Avoidance of smoky establishments: findings from Erie and Niagara Counties in New York.

The objective of this study was to determine the extent to which people avoid smoky restaurants, bars, bowling alleys, casinos, and bingo halls because of secondhand smoke. Data were collected with telephone interviews of a sample of 1,548 randomly selected adults in Erie and Niagara Counties between October 2002 and March 2003. Most nonsmokers (71%) reported that they are bothered by secondhand smoke. Thirty-four percent of nonsmokers and 10% of smokers responded that they had avoided patronizing a smoky establishment in the past 12 months. The places that were most often avoided were restaurants (17%), bars or taverns (13%), and bingo halls (9%).     

Smoky indoor cooking fires are associated with elevated hemoglobin concentration in iron-deficient women.

OBJECTIVE: Indoor air pollution from the burning of such biomass fuels as wood and agricultural waste is associated with a higher risk of a number of respiratory problems. The effect on other health outcomes, such as fetal growth, has not yet been adequately documented. The objective of this study was to determine whether, among women who burn biomass fuels for cooking indoors, the use of "smoky" fires is associated with elevated hemoglobin concentration in comparison to women using "smokeless" stoves, that is, stoves that are designed to reduce indoor air pollution. This research was conducted as part of a series of preliminary studies to determine the feasibility and potential health benefits of a randomized stove intervention to reduce indoor air pollution from the burning of biomass fuels for cooking. METHODS: A cross-sectional observational study was conducted in rural highland communities of Guatemala from March to August 1994. Venous blood samples were collected and analyzed for hemoglobin and ferritin. All the women studied burned biomass fuels and cooked indoors, and none of the women was pregnant. Eighty-nine indigenous women using smokeless stoves (designated as the not-exposed group) and 185 indigenous women from the same communities using smoky fires (the exposed group) were studied. Multiple linear regression analyses were used to investigate the relationship between exposure (smokeless stove or smoky fire) and hemoglobin concentration, with adjusting for potential confounding factors. RESULTS: No effect of exposure (smokeless stove or smoky fire) on hemoglobin concentration was found in univariate or multivariate analyses. In routine post hoc analysis to determine whether hemoglobin elevation is observed in some particular subgroup, we found that the use of a smoky fire was associated with a 5.2 g/L elevation in hemoglobin concentration among women with low ferritin stores (P < 0.10). CONCLUSIONS: The elevation of hemoglobin concentration through exposure to indoor air pollution resulting from the burning of biomass fuels in smoky fires for cooking could have important implications for the diagnosis of anemia. However, considering the observational nature of this study, further research using more rigorous measures of exposure to carbon monoxide as well as additional measures of iron status are needed to confirm the relationships among iron status, exposure to smoke from the burning of biomass fuels indoors, and hemoglobin concentration of women living at moderately high altitude. Further study of this matter could help to assure that appropriate adjustments to anemia cutoffs are made, if warranted, and could assist in clarifying potentially negative outcomes of exposure to smoke from biomass fuels burned indoors.     

Characteristics of and Issues Faced by Rural Female Family Physicians

The purpose of this study was to identify characteristics of and issues faced by female family physicians practicing in rural areas. A 37-item survey was designed to obtain demographic information about the background, community and practice of rural female physicians. An open-ended question regarding the issues and problems faced by female physicians in rural communities was included. Study subjects were identified from the membership of the American Academy of Family Physicians (AAFP). The questionnaire was mailed to all 850 active female AAFP members practicing in communities with less than 50,000 inhabitants during the winter of 1999. Completed and usable surveys were received from 587 (69.9 percent). The average age of respondents was 45. The majority were married (81.1 percent) and had children (80.1 percent). Half of the women had grown up in communities of 25,000 or less population. Twenty-seven percent of the respondents had no rural exposure in medical school; 39 percent had no rural exposure in residency; and 16 percent had no rural exposure in medical school or residency. The majority of respondents (62 percent) practiced in communities of less than 10,000. A large majority (70 percent) of these women planned to stay in the community for 10 years or more, with 58.6 percent responding that they plan to stay indefinitely. Assumptions regarding rural physicians, especially women, must be updated to accurately assist communities in recruiting rural physicians and to assist medical schools and residencies in adequately preparing graduates for rural practice.     

Obstructive airway diseases in women exposed to biomass smoke

The majority of women living in rural areas in Turkey use biomass fuels for domestic energy and are exposed to high levels of indoor air pollution every day. The objective of this study was to compare the presence of chronic airway diseases (CAD) in two groups of nonsmoking women older than 40 years with (exposed group, n=397) and without a history of exposure to biomass cooking (liquid petroleum gas (LPG); control group, n=199), in 2002 in Kirikkale, Turkey. Detailed respiratory symptoms were collected with a standard questionnaire adapted from that of the British Medical Research Council. Exposure was calculated as the average hours spent daily for cooking multiplied by the number of years. CAD were defined as either chronic airway obstruction (CAO; (forced expiratory volume in 1s/forced vital capacity)<0.70), chronic bronchitis, or chronic bronchitis with CAO. The prevalence of CAD in the exposed group was found to be higher than that in the LPG group (28.5% vs. 13.6%, crude odds ratios (ORs) 2.5 (1.5--4.0), P=0.0001). The fraction of CAD attributed to exposure to biomass smoke after adjusting for possible confounding factors was 23.1% (95% confidence interval (CI) 13.4--33.2). Acute symptoms during exposure to biomass smoke were important predictors for the presence of CAD. Biomass smoke pollution is an important contributing factor in the development of CAD in nonsmoking women living in a rural area. The presence of acute symptoms during cooking in women in rural areas should signal to general practitioners the possibility of CAD.     

农村环境烟雾暴露与家族史对女性慢性支气管炎的交互作用研究

目的 探讨湖南省浏阳市农村女性环境烟雾暴露及慢性支气管炎(慢支)家族史与慢支的关系,及二者之间的交互作用.方法 采用以人群为基础的病例对照研究方法,应用X2检验分析环境烟雾暴露及慢支家族史与慢支的关系,应用相加效应模型分析农村女性环境烟雾暴露与慢支家族史的交互作用.结果 在第一阶段对农村24 268名女性居民筛查中发现慢支患者157例(患病率6.47‰),第二阶段病例对照研究最终调查慢支患者92例,健康对照114人.结果 显示,使用煤炭/柴草取暖(OR=36.21)及慢支家族史(OR=6.41)可能是女性患慢支的危险因素(P＜0.05);经常下厨及使用煤炭/柴草取暖与慢支家族史有明显的正交互作用,交互作用指数分别为5.39和9.02;交互作用归因危险比分别为72%和88%;交互作用相对超额危险度分别为6.50和225.99.结论 使用煤炭/柴草取暖和慢支家族史可能是女性慢支的危险因素,经常下厨、使用煤炭/柴草取暖与慢支家族史之间有正交互作用.     

Indoor air pollution and its effect on pulmonary function of adult non-smoking women: III. Passive smoking and pulmonary function

The association between pulmonary function and exposure to tobacco smoke in the home was investigated in a sample of adult, non-smoking women living in a rural area. The women were all participants in a large longitudinal survey on the natural history and determinants of chronic non-specific lung disease. On cross-sectional analysis, several pulmonary function parameters were found to be significantly associated with exposure to tobacco smoke in the home. There was no association between exposure and pulmonary function decline.     

Rural print media portrayal of secondhand smoke and smoke-free policy

The purpose of this article is to describe how the print media portrays secondhand smoke and smoke-free policy in rural communities. Baseline print media clips from an ongoing 5-year study of smoke-free policy development in 40 rural communities were analyzed. The authors hypothesized that community population size would be positively associated with media favorability toward smoke-free policy. Conversely, pounds of tobacco produced and adult smoking prevalence would be negatively associated with media favorability. There was a positive correlation between population size and percentage of articles favorable toward smoke-free policy. The authors did not find a correlation between adult smoking or tobacco produced and media favorability toward smoke-free policy, but we did find a positive relationship between tobacco produced and percentage of pro-tobacco articles and a negative relationship between adult smoking prevalence and percentage of articles about health/comfort. Implications for targeting pro-health media in rural communities as well as policy-based initiatives for tobacco control are discussed.     

Occupational and Environmental Risk Factors for Asthma in Rural Communities in China

Abstract

Respiratory allergens such as dust, gases/fumes, and hay smoke, which are frequently present in agricultural settings, can cause or aggravate asthma. The purpose of this study was to examine the relationships between occupational and environmental exposures and asthma in Chinese rural communities. The study population consisted of 28,946 people 15 years old or older, living in rural areas of Anhui province, China. A modified Mandarin translation of the ATS-DLD questionnaire was administered by trained interviewers to request information about exposures to specific occupational/environmental agents and respiratory disorders. In Huaining, the prevalence of wheezing was 3.8% for men; 2.1% for women; the prevalence of asthma was 1.6% for men; 1.8% for women. In Zongyang, the prevalence of wheezing was 2.7% for men; 1.9% for women; the prevalence of asthma was 1.7% for men; 1.2% for women. With control for potential confounders such as gender, age, residential area, education level, and smoking status, the pooled adjusted odds ratios (ORs) of wheezing and asthma for the group exposed to wood/hay smoke were 1.36 (95% CI: 1.14–1.61) and 1.27 (95% CI: 1.021.58), respectively. For coal-stove users, the pooled adjusted ORs were 1.47 (95% CI: 1.091.98) for wheezing and 1.51 (95% CI: 1.05–2.17) for asthma. After stratification of the subjects by dust type, the estimated ORs for wheezing were 1.58 (95% CI: 1.02–2.44) among the group exposed to inorganic dust and 3.03 (95% CI: 1.25–7.33) among the group exposed to metal dust. Asthma was not shown to be significantly associated with any specific dust type. Findings of the present study are consistent with previously reported adverse respiratory health effects related to occupational/environmental exposures to wood/hay smoke and dust, and indicate the need for further occupational disease surveillance in rural communities.     

Peer Reviewed: Demographic and Geographic Differences in Exposure to Secondhand Smoke in Missouri Workplaces, 2007-2008

Introduction

African Americans, Hispanics, service and blue-collar workers, and residents of rural areas are among those facing higher rates of workplace secondhand smoke exposure in states without smokefree workplace laws. Consequently, these groups also experience more negative health effects resulting from secondhand smoke exposure. The objective of this study was to examine disparities in workplace secondhand smoke exposure in a state without a comprehensive statewide smokefree workplace law and to use this information in considering a statewide law.

Methods

We developed a logistic multilevel model by using data from a 2007-2008 county-level study to account for individual and county-level differences in workplace secondhand smoke exposure. We included sex, age, race, annual income, education level, smoking status, and rural or urban residence as predictors of workplace secondhand smoke exposure.

Results

Factors significantly associated with increased exposure to workplace secondhand smoke were male sex, lower education levels, lower income, living in a small rural or isolated area, and current smoking. For example, although the overall rate of workplace exposure in Missouri is 11.5%, our model predicts that among young white men with low incomes and limited education living in small rural areas, 40% of nonsmokers and 56% of smokers may be exposed to secondhand smoke at work.

Conclusion

Significant disparities exist in workplace secondhand smoke exposure across Missouri. A statewide smokefree workplace law would protect all citizens from workplace secondhand smoke exposure.     

"One country,two systems": Sociopolitical implications for female migrant sex workers in Hong Kong

Background

The burning of biomass fuels results in exposure to high levels of indoor air pollution, with consequent health effects. Possible interventions to reduce the exposure include changing cooking practices and introduction of smoke-free stoves supported by health education. Social, cultural and financial constraints are major challenges to implementation and success of interventions. The objective of this study is to determine awareness of women in Gondar, Ethiopia to the harmful health effects of cooking smoke and to assess their willingness to change cooking practices.

Methods

We used a single, administered questionnaire which included questions on household circumstances, general health, awareness of health impact of cooking smoke and willingness to change. We interviewed 15 women from each of rural, urban-traditional and middle class backgrounds.

Results

Eighty percent of rural women cooked indoors using biomass fuel with no ventilation. Rural women reported two to three times more respiratory disease in their children and in themselves compared to the other two groups. Although aware of the negative effect of smoke on their own health, only 20% of participants realised it caused problems in children, and 13% thought it was a cause for concern. Once aware of adverse effects, women were willing to change cooking practices but were unable to afford cleaner fuels or improved stoves.

Conclusion

Increasing the awareness of the health-effects of indoor biomass cooking smoke may be the first step in implementing a programme to reduce exposure.     

Disadvantaged mothers, young children and smoking in the home: mothers' use of space within their homes

Breathing tobacco smoke is linked to poor health in young children, with their homes identified as the primary place of exposure. This UK study uses focus group discussions to explore how mothers living in disadvantaged areas use space within their homes to smoke while looking after children aged 0-4 years, and critically examines how they define non-smoking or smoking homes. Many women imposed temporary and ad hoc restrictions, and this research highlights how the mothers' desire to create a smoke-free environment for their children competes with their caring responsibilities, and how their efforts are restricted by the limitations of the physical environment of their homes.     

Urinary levoglucosan levels in Austrian communities differing in agrarian quota

Levoglucosan is a sugar anhydride produced by combustion of carbohydrates. In ambient monitoring it serves as an indicator for wood smoke. Its use in human biomonitoring, however, is not yet widespread. This study investigated whether levoglucosan in urine is a suitable biomarker for regional differences in wood smoke exposure in the winter season.Within the first Austrian biomonitoring survey, pooled urine samples from mothers as well as children of five communities of different size (two-stage random stratified sampling) were analysed by HPLC. As an indicator of exposure to polycyclic aromatic hydrocarbons (PAH) that are also prevalent in wood smoke, 1-hydroxypyrene was determined.In each town levoglucosan was found in higher levels in the pooled children's samples than in the pooled mothers’ samples. It correlated well with the agrarian quota. 1-Hydroxypyrene concentrations were higher in areas with higher population density.Correlation of urinary levoglucosan concentrations with the agrarian quota may be explained by higher wood smoke exposure in communities with higher agrarian quota.To our knowledge this study is the first investigation on this issue in Europe. It indicates that human biomonitoring of levoglucosan may be suitable to detect differences in regional exposure to wood smoke.     

Pregnancy experiences of women in rural Romania: understanding ethnic and socioeconomic disparities

Women in rural Romania face significant health disadvantages. This qualitative pilot study describes the structural disadvantage experienced during pregnancy by women in rural Romania, focusing on the lived experiences of Roma women. We explore how women in rural communities experience pregnancy, their interactions with the healthcare system, and the role that ethnic and social factors play in pregnancy and childbearing. We conducted 42 semi-structured interviews with health and other professionals, seven narrative interviews with Roma and non-Roma women and a focus group with Roma women. Data were analysed using thematic analysis. We identified intersectional factors associated with women’s pregnancy experiences: women perceiving pregnancy as both unplanned and wanted, joyful, and normal; women’s and professionals’ differing prenatal care perceptions; transport and cost related barriers to care; socioeconomic and ethnic discrimination; and facilitators to care such as social support, having a health mediator and having a doctor. Talking directly with professionals and Roma and non-Roma women helped us understand these many factors, how they are interconnected, and how we can work towards improving the pregnancy experiences of Roma women in rural Romania.     

Health of women living near oil wells and oil production stations in the Amazon region of Ecuador]

OBJECTIVE: Investigate the environmental conditions in and the state of health of women who live in rural communities surrounded by oil wells and oil production stations in the Amazon region of Ecuador. METHOD: We used a comparative cross-sectional design, classifying exposure according to the location of the communities with respect to the oil wells and production stations. Water samples from the local rivers were analyzed to determine total petroleum hydrocarbons, and a structured questionnaire was used with the head of each family in the study. The study was performed in rural communities in northeastern Ecuador from November 1998 through April 1999. The study included 9 communities in the exposed area (368 participants) and 14 communities in the unexposed area (291 participants). RESULTS: The rivers of the exposed communities showed contamination levels much above the limits acceptable for human use. Statistically significant differences between the exposed communities and the unexposed communities were found for the prevalence of skin fungi for the two weeks prior to the study (odds ratio (OR) = 1.37; 95% confidence interval (CI) = 1.01-1.86) as well as for nasal irritation (OR = 2.18, 95% CI = 1.64-2.91) and for throat irritation (OR = 1.68, 95% CI = 1.02-2.75) in the preceding 12 months. Also associated with exposure in the two preceding weeks were fatigue and the category of "other symptoms"; similarly associated with exposure in the preceding 12 months were headaches, eye irritation, earaches, diarrhea, and gastritis. CONCLUSIONS: The symptoms found among the participants in the exposed communities match the toxicity symptoms caused by oil. There is an urgent need to establish an adequate environmental control and remediation program in order to prevent unnecessary and unacceptable health hazards for these populations.     

HIV-related Stigma in Rural and Tribal Communities of Maharashtra,India

Stigma is a recognized barrier to early detection of HIV and causes great suffering for those affected. This paper examines HIV-related stigma in rural and tribal communities of Maharashtra, an area of relatively high HIV prevalence in India. The study used a mix of qualitative and quantitative methods to compare adult women and adolescents in a rural area, women in a rural area, and women in a tribal area. The respondents included 494 married women and 186 adolescents in a rural community and 49 married women in six tribal villages. HIV-related stigma was prevalent in all communities and was the highest among tribal and older respondents. High-risk behaviour was reported in both areas, accompanied with denial of personal risk. Our findings suggest that HIV may be spreading silently in these communities. To our knowledge, this is the first community-based study to make an in-depth assessment of HIV-related stigma in rural and tribal areas of India. By situating our findings within the broader discourse on stigma in the national and state-level data, this study helps explain the nature and persistence of stigma and how to address it more effectively among subcultural groups in India.Key words: Community, HIV-related stigma, Rural health, Tribal, India     

Peat bog wildfire smoke exposure in rural North Carolina is associated with cardiopulmonary emergency department visits assessed through syndromic surveillance

Background: In June 2008, burning peat deposits produced haze and air pollution far in excess of National Ambient Air Quality Standards, encroaching on rural communities of eastern North Carolina. Although the association of mortality and morbidity with exposure to urban air pollution is well established, the health effects associated with exposure to wildfire emissions are less well understood.Objective: We investigated the effects of exposure on cardiorespiratory outcomes in the population affected by the fire.Methods: We performed a population-based study using emergency department (ED) visits reported through the syndromic surveillance program NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool). We used aerosol optical depth measured by a satellite to determine a high-exposure window and distinguish counties most impacted by the dense smoke plume from surrounding referent counties. Poisson log-linear regression with a 5-day distributed lag was used to estimate changes in the cumulative relative risk (RR).Results: In the exposed counties, significant increases in cumulative RR for asthma [1.65 (95% confidence interval, 1.25–2.1)], chronic obstructive pulmonary disease [1.73 (1.06–2.83)], and pneumonia and acute bronchitis [1.59 (1.07–2.34)] were observed. ED visits associated with cardiopulmonary symptoms [1.23 (1.06–1.43)] and heart failure [1.37 (1.01–1.85)] were also significantly increased.Conclusions: Satellite data and syndromic surveillance were combined to assess the health impacts of wildfire smoke in rural counties with sparse air-quality monitoring. This is the first study to demonstrate both respiratory and cardiac effects after brief exposure to peat wildfire smoke.     

Burden of Household Environmental Tobacco Smoke on Medical Expenditure for Japanese Women: A Population-Based Cohort Study

Background

The economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women.

Methods

This population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors.

Results

We analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum.

Conclusions

We calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS.Key words: secondhand smoke, tobacco smoke pollution, longitudinal study, environment and public health, health care costs     

Passive smoking in Germany and Poland: comparison of exposure levels, sources of exposure, validity, and perception.

Nonsmoking females age 35-65 years from Bremen, Germany (91 women), and Opole, Poland (98 women), were interviewed about their recent passive smoking exposure. We obtained urine samples at the time of interview and determined the concentration of cotinine as an indicator of tobacco smoke exposure. In Poland and in Germany, the vast majority of nonsmoking women are involuntarily exposed to environmental tobacco smoke (ETS). Polish women had slightly higher exposure levels than German women, with overall means of 9.93 and 8.65 ng cotinine/mg creatinine, respectively. Smoking by the husband was the major source of exposure in both study groups. In the Polish group, the work place was also an important source of ETS exposure. The validity of self-reported passive smoking exposure was found to be generally good; it was somewhat better in the German study group. A negative attitude toward tobacco smoke was slightly stronger among the German women. The percentage of women misreporting their active smoking status was low.     

2015年陕西省成人吸烟及“二手烟”现状调查

目的 描述2015年陕西省成人吸烟、“二手烟”、戒烟、日均吸烟量的流行水平。方法 采用多阶段整群随机抽样的方法选择调查对象,对陕西省监测点覆盖的监测人群,年龄18岁及以上进行入户面访调查,采用现在吸烟率、“二手烟”暴露率、对主动和被动吸烟的危害认知率、戒烟率等指标,依据抽样权重进行加权计算。结果 陕西省18岁及以上年龄吸烟率32.73%,现在吸烟率28.30%,男性和女性的现在吸烟率为53.78%和1.64%;城市现在吸烟率为24.52%,农村31.53%;每日吸烟率25.32%;现在每日吸烟者日均吸烟量16.98支,男性日均吸烟量17.14支,女性日均吸烟量9.74支;人群戒烟率为13.54%,男性戒烟率13.43%,女性17.11%;城市戒烟率13.90%,农村戒烟率13.30%;“二手烟”暴露率65.14%,对吸烟引起中风、心脏病、肺癌疾病的知晓率为30.8%,对被动吸烟引起成人心脏疾病、儿童肺部疾病、成人肺癌疾病的知晓率为36.0%。结论 陕西省18岁及以上居民的人群吸烟及“二手烟”暴露比较严重,戒烟率偏低,对烟草危害知识认知不足。     

Factors associated with past household exposure to tobacco smoke

With data that were obtained in a private census in Washington County, Maryland, in 1963, the prevalence of household exposure to tobacco smoke was determined, and factors associated with passive smoke exposure were identified among 48,342 white adults. In 1963, 52% of men and 72% of women were exposed to smoke from others at home. Smokers of both sexes were more likely to live with other smokers than were nonsmokers. However, 30% of men who never smoked and 64% of women who never smoked lived with smokers. Marriage was a primary determinant of exposure for women but not for men, with 75% of married women who did not smoke exposed but only 38% of unmarried women who did not smoke exposed. Conversely, among men who did not smoke, exposure was more common among those who were not married than among those who were married. After control for other factors associated with exposure, exposure prevalence increased with years of school among men who did not smoke but decreased with years of school among women who did not smoke. Exposure prevalence also varied slightly with housing quality and location of residence. Smoking by spouse was an accurate reflection of household exposure for women but not for men; 88% of the exposure among women who did not smoke was contributed by the spouse, whereas only 62% of exposure among men who did not smoke was from the spouse.