环境香烟烟雾对妊娠结局影响的研究进展

环境香烟烟雾 (environmentaltobaccosmoke ,ETS)对胎儿健康的影响越来越受到人们的关注。本文就 ( 1)ETS暴露的指标及评价 ;( 2 )ETS暴露对妊娠结局 ,其中包括胎儿出生体重、早产、自然流产和死产的影响等方面进行综述。研究表明 ,体液中的可的宁及头发中的尼古丁是评价较长时间内ETS暴露量的较理想的生物标记物 ,脐带血清中的可的宁是反映胎儿在怀孕后期暴露于ETS的适宜标记物。孕妇被动吸烟可降低新生儿的平均出生体重 ,增高低出生体重儿或小于胎龄儿的发生率 ,使胎儿发生早产、自然流产或死产的危险度增加     

Exposure to environmental tobacco smoke: association with personal characteristics and self reported health conditions

STUDY OBJECTIVE: To examine the association between exposure to environmental tobacco smoke (ETS) and demographic, lifestyle, occupational characteristics and self reported health conditions. DESIGN: Cross sectional study, using data from multiphasic health checkups between 1979 and 1985. SETTING: Large health plan in Northern California, USA. PARTICIPANTS: 16 524 men aged 15-89 years and 26 197 women aged 15-105 years who never smoked. RESULTS: Sixty eight per cent of men and 64 per cent of women reported any current ETS exposure (at home, in small spaces other than home or in large indoor areas). The exposure time from all three sources of ETS exposure correlated negatively with age. Men and women reporting high level ETS exposure were more likely to be black and never married or separated/divorced, to have no college or partial college education, to consume three alcoholic drink/day or more and to report exposure to several occupational hazards. Consistent independent relations across sexes were found between any current exposure to ETS and a positive history of hay fever/asthma (odds ratio (OR)=1.22 in men, 1.14 in women), hearing loss (OR=1.30 in men, 1.27 in women), severe headache (OR=1.22 in men, 1.17 in women), and cold/flu symptoms (OR=1.52 in men, 1.57 in women). Any current ETS exposure was also associated with chronic cough (OR=1.22) in men and with heart disease (OR=1.10) in women. Self reported stroke was inversely associated with any current ETS exposure in men (OR=0.27). No associations were noted for cancer or tumour and for migraine. CONCLUSION: ETS exposure correlated with several personal characteristics potentially associated with adverse health outcomes. Although the study design precluded causal inference, ETS exposure was associated with several self reported acute and chronic medical conditions.     

Prenatal and childhood environmental tobacco smoke exposure and age at menarche

Ferris JS, Flom JD, Tehranifar P, Mayne ST, Terry MB. Prenatal and childhood environmental tobacco smoke exposure and age at menarche. Paediatric and Perinatal Epidemiology 2010; 24: 515–523. Previous studies have reported mixed results regarding the association between age at menarche and environmental tobacco smoke exposure, both prenatally and during early childhood; however, few studies have had data available during both time periods. The present study examined whether exposure to prenatal tobacco smoke (PTS) via maternal smoking during pregnancy or childhood environmental tobacco smoke (ETS) was associated with age at menarche in a multi‐ethnic birth cohort. With the uniquely available prospectively collected data on body size and growth at birth and in early life, we further examined whether the association between PTS and ETS exposure and age at menarche was mediated by these variables. From 2001 to 2006, we recruited 262 women born between 1959 and 1963 who were enrolled previously in a New York City site of the National Collaborative Perinatal Project. Mothers who smoked during pregnancy vs. those who did not were more likely to be White, younger, have more education and have lower birthweight babies. Daughters with heavy PTS exposure (≥20 cigarettes per day) had a later age at menarche (>12 years vs. ≤12 years), odds ratio (OR) = 2.1 [95% confidence interval (CI) 0.9, 5.0] compared with daughters with no PTS. Daughters exposed to only childhood ETS had a later age at menarche, OR = 2.1 [95% CI 1.0, 4.3], and those exposed to PTS and ETS combined had a statistically significant later age at menarche, OR = 2.2 [95% CI 1.1, 4.6] compared with daughters with no PTS and no ETS. These results did not change after further adjustment for birthweight and postnatal growth suggesting that exposure to PTS and ETS is associated with later age at menarche even after considering possible relationships with growth.     

澳门儿童家庭被动吸烟状况及其影响因素

目的了解澳门儿童家庭被动吸烟状况, 探讨其危险因素, 为儿童被动吸烟干预措施的制定提供科学依据。方法采用方便抽样方法抽取澳门花地玛堂区875名6～14岁儿童家长, 调查儿童家庭被动吸烟状况, 采用非条件logistic回归分析方法分析影响儿童家庭被动吸烟的危险因素。结果在回收的875份有效问卷中, 儿童家庭总被动吸烟率为37.0%, 儿童每日被动吸烟率为28.3%, 不同性别儿童被动吸烟率差异无统计学意义(χ²=0.326, P>0.05);父亲吸烟率高达43.7%, 母亲和祖父母或外祖父母吸烟率分别为3.8%、8.3%;父亲吸烟是导致儿童家庭被动吸烟最主要的危险因素(OR=34.061, 95%CI=21.819~53.173), 而父亲文化程度(OR=0.606, 95%CI=0.513~0.716)和母亲年龄(OR=0.973, 95%CI=0.950~0.997)是父亲吸烟的保护因素, 与双亲家庭相比, 单亲母亲的吸烟率较高(OR=8.137, 95%CI=3.209~20.637)。结论澳门儿童被动吸烟率较高, 父亲吸烟是儿童家庭被动吸烟最主要的危险因素。提高父亲的文化程度和自身修养, 建立良好的家庭关系有益于降低父母的吸烟率, 从而有效降低儿童家庭被动吸烟率。     

Developing asthma in childhood from exposure to secondhand tobacco smoke: insights from a meta-regression

OBJECTIVE: Studies have identified associations between household secondhand tobacco smoke (SHS) exposure and induction of childhood asthma. However, the true nature and strength of this association remains confounded in many studies, producing inconsistent evidence. To look for sources of potential bias and try to uncover consistent patterns of relative risk estimates (RRs), we conducted a meta-analysis of studies published between 1970 and 2005. DATA SOURCES: Through an extensive literature search, we identified 38 epidemiologic studies of SHS exposure and the development of childhood asthma (that also controlled for atopy history) from 300 potentially relevant articles. DATA SYNTHESIS: We observed substantial heterogeneity within initial summary RRs of 1.48 [95% confidence interval (CI), 1.32-1.65], 1.25 (1.21-1.30), and 1.21 (1.08-1.36), for ever, current, and incident asthma, respectively. Lack of control for type of atopy history (familial or child) and child's own smoking status within studies and age category altered summary RRs in separate meta-regressions. After adjusting for these confounding characteristics, consistent patterns of association emerged between SHS exposure and childhood asthma induction. Our summary RR of 1.33 (95% CI, 1.14-1.56) from studies of incident asthma among older children (6-18 years of age) is 1.27 times the estimate from studies of younger children and higher than estimates reported in earlier meta-analyses. CONCLUSIONS: This new finding indicates that exposure duration may be a more important factor in the induction of asthma than previously understood, and suggests that SHS could be a more fundamental and widespread cause of childhood asthma than some previous meta-analyses have indicated.     

A questionnaire for assessing environmental tobacco smoke exposure

Exposure to environmental tobacco smoke (ETS) has been associated with adverse health consequences. In this study, the association between self-reported ETS exposure and serum cotinine levels was examined. As part of the population-based Epidemiology of Hearing Loss Study in Beaver Dam, WI, self-reported data on ETS were obtained at the 5-year follow-up examination (1998-2000; n = 2800). Serum cotinine levels were obtained on 643 of these participants (53-75 years old). Serum cotinine levels increased with reported number of hours of recent ETS exposure. Most (95.3%) participants who reported being smokers had serum cotinine levels >15 ng/mL, compared with only 2.7% of nonsmokers. Usual ETS exposure among nonsmokers was assessed with a brief questionnaire quantifying exposure at work, at home, and in social settings, and then classified into three levels of exposure. Those reporting little or no exposure had a geometric mean cotinine level of 0.06 ng/mL (95% confidence interval (CI): 0.05, 0.07), compared with 0.14 (95% CI: 0.09, 0.22) and 0.63 (95% CI: 0.36, 1.10) for those reporting moderate and high ETS exposure, respectively (F-test for trend: P < 0.001). These results suggest that the questionnaire can be used to distinguish relative levels of exposure to ETS.     

金昌队列人群结直肠癌疾病负担分析

目的 评价金昌队列人群结直肠癌的疾病负担及变化趋势。方法 应用历史队列研究方法收集金昌队列人群2001－2013年结直肠癌全死因资料及2001－2010年结直肠癌住院患者病案资料,应用死亡率、标化死亡率、直接住院费用、潜在减寿年(PYLL)、人均PYLL(APYLL)、潜在工作损失年(WPYLL)以及人均WPYLL(AWPYLL)等指标描述结直肠癌造成的疾病负担状况,运用Spearman秩相关和平均增长速度分析疾病负担的变化趋势。结果 2001－2013年金昌队列人群结直肠癌粗死亡率为9.53/10万,平均年增长速度为12.89%。结直肠癌造成该队列人群PYLL、APYLL、WPYLL和AWPYLL分别为485.00人年、9.15年、253.00人年和4.77年。2001－2010年该队列人群结直肠癌住院患者人均例次直接住院费用为7 064.38元,日均直接住院费用为408.43元,均无明显增长趋势。结论 金昌队列人群结直肠癌死亡率呈上升趋势,疾病负担逐渐沉重。     

Knowledge and attitudes of economically disadvantaged women regarding exposure to environmental tobacco smoke: a Michigan,USA study

BACKGROUND: Exposure to environmental tobacco smoke (ETS) is a global public health problem which is particularly acute in groups where smoking rates are higher than in the general population. A study was undertaken to investigate knowledge, attitudes and preventive efforts with regard to exposure to ETS in a sample of economically disadvantaged women residing in Michigan, USA. METHODS: Analysis-of-variance techniques were used to investigate how knowledge, attitudes and preventive efforts regarding exposure to ETS relate to demographic variables such as smoking status, ethnicity, education, employment, and income; and analysis-of-covariance techniques were applied to determine the degree to which knowledge, attitudes, age, smoking status, ethnicity, education, employment, income and home environment predict these women's preventive efforts regarding exposure to ETS. RESULTS: Generally, women with no high school diploma and women who were smokers were less knowledgeable about the adverse health effects of exposure to ETS, had worse attitudes concerning exposure to ETS and were less likely to take preventive steps to limit their exposure to ETS than were women who had more formal education or who were nonsmokers, respectively. The primary predictors of preventive efforts were knowledge, attitudes and smoking status. CONCLUSIONS: The results suggest that educational efforts focusing on increasing knowledge and improving attitudes regarding exposure to ETS, as well as providing practical strategies for limiting exposure to ETS, should be developed and delivered to at-risk populations.     

Exposure to environmental tobacco smoke in pregnant women: the association between self-report and serum cotinine

The risk of delivering a low-birth-weight infant as the result of exposing a nonsmoking pregnant woman to environmental tobacco smoke (ETS) is not well defined. The method of ascertaining ETS exposure during pregnancy may explain the lack of consistent study findings. In a large sample of pregnant women, we compared distributions between two methods of ETS exposure: self-report and cotinine, a nicotine metabolite, from serum. At livery, subjects were asked about duration and location of exposure to ETS during their second trimester. A single cotinine measurement was assayed from serum collected at 15-19 weeks gestation (limit of detection=0.05 ng/mL). Self-reported (hours per day) ETS exposure was correlated (r=0.38) with cotinine concentration. Regression analysis revealed that while self-reported ETS was significantly associated with (log) cotinine, it did not explain a large amount of total variation. While 72% of subjects reported no exposure to ETS, almost all had measurable levels of cotinine. Studies of pregnant women based upon an hours per day ETS question have likely misclassified a sizable portion of ETS-exposed women as "unexposed." Since there is recent evidence that low levels of ETS exposure result in unfavorable pregnancy outcomes, these studies have underestimated the effect of ETS.     

Secondhand Tobacco Smoke Exposure in Open and Semi-Open Settings: A Systematic Review

Background: Some countries have recently extended smoke-free policies to particular outdoor settings; however, there is controversy regarding whether this is scientifically and ethically justifiable.Objectives: The objective of the present study was to review research on secondhand smoke (SHS) exposure in outdoor settings.Data sources: We conducted different searches in PubMed for the period prior to September 2012. We checked the references of the identified papers, and conducted a similar search in Google Scholar.Study selection: Our search terms included combinations of “secondhand smoke,” “environmental tobacco smoke,” “passive smoking” OR “tobacco smoke pollution” AND “outdoors” AND “PM” (particulate matter), “PM_2.5” (PM with diameter ≤ 2.5 µm), “respirable suspended particles,” “particulate matter,” “nicotine,” “CO” (carbon monoxide), “cotinine,” “marker,” “biomarker” OR “airborne marker.” In total, 18 articles and reports met the inclusion criteria.Results: Almost all studies used PM_2.5 concentration as an SHS marker. Mean PM_2.5 concentrations reported for outdoor smoking areas when smokers were present ranged from 8.32 to 124 µg/m³ at hospitality venues, and 4.60 to 17.80 µg/m³ at other locations. Mean PM_2.5 concentrations in smoke-free indoor settings near outdoor smoking areas ranged from 4 to 120.51 µg/m³. SHS levels increased when smokers were present, and outdoor and indoor SHS levels were related. Most studies reported a positive association between SHS measures and smoker density, enclosure of outdoor locations, wind conditions, and proximity to smokers.Conclusions: The available evidence indicates high SHS levels at some outdoor smoking areas and at adjacent smoke-free indoor areas. Further research and standardization of methodology is needed to determine whether smoke-free legislation should be extended to outdoor settings.     

Exposure to secondhand smoke outside of a bar and a restaurant and tobacco exposure biomarkers in nonsmokers

Background: With an increase in indoor smoking bans, many smokers smoke outside establishments and near their entrances, which has become a public health concern.Objectives: We characterized the exposure of nonsmokers to secondhand smoke (SHS) outside a restaurant and bar in Athens, Georgia, where indoor smoking is banned, using salivary cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL).Methods: In a crossover study, we assigned 28 participants to outdoor patios of a restaurant and a bar and an open-air site with no smokers on three weekend days; participants visited each site once and stayed for 3 hr. We collected saliva and urine samples immediately before and after the visits (postexposure) and on the following morning and analyzed samples for cotinine and total NNAL, respectively. Regression models were fitted and changes in biomarkers were contrasted between locations.Results: Postexposure and preexposure geometric mean salivary cotinine concentrations differed by 0.115 ng/mL [95% confidence interval (CI): 0.105, 0.126)] and by 0.030 ng/mL (95% CI: 0.028, 0.031) for bar and restaurant visits, respectively. There were no significant post- and preexposure differences in cotinine levels after control site visits, and changes after bar and restaurant site visits were significantly different from changes after control site visits (p < 0.001). Results comparing next-day and preexposure salivary cotinine levels were similar. Next-day creatinine-corrected urinary NNAL concentrations also were higher than preexposure levels following bar and restaurant visits [1.858 pg/mg creatinine higher (95% CI: 0.897, 3.758) and 0.615 pg/mg creatinine higher (95% CI: 0.210, 1.761), respectively], and were significantly different from changes after the control visits (p = 0.005).Conclusion: Salivary cotinine and urinary NNAL increased significantly in nonsmokers after outdoor SHS exposure. Our findings indicate that such exposures may increase risks of health effects associated with tobacco carcinogens.     

Prenatal environmental tobacco smoke exposure and early childhood body mass index

Maternal smoking during pregnancy is associated with increased risk of childhood overweight body mass index (BMI). Less is known about the association between prenatal secondhand tobacco smoke (SHS) exposure and childhood BMI. We followed 292 mother-child dyads from early pregnancy to 3 years of age. Prenatal tobacco smoke exposure during pregnancy was quantified using self-report and serum cotinine biomarkers. We used linear mixed models to estimate the association between tobacco smoke exposure and BMI at birth, 4 weeks, and 1, 2 and 3 years. During pregnancy, 15% of women reported SHS exposure and 12% reported active smoking, but 51% of women had cotinine levels consistent with SHS exposure and 10% had cotinine concentrations indicative of active smoking. After adjustment for confounders, children born to active smokers (self-report or serum cotinine) had higher BMI at 2 and 3 years of age, compared with unexposed children. Children born to women with prenatal serum cotinine concentrations indicative of SHS exposure had higher BMI at 2 (mean difference [MD] 0.3 [95% confidence interval -0.1, 0.7]) and 3 (MD 0.4 [0, 0.8]) years compared with unexposed children. Using self-reported prenatal exposure resulted in non-differential exposure misclassification of SHS exposures that attenuated the association between SHS exposure and BMI compared with serum cotinine concentrations. These findings suggest active and secondhand prenatal tobacco smoke exposure may be related to an important public health problem in childhood and later life. In addition, accurate quantification of prenatal secondhand tobacco smoke exposures is essential to obtaining valid estimates.     

Acute effects of second-hand smoke on complete blood count

We assessed the acute effects of a 1-h exposure to second-hand smoke (SHS) on complete blood count (CBC) markers in a controlled simulated bar/restaurant environment. Nineteen adult never-smokers completed a 1-h .exposure to SHS at bar/restaurant levels, and a 1-h exposure to normal room air. Blood samples were collected at the baseline at 30?min during each exposure, and at 0, 0.5, 1, 2, 3, and 4?h after each exposure. The values of white blood cells (WBC) at 1?h (p?=?0.010), 3?h (p?=?0.040), and 4?h (p?=?0.008) following SHS were significantly increased compared with the baseline values. Also, there was a positive association between the WBC and cotinine levels (r?=?0.28, p?=?0.007). A 1-h exposure to SHS at bar/restaurant levels significantly increased the WBC for at least 4?h following the exposure time. This effect of SHS on WBC has dose–response characteristics and should be considered to prescribing CBC.     

2008—2010年乳山市居民脑卒中、冠心病疾病负担分析

目的应用疾病负担指标衡量乳山市脑卒中、冠心病的危害程度,定量估计疾病对健康状况的影响程度和经济损失。方法利用乳山市2008—2010年本地户籍的脑卒中、冠心病患者资料,计算脑卒中、冠心病的潜在寿命损失年(years of potential life lost,PYLL)、致残率、经济损失。结果乳山市脑卒中、冠心病的总体死亡率分别为167.71/10万、117.60/10万,平均每例因脑卒中、冠心病死亡的PYLL分别为10.34、10.02年,PYLL率(减寿率)为3.68‰、2.92‰。结论乳山市脑卒中、冠心病的死亡率随着年龄的增加而增加,男性高于女性;脑卒中的疾病负担和济负担均于冠心病;40岁以上的疾病负担总负担的90%以上。     

湖北某市2007-2009年城区儿童疾病负担分析

目的 了解十堰市儿童疾病负担情况,为制定相应的儿童预防保健策略提供科学依据。 方法 分析十堰市城区2007-2009年死因监测数据,采用WHO推荐方法计算十堰市城区儿童死亡率、早死损失寿命年(years of life lost,YLL)、伤残损失寿命年(years lost due to disability,YLD)及伤残调整寿命年(disability adjusted life year,DALY),评价十堰市城区儿童的疾病负担。 结果 十堰市2007-2009年儿童平均死亡率男性1.11‰,女性0.69‰,男女合计0.90‰;感染性、孕产妇、围生期和营养性疾病(Ⅰ),非感染性疾病(Ⅱ),伤害 (Ⅲ)死亡率分别为0.36‰,0.28‰,0.23‰,不同死因的死亡率存在年龄和性别差异,三类死因死亡率0~4岁组均高于5~14岁组,男童死亡率高于女性。男童DALY为84.15/千人,女童为51.56/千人,男女合计为68.47/千人,男童高于女童。以死亡率进行疾病负担评价,围生期疾病(0.289‰)、意外伤害(0.204‰)、恶性肿瘤(0.079‰)、先天异常(0.072‰)、心血管疾病(0.066‰)等疾病排在前5位。以DALY评价疾病负担,前5为排序变为神经精神疾病(31.60‰)、围生期疾病(12.12‰)、意外伤害(11.25‰)、呼吸系统疾病(5.33‰)、先天异常(4.23‰)。 结论 儿童疾病负担要从疾病死亡负担和健康负担进行综合评价,围生期疾病、伤害是导致儿童疾病负担的主要原因。     

Occupational exposure of non-smoking restaurant personnel to environmental tobacco smoke in Finland

BACKGROUND: Environmental tobacco smoke (ETS) exposure levels in different restaurant types in Finland were assessed before the National Tobacco Act restricting smoking in restaurants was activated. METHODS: Exposure to ETS was determined by measuring nicotine in the breathing zone of non-smoking restaurant workers and by quantification of the nicotine metabolites cotinine and 3-hydroxycotinine in the urine of these workers during one whole work week. Altogether 23 workers from 15 restaurants were included in the study. RESULTS: The geometric mean (GM) breathing-zone nicotine level was 3.9 microg/m(3) (3.7 microg/m(3) in pubs, 1.4 microg/m(3) in dining restaurants, and 10.2 microg/m(3) in nightclubs). The GM cotinine and trans-3'-hydroxycotinine level in urine were 3.3 ng/mg((creatinine)) and 15.3 ng/mg((creatinine)), respectively. The exposure to ETS of restaurant workers in dining restaurants was clearly lower than that of workers in pubs and nightclubs as indicated by all ETS-markers used in the present study. During the work week, the cotinine and 3'-hydroxycotinine levels in urine of the study subjects increased. The correlation between breathing zone nicotine and urine cotinine and hydroxycotinine was 0.66 for both compounds. Post-shift cotinine and hydroxycotinine levels were not significantly higher than the pre-shift levels. CONCLUSIONS: If 9 ng cotinine/mg((creatinine)) is considered as the level above which heavy exposure has occurred, then this level was exceeded by 14 (approximately 60%) subjects at least once during the work week. Nicotine metabolite concentrations in the urine increased during the work week in 80% of the subjects, and the increase was especially noticeable for subjects working in both pubs and nightclubs. The study indicates that measures to restrict ETS exposure in restaurants are needed.     

Cooking smoke and tobacco smoke as risk factors for stillbirth

Smoke from biomass combustion produces some of the same pollutants found in tobacco smoke and ambient air, yet only one study to date has linked cooking with biomass fuels to increased risk of stillbirth. The mechanisms by which biomass smoke may cause stillbirth are through exposure to CO and particulates in biomass smoke. Using information on 19,189 ever-married women aged 40-49 included in India's 1998-99 National Family Health Survey, we examined the association between household use of biomass fuels (wood, dung, and crop residues), tobacco smoke (both active and passive), and risk of stillbirth. Data were analyzed using binary and multinomial logistic regression after controlling for several potentially confounding factors. Results indicate that, with other factors controlled, women who cook with biomass fuels are significantly more likely to have experienced a stillbirth than those who cook with cleaner fuels (OR= 1.44; 95% CI: 1.04, 1.97). Women who cook with biofuels are twice as likely to have experienced two or more stillbirths as those who cook with cleaner fuels (RRR= 2.01; 95% CI: 1.11, 3.62). The adjusted effect of active tobacco smoking is also positive (OR = 1.23) but not statistically significant. No effect of passive smoking was found, nor was there evidence of any modifying effects of tobacco smoking.     

The interpersonal management of environmental tobacco smoke in the home–a qualitative study

The home is a significant source of environmental tobacco smoke (ETS) exposure for many children and, therefore, increasingly a focus of intervention, although evidence of effectiveness remains equivocal. However, little is known about the nature, genesis, and micro-social context of self-imposed restrictions on smoking in the home. In this exploratory study, interviews were conducted in 15 diverse households that had resident children in Toronto, Canada. The results suggest that households cluster into three distinctive groups, from a high degree of restrictions to a lack of consistent measures. Attempts to control ETS exposures in homes often emerge as a result of protracted negotiations and must be understood in the context of situated relationships within the family. Implications for policy and practice, as well as recommendations for future research, are addressed.     

Litigation on behalf of victims of exposure to environmental tobacco smoke. The experience from the USA.

BACKGROUND: For a quarter of a century, lawsuits have been filed on behalf of individuals who have been harmed by exposure to environmental tobacco smoke (ETS). METHODS: A review of hundreds of legal cases where exposure to ETS was the basis for the lawsuit was undertaken. The history of ETS-based lawsuits was categorised and analysed. RESULTS: While ETS-based lawsuits have arisen in a variety of divergent settings, there have been an increasing number of instances in which individuals have achieved relief from exposure to ETS and/or monetary compensation for having been so exposed. Such successful outcomes make it easier for others to achieve similar results through litigation. CONCLUSION: Lawsuits will probably continue to be a viable remedy in assisting those being harmed by exposure to ETS, both-inside and outside the USA.     

Prevalence and determinants of SHS exposure in public and private areas after the 2010 smoke-free legislation in Greece

The objective of the present survey was to assess the extent and socio-economic determinants of population exposure to secondhand smoke (SHS) in Greece in 2011. The national household survey Hellas Health IV was conducted in October 2011. SHS exposure was based on self-reported exposure within home, workplace and public places. Thirty-three per cent of the respondents reported living in a smoke-free home. Smokers (p?<?0.001) and single individuals (p?<?0.017) were less likely to prohibit smoking at home. SHS exposure at work, in restaurants and in bars/clubs/cafes was frequently mentioned by 41.6, 84.2 and 90.5%, respectively. SHS exposure in a bar/club/cafe was noted more among single individuals (p?=?0.004) and those aged 18–34?years (p?=?0.007). Inhabitants of rural areas were more likely to report someone smoking indoors in all the above venues. Public health education and effective enforcement of the nationwide smoke-free legislation are imperative.