnant woman, environmental tobacco smoke (ETS), number of smoker, exposure duration

Residential exposure to environmental tobacco smoke, and its associates: Findings from the Global Adult Tobacco Survey in Poland.

Expanding the information on exposure to environmental tobacco smoke (ETS) at home and its associates is of great public health importance. The aim of the current analysis was to evaluate associates of exposure to environmental tobacco smoke among economically active male and female adults in Poland in their place of residence. Data on the representative sample of 7840 adults from the Global Adult Tobacco Survey (GATS) carried out in Poland in the years 2009 and 2010 were applied. The Global Adult Tobacco Survey is a nationally representative household study. The logistic regression model was used for relevant calculations. The exposure to environmental tobacco smoke in the place of living affected 59% of studied subjects. Out of non-smokers 42% of males and 46% females were exposed to the ETS in the at home. Increased risk of residential ETS exposure was associated with low education attainment, lack of awareness on adverse health consequences of second hand smoke (SHS), low level of support for tobacco control policies, living with a smoker. One of the factors associated with the ETS exposure was also the approval for smoking at home of both genders. The residential ETS exposure risk was the highest among males (odds ratio (OR) = 7.1, 95% confidence interval (CI): 6.1-13.8, p < 0.001) and females (OR = 8.1, 95% CI 6.5-11.8, p < 0.001) who declared that smoking was allowed in their place of residence compared to respondents who implemented smoking bans at their place of residence. Campaigns to decrease social acceptance of smoking and encourage adopting voluntary smoke-free rules at home might decrease the ETS exposure and reduce related risks to the health of the Polish population. Educational interventions to warn about adverse health effects of the ETS should be broadly implemented particularly in high risk subpopulations.

Are Urban Low-Income Children From Unplanned Pregnancy Exposed to Higher Levels of Environmental Tobacco Smoke?

IntroductionThe negative consequences of environmental tobacco smoke (ETS) in children have been well documented. Our objective is to assess whether children of unplanned pregnancies are at increased risk for ETS exposure. MethodData were collected through interviews of mothers who accompanied their children to the Children’s Hospital of Michigan, Detroit, Michigan. Associations of ETS exposure with unplanned pregnancy were analyzed using the χ2 test and stratified by maternal smoking status. Results from the bivariate analysis were further verified using a multiple logistic regression method to control for significant covariates. ResultsAmong the sample of 399 children, 125 (31.3%) were born from unplanned pregnancies; 47.2% of the unplanned children and 25.6% of the planned children were exposed to ETS (χ2 = 18.4, p < .01). Unplanned children of non-smoking mothers also experienced higher levels of exposure to ETS compared with planned children (22.45% vs. 10.05%, χ2 = 5.50, p < .05). The association remained significant after controlling for covariates (adjusted odds ratio = 2.45; 95% confidence interval = 1.03, 5.84; p < .05). DiscussionFindings of this study suggest the importance of preventing ETS in urban children, particularly those from unplanned pregnancies.

Correlation between the Urine Profile of 4-(Methylnitrosamino)-1-(3-Pyridyl)-1-Butanone Metabolites and N7-Methylguanine in Urothelial Carcinoma Patients

A major carcinogen, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), is present in cigarette smoke and its metabolite, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), is used as an exposure biomarker for environmental tobacco smoke (ETS). This metabolite (NNAL) can be either detoxified into glucuronidated NNAL (NNAL-Gluc) or activated into an unstable reactive metabolite that methylates DNA along with formation of 4-hydroxy-4-(3-pyridyl)-butyric acid [hydroxy acid (HA)]. Therefore, the carcinogenic risk associated with ETS exposure is greatly modulated by individual variations in metabolic activation and detoxification capabilities. In this study, we defined the urinary HA/total NNAL [HA/total NNAL] ratio as the activation index and NNAL-Gluc/free NNAL [(total NNAL-free NNAL)/free NNAL] ratio as the detoxification index of NNK. The major methylated DNA adduct N(7)-methylguanine (N(7)-MeG), considered as the carcinogenic biomarker for cigarette smoking, was excreted in urine. The objective of this study was to investigate the effects of these metabolic indexes of NNK on N(7)-MeG urinary excretion in a population of urothelial carcinoma patients. Urinary levels of total NNAL (free NNAL plus NNAL-Gluc), free NNAL, HA, and N(7)-MeG were positively correlated with smoking. Furthermore, activation index and detoxification index correlated positively and negatively with N(7)-MeG levels, respectively. Our results suggest that these metabolic indices may represent the phenotype of individual metabolism capability and modulate the carcinogenic risk of ETS exposure.

Screening for Children’s Exposure to Environmental Tobacco Smoke in a Pediatric Primary Care Setting

Purpose of the Study. To develop a brief screening tool to accurately predict environmental tobacco smoke (ETS) exposure. Study Population. A total of 291 healthy children aged 2 weeks to 3 years. These children were recruited from a primary care center that provides care to a low-income population. Exclusion criteria included history of birth at &amp;lt;36 weeks’ gestation, asthma, other chronic pulmonary disease, or cardiac disease. Methods. The primary caregivers of the children in the study filled out a questionnaire that included items on demographics, smoking status of individuals living in the children’s homes, number of cigarettes smoked per day, and the locations in which individuals smoked. Primary caregivers also gave samples of their own and their children’s hair for measurement of levels of cotinine. Results. A total of 7 subjects (2%) had hair cotinine levels of &amp;lt;0.01 ng/mg, 99 subjects (34%) had levels of &amp;lt;0.3 mg/ng, 68 (23%) had midrange levels of 0.3–0.7 ng/mg, and 124 (43%) had levels of &amp;gt;0.7 mg/ng. Factors associated with higher cotinine levels included maternal smoking, the presence of other smokers in the home, and where persons other than the mothers smoke (ie, in the home or outside the home). Interestingly, the reported location of mothers’ smoking (indoors versus outdoors) was not associated with cotinine levels in the hair. The investigators used this information to create a model questionnaire to predict ETS exposure. Three questions were selected: does the mother smoke, do others in the home smoke, do others who smoke remain inside the home or go outside. Using this model, children of mothers who smoke and are also exposed to others who smoke inside the home have an 81% chance of having high exposure to ETS. In contrast, children of mothers who do not smoke and are not exposed to others who smoke have a 64% chance of low exposure to ETS. Conclusions. It was possible to derive a simple and valid screening tool to identify children at risk for ETS exposure, but this tool still needs to be tested prospectively. Reviewer Comments. We all struggle with our patients’ exposure to ETS in the home. Part of the struggle has to do with obtaining accurate information about exposures. The screening tool described in this study needs to be tested prospectively, but it may prove to be highly useful. Of interest is the finding that it did not matter, in terms of levels of cotinine in children’s hair, whether their mothers smoked indoors or reported that they limited themselves to outdoor smoking. We may speculate that this finding has to do with inaccurate reporting (shame about smoking indoors) or to the large amount of particulate residue that remains on smokers after they smoke.

Screening for children's exposure to environmental tobacco smoke in a pediatric primary care setting

Context The American Academy of Pediatrics has recommended that pediatricians assess their patients' environmental tobacco smoke (ETS) exposure, but the specific questions most likely to identify children with high ETS exposure are not known. Cotinine, a nicotine metabolite present in hair, can be used to quantify months of ETS exposure. Objective To develop a brief screening tool that will accurately predict ETS exposure as defined by a child's hair cotinine level. Setting Columbus Children's Hospital Primary Care Center. Participants A convenience sample of healthy children age 2 weeks to 3 years of both self-reported smokers and nonsmokers. Interventions Screening questions regarding home ETS exposure. Main Outcome Measure Performance of the screening questions compared with child hair cotinine levels. Results Hair samples and questionnaire data were obtained from 291 children. Based on clinical applicability and statistical significance, 3 questions (Does the mother smoke?, Do others smoke?, and Do others smoke inside?) were selected as a valid screening tool to determine children's ETS exposure risk. Maternal reports of smoking outside only or smoking only a few cigarettes per day had no impact on child hair cotinine levels. Conclusions It was possible to derive a simple, specific, and valid screening tool that can be used in pediatric offices to identify children at risk for ETS exposure. Further research is needed to test this tool prospectively.

Screening for Children’s Exposure to Environmental Tobacco Smoke in a Pediatric Primary Care Setting

The American Academy of Pediatrics (Elk Grove Village, Ill) has recommended that pediatricians assess their patients' environmental tobacco smoke (ETS) exposure, but the specific questions most likely to identify children with high ETS exposure are not known. Cotinine is a nicotine metabolite, present in hair, that can be used to quantify months of ETS exposure. To develop a brief screening tool that will accurately predict ETS exposure as defined by child hair cotinine level. We compared the performance of a series of easily administered screening questions regarding home ETS exposure to child hair cotinine levels. Subjects were a convenience sample of healthy children aged 2 weeks to 3 years of both self-reported smokers and nonsmokers. Hair samples and questionnaire data were obtained from 291 children. Based on clinical applicability and statistical significance, 3 questions ("Does the mother smoke?", "Do others smoke?", and "Do others smoke inside?") were selected as a valid screening tool to determine children's ETS exposure risk. Maternal report of smoking outside only or smoking few cigarettes per day had no impact on child hair cotinine levels. It was possible to derive a simple, specific, and valid screening tool that can be used in pediatric offices to identify children at risk for ETS exposure. Further research is needed to test this tool prospectively.

Environmental tobacco smoke in Norwegian homes, 1995 and 2001: changes in children's exposure and parents attitudes and health risk awareness

The aims of the present study were to assess changes between 1995 and 2001 in the prevalence of child exposure to environmental tobacco smoke (ETS), attitudes towards ETS among parents of small children and awareness among parents regarding the potential hazards of passive smoking to children. A questionnaire, along with a stamped, addressed envelope, was sent to a stratified random sample of 1000 households in Norway containing children aged 3 years old at the time of the investigation (May 1995 and August 2001). The prevalence of households containing smokers was similar in the two study periods. However, households reporting exposure of children to ETS fell from 32% in 1995 to 18% in 2001. Health-risk awareness had significantly increased in households containing smokers. In both surveys, the probability of children being exposed to ETS was positively correlated with the number of parents smoking, and inversely correlated to strength of health-risk awareness, negative attitudes towards ETS and length of household education. Increasing parents' awareness of the health risk of ETS exposure to children may significantly reduce children's ETS exposure.

Does Having Children Affect Adult Smoking Prevalence and Behaviours at Home?

BackgroundSmoking prevalence and smoking behaviours have changed in society and an increased awareness of the importance of protecting children from environmental tobacco smoke (ETS) is reported. The aim of this study was to find out if smoking prevalence and smoking behaviours were influenced by parenthood, and if differences in health-related quality of life differed between smoking and non-smoking parents.MethodsQuestionnaires were sent to a randomly selected sample, including 1735 men and women (20–44 years old), residing in the south-east of Sweden. Participation rate was 78%. Analyses were done to show differences between groups, and variables of importance for being a smoker and an indoor smoker.ResultsParenthood did not seem to be associated with lower smoking prevalence. Logistic regression models showed that smoking prevalence was significantly associated with education, gender and mental health. Smoking behaviour, as well as attitudes to passive smoking, seemed to be influenced by parenthood. Parents of dependent children (0–19 years old) smoked outdoors significantly more than adults without children (p < 0.01). Logistic regression showed that factors negatively associated with outdoor smoking included having immigrant status, and not having preschool children. Parents of preschool children found it significantly more important to keep the indoor environment smoke free than both parents with schoolchildren (p = 0.02) and adults without children (p < 0.001). Significant differences in self-perceived health-related quality of life indexes (SF-36) were seen between smokers and non-smokers.ConclusionAs smoking behaviour, but not smoking prevalence, seems to be influenced by parenthood, it is important to consider the effectiveness of commonly used precautions when children's risk for ETS exposure is estimated.

Estimation of the impact on children’s health of environmental tobacco smoke in England and Wales

In this paper, the population attributable risk (PAR), a measure of the excess risk of disease associated with a risk factor, is calculated for some of the common adverse health effects that have been associated with exposure of children to environmental tobacco smoke (ETS): childhood lower respiratory illness, chronic middle ear disease, asthma and sudden infant death syndrome (SIDS). Published data on both risk estimates and the percentage of children exposed to ETS in the home (prevalence of ETS) have been utilised. The percentage of childhood lower respiratory illness and middle ear disease typically attributable to ETS from either parent smoking ranged from 9% for asthma prevalence and for referral for glue ear, to 25% for hospital admission for lower respiratory illness. Where data were available to calculate PARs separately for mother only smoking and father only smoking, the PARs were generally larger for mothers only smoking, due mainly to higher odds ratios for mothers only smoking. The PAR for SIDS attributable to ETS from mother only smoking was 11%. Although based on a small number of studies, the PAR for SIDS attributable to smoking of fathers only was similar to that attributable to the smoking of mothers only, largely due to the higher prevalence of households where only the father smokes. This study has shown that the impact of ETS on childhood illness can be considerable, emphasising the importance of the need to develop effective strategies for reducing the risk of ETS exposure in the home and elsewhere.

Does having children affect adult smoking prevalence and behaviours at home?

BackgroundSmoking prevalence and smoking behaviours have changed in society and an increased awareness of the importance of protecting children from environmental tobacco smoke (ETS) is reported. The aim of this study was to find out if smoking prevalence and smoking behaviours were influenced by parenthood, and if differences in health-related quality of life differed between smoking and non-smoking parents.MethodsQuestionnaires were sent to a randomly selected sample, including 1735 men and women (20–44 years old), residing in the south-east of Sweden. Participation rate was 78%. Analyses were done to show differences between groups, and variables of importance for being a smoker and an indoor smoker.ResultsParenthood did not seem to be associated with lower smoking prevalence. Logistic regression models showed that smoking prevalence was significantly associated with education, gender and mental health. Smoking behaviour, as well as attitudes to passive smoking, seemed to be influenced by parenthood. Parents of dependent children (0–19 years old) smoked outdoors significantly more than adults without children (p < 0.01). Logistic regression showed that factors negatively associated with outdoor smoking included having immigrant status, and not having preschool children. Parents of preschool children found it significantly more important to keep the indoor environment smoke free than both parents with schoolchildren (p = 0.02) and adults without children (p < 0.001). Significant differences in self-perceived health-related quality of life indexes (SF-36) were seen between smokers and non-smokers.ConclusionAs smoking behaviour, but not smoking prevalence, seems to be influenced by parenthood, it is important to consider the effectiveness of commonly used precautions when children's risk for ETS exposure is estimated.

Epidemiology of environmental tobacco smoke exposure

The health hazards due to exposure to environmental tobacco smoke (ETS) are increasingly established. ETS contains thousands of chemicals including 43 known carcinogens. One of the most important known health effects of ETS exposure is lung cancer in non-smokers, based on epidemiologic evidence and knowledge of the uptake and metabolism of ETS. Epidemiologic studies need to carefully take into account confounding and potential errors in exposure assessment. More research is needed to understand the genetic factors that influence ETS-induced lung cancer. Studies of the patterns of ETS exposure suggest higher rates of exposure in people employed as blue collar workers, in service occupations, earning lower incomes, and among the less educated. Certain racial/ethnic groups (e.g. Blacks, American Indians) may be at higher risk of ETS exposure. Despite substantial progress in protecting individuals from ETS exposure, additional efforts are needed in improving and enforcing policies to reduce exposure.

Testing a Model of Avoiding Environmental Tobacco Smoke in Young Adults

To test an explanatory model of gender, self-efficacy, situational influences, and other health-promoting behaviors on the avoidance of environmental tobacco smoke (ETS) in young adults. ETS is a cause of lung cancer, pulmonary disease, and cardiovascular disease. Although young adults are at increased risk for ETS exposure, there are few behavioral studies of ETS exposure and no reported studies of ETS exposure in young adults. Although college students are often exposed to ETS, the college environment offers a setting in which the opportunities for change are substantial. Model-testing. Data are reported on a convenience sample of 136 nonsmoking 18- to 25-year old students in one mid-atlantic U.S. university. This sample of nonsmokers was drawn from a larger sample of 241 smokers and nonsmokers in 1995. Model constructs were based on Pender's health promotion model (HPM). The General Self-efficacy Scale, Health Promotion Lifestyle Profile, and ETS Avoidance Scale were used along with items measuring ETS-avoidance efficacy and Living with Smoke. Path analysis was used to test the model. The trimmed explanatory model showed that 26% of the variance in avoiding ETS was accounted for by gender, having self-efficacy, and ETS-avoidance efficacy, not living with people who smoke, and performing other healthy behaviors. Being female and general self-efficacy indirectly influenced ETS avoidance through their effects on related health promoting behaviors. The explanatory model of ETS avoidance can provide useful information for the development of interventions to prevent exposure to passive smoke. Given the occurrence of ETS exposure in young adults, longitudinal research using this explanatory model is yielding promising results. Enhancing the self-efficacy of young adults and encouraging healthy lifestyle behaviors may be an important factor in their avoidance of ETS.