The impact of parental smoking on asthma and wheezing. SIDRIA Collaborative Group. Studi Italiani sui Disturbi Respiratori nell'Infanzia e l'Ambiente.

To evaluate the impact of parental smoking on childhood asthma and wheezing, we studied two random samples of subjects ages 6-7 and 13-14 years in ten areas of northern and central Italy. Standardized questionnaires were completed by parents of 18,737 children and 21,068 adolescents (response rates, 92.8% and 96.3%, respectively) about their smoking habits and the respiratory health of their children. Adolescents were asked about their respiratory health and personal smoking. We compared two groups of cases with healthy subjects: (1) "current asthma" (children, 5.2%; adolescents, 6.2%) and (2) "current wheezing" not labeled as asthma (children = 4.5%, adolescents = 8.5%). Exposure to smoke of at least one parent increased the relative risk of current asthma among children [odds ratio (OR) = 1.34; 95% confidence interval (CI) = 1.11-1.62] and of current wheezing among adolescents (OR = 1.24; 95% CI = 1.07-1.44). Maternal smoking had a stronger effect than paternal smoking. Maternal smoking during pregnancy was associated with current asthma (OR = 1.62; 95% CI = 1.34-1.96) and current wheezing in children (OR = 1.31; 95% CI = 1.06-1.62); the effects were lower among adolescents. Among subjects with a negative history of parental asthma, maternal smoking was associated with current wheezing in both age groups, whereas among those with a positive history of parental asthma it was associated with current asthma in children, but not in adolescents. We estimated that 15% (95% CI = 12-19) of the current asthma cases among children and 11% (95% CI = 8.3-14) of the current wheezing cases among adolescents are attributable to parental smoking in Italy.     

Smoking and its associated factors in Portuguese adolescent students

OBJECTIVE: To describe smoking habits and to identify their determinants in adolescent students. METHODS: A cross-sectional study was carried out on smoking habits comprising 1,052 girls and 984 boys aged 13 years attending public and private schools in the city of Porto, Portugal. The proportion of participation was 77.5%. Information on sociodemographic and behavioral characteristics was obtained from a questionnaire filled out at home by participants and their parents. At school, another self-administered questionnaire was used to obtain information about tobacco use. Several independent samples were compared using the Kruskal-Wallis test and proportions were compared by Chi-square test. Odds ratio and 95% confidence intervals were calculated by unconditional logistic regression. RESULTS: Overall, 19.9% (22.4% of girls and 17.1% of boys) students only had ever experimented smoking but were not smokers; 1.8% (2.0% of girls and 1.5% of boys) were occasional smokers and 1.3% (2.0% of girls and 0.4% of boys) smoked at least one cigarette/day. Curiosity was the main reason given by adolescents to experiment smoking (48.4% of girls and 45.6% of boys). After adjustment to parental, siblings' and friends' smoking habits, the stronger association was with the smoking habits of their friends for both girls (OR=4.03; 95% CI: 2.69-6.04) and boys (OR=5.39; 95% CI: 3.34-8.70). CONCLUSIONS: A high proportion of students had ever experimented smoking. Smoking habits among peers proved to be the strongest determinant of smoking during adolescence.     

Cigarette smoking and breast cancer.

An epidemiological case-control study was conducted in New York State, with 1617 primary breast cancer patients and an equal number of controls, to examine the relationship between cigarette smoking and breast cancer. Results showed no overall association between ever smokers versus never smokers and breast cancer risk (odds ratio [OR] = 1.03, 95% confidence interval [CI]: 0.90-1.19), nor was there any dose response trend observed with increased levels of smoking. In addition, no association was found with risk and age started smoking, age stopped smoking, amount smoked or total years smoked. Controlling for previously identified risk factors for breast cancer in the analysis did not significantly alter these relationships. Previous studies have found a difference in menopausal age among smokers compared to nonsmokers. The mean menopausal age was only slightly lower in smokers than in never smokers for both cases and controls. Breast cancer risk was observed to be close to unity for premenopausal women (OR = 0.97, 95% CI: 0.74-1.34) and postmenopausal women (OR = 1.06, 95% CI: 0.91-1.26). A recent study suggested breast cancer risk was more strongly related to starting smoking at a young age among women who smoked at least 25 or more cigarettes per day in the most recent year of smoking. This hypothesis was not supported by these data.     

Prevalence of youth access to alcohol, guns, illegal drugs, or cigarettes in the home and association with health-risk behaviors

PURPOSE: To describe the prevalence of access to alcohol, guns, drugs, or cigarettes in the home and its association with related health-risk behaviors among adolescents.METHODS: We analyzed cross-sectional data from the 1995 in-home survey of the National Longitudinal Study on Adolescent Health which used a nationally representative school-based sample (N = 6,504) of adolescents in grades 7-12. We used logistic regression analysis, adjusted for gender, race/ethnicity and age, to examine the associations between access to alcohol, guns, drugs, and cigarettes in the home and the practice of risk behaviors involving those variables.RESULTS: Overall, 1,817 (28%) adolescents reported having easy access to alcohol in the home, 1,616 (25%) had access to a gun, 189 (3%) had access to drugs, and 2,067 (32%) had access to cigarettes. Associations were found between easy home access to alcohol and drinking during the past 12 months (Adj. OR = 2.16, 95% CI = 1.89-2.47), ever being drunk at school (Adj. OR = 2.33, 95% CI = 1.85-2.95, and ever driving drunk (Adj. OR = 1.64, 95% CI = 1.29-2.09). Access to a gun at home was associated with carrying a gun to school (Adj. OR = 2.54, 95% CI = 1.40-4.64). Associations were also found between access to drugs and cigarettes in the home and ever using drugs and smoking regularly.CONCLUSIONS: Easy access to alcohol, guns, and cigarettes in the home is prevalent among adolescents and may increase involvement in risky behaviors. Limiting access therefore is important in order to reduce the occurrence of health-risk behaviors associated with substance use, deliquency and injury among adolescents.     

青春期性发育对青少年吸烟行为的影响

目的 研究青春期性发育早晚对青少年吸烟行为的影响。方法 2000年11月对随机整群抽取的1453名上海市高中学生进行横断面问卷调查，获取青少年吸烟，男孩首次遗精年龄，女孩月经初潮年龄及可能影响青少年吸烟的社会心理因素等信息。结果 男生的尝试吸烟率在性发育较晚组中最高（28．6％），其次为发育较早（21．3％）和中等组（21．7％）；现在吸烟率在性发育较早组最高（16．4％），然后依次为发育较晚（7．1％）和中等组（4．8％）；女生的曾经吸烟率在性发育早，中，晚各组中依次为24．2％，12．0％，6．3％。在控制影响青少年吸烟的一系列社会心理因素后，性发育较早是导致男生现在吸烟的独立危险因素（OR＝3.68,95%,CI:1.23-10.99)，也是女生吸烟的危险因素（OR＝2.23,95%,CI:0.89-5.60)；而性发育较晚可能导致男生尝试吸烟（OR＝1．48，95％CI：0．72－3．06），对女性却可能有一定的保护作用（OR＝0.64,95%CI:0.22-1.86)。结论 学校，家庭和社会应该关心，引导性发育时间偏离正常的男女青少年，加强吸烟危害健康教育。     

Lung cancer risk of workers in shoe manufacture and repair

BACKGROUND: The occupational lung cancer risk in manufacturing and repair of shoes was studied by pooling of two major case-control studies from Germany. METHODS: Some 4184 incident hospital-based cases of primary lung cancer and 4253 population controls, matched for sex, age, and region of residence were intensively interviewed with respect to their occupational and smoking history. Based on the occupational coding and a free text search, all individuals who had ever worked in shoe manufacturing or repair for at least half a year were identified. Shoemaker-years were calculated as the cumulated duration of working in shoe manufacturing or repair. Odds ratios (OR) and 95% confidence intervals (CI) were calculated via conditional logistic regression. Additional adjustment for smoking and occupational asbestos exposure was used. RESULTS: Seventy-six cases and 42 controls who had ever worked in shoe manufacture or repair (OR = 1.89, 95% CI: 1.29-2.78). After adjustment for smoking, this risk was lowered to 1.69 (95% CI: 1.09-2.62). Further adjustment for asbestos exposure only slightly changed the risk estimates upwards. The smoking adjusted OR in males was 1.50 (95% CI: 0.93-2.41) and 2.91 (95% CI: 0.90-9.44) in females. Logistic regression modeling showed a positive dose-effect relationship between duration of exposure in shoe manufacture and repair and lung cancer risk. The odds ratio for 30 years of exposure varied between 1.98 and 2.24 depending on the model specified. CONCLUSIONS: The study demonstrates an increased lung cancer risk for shoemakers and workers in shoe manufacturing. The risk seems to double after being 30 years in these occupations.     

Gas cooking and smoking habits and the risk of childhood and adolescent wheeze

The authors investigated the risk of wheezing illnesses in relation to contemporaneous pollutant exposures (gas cooking, heating, and smoking) in childhood and adolescence in a cohort of 2,289 United Kingdom subjects. Data from two questionnaires assessing wheezing at ages 7-8 and 15-17 years and one questionnaire on current and past pollutant exposures at age 16-18 years were studied (1987-1996). The 1,868 subjects returning all three questionnaires were divided into three groups representing childhood (10.5%), adolescent (10.9%), and persistent (i.e., both; 16.3%) wheezing and compared with 1,165 controls (62.4%) without wheezing. The estimated risks of childhood wheezing were increased by exposure to any gas in childhood (odds ratio (OR) = 1.47, 95% confidence interval (CI): 1.05, 2.04) and exposure to a gas hob in childhood (OR = 1.56, 95% CI: 1.13, 2.16) and were increased further in those persistently exposed. Risk of persistent wheezing in adolescence was paradoxically reduced by exposure to a gas hob (OR = 0.67, 95% CI: 0.50, 0.91), possibly because of selection avoidance. Contemporaneous exposure to combined smoking by both parents was associated with wheezing in all groups (odds ratios ranged from 1.62 (95% CI: 1.06, 2.46) to 1.93 (95% CI: 1.10, 3.38)). Maternal smoking alone was associated with persistent wheezing and with both childhood (OR = 1.90, 95% CI: 1.06, 3.39) and persistent (OR = 2.18, 95% CI: 1.15, 4.14) wheezing if smoking occurred throughout childhood and adolescence. The authors conclude that exposures to gas cooking and smoking in childhood and adolescence increase the overall risk of wheezing.     

Associations of cigarette smoking and alcohol consumption with advanced or multiple colorectal adenoma risks: a colonoscopy-based case-control study in Korea

The associations between alcohol consumption and cigarette smoking habits and the risk for colorectal adenomatous polyps according to the detailed clinical information about polyps were assessed in a large colonoscopy-based study. The study enrolled participants who visited the National Cancer Center of the Republic of Korea for cancer screening between April 2007 and April 2009. In 1,242 newly diagnosed colorectal adenoma patients and 3,019 polyp-free controls, past smokers (odds ratio (OR) = 1.31, 95% confidence interval (CI): 1.04, 1.65) and current smokers (OR = 1.70, 95% CI: 1.37, 2.11) had increased risks for adenomas compared with nonsmokers. Cigarette smoking conferred an even higher risk for advanced adenomas and 3 or more adenomas than for low-risk adenomas or a single adenoma. Dose-response relations were observed among the daily number of cigarettes smoked, the duration of smoking, the pack-years of smoking, and the risk for adenomas. A longer duration of alcohol consumption was associated with a higher risk for advanced adenomas (for >28 years of consumption: OR = 2.0, 95% CI: 1.10, 3.64) and 3 or more adenomas (OR = 2.19, 95% CI: 1.27, 3.76). In conclusion, cigarette smoking and alcohol consumption play roles in colorectal carcinogenesis, and the association differs by the clinical features of the adenomas.     

Fetal and Postnatal Exposure to Tobacco Smoke and Respiratory Health in Children

The aim of this paper was to find out whether fetal exposure to environmental tobacco smoke (ETS), as compared to postnatal ETS exposure, is an independent risk factor for respiratory symptoms and diseases in younger schoolchildren. The cross-sectional epidemiological study comprised population of 1,561 Polish schoolchildren, aged 9–11 years. Information on the exposure to tobacco smoke and other sources of indoor air pollution at home, respiratory and allergic health status, and socio-economic status of the family was obtained by questionnaire survey. The respiratory health status was described by presence of wheezing, attacks of dyspnoea (noted during the last year or ever), bronchitis, wheezy bronchitis and asthma, ever diagnosed by a physician. Multivariate logistic regression analysis with adjustment for age, sex, area of residence, household density, damp and mould stains found at home, use of coal-fired stove, co-habitant pets, mother’s education and paternal current and past smoking habit was used to assess the effect of fetal and postnatal exposures on respiratory health outcomes. The results of the multivariate analyses revealed statistically significant associations between fetal exposure to ETS and wheezing ever: log OR = 1.4 (95% CI: 1.0–2.0), attacks of dyspnoea ever: log OR = 1.8 (95% CI: 1.1–2.9), bronchitis: log OR = 2.1 (95% CI: 1.5–2.9), and wheezy bronchitis: log OR = 1.8 (95% CI: 1.1–2.9). The effect of postnatal ETS was statistically significant only for bronchitis: log OR = 1.4 (95% CI: 1.1–1.9). The results of our study showed that fetal exposure to tobacco smoke is an independent risk factor for symptoms of wheeze and wheezy bronchitis in schoolchildren when compared to postnatal ETS exposure.     

Smoking at home is strongly associated with symptoms of asthma and rhinitis in children of primary school age in Trinidad and Tobago.

OBJECTIVE: To compare, in the twin-island republic of Trinidad and Tobago, the prevalence of symptoms of asthma and rhinitis among children of primary school age who are exposed to household environmental tobacco smoke with the prevalence of these symptoms in their colleagues without this exposure. METHODS: Between September and December 2002, questionnaires based on the instrument developed for the International Study of Asthma and Allergies in Childhood (ISAAC) were distributed, via the children in their schools, to parents of 6,611 Year 2 pupils (typically 6 years old) or Year 3 pupils (typically 7 years old) in 106 randomly selected schools in Trinidad and Tobago (5,511 pupils on Trinidad and 1,100 pupils on Tobago). We added to the standard ISAAC questionnaires two questions, one on household smoking and one on the ethnicity of the children. RESULTS: A total of 3 170 completed questionnaires were suitable for further analysis (2,618 from Trinidad and 552 from Tobago). On Trinidad 782 of the children (29.9%) lived in homes where one or both parents smoked, and 513 (19.6%) had other relatives in the household who smoked. On Tobago 94 of the pupils (17.0%) had parents who smoked, and 84 (15.4%) came from homes where other residents smoked. Parental smoking was significantly associated with wheezing (odds ratio (OR): 1.43; 95% confidence interval (CI): 1.11-1.83), exercise-induced wheezing (OR: 2.12; 95% CI: 1.59-2.82), nocturnal coughing (OR: 1.64; 95% CI: 1.37-1.97), and symptoms of rhinitis (OR: 1.35; 95% CI: 1.10-1.65) in the last 12 months as well as a history of hay fever/sinus problems (OR: 1.39; 95% CI: 1.11-1.74). Smoking in the home by adult residents other than parents was also significantly associated with all of these symptoms as well as a history of asthma (OR: 1.49; 95% CI: 1.13-1.97). In terms of ethnic differences, parental smoking was most prevalent in the homes of South Asian students, while smoking by other adults in the home occurred most commonly in the households of pupils of mixed race. CONCLUSIONS: Even in Trinidad and Tobago, which is a tropical environment where more time is spent outdoors and homes have more open ventilation than in temperate climates, environmental tobacco smoke exposure is closely associated with an increased prevalence of symptoms of asthma and rhinitis in primary-school-aged children.     

亚甲基四氢叶酸还原酶基因C677T多态性与胃癌易感性的关系

目的 研究亚甲基四氢叶酸还原酶（MTHFR）基因C677T多态性及其和烟酒嗜好相互作用与胃癌中易感性的关系。方法 在上消化道癌高发区江苏省淮安市进行病例对照研究（胃癌患者107例，对照人群200名）。调查研究对象的生活习惯，采用PCR－RFLP技术检测研究对象的MTHFR基因型。结果 （1）胃癌组中MTHFR变异基因型拥有者的比例79．4％，显著高于对照组的68．5％（x^2=4.15,P=0.0416)。MTHFR变异基因型拥有者发生胃癌的危险性显著升高（OR＝1.78,95%,CI:0.99-3.22；性别和年龄调整OR＝1．89，95％CI：1．08－3．32）。（3）在MTHFR变异基因型拥有者中，伴有吸烟习惯者发生胃癌的OR为7．72％（95％CI：2．23－26．79），伴有经常饮酒习惯者发生胃癌的OR为3．08％（9T％CI：1．30－7．23）。与不吸烟，不经常饮酒的野生型纯合子MTHFR基因型拥有者相比，伴有吸烟的经常饮酒习惯的MTHFR变异基因型拥有者发生胃癌的OR为13．96％（95％CI：2．76－70．46）。结论 MTHFR C677T变异基因型与胃癌的易感性有关；吸烟和饮酒与MTHFR变异基因型在胃癌发生中有明显的协同作用。     

Correlates of smoking in pregnant women in six Brazilian cities

OBJECTIVE: To evaluate sociodemographic and lifestyle correlates of smoking in pregnant women sampled from hospitals. METHODS: A cross-sectional study was conducted in 5,539 pregnant women aged 20 or more who sought medical attention in prenatal clinics of affiliate hospitals of the Brazilian National Health System in the cities of Manaus, Fortaleza, Salvador, Rio de Janeiro, S?o Paulo, and Porto Alegre from 1991 to 1995. Interviews were conducted using a standardized questionnaire that covered sociodemographics and smoking habits before and during pregnancy. Current smoking was defined as smoking at least one cigarette/day, former smoking as reporting having smoked at least one cigarette/day but having quit, and never smoking as never having smoked one cigarette/day. RESULTS: Smoking during pregnancy was associated with lower education (OR=2.13; CI 95%: 1.76-2.57) and greater parity (OR=1.84; CI 95%: 1.53-2.21). Positive associations were also found with increased gestational age and alcohol consumption. No significant association was found with skin color or occupation status. A protective effect was observed for women married or living with a partner (OR=0.55 CI 95%: 0.42-0.72). Having Manaus' women as a reference, Porto Alegre's women showed the greatest risk for smoking in pregnancy (OR=5.00; CI 95%: 3.35-7.38), followed by S?o Paulo's (OR=3.42; CI 95%: 2.25-5.20), Rio de Janeiro (OR=2.53; CI 95%: 1.65-3.88) and Fortaleza's (OR=2.56; CI 95%: 1.74-3.78). CONCLUSIONS: The study findings are similar to those described in the literature regarding education, parity, and marital status. However, no association with skin color was seen in the multivariate analysis. Former smokers had sociodemographic characteristics more similar to non-smokers than former smokers.     

天津市区胃癌危险因素的配对病例对照研究

目的 进一步探讨各危险因素与胃癌的关系。方法 选取天津市市内六区1998年和1999年的189例新发胃癌病人并按性别、年龄、民族等配比条件选取该市189名健康人群进行1：1配对的病例对照研究,资料处理采用条件logistic回归分析。结果 多因素条件logistic回归分析显示胃癌的发病与下列4种因素关节密切：烟熏食品OR=2.34,95%CI：1.60-4.98;吸烟量OR=6.07,95%CI：1.26-7.16;喜食重盐饮食OR=1.95,95%CI：1.27-3.23;过量摄入动物肉类OR=1.46,95%CI：1.05-2.02。结论 经常食用烟熏食品、吸烟量大、喜食重盐饮食、过量摄入动物肉类可能是胃癌的危险因素。     

Preventable lifestyle risk factors for non-communicable diseases in the Pakistan Adolescents Schools Study 1 (PASS-1)

Objectives

The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents.

Methods

In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis.

Results

Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had ≥2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78).

Conclusions

Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders.     

Prevalence and risk factors for smoking among adolescents

OBJECTIVE: Tobacco smoking is one of the main causes of preventable disease and premature disability. The study was aimed at measuring smoking prevalence and related risk factors among adolescents. METHODS: A population-based cross-sectional study was carried out in a representative sample of 1,187 adolescents aged 10 to 19 years living in the urban area of Pelotas, southern Brazil. All adolescents were interviewed separately using a confidential coded questionnaire. Kaplan-Meier test was performed for survival curve analysis. RESULTS: The overall smoking prevalence rate in the sample was 12.1% (95% CI 10.3%-14%). Boys and girls had similar prevalence rates. The following were the risk factors for smoking found in the multivariate logistic regression analysis: older age (OR=28.7; 95% CI 11.5-71.4), older smoking siblings (OR=2.4; 95% CI 1.5-3.8), three or more smoking friends (OR=17.5; 95% CI 8.8-34.8) and low schooling (OR=3.5; 95% CI 1.5-8.0). CONCLUSIONS: The prevalence of smoking among adolescents in the city of Pelotas was high. Campaigns against tobacco use should be aimed at the community and families, targeting adolescents. The government must adopt legal actions in order to prevent adolescents to have access to to smoking.     

Tobacco Use and Other Risk Behaviors among Adolescents in an STD Clinic

Background. This study examined the potential for tobacco use and other health risk behavior interventions in the context of an urban sexually transmitted diseases (STD) clinic.Methods. A cross-sectional survey of two populations. Adolescents seen at an STD clinic or at the teen clinic of a community health center completed a self-administered computer survey in 1996. Risk behaviors, attitudes, and readiness to stop smoking were analyzed for 225 patients at the STD clinic and 248 patients at the teen clinic.Results. Compared with adolescents in the teen clinic, adolescents in the STD clinic were more likely to have smoked frequently (OR 1.7, 95% CI 1.1, 3.0), used any illegal drug (OR 2.7, 95% CI 1.3, 5.5), recently binged on alcohol (OR 1.7, 95% CI 1.0, 2.8), and had more than 10 lifetime sexual partners (OR 1.9, 95% CI 1.0, 3.4). Weapon carrying, readiness to stop smoking, and attitudes toward smoking did not differ between sites.Conclusions. Cigarette smoking and other health risk behaviors are more prevalent among adolescents in an STD clinic than among adolescents in a community health center. STD clinics are potential sites for cigarette, alcohol, and drug use interventions among “hard to reach” adolescents.     

Paternal and Maternal Smoking Habits before Conception and During the First Trimester: Relation to Spontaneous Abortion

PURPOSE: This study examined the association between maternal smoking before and during the first trimester of pregnancy and spontaneous abortion.

METHODS: We have been conducting a hospital-based case-control study on risk factors for spontaneous abortion in the greater Milan area. We collected information from 782 cases of spontaneous abortions and 1543 controls (women who delivered at term healthy infants).

RESULTS: With respect to never smokers, the odds ratio (OR) were 0.7 (95%, confidence interval (CI), 0.5–1.0) for women who quit smoking and 1.3 (95% CI, 1.0–1.6) for those who continued during pregnancy. Women who smoked more than 10 cigarettes/day in the first trimester were at increased risk of miscarriage, with an OR of 1.4 (95% CI, 1.0–2.1). No relationship was evident between the number of cigarettes smoked before conception and the risk of abortion. Likewise, no association emerged between paternal smoking and miscarriage. Moreover, no significant interaction or modification effect was obtained when strata of age and other major characteristics were investigated.

CONCLUSIONS: The risk of abortion associated with cigarette smoking during the first trimester of pregnancy was measurable and noticeable in this population, and accounted for 9% (95% CI, 6–13%) of all cases. The increased risk of spontaneous abortion in women smoking during pregnancy is a further reason to encourage pregnant women to quit.     

Modifiable risk factors for invasive meningococcal disease during an Edmonton, Alberta outbreak, 1999-2002

BACKGROUND: An outbreak of invasive meningococcal disease (IMD) in metro Edmonton, Alberta, Canada between December 1999 and June 2002 resulted in 84 laboratory-confirmed cases. Most cases were infected with Neisseria meningitidis serogroup C, and the highest age-specific incidence was observed in the 15-19 year age group. METHODS: A case-control study was conducted to identify modifiable IMD risk factors among outbreak cases. Two controls were matched to each case on age and sex, and were recruited through random-digit dialing. A questionnaire was telephone-administered to 132 study participants (44 cases, 88 controls). Conditional logistic regression was utilized to calculate risk measures. RESULTS: Multivariate analysis revealed three statistically significant risk factors: bar patronage (OR 35.2; 95% CI: 2.64-468), "rave" attendance (OR 12.8; 95% CI: 1.47-111) and maternal smoking (OR 8.88; 95% CI: 1.67-47.4). Humidifier use in the home was protective (OR 0.07; 95% CI: 0.009-0.64). CONCLUSION: While the precision of risk estimates was low in the multivariate model, this study has identified rave attendance as an emergent IMD risk factor.     

Prevalence and Predictors of Environmental Tobacco Smoke Exposure among Adolescents in Cambodia

Objective:

To estimate the prevalence and predictors of environmental tobacco smoke (ETS) exposure among nonsmoking adolescents in Cambodia.

Materials and Methods:

Analysis of data from the Global Youth Tobacco Survey (GYTS) conducted in 2003 in Cambodia. Data were analysed to obtain the prevalence of ETS exposure at home and elsewhere by age and gender. Logistic regression analysis was conducted to assess the association between ETS and gender, age, smoking status of parents and friends.

Results:

67.1% (64.0, 70.0) males and 67.4% (64.2, 70.5) females reported being exposed to ETS either at home or elsewhere. Adolescents who had one or both smoking parents had a more than three times the odds of ETS exposure at home (OR = 3.71; 95% CI (3.02, 4.57)). Those who had smoking friends were more likely to be exposed to ETS both at home and outside home (OR = 1.74; 95% CI (1.36, 2.24)). The overall proportion of adolescents exposed to ETS outside home was higher than those exposed at home (P < 0.001), suggesting that exposure in public areas was the main form of ETS among adolescents in Cambodia.

Conclusions:

Exposure to ETS is high among adolescent in Cambodia, which indicates an urgent need for specific measures, policies and regulations to protect nonsmoker Cambodian adolescents both within and outside home.     

Lung and bladder cancer in a Norwegian municipality with iron and steel producing industry: population based case-control studies

OBJECTIVES: To investigate the influence of occupation on the rising incidence of lung and bladder cancer among men in a Norwegian municipality where an iron and steel plant constituted the key industry between 1955 and 1989. METHODS: Based on the lung cancer cases reported to the Cancer Registry of Norway from 1980 to 1992 a population based case-control study was performed, including 86 cases and 196 controls. Information on occupations and smoking habits was collected through interviews and from the personnel files from the industrial plants. A case-control study on bladder cancer with 52 cases and 156 controls was carried out to cast light on the role of polycyclic aromatic hydrocarbons (PAHs). RESULTS: An odds ratio (OR) for lung cancer of 2.9 (95% confidence interval (95% CI) 1.2 to 6.7) was associated with exposure to PAHs. Based on data from personnel files, increased risk of lung cancer (OR 2.8 95% CI 1.1 to 7.0) was associated with work experience in the pig iron department at the ironworks. A non- significant OR of 1.8 was associated with exposure to asbestos. Bladder cancer was not associated with exposure to PAHs at the iron, steel, and coke plant, or with experience from any of the production departments at the plant. CONCLUSIONS: One fifth of the lung cancer cases were attributed to exposure to PAHs or asbestos. More than 80% of the cases of lung cancer were attributed to tobacco smoking. The cancer risk in the pig iron department may be due to a combination of exposures to PAH, asbestos, or dust of mixed composition.