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

BACKGROUND: 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. METHOD: 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). RESULTS: 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. CONCLUSIONS: Increasing parents' awareness of the health risk of ETS exposure to children may significantly reduce children's ETS exposure.     

Effect of feedback regarding urinary cotinine and brief tailored advice on home smoking restrictions among low-income parents of children with asthma: a controlled trial.

BACKGROUND: Since most smoker parents of children with asthma are unable to quit, an alternative measure that would reduce their children's exposure to environmental tobacco smoke (ETS) is to ban smoking in the home. METHODS: Compared with 136 usual-care controls, 128 intervention-group parents recruited from South Australian pediatric hospital outpatient waiting rooms were given written and verbal feedback about their 1- to 11-year-old child's urinary cotinine-to-creatinine level, information booklets, and two telephone calls encouraging a ban on smoking at home. RESULTS: At 6 months, 49.2% of the intervention group reported having banned smoking in the home compared with 41.9% of controls, but the differential rate of change from baseline was not significant (P = 0.40). At follow-up, there were no significant differences between groups in the percentage reporting bans on smoking in the car, the mean reduction from baseline in total daily consumption or consumption in front of the child, children's urinary cotinine level, or parental smoking cessation. CONCLUSIONS: The intervention did not change parents' propensity to create or maintain bans on smoking in their homes or otherwise change smoking habits to reduce their children's exposure to ETS. More intensive interventions may be required to achieve change among low-income smoker parents of children with asthma.     

Smoking is an occupational hazard

BACKGROUND: Even though the prevalence of tobacco smoking has declined in the general population and among white-collar workers, the prevalence of tobacco smoking among blue-collar workers remains unacceptably high. Blue-collar workers experience greater exposure to workplace toxins which can add to, or even multiply, their risk of adverse health effects from tobacco smoking. Among blue-collar workers, workers in the restaurant, bar, and gaming industries are exposed to much higher levels of environmental tobacco smoke (ETS) than are office workers, and are at increased risk of cancer and cardiovascular diseases even if they are non-smokers themselves. METHODS: The literature on health risks, and the disparity between white and blue collar workers in smoking prevalence, and the literature on various tobacco control strategies provide the sources on which this review is based. CONCLUSIONS: Over the past 20 years, the accumulating scientific evidence about smoking as an occupational hazard has prompted the implementation of various educational, economic, and legal tobacco control strategies.     

Cigarette smoking and exposure to environmental tobacco smoke in China: the international collaborative study of cardiovascular disease in Asia

OBJECTIVES: We estimated the prevalence of cigarette smoking and the extent of environmental tobacco smoke exposure (ETS) in the general population in China. METHODS: A cross-sectional survey was conducted on a nationally representative sample of 15540 Chinese adults aged 35-74 years in 2000-2001. Information on cigarette smoking was obtained by trained interviewers using a standard questionnaire. RESULTS: The prevalence of current cigarette smoking was much higher among men (60.2%) than among women (6.9%). Among nonsmokers, 12.1% of men and 51.3% of women reported exposure to ETS at home, and 26.7% of men and 26.2% of women reported exposure to ETS in their workplaces. On the basis of our findings, 147358000 Chinese men and 15895000 Chinese women aged 35-74 years were current cigarette smokers, 8658000 men and 108402000 women were exposed to ETS at home, and 19072000 men and 55372000 women were exposed to ETS in their workplaces. CONCLUSIONS: The high prevalence of cigarette smoking and environmental tobacco smoke exposure in the Chinese population indicates an urgent need for smoking prevention and cessation efforts.     

Decrease in the prevalence of environmental tobacco smoke exposure in the home during the 1990s in families with children

OBJECTIVES: This study explored correlates with and changes in the prevalence of environmental tobacco smoke (ETS) exposure of children in the home. METHODS: We used multiple logistic regression to explore ETS exposures as reported in the 1992 and 2000 National Health Interview Survey. RESULTS: ETS exposure in homes with children declined from 35.6% to 25.1% (P <.001) between 1992 and 2000, whereas smoking prevalence declined 26.5% to 23.3%. Home ETS exposures were more prevalent among non-Hispanic Whites than among African Americans (adjusted odds ratio [AOR] = 0.702; 95% confidence interval [CI] = 0.614, 0.802), Asian Americans (AOR = 0.534; 95% CI = 0.378, 0.754), and Hispanics (AOR = 0.388; 95% CI = 0.294, 0.389). Exposures declined across all groups, with greater gains in higher education and income groups. CONCLUSIONS: Home ETS exposure declined sharply between 1992 and 2000, more than would be predicted by the decline in adult smoking prevalence.     

Lifetime environmental exposure to tobacco smoke and primary lung cancer of non-smoking Taiwanese women

BACKGROUND: For a female population with a high lung cancer mortality rate, such as Taiwanese women, who smoke relatively rarely, but live in an environment with high male smoking prevalence, the risk and population burden of lung cancer due to environmental tobacco smoke (ETS) are relatively important. METHODS: An age-matched case-control study was designed to investigate the effects of cumulative environmental exposure to tobacco smoke during childhood and adult life on lung cancer risk among non-smoking women in Taiwan. Information on passive smoking from all possible sources and life periods were obtained from interviews with 268 and 445 lifetime non-smoking cases and controls. Conditional logistic regression and synergism 'S' index were applied to the data to assess the independent and joint effects of passive smoking in different life stages while controlling for possible confounding variables. RESULTS: Risks of contracting lung cancer among women near-distantly exposed to the highest level of ETS in childhood (>20 smoker-years) and in adult life (>40 smoker-years) were 1.8-fold (95% CI: 1.2-2.9) and 2.2-fold (95% CI: 1.4-3.7) higher than that among women being never exposed to ETS, and the two variables accounted for about 37% of tumours in this non-smoking female population. Children were found to be more susceptible to ETS than adults and such early exposure was found to modify the effect of subsequent tobacco smoke exposure in adult life based on an additive interaction model. CONCLUSIONS: Environmental tobacco smoke exposure occurring in childhood potentiates the effect of high doses of exposure in adult life in determining the development of lung cancer. Smoking prohibition would be expected to protect about 37% of non-smoking Taiwanese women against lung cancer.     

Environmental tobacco smoke and its effect on the symptoms and medication in children with asthma

Environmental tobacco smoke (ETS) worsens asthmatic symptoms. We analyzed the relationship between levels of ETS and asthmatic symptoms and medication. We asked parents of 282 asthmatic children about the general condition, smoke exposure and medication. Patients were classified into three groups: no-ETS (no smoking), mild-ETS (smoking in the house but not in the same room as patient), and heavy-ETS (smoking in the same room as patient). We classified 116 children in no-ETS group, 124 children in mild-ETS group and 42 children in heavy-ETS group. The symptoms were worst and prevalence of leukotriene receptor antagonist and long-acting β₂-agonist use were highest in heavy-ETS group. However, there was no statistical difference between no-ETS and mild-ETS groups in prevalence of anti-asthmatic drug use and symptoms. We conclude that a smoking ban in rooms used by asthmatic children is an easy way to reduce ETS, asthmatic symptoms and the use of anti-asthmatic drugs.     

Health impact of exposure to environmental tobacco smoke in Italy

Household and workplace exposure to environmental tobacco smoke (ETS) is associated with various deleterious health effects. We evaluated the health impact of ETS in Italy. We considered only those health conditions for which systematic quantitative reviews were available. We used relative risks from the reviews while data on the proportion of the Italian population exposed to ETS were derived from national statistics or from ad hoc studies. A total of 2.033 newborns per year are of low birth weight (< 2500 grams) in Italy (7.9%) because of maternal exposure to ETS during pregnancy. There are 87 sudden infant deaths (16.9%) due to post natal maternal active smoking. 21.3% of acute respiratory infections during the first two years of life are due to parental smoking (about 77.000 children); 27.000 cases of asthma (9.1%), 48.000 cases of chronic respiratory symptoms, 64.000 cases of middle ear effusions among children and adolescents are due to parental smoking exposure. The annual estimates of mortality from lung cancer and ischemic heart disease due to ETS exposure from the spouse are 221 and 1896, respectively. Workplace exposure is associated with 324 lung cancer deaths and 235 deaths from ischemic heart disease. Although these estimate are based on several assumptions and they have large uncertainties, the results underline the need and the urgency of public health measures to reduce ETS exposure in the household and in the workplaces in Italy.     

Household smoking behaviours and exposure to environmental tobacco smoke among infants: are current strategies effectively protecting our young?

Objective: To determine the prevalence of infant exposure to environmental tobacco smoke (ETS) among infants attending child health clinics in regional NSW; the association between such exposure and household smoking behaviours; and the factors associated with smoking restrictions in households with infants. Methods: Parents completed a computer‐based questionnaire and infant urine samples were collected. Information was obtained regarding the smoking behaviours of household members and samples were analysed for cotinine. Results: Twenty seven per cent of infants had detectable levels of cotinine. Infant ETS exposure was significantly associated with the smoking status of household members, absence of complete smoking bans in smoking households and having more than one smoker in the home. Smoking households were significantly less likely to have a complete smoking ban in place. Conclusions: This study suggests that a significant proportion of the population group most vulnerable to ETS were exposed. Implications: Future efforts to reduce children's exposure to ETS need to target cessation by smoking parents, and smoking bans in households of infants where parents are smokers if desired reductions in childhood ETS‐related illness are to be realised.     

Indoor and outdoor smoking: impact on children's health

BACKGROUND: Many children are exposed to ETS (environmental tobacco smoke), which has both immediate and long-term adverse health effects. The aim was to determine the prevalence and nature of smoking among parents with infants and the association of indoor or outdoor smoking with the health of their children. METHODS: Mail-questionnaire study, which was performed in a county in the south-east of Sweden, as a retrospective cross-sectional survey including 1990 children, 12-24 months old. RESULTS: 20% of the children had at least one smoking parent; 7% had parents who smoked indoors and 13% parents who smoked only outdoors. Indoor smoking was most prevalent among single and blue-collar working parents. In the case of smoking cessation during pregnancy, smoking was usually resumed after delivery or at the end of the breast-feeding period. Coughing more than two weeks after a URI (upper respiratory infection), wheezing without a URI as well as pooled respiratory symptoms differed significantly between children of non-smokers and indoor smokers. CONCLUSION: Further research of the common belief that outdoor smoking is sufficient to protect infants from health effects due to ETS exposure is warranted.     

Risk factors for asthma and cough among Hispanic children in the southwestern United States of America, 2003-2004.

OBJECTIVES: To investigate the impact of environmental tobacco smoke (ETS) exposure and mother's place of birth (Mexico vs. United States of America) on the prevalence of asthma and dry nighttime cough among children 2-12 years old residing in the southwestern United States. METHODS: Data were collected from November 2003 through March 2004 as part of a health survey of Hispanic mothers with young children who sought emergency, nutrition, or other clinical services. Information about respiratory health was obtained for one randomly selected child per United States-born (no. = 144) or Mexico-born (no. = 125) mother. Information on maternal and household sociodemographic variables, smoking, parental asthma, and child's exposure to room or automobile ETS during the previous seven days was also collected. Adjusted prevalence ratios were estimated with modified Poisson regression models. RESULTS: Most sociodemographic and ETS exposure variables differed significantly by mother's country of birth. Modeled asthma prevalence was 1.95 [95% confidence interval (CI) = 1.03-3.68] times greater in children of United States-born mothers than children of Mexico-born mothers. This difference persisted after known asthma risk factors were controlled for, including parental asthma, socioeconomic and demographic variables, and child ETS exposure. Children's recent automobile ETS exposure was associated with dry nighttime cough [adjusted prevalence ratio (PR) = 1.94, 95% CI = 1.19-3.15] and asthma (PR = 2.09; 95% CI = 0.99-4.39). CONCLUSIONS: Exposure to ETS in automobiles is an important risk factor for asthma and dry nighttime cough among Hispanic children in the southwest United States, regardless of mother's country of birth. Further research is needed to identify causes of the higher prevalence of asthma in Hispanic children of United States-born mothers.     

Effects of tobacco smoke exposure on asthma prevalence and medical care use in North Carolina middle school children

OBJECTIVES: We sought to determine the effects of exposure to environmental tobacco smoke (ETS) and childhood cigarette smoking on asthma symptoms among middle school children in North Carolina. METHODS: During 1999-2000, information was collected from a survey completed by the children. Outcomes of asthma symptom reporting were regressed on tobacco smoke exposures. RESULTS: Children who currently smoked or reported any exposure to ETS were at increased risk of reporting active asthma symptoms. Exposure to ETS and childhood cigarette smoking was responsible for 15% of the asthma cases observed in the study population and $1.34 million in excess medical expenditures. CONCLUSIONS: Even at low levels of exposure, childhood cigarette smoking and ETS are independently associated with asthmatic symptoms.     

Factors influencing openness to future smoking among nonsmoking adolescents

BACKGROUND: To investigate the correlates of youth tobacco use in terms of nonsmoking adolescents' openness to future smoking, a secondary analysis of the 2000 and 2004 Indiana Youth Tobacco Survey (IYTS) was conducted. METHODS: A representative sample of 1416 public high school students in grades 9-12 and 1516 public middle school students in grades 6-8 (71.44% and 72.53% response rates, respectively) were surveyed in 2000, and 3433 public high school students and 1990 public middle school students (63.04% and 65.44% response rates, respectively) were surveyed in 2004. RESULTS: Seventy-four percent of students in 2000 were not open to future smoking and 77% were not open in 2004. The adolescent cohort in 2004 became more exposed to antitobacco messages and less exposed to protobacco messages and environmental tobacco smoke (ETS) compared with their counterpart in 2000. Whereas gender, grade, race/ethnicity, and exposure to antitobacco messages were insignificant predictors for openness to future smoking, exposure to ETS either in homes or in cars was a strong predictor for openness to future smoking (the higher the exposure to ETS, the more open to future smoking) in both unadjusted and adjusted multivariate models. Exposure to protobacco messages had a greater effect on openness to future smoking than exposure to antitobacco messages. The rate of transition from openness to future smoking to tobacco use initiation is higher among white adolescents than among minority adolescents. CONCLUSIONS: More efforts should be made to reduce adolescents' exposure to ETS and protobacco messages.     

How home-smoking habits affect children: a cross-sectional study using urinary cotinine measurement in Italy

Objectives

To assess the impact of different home-smoking rules and smoking habits of cohabitant on environmental tobacco smoke (ETS) exposure of children.

Methods

Information about 396 Italian children (5–11?years old) and cohabitants’ smoking habits was collected by a questionnaire. Exposure assessment was performed by determination of urinary cotinine (u-cotinine).

Results

Median u-cotinine concentrations in children significantly increased in a similar fashion as theoretical ETS exposure increase: cohabitants do not smoke (1.79?μg/g creatinine), cohabitant(s) smoker(s) never smoke at home (2.84), smoke at home only when children are out (3.90), and smoke at home even if children are in (6.02). Median u-cotinine levels of exposed children were associated to the strength of cohabitant’s smoking behaviours when smoker(s) consume daily a high number of cigarettes (≥?20) respect to light consumption (1–9) (4.52 and 3.24?μg/g creatinine).

Conclusions

The magnitude of ETS exposure in children is correlated with smoking habits and home-smoking precautions adopted by their cohabitants. Educational interventions on parents are essential to increase their awareness about ETS exposure and to teach correct behaviours to protect health of kids, especially in household environment.     

Observational survey of smoking provisions in food service establishments--Southeast Health District,Georgia, 2001

In the United States, approximately 38,000 deaths are attributable to second hand smoke (SHS) exposure each year. One of the national health objectives for 2010 is to reduce public exposure to environmental tobacco smoke (ETS) (objective 27.10). To reduce public exposure to ETS, CDC recommends smoking bans and restrictions in public places. Some of the highest reported exposures to concentrations of SHS are found in food service establishments; however, Georgia does not have a state law prohibiting smoking in these places. In March 2001, the director of Georgia's Southeast Health District requested assistance from the state health department in developing a surveillance system of smoking provisions in food service establishments. This report summarizes an observational survey of smoking provisions in food service establishments of Georgia's Southeast Health District in 2001, which found that although 69.4% (506) of all surveyed establishments were completely smoke free, the remaining establishments failed to provide several physical modifications designed to minimize ETS exposure. Public health officials in the Southeast Health District will use survey results to target interventions toward establishments lacking ETS-minimizing provisions.     

Parental smoking behaviour and effects of tobacco smoke on children's health in Finland and Russia

BACKGROUND: There is little information on potential differences in smoking behaviour of parents between Finland and Russia and on the effects of environmental tobacco smoke (ETS) exposure on allergic and respiratory diseases among Finnish and Russian children. The aim of the study was to compare the smoking behaviour of parents and school children and to assess the relations of tobacco smoke exposure during pregnancy and childhood with occurrence of allergic diseases and respiratory infections among school children. METHODS: We conducted a population-based cross-sectional study in the neighbour towns across the border of Imatra in Finland and Svetogorsk in Russia. The study population consisted of 512 Finnish and 581 Russian school children aged 7-16 years (response rate 79%). RESULTS: Children's tobacco smoke exposure differed markedly between Finland and Russia. The risk of asthma was particularly related to high maternal smoking exposure during pregnancy (adjusted OR 3.51, 95% CI 1.00-12.3), infancy (3.34, 1.23-9.07) and currently (3.27, 1.26-8.48), and the risk of common cold was related to high combined parental smoking during infancy (1.83, 1.06-3.17) in Finnish children. Among Russian children allergic conjunctivitis was related to maternal smoking during infancy (4.53, 1.49-13.8) and currently (2.82, 1.07-7.44). CONCLUSIONS: Smoking behaviour of parents and ETS exposure during childhood differed markedly between Finland and Russia. Asthma was particularly increased in relation to high exposure to maternal smoking in Finland. The results suggest that more efforts should be directed to reducing tobacco smoke exposure of children in both Finland and Russia. (250 words).     

Smoking in prisons: the need for effective and acceptable interventions

Tobacco-smoking prevalence has been decreasing in many high-income countries, but not in prison. We provide a summary of recent data on smoking in prison (United States, Australia, and Europe), and discuss examples of implemented policies for responding to environmental tobacco smoke (ETS), their health, humanitarian, and ethical aspects. We gathered data through a systematic literature review, and added the authors' ongoing experience in the implementation of smoking policies outside and inside prisons in Australia and Europe. Detainees' smoking prevalence varies between 64 per cent and 91.8 per cent, and can be more than three times as high as in the general population. Few data are available on the prevalence of smoking in women detainees and staff. Policies vary greatly. Bans may either be 'total' or 'partial' (smoking allowed in cells or designated places). A comprehensive policy strategy to reduce ETS needs a harm minimization philosophy, and should include environmental restrictions, information, and support to detainees and staff for smoking cessation, and health staff training in smoking cessation.     

Tobacco use behaviors and household smoking bans among Chinese Americans

PURPOSE: To assess the relationship between household smoking restrictions and smoking patterns among Chinese American adults. DESIGN: This is a cross-sectional analysis based on a National Institutes of Health-funded population-based household and telephone survey of 2537 Chinese American adults. SETTING: Two communities in New York City. SUBJECTS: The analyses focused on male current smokers (N = 600). MEASURES: Demographic characteristics, smoking status, household smoking restrictions, cigarettes smoked per day, and past quit attempts were based on self-reported data. RESULTS: Among current smokers, 37% reported living in a home with a complete smoking ban. Smokers with a full household smoking ban smoked fewer cigarettes on weekdays and weekends than smokers with no household smoking ban (p < or = .05) and were 3.4 times (p < .01) more likely to report having at least one quit attempt in the past 12 months. Smokers with knowledge of the dangers of environmental tobacco smoke (ETS) exposure were 2.8 times (p < or = .01) more likely to have at least one quit attempt in the last 12 months compared with those who were unaware of the danger of ETS and more likely to live in a smoke-free household. CONCLUSIONS: Smoke-free home policies and interventions to raise awareness among smokers of the dangers of ETS have the potential to significantly reduce tobacco use and exposure to household ETS among this immigrant population.     

Health impact of environmental tobacco smoke in the home

Environmental tobacco smoke (ETS) can be a major constituent of air pollution in indoor environments, including the home. Regulation on smoking in the workplace and public places has made the home the dominant unregulated source of ETS, with important potential impacts on children. Between 40% and 60% of children in the United Kingdom are exposed to ETS in the home. Many experimental and human and studies have investigated the adverse health effects of ETS. Substantial evidence shows that in adults ETS is associated with increased risk of chronic respiratory illness, including lung cancer, nasal cancer, and cardiovascular disease. In children, ETS increases the risk of sudden infant death syndrome, middle ear disease, lower respiratory tract illness, prevalence of wheeze and cough, and exacerbates asthma. Although banning smoking in the home would be the optimal reduction strategy, several barrier and ventilation methods can be effective. Nevertheless, such methods are not always practical or acceptable, particularly when social pressures contribute to a lack of support for ETS control in the home. Smoking cessation interventions have had limited success. Research is needed to explore the barriers to adopting ETS risk-reducing behaviors.