Lifetime exposure to environmental tobacco smoke and cervical intraepithelial neoplasms among nonsmoking Taiwanese women

Cigarette smoke is one of the most important environmental risk factors for the development of cervical intraepithelial neoplasms (CINs). Given that the prevalence of cigarette smoking in Taiwanese women is very low, compared with Caucasian women (3-4% vs. approximately 28%, respectively), direct smoking is likely a minimal risk factor in the Taiwanese group. However, the evaluation of the association between indirect tobacco exposure, or exposure to environmental tobacco smoke (ETS), and CIN risk in Taiwanese women may be enlightening. The authors designed a community-based nested case-control study to examine the association between ETS exposure and CIN risk among Taiwanese women who were nonsmokers. The study was conducted in Chia-Yi, a city in southwestern Taiwan. The test population comprised adult females (n = 32,466) who had undergone Pap smear screening during the 14-mo period that preceded this study. Potential cases were chosen from individuals who demonstrated positive Pap smear results, which were indicative of at least a level II cervical intraepithelial neoplasm (i.e., > or = CIN2), as confirmed by cervical biopsy (n = 116). The authors chose 2 matched controls for each case; criteria used were (a) the 2 controls for each case had to be approximately the same age (+/- 2 yr) as the case; (b) each case and respective control lived in the same residential area; and (c) each control had a negative Pap smear, determined during the same time frame (+/- 6 mo) that the matched study subject was tested. A total of 100 study subjects and 197 control females (3 cases had only 1 control) underwent interviews by public health nurses, who obtained information about the participants' active and passive smoking histories and other potential risk factors. The incidence of cigarette smoking was low (5.0% [n = 5]) in study subjects and lower in controls (3.1% [n = 6]). The authors' final analysis was restricted to 89 nonsmoking pairs (89 subjects and 175 controls). Of the affected subjects, 85.4% reported exposure to passive smoke at home during their adulthood, vs. 61.1% of controls. The authors found that, after adjusting for other covariates, there was a 2.73-fold increased risk of contracting CIN (95% confidence interval [CI] = 1.31, 5.67) among ETS-exposed individuals. The authors assessed cumulative dose in terms of pack-years (i.e., average daily exposure [number of packs smoked] multiplied by the number of years the same exposure continued). Compared with nonsmokers, women exposed to 1-20 pack-yr and more than 20 pack-yr had 1.90-fold (95% CI = 0.72, 5.03) and 2.99-fold (95% CI = 1.10, 8.09) increased risks, respectively, of developing CIN. The authors concluded that lifetime ETS exposure is a major determinant for contracting cervical neoplasms among nonsmoking women in Taiwan.     

Restaurant smoking restrictions and environmental tobacco smoke exposure.

OBJECTIVES: This study evaluated the effectiveness of smoking restrictions. METHODS: We measured particulate concentrations in restaurants with different levels of allowable smoking. RESULTS: Mean particulate concentrations were 70% higher in establishments without smoking restrictions compared with those with partial smoking restrictions. Concentrations in nonsmoking restaurants were reduced by an additional 20% to 30%. Measurements of cadmium, an environmental tobacco smoke (ETS) marker, implicated ETS as the major source of particulate in restaurants that allowed smoking. CONCLUSIONS: Partial smoking restrictions substantially reduce, but do not eliminate, ETS exposure in restaurants. Occupants of nonsmoking restaurants avoid ETS exposure but may experience substantial particulate exposures from cooking emissions.     

Exposure to environmental tobacco smoke in restaurants without separate ventilation systems for smoking and nonsmoking dining areas

In this study, the author examined (a) levels of airborne pollutants from environmental tobacco smoke in 8 restaurants, and (b) changes in urinary cotinine and nicotine levels among 97 nonsmoking subjects (i.e., 40 restaurant employees, 37 patrons, and 20 referents). Airborne pollutant levels were significantly lower in the control environments than in the nonsmoking dining rooms in which smoking was not permitted, and the levels were significantly lower in the dining rooms in which smoking was not permitted than in the dining rooms in which smoking was permitted. Levels of urinary cotinine and nicotine increased among subjects in the dining rooms in which smoking was permitted, and the increase was significantly greater in employees than patrons. There was a significant positive correlation between levels of urinary nicotine increase and the levels of airborne nicotine and solanesol. The results of this study support the restriction of smoking to designated areas that have separate ventilation systems, or the prohibition of smoking in restaurants.     

Exposure of young infants to environmental tobacco smoke: breast-feeding among smoking mothers.

OBJECTIVES: This study examined the degree to which breast-feeding and cigarette smoking by mothers and smoking by other household members contribute to the exposure of infants to the products of tobacco smoke. METHODS: The subjects were 330 mother-infant pairs derived from a cohort of 1000 pairs enrolled in a longitudinal study of the pulmonary effects of prenatal and postnatal smoking. The main outcome measure was corrected urinary cotinine levels. RESULTS: Urinary cotinine levels were 10-fold higher in breast-fed infants of smoking mothers than among bottle-fed infants of smoking mothers. Among infants of nonsmoking mothers, urine cotinine levels were significantly increased in infants living in homes with other smokers; in this group there was no significant difference between bottle-fed and breast-fed infants. Infants whose mothers smoked in the same room as the infant had only nonsignificant increases in cotinine levels compared with infants whose mothers restricted their smoking to other rooms. CONCLUSIONS: Breast-fed infants of smoking mothers have urine cotinine levels 10-fold higher than bottle-fed infants whose mothers smoke, suggesting that breast-feeding, rather than direct inhalation of environmental tobacco smoke, is the primary determinant of cotinine levels in infants whose mothers smoke.     

Exposure to environmental tobacco smoke in the nonsmoking population of Cambodia

OBJECTIVE: To estimate the extent of environmental tobacco smoke (ETS) exposure among nonsmokers in the adult population of Cambodia. METHODS: A cross-sectional survey was conducted on a nationally representative sample of 13,988 Cambodian adults in 2005. Information on smoking and exposure to ETS was obtained by trained interviewers using a standard questionnaire. RESULTS: Overall, 37.4% of the 10,263 nonsmoking responders, or an estimated 1,629,700 nonsmoking Cambodians, were exposed to ETS. One third of pregnant women (31.4%) were exposed to ETS at home. In both unadjusted and adjusted models, men were less likely to be exposed to ETS at home (OR=0.34; 95% CI=0.29-0.41) and more likely to be exposed to ETS at work and in public places (OR=3.08; 95% CI=2.14-4.43 and OR=2.17; 95% CI=1.82-2.59, respectively). Education was inversely related to ETS exposure at home (OR=0.51; 95% CI=0.27-0.96 for 10 years of education vs 5 years or less). Legislators, senior officials, and managers were less likely to be exposed to ETS at home than professionals (OR=0.13; 95% CI=0.04-0.46), but more likely to be exposed at work or in public places. Rural residence was associated with higher ETS exposure in the home (OR=2.52; 95% CI=1.71-3.71) and lower ETS exposure at work (OR=0.42; 95% CI=0.24-0.76) compared to urban residence. CONCLUSIONS: The high prevalence of ETS exposure among adult Cambodians indicates an urgent need for specific measures such as public awareness campaigns, policies, and regulations to protect nonsmokers in Cambodia.     

Medicine students and exposure to environmental tobacco smoke

Objective

Although medicine students express positive attitudes toward providing lifestyle counseling, they require more instruction in many areas of health behavior in order to be helpful to their patients. The presented study included the students’ questionnaires analysis regarding their lifestyle and exposure to tobacco smoke. The aim of this study was to examine students’ exposure to chosen xenobiotics by determination of selected biomarkers in urine samples, which underlay the basis for exposure assessment towards tobacco smoke.

Materials and Methods

The investigated group consisted of first- and second-year medicine students from the Silesian Medical University (N = 133). Data obtained from a questionnaire survey was compared with the results of chosen biomarkers determined in urine samples. The analyses of the main nicotine metabolites were carried out firstly with use of ELISA, followed by the TLC technique with densitometry.

Results

According to questionnaires, every third student examined was exposed to passive smoking. The mean concentration of the main nicotine metabolites determined by ELISA in urine samples of smoking students was 1293.52±396.70 μg/g creatinine. The results of the TLC analysis in the group of smoking students were as follows: for cotinine ? 523.10±68.10 μg/g creatinine and for trans-3’-hydroxycotinine ? 653.81±62.30 μg/g creatinine.

Conclusions

Medicine students, regardless of their area of study, are a highly-exposed part of the population to tobacco smoke, not only actively but also passively. Tobacco smoke exposure can be assessed by ELISA as a screening method as well as by more specific TLC technique with densitometry.     

Maternal smoking during pregnancy and postnatal exposure to environmental tobacco smoke as predisposition factors to acute respiratory infections.

This study compared susceptibility to respiratory morbidity in a cohort of 9-year-old children exposed congenitally and postnatally to environmental tobacco smoke (ETS) to susceptibility in a cohort of unexposed children. The epidemiologic study included 1129 children: 594 boys and 535 girls attending the second grade of grammar schools in Kraków, Poland. We found strong evidence that children exposed to ETS in their homes were more susceptible to acute respiratory tract illnesses than unexposed children. A dose-response relationship between degree of exposure [for lower ETS exposure, odds ratio (OR) = 1.32; for higher ETS exposure, OR = 1.74] supports a causal explanation for the association observed. The significant trend of increased risk of respiratory infections due to ETS level in nonatopic children whose mothers did not smoke cigarettes during pregnancy suggests a direct effect of ETS exposure on the child's respiratory health. ETS combined with allergy nearly tripled the risk of acute respiratory tract illness (OR = 3.39; 95% CI, 1.93-5.93), and maternal smoking during pregnancy had a modifying effect on the risk of respiratory illnesses due to ETS after accounting for atopy. The stronger effect of ETS in atopic children and in those whose mothers smoked during pregnancy may be result of biologic interaction of endogenous and environmental factors. The results of this study are of relevance to public health policy, as children with higher risk of respiratory infections may be more susceptible to environmental hazards later in adolescence or in adulthood. Respiratory infections also increase demands for medical interventions in terms of outpatient services and hospital administrations. In addition, respiratory illnesses cause missed school days, and caring for a sick child may lead to absenteeism from work.     

Maternal smoking and environmental tobacco smoke exposure and the risk of orofacial clefts

BACKGROUND: Smoking during pregnancy has been associated with orofacial clefts in numerous studies. However, most previous studies have not been able to assess the relation between maternal smoking and specific phenotypes (eg, bilateral clefts). METHODS: We examined the association between periconceptional maternal smoking, environmental tobacco smoke (ETS) exposure, and cleft lip with or without cleft palate (CLP) (n = 933) and cleft palate only (CPO) (n = 528) compared with infants with no major birth defects (n = 3390). Infants were born between 1 October 1997 and 31 December 2001, and exposures were ascertained from maternal telephone interviews for the National Birth Defects Prevention Study. We excluded infants who had a first-degree relative with an orofacial cleft. Effect estimates were adjusted for folic acid use, study site, prepregnancy obesity, alcohol use, gravidity, and maternal age, education, and race/ethnicity. RESULTS: Periconceptional smoking was associated with CLP (odds ratio = 1.3; 95% confidence interval = 1.0-1.6), and more strongly associated with bilateral CLP (1.7; 1.2-2.6), with a weaker association observed for CPO. Heavy maternal smoking (25+ cigarettes/day) was associated with CLP (1.8; 1.0-3.2), bilateral CLP (4.2; 1.7-10.3), and CPO with Pierre Robin sequence (2.5; 0.9-7.0). ETS exposure was not associated with CLP or CPO. CONCLUSIONS: This study confirmed the modest association between smoking and orofacial clefts that has been consistently reported, and identified specific phenotypes most strongly affected.     

Passive smoking at work: biochemical and biological measures of exposure to environmental tobacco smoke

Summary Several biochemical and biological measures of tobacco smoke intake were used to evaluate exposure of restaurant personnel to environmental tobacco smoke as compared with active smokers and non-exposed non-smokers. All of the measured parameters — carboxyhaemoglobin (COHb), thiocyanate (SCN) and cotinine in plasma, cotinine and mutagenicity in urine, total white blood cell count (WBC), and sister chromatid exchange (SCE) frequency in cultured lymphocytes — were significantly elevated in the smoker group (n = 22) compared to the non-exposed group (n = 20). Work-related passive exposure (n = 27) was seen most clearly in the cotinine values, both from plasma (mean P-cot in passive smokers 10 ng/ml vs 5.2 ng/ml in non-exposed) and from urine (mean U-cot in passive smokers 56 ng/ml vs 8.3 ng/ml in non-exposed), but significant increases were also seen in the thiocyanate levels (mean P-SNC in passive smokers 58 mol/1 vs 46 mol/1 in non-exposed) and, as a preliminary finding, in total leucocyte count (in passive smokers 8.0 × 10⁹/1 vs 6.8 x 10⁹/1 in non-exposed). The results demonstrate that environmental tobacco smoke may be an occupational health hazard.     

Measurement of current exposure to environmental tobacco smoke

Reports of recent exposure to environmental tobacco smoke (ETS) and urinary cotinine levels were obtained on 663 never- and ex-smokers who attended a cancer screening clinic in Buffalo, New York, in 1986. Study objectives included determining the prevalence of exposure to ETS using urinary cotinine and identifying questionnaire exposure measures predictive of cotinine. Findings demonstrate that exposure to environmental tobacco smoke is extremely prevalent, even among those not living with a smoker. A total of 76% of subjects reported exposure to ETS in the 4 d preceding the interview. The most frequently mentioned sources of exposure were at work (28%) and at home (27%). Cotinine was found in the urine of 91% of subjects. Cotinine values increased significantly with the number of exposures reported. Among the different questionnaire measures of exposure that were evaluated, the single best predictor of cotinine was the number of friends and family members seen regularly by the subject who smoke.     

Socioeconomic determinants of children's environmental tobacco smoke exposure and family's home smoking policy

Background: Few studies have analysed the impact of differentsocioeconomic indicators on the prevalence of children's environmentaltobacco smoke (ETS) exposure at several indoor environmentsand on family's home smoking policy. Methods: Dataon 12 422 pre-school children (48% female) from two cross-sectionalsurveys conducted during 2004–06 in Germany were analysed.Exposure assessment was based on parental report. Independenteffects of socioeconomic indicators were determined by mutuallyadjustment in logistic regression analyses. Results: Lowparental education, unemployment, low household equivalent income,non-German nationality, single-parent family and family sizewere independently associated with children's ETS exposure athome and in cars. The strongest associations were observed forlow parental education [at home: adjusted odds ratio (OR) 3.94;95% confidence interval (CI) 3.46–4.49; in cars: 5.00;3.84–6.50]. Indicators of material living conditions (relativepoverty: 0.48; 0.39–0.57, parental unemployment: 0.55;0.46–0.65), as well as single-parent family, non-Germannationality and family size, but not parental education, wereindependently associated with ETS exposure at hospitality venues.Smoking households with low parental education, unemployment,poverty, single-parent family and non-German nationality wereless likely to have the rule of exclusively smoking on the balconyor terrace. Low parental education and unemployment were negativelyassociated with no smoking in presence of the child in householdswith smoking inside the flat. Conclusion: Severaldimensions of socioeconomic position have to be considered inexplanations of social inequalities in children's ETS exposureand family's home smoking policy as well as in development oftargeted interventions.     

Adolescent exposure to and perceptions of environmental tobacco smoke

Environmental tobacco smoke (ETS) poses an underappreciated risk to adolescent health. This study examined perceptions of adolescents (n = 574) regarding ETS. About one half (54%) were exposed to ETS the previous week, and one third (30%) were exposed to 3 or more hours of ETS the past week. Concurrently, 29% believed that breathing someone else's cigarette smoke had little or no effect on their health. Most adolescents (56%) believed that smoking should not be allowed in restaurants without bars but were less supportive of prohibiting smoking in restaurants with bars (20%) or in bars (14%). Two thirds (69%) of adolescents believed that the government should be involved in making laws that protect the health of people who work in bars and restaurants. Almost one half (49%) believed that the government should be involved in passing laws that make it illegal for people to smoke in public places. Odds ratios revealed that females, nonwhites, younger students, nonsmoking students, and students who believed that ETS exposure had a moderate or major effect on health were statistically significantly more likely to support clean indoor air ordinances in select locations compared to males, whites, older students, students who smoke, and students who perceived that ETS exposure has little to no effect on health.     

Doses and lung burdens of environmental tobacco smoke constituents in nonsmoking workplaces

This paper models nicotine dose and ultraviolet-absorbing particulate matter (UVPM) alveolar lung burden resulting from exposure to environmental tobacco smoke (ETS) for nonsmokers in workplaces where smoking was reported not to occur. Data were obtained from personal monitoring of ETS in 16 U.S. cities [Jenkins R.A., Guerin M.R., Palausky A., Counts R.W., Bayne C.K., and Dindal A.B. Determination of human exposure to environmental tobacco smoke (ETS): a study conducted in 16 U.S. cities. Draft final report by Oak Ridge National Laboratory for Center for Indoor Air Research, Linthicum, MD, 1996a; Jenkins R.A., Palausky A., Counts R.W., Bayne C.K., Dindal A.B., and Guerin M.R. Exposure to environmental tobacco smoke in sixteen cities in the United States as determined by personal breathing zone air sampling. J. Expos. Anal. Environ. Epidemiol. 1996b: 6(4): 473-502.]. This is a continuation of earlier analyses focusing on nonsmokers in smoking workplaces (SWs) [LaKind J.S., Graves C.G., Ginevan M.E., Jenkins R.A., Naiman D.Q., and Tardiff R.G. Exposure to environmental tobacco smoke in the workplace and the impact of away - from - work exposure. Risk Anal. 1999a: 19(3): 349-358; LaKind J.S., Jenkins R.A., Naiman D.Q., Ginevan M.E., Graves C.G., and Tardiff R.G. Use of environmental tobacco smoke constituents as markers for exposure. Risk Anal. 1999b: 19 (3): 359-373; LaKind J.S., Ginevan M.E., Naiman D.Q., James A.C., Jenkins R.A., Dourson M.L., Felter S.P., Graves C.G., and Tardiff R.G. Distribution of exposure concentrations and doses for constituents of environmental tobacco smoke. RiskAnal. 1999c: 19 (3): 375-390.]. Even though study participants characterized their workplaces as nonsmoking, some individuals reported observing cigarettes in the workplace. Individuals observing six or more cigarettes were excluded from the analysis on the grounds that they were in defacto SWs. Exposure to ETS was lower in nonsmoking than SWs, but even with this exclusion, exposure was not zero. Distributions were selected for each model input, and at least 2000 iterations of the model were made for each dose or lung burden characterization (e.g., for females, for males). In these nonsmoking workplaces (NSWs), neither nicotine nor UVPM concentrations were lognormally distributed. Hence, observed concentrations were used directly via bootstrap sampling (nicotine) or a constant number of times (UVPM) as input to the models. As in SWs, individuals from smoking homes (SHs) experienced greater exposure in NSWs to both nicotine and UVPM than did individuals from nonsmoking homes (NSH; P<0.001 ). The distributions of modeled nicotine dose and UVPM lung burden were highly skewed, with most individuals receiving relatively low exposure to ETS in the workplace. Comparing doses from NSWs modeled here to doses from SWs modeled previously, less difference between smoking and NSWs was apparent in UVPM levels than in nicotine levels. For average exposure, UVPM alveolar lung burdens were approximately 10-fold higher in smoking than NSWs, while average nicotine doses were 20-25 times higher in smoking than NSWs. These findings are in the range observed by other investigators and are partly explained by very low denominators in the ratios (i.e., very low levels experienced in NSWs). For upper bound exposure, the nonsmoking-to-smoking ratios remained about the same for UVPM. For nicotine, the upper bound ratios remained the same for people from NSHs but were halved for people from SHs.     

Effects of restaurant and bar smoking regulations on exposure to environmental tobacco smoke among Massachusetts adults

OBJECTIVES: We examined the association of local restaurant and bar regulations with self-reported exposure to environmental tobacco smoke among adults. METHODS: Data were derived from a telephone survey involving a random sample of Massachusetts households. RESULTS: Compared with adults from towns with no restaurant smoking restrictions, those from towns with strong regulations had more than twice the odds of reporting nonexposure to environmental tobacco smoke (odds ratio [OR]=2.74; 95% confidence interval [CI]=1.97, 3.80), and those from towns with some restrictions had 1.62 times the odds of reporting nonexposure (OR=1.62; 95% CI=1.29, 2.02). Bar smoking bans had even greater effects on exposure. CONCLUSIONS: Strong local clean indoor air regulations were associated with lower levels of reported exposure to environmental tobacco smoke in restaurants and bars.     

Effect of local restaurant smoking regulations on environmental tobacco smoke exposure among youths

OBJECTIVES: We examined the effect of local restaurant smoking regulations on restaurant environmental tobacco smoke exposure among youths. METHODS: We interviewed 3863 Massachusetts youths aged 12-17 years and ascertained how often they saw smokers in restaurants in their town. We assessed the effect of local restaurant smoking regulation strength on nonexposure to environmental tobacco smoke (seeing smokers never or only rarely). RESULTS: Compared with youths from towns with weak regulations, youths from towns with medium-strength regulations had 1.4 times the odds (odds ratio = 1.36; 95% confidence interval = 1.12, 1.65) and youths from towns with strong regulations had twice the odds (odds ratio = 2.03; 95% confidence interval = 1.64, 2.52) of reporting nonexposure. CONCLUSIONS: Strong local restaurant smoking regulations are associated with reduced environmental tobacco smoke exposure among youths     

Biochemical validation of self-reported exposure to environmental tobacco smoke

Biochemical validation of reported exposure to environmental tobacco smoke (ETS) lends credibility to epidemiological studies investigating the association of passive inhalation of smoke to respiratory disease or lung cancer. In the current study, a series of questions regarding ETS exposure was self-administered to nonsmokers and self-reported intensity of exposure was compared with cotinine levels in urine samples obtained on site. The target population of this study was a group of municipal workers who reported exposure in a domestic setting and/or in the workplace. When asked if they were exposed to ETS on social occasions, both males and females who responded positively had higher urinary cotinine levels (P less than 0.02) than those who gave a negative response. Mean urinary cotinine concentrations were found to be elevated in both men and women who reported that they lived with a smoker. Cotinine levels in the urine of those reporting exposure were over twice as high as those in the urine of respondents who denied having been exposed. ETS exposure in the home was the greatest contributor to increased urinary cotinine levels in both men and women. Among individuals who were exposed at work only, the reported degree of exposure agreed well with the mean urinary cotinine values. Those findings emphasize that the validation of exposure status with a biomarker is an essential prerequisite for epidemiological studies investigating passive smoking.     

Prospective study of exposure to environmental tobacco smoke and dysmenorrhea

Dysmenorrhea is a common gynecologic disorder in women of reproductive age. Previous studies have found an association between current cigarette smoking and prevalence of dysmenorrhea. This study investigated the association between exposure to environmental tobacco smoke (ETS) and the occurrence of dysmenorrhea among women without a history of this disorder. The study population consisted of 165 newly wed, nonsmoking Chinese women (in Shenyang, China), who intended to get pregnant and who had no past history of dysmenorrhea at the time of enrollment. These women completed a baseline questionnaire interview upon enrollment and were prospectively followed by daily diary. Dysmenorrhea was defined as a diary recording of abdominal pain or low back pain for at least 2 days during a menstrual period. A subject's ETS exposure was defined as the mean number of cigarettes smoked per day at home by household members over an entire menstrual cycle before the menstrual period. A logistic regression model was used to assess the effect of ETS on the risk of dysmenorrhea, with adjustment for age, body mass index, education, season, area of residence, occupation, shift work, perceived stress, passive smoking at work, and occupational exposure to chemical hazards, dust, and noise. Generalized estimating equations were used to account for autocorrelations as a result of multiple cycles per subject. This report is based on 625 prospectively followed menstrual cycles with complete baseline and diary data. ETS exposure was reported in 77% of cycles, within which average daily exposures throughout the cycle ranged from 0.02 to 10. 3 cigarettes. The incidence of dysmenorrhea was 9.7% and 13.3% among nonexposed and exposed cycles, respectively. Among ETS-exposed cycles, there was a positive dose-response relationship between the numbers of cigarettes smoked and the relative risk of dysmenorrhea. The adjusted odds ratios of dysmenorrhea associated with "low," "middle," and "high" tertiles of ETS exposure versus no exposure were 1.1 [95% confidence interval (CI), 0.5-2.6], 2.5 (CI, 0.9-6.7), and 3.1 (CI, 1.2-8.3), respectively. The findings were consistent with those of analyses limited to the first follow-up menstrual cycle from each woman. These data suggest a significant dose-response relationship between exposure to ETS and an increased incidence of dysmenorrhea in this cohort of young women.