Effect of smoke-free patio policy of restaurants and bars on exposure to second-hand smoke

ObjectiveWhile there is increasing support for restricting smoking in restaurant and bar patios, there is limited evidence on the effectiveness of this policy. This study examined the effect of smoke-free patio policy of restaurants and bars on adult second-hand smoke (SHS) exposure.MethodsData were drawn from the 2005–2012 Canadian Tobacco Use Monitoring Survey (n = 89,743), a repeated cross-sectional survey of youth and adult. Regression analysis, a quasi-experimental design was used to examine the effect of provincial smoke-free patio policy on self-reported exposure to SHS.ResultsAnalyses suggest that exposure to SHS on patios of bars and restaurants declined following the adoption of provincial smoke-free patio policy. Relative to pre-policy SHS exposure, regression results showed a reduction in the probability of SHS exposure of up to 25% in Alberta. Similarly, in Nova Scotia, the probability of SHS exposure declined by up to 21%. Analyses stratified by smoking status found similar significant effect on both smokers and non-smokers.ConclusionsFindings suggest that provincial patio smoking ban on bars and restaurants had the intended effect of protecting non-smokers from SHS exposure. This study is consistent with a large body of evidence showing that a strong smoke-free legislation is an effective public health measure.     

Validity of self-reported intensity of exposure to second-hand smoke at home against environmental and personal markers

The objective of this study was to assess the validity of two questions about the perception of intensity of exposure to secondhand smoke (SHS) at home using as a reference environmental markers (airborne nicotine and benzene) and biomarkers of exposure (cotinine in saliva and urine). This was a cross-sectional study in a convenience sample of 49 non-smoking volunteers. We found a high correlation between self-reported SHS exposure and airborne nicotine (r_sp = 0.806, p < 0.05), salivary cotinine (r_sp = 0.752, p < 0.05), and urinary cotinine (r_sp = 0.626, p < 0.05). We did not find differences between the score question and the conventional ones (p > 0.05). In conclusion, the significant correlation of the two questions proposed with environmental markers and personal markers indicates their potential validity to assess exposure to SHS at home.     

Adolescents validly report their exposure to secondhand smoke

ObjectiveThis study examined the validity of child-reported exposure to secondhand smoke (SHS) and investigated factors, such as child's age, which might affect accuracy of recall.Study Design and SettingParticipants were drawn from a nonprobability sample of 380 families who completed baseline assessment as part of a randomized trial of an SHS reduction intervention conducted in an urban setting in Southern California. Parents and children (aged 8–13 years) retrospectively reported child's exposure to SHS using timeline followback methodology; reports were compared with child's urine cotinine.ResultsValidity coefficients for parents and children were comparable (r = 0.58 vs. r = 0.53), but parents recalled three times more exposure than children (2.2 vs. 0.8 cigarettes per day; P < 0.001). Regression models predicting cotinine indicated that including child in addition to parent reports resulted in better prediction than either alone.ConclusionWhen there is a choice, parent reports are preferable over child reports because of decreased underreporting. However, child-reported SHS exposure had adequate validity (r > 0.50) and might be appropriate in some situations. Researchers might consider collecting both parent and child reports because each made a unique contribution to the prediction of cotinine.     

Portuguese children's exposure to second-hand tobacco smoke in the family car

ObjectivesTo assess the prevalence of children's exposure to second-hand smoke in the family car; to compare exposure among children with smoking and non-smoking parents.MethodsIn 2011, a self-administered questionnaire was applied to a 4th grade Portuguese children national sample (N = 3187, mean age 9.5 ± 0.7, 51.1% boys). Prevalence rates and chi-square tests were computed.ResultsOf the participants, 52.0% reported having, at least, one smoking parent. Overall exposure in the car was 28.9% (95% CI 27.3-30.5). Children's exposure among those reporting smoking parents was 46.9% (95% CI 44.4-49.4); and 8.6% (95% CI 7.1-10.1) among those reporting non-smoking parents (p<.001). Therefore, children with smoking parents were 5.44 times more likely to be exposed.ConclusionsChildren's exposure to second-hand smoke in the family car is frequent, especially if one or both parents smoke. This highlights the need for effective tobacco control measures to prevent this severe health hazard.     

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.     

Bar workers' exposure to second-hand smoke: the effect of Scottish smoke-free legislation on occupational exposure

OBJECTIVES: To examine changes in bar workers' exposure to second-hand smoke (SHS) over a 12-month period before and after the introduction of Scottish smoke-free legislation on the 26 March 2006. METHODS: A total of 371 bar workers were recruited from 72 bars in three cities: Aberdeen, Glasgow, Edinburgh and small towns in two rural regions (Borders and Aberdeenshire). Prior to the introduction of the smoke-free legislation, we visited all participants in their place of work and collected saliva samples, for the measurement of cotinine, together with details on work patterns, self-reported exposure to SHS at work and non-work settings and smoking history. This was repeated 2 months post-legislation and again in the spring of 2007. In addition, we gathered full-shift personal exposure data from a small number of Aberdeen bar workers using a personal aerosol monitor for fine particulate matter (PM(2.5)) at the baseline and 2 months post-legislation visits. RESULTS: Data were available for 371 participants at baseline, 266 (72%) at 2 months post-legislation and 191 (51%) at the 1-year follow-up. The salivary cotinine level recorded in non-smokers fell from a geometric mean of 2.94 ng ml(-1) prior to introduction of the legislation to 0.41 ng ml(-1) at 1-year follow-up. Paired data showed a reduction in non-smokers' cotinine levels of 89% [95% confidence interval (CI) 85-92%]. For the whole cohort, the duration of workplace exposure to SHS within the last 7 days fell from 28.5 to 0.83 h, though some bar workers continued to report substantial SHS exposures at work despite the legislation. Smokers also demonstrated reductions in their salivary cotinine levels of 12% (95% CI 3-20%). This may reflect both the reduction in SHS exposure at work and falls in active cigarette smoking in this group. In a small sub-sample of bar workers, full-shift personal exposure to PM(2.5), a marker of SHS concentrations, showed average reductions of 86% between baseline and 2 months after implementation of the legislation. CONCLUSIONS: Most bar workers have experienced very large reductions in their workplace exposure to SHS as a result of smoke-free legislation in Scotland. These reductions have been sustained over a period of 1 year.     

Stages of change, smoking characteristics, and cotinine concentrations in smokers: setting priorities for smoking cessation

ObjectiveWe assessed whether the salivary cotinine content of daily smokers varied with the readiness to quit and smoking characteristics.MethodsThis cross-sectional study was conducted in Barcelona, Spain (n = 1245) in 2004–2005. We administered a questionnaire to assess smoking behaviour and collected saliva to determine the cotinine content. We determined the distribution of 278 adult daily smokers across different stages of change and categorised them by individual and smoking characteristics. We used medians and interquartile ranges (IQR) to relate cotinine concentrations to different stages of change, tobacco consumption, and nicotine dependence based on the Fagerström Test for Nicotine Dependence (FTND).ResultsAround 68%, 22%, and 11% of smokers were in precontemplation, contemplation, and preparation stages, respectively. A mean of 17.0 cigarettes was smoked daily, with no differences among stages of change. The median cotinine concentration was 151.3 ng/ml (IQR: 83.2–227.8 ng/ml), with no differences among stages of change. The cigarette consumption scores, FTND, and time to first cigarette of the day were positively associated with cotinine concentration.ConclusionsThe cotinine concentration was similar among the stages of change, but varied within each stage according to the number of cigarettes smoked, time to first cigarette of the day, and nicotine dependence.     

Urinary concentrations of polycyclic aromatic hydrocarbons in Israeli adults: Demographic and life-style predictors

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants associated with adverse health outcomes, including cancer, asthma, and reduced fertility. Because data on exposure to these contaminants in Israel and the Middle East are very limited this study was conducted to measure urinary levels of PAHs in the general adult population in Israel and to identify demographic and life-style predictors of exposure.We measured concentrations of five PAH metabolites: 1-hydroxypyrene (1OH_pyrene) and four different hydroxyphenanthrenes (1-hydroxyphenanthrene, 2-hydroxyphenanthrene, 3-hydroxyphenanthrene, 4-hydroxyphenanthrene), as well as cotinine in urine samples collected from 243 Israeli adults from the general population. We interviewed participants using structured questionnaires to collect detailed demographic, smoking and dietary data. For over 99% of the study participants, urinary concentration of at least one of the PAHs was above both the limit of detection (LOD) and the limit of quantification (LOQ). All PAHs were significantly correlated (rho = 0.67–0.92). Urinary concentration of hydroxyphenanthrenes, but not 1OH_pyrene, was significantly higher among Arabs and Druze study participants (N = 56) compared to Jewish participants (N = 183). For 4-hydroxyphenanthrene, concentration in Arabs and Druze was 1.95 (95% CI 1.50–2.52) that of Jews, after controlling for creatinine, age and cotinine levels. Urinary concentrations of all PAHs were significantly higher among current smokers or participants with higher cotinine levels and increased significantly with smoking frequency. While PAHs concentrations were not associated with cotinine concentrations in nonsmokers in the overall study population, PAHs concentration was significantly higher among nonsmoking Jews with cotinine ≥LOQ (1 μg/L), which represents exposure to environmental tobacco smoking, compared to nonsmoking Jews with cotinine concentrations <LOQ, with the highest ratio for 1OH_pyrene (Ratio = 2.38, 95% CI 1.47–3.85). Among nonsmoking Arabs and Druze, higher hydroxyphenanthrenes concentrations were found for those consuming grilled food once a month or more. For 3-hydroxyphenanthrene, concentration in those consuming grilled food once a month or more was 2.72 (95% CI 1.01–4.98) times that of those consuming grilled food less than once a month or not at all, after controlling for creatinine, age and cotinine levels.In conclusion, we found that the general adult population in Israel is widely exposed to PAHs. Exposure differed by ethnic sub-groups both in magnitude and sources of exposure. The finding of higher exposure among Arabs and Druze highlights disparities in environmental exposures across subpopulations and suggests that further research and preventive measure are warranted to reduce PAHs exposure and associated health outcomes, especially in the Arab population in the Middle East.     

Blood lead concentration and related factors in Korea from the 2008 National Survey for Environmental Pollutants in the Human Body

This study evaluated blood lead concentrations in the Korean general population and the correlation between various exposure sources using data from the 2008 Korea National Survey for Environmental Pollutants in the Human Body (National Institute of Environmental Research, Korea). The general and occupational characteristics were gathered from 5136 participants who were 20 years of age and older using a structured questionnaire. Blood lead concentrations were analyzed using an atomic absorption spectrophotometer. Statistical analysis was performed using multiple linear regressions of the log lead concentrations to the independent variables such as age, gender, smoke, herbal medication and drug consumption, drinking water, and living area. Geometric mean (GM) blood lead concentrations in Korean adults were 19.7 μg/l. The blood lead concentrations increased with age; the highest concentrations were found in the 50–69-year age group (p < 0.001). Males were higher than in females (p < 0.001). Current smokers and drinkers had higher concentrations than nonsmokers (p < 0.001) and nondrinkers (p < 0.001), respectively. People who took herbal medication and drug consumption were higher than those who did not (p < 0.001). Education level was negatively associated with blood lead concentration (p < 0.001). People living in or around industrial areas had elevated blood lead concentration (p < 0.001). Family income was also negatively associated with lead concentration, but not significantly. For drinking water, the underground water (spring or well water) drinking group had higher concentrations than other types of water drinking groups, but not significantly (p = 0.063). The blood lead concentrations by occupation were significant (p < 0.034): the highest was in laborer and Agricultural–Fishery–Forestry and the lowest in office workers. In women, blood lead concentrations tended to decrease with increasing delivery times, but not significantly. The blood lead concentration (GM) of the general adult population in Korea has decreased over time from 45.8 μg/l (1999) to 19.7 μg/l (2008). Although it is still higher than in other countries such as the United States and Canada, it is rapidly decreasing. Gender, age, smoking and alcohol drinking status, herbal medication and drug consumption, education level, living area and occupation were significantly related to the blood lead concentrations in Korea.     

Tackling second-hand exposure to tobacco smoke and aerosols of electronic cigarettes: the TackSHS project protocol

ObjectiveThe TackSHS project aims to comprehensively elucidate the impact that exposure to second-hand smoke (SHS) from cigarettes and second-hand aerosols (SHA) from electronic cigarettes have on the respiratory health of the European population according to socioeconomic characteristics and other determinants.MethodThe TackSHS project involves a series of coordinated studies carried out by 11 academic and public health organisations from six European countries. The project will investigate: a) the determinants of SHS and SHA exposure assessed at the individual level (surveys on representative general population samples) and in common environments (environmental sampling in specific settings); b) the overall disease burden, mortality and morbidity attributable to such exposure; and c) its economic impact in terms of direct health care costs. The project will also examine specific acute respiratory health changes in healthy individuals and patients with respiratory diseases exposed to SHS and SHA. In addition, the project will examine the effectiveness of a novel intervention to reduce SHS exposure in households where smoking is permitted. All these studies are inter-related and involve collaborative coordination among the participant organisations.ConclusionThe comprehensive, integrated approach of the TackSHS project will enable a significant step forward from the current status quo in the understanding of the impact of SHS and SHA exposure on health and provide the basis for health policy recommendations to help European countries to further reduce the harm caused by SHS and SHA exposure.     

Increase in saliva cotinine after three hours' exposure to second-hand smoke in bars

OBJECTIVE: To determine whether measurement of cotinine in saliva is a sensitive measure of exposure to second-hand smoke (SHS) among customers in bars. DESIGN: Before/after comparison of saliva cotinine and subjective assessments of SHS. SETTING: Three bars in Wellington, New Zealand, June 2003. PARTICIPANTS: Eleven non-smoking medical students spent three hours in each location. They provided saliva samples before and after the visit, counted numbers of lit cigarettes in each bar, and assessed the smokiness of the venue. Samples were tested for cotinine using liquid chromatography coupled with mass spectrometry. RESULTS: Cotinine levels post-visit were consistently higher than baseline. The mean difference was 1.03 ng/mL with a 95% confidence interval of 0.76-1.30 ng/ mL. Adjustments to post-visit levels for metabolism and clearance of cotinine made very little difference to these results. Males tended to have higher baseline levels than females, and to show smaller increases. The bar with the greatest increase in cotinine was judged to be the smokiest on the basis of averaged cigarette counts and scores for presence of smoke and odour. CONCLUSION: The cotinine in saliva, when tested with the analytic methods described here, provides a means of assessing relatively short-term exposures to SHS.     

Assessment of tobacco smoke exposure in the pediatric emergency department

ObjectiveTobacco smoke exposure causes significant childhood morbidity and is associated with a multitude of conditions. National organizations recommend tobacco smoke exposure screening at all pediatric clinical encounters. Data regarding tobacco smoke exposure screening in the pediatric emergency department is sparse, although children with tobacco smoke exposure-associated conditions commonly present to this setting. We aimed to determine the frequency and outcome of tobacco smoke exposure screening in the pediatric emergency department, and assess associated sociodemographic/clinical characteristics.MethodsThis retrospective review included pediatric patients presenting to a large pediatric emergency department in Cincinnati, Ohio between 2012 and 2013. Variables extracted included: age, sex, race/ethnicity, insurance, child's tobacco smoke exposure status, triage acuity, diagnosis, and disposition. Regression analyses examined predictors of tobacco smoke exposure screening and tobacco smoke exposure status.ResultsA total of 116,084 children were included in the analysis. Mean child age was 6.20 years (SD ± 5.6); 52% were male. Nearly half of the children in the study did not undergo tobacco smoke screening; only 60% of children with tobacco smoke exposure-related illnesses were screened. Predictors of tobacco smoke exposure screening were: younger age, male, African American, non-commercial insurance, high acuity, tobacco smoke exposure-related diagnoses and non-intensive care admission. Of children screened for tobacco smoke exposure, 28% were positive. Children more likely to screen positive were non-Hispanic, had non-commercial insurance, and had tobacco smoke exposure-related diagnoses. NonAfrican American children triaged as low acuity were more likely to have tobacco smoke exposure, yet were less likely to be screened.ConclusionDespite national recommendations, current tobacco smoke exposure screening rates are low and fail to identify at-risk children. Pediatric emergency department visits for tobacco smoke exposure-associated conditions are common, thus further research is needed to develop and assess standardized tobacco smoke exposure screening tools/interventions in this setting.     

Cancer du rein et expositions au trichloroéthylène : les valeurs limites d’exposition professionnelle françaises en vigueur sont-elles adaptées ?

BackgroundSeveral studies have investigated the association between trichloroethylene (TCE) exposure and renal cell cancer (RCC) but findings were inconsistent. The analysis of a case control study has shown an increased risk of RCC among subjects exposed to high cumulative exposure. The aim of this complementary analysis is to assess the relevance of current exposure limits regarding a potential carcinogenic effect of TCE on kidney.MethodsEighty-six cases and 316 controls matched for age and gender were included in the study. Successive jobs and working circumstances were described using a detailed occupational questionnaire. An average level of exposure to TCE was attributed to each job-period in turn. The main occupational exposures described in the literature as increasing the risk of RCC were assessed as well as non-occupational factors. A conditional logistic regression was performed to test the association between TCE and RCC risk. Three exposure levels were studied (average exposure during the eight-hour shift): 35 ppm, 50 ppm and 75 ppm. Potential confounding factors identified were taken into account at the threshold limit of 10% (p = 0.10) (body mass index [BMI], tobacco smoking, occupational exposures to cutting fluids and to other oils).ResultsAdjusted for tobacco smoking and BMI, the odd-ratios associated with exposure to TCE were respectively 1.62 [0.77–3.42], 2.80 [1.12–7.03] and 2.92 [0.85–10.09] at the thresholds of 35 ppm, 50 ppm and 75 ppm. Among subjects exposed to cutting fluids and TCE over 50 ppm, the OR adjusted for BMI, tobacco smoking and exposure to other oils was 2.70 [1.02–7.17].ConclusionResults from the present study as well as those provided in the international literature suggest that current French occupational exposure limits for TCE are too high regarding a possible risk of RCC.     

Consumo de tabaco y alcohol según la jornada laboral en España

ObjectiveTo examine the association between smoking and alcohol consumption and the type of working day in the Spanish populationMethodsCross-sectional study among employees residing in Spain aged >18 years (N = 8,736). We took data from the National Health Survey (2011-2012). Information was collected on the type of working day (morning, afternoon, evening, part-time, reduced hours, and shift-work) and smoking and drinking habits. Demographic characteristics and health- and work-related factors were also taken into account. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated through log-binomial regressions.ResultsAmong respondents, 32.1% smoked regularly, especially those working the night shift (43.5%). Moderate alcohol consumption was found in 54.8% of workers and excessive consumption in 1.5%. Most of the moderate and heavy drinkers worked part-time, with 57.6% and 1.8% respectively. The aOR of being a smoker was higher among night workers (OR = 1.58; 95% CI: 1.01-2.46). None of the work shifts were significantly associated with alcohol consumption.ConclusionsNight shift work was associated with regular smoking. This collective of workers should be monitored closely by occupational health services and regularly undergo programs to control tobacco consumption and smoking-related diseases. Additional research to elucidate the reasons for this association could help to achieve preventive and therapeutic success.     

Effect of nocturnal road traffic noise exposure and annoyance on objective and subjective sleep quality

BackgroundVarious epidemiological studies have found an association between noise exposure and sleep quality, but the mediating role of annoyance is unclear for this association.ObjectivesTo investigate the effects of both objectively modeled road traffic noise exposure as well as noise annoyance on subjective and objective sleep quality measures.Methods1375 randomly selected participants from Basel, Switzerland, were enrolled in a questionnaire survey in 2008 with follow-up one year later (1122 participants). We assessed sleep quality by using a standardized sleep disturbance score, as well as the level of annoyance with road traffic noise at home. Objective sleep efficiency data was collected in a nested diary study by means of actigraphy from 119 subjects for 1551 nights. Residential nocturnal exposure to road traffic noise was modeled using validated models. Data were analyzed with random intercept mixed-effects regression models.ResultsIn the main study, self-reported sleep quality was strongly related to noise annoyance (p for trend <0.001) but only moderately correlated with modeled noise exposure (p = 0.07). In the nested diary study objectively measured sleep efficiency was not related to annoyance (p = 0.25) but correlated with modeled noise exposure (p = 0.02). Strikingly, noise induced decreased sleep efficiency was even more significant for study participants who were not annoyed with traffic noise (p = 0.001).ConclusionsThis study indicates that effects of nocturnal traffic noise on objective sleep quality are independent of perceived noise annoyance, whereas the association between self-reported sleep quality and noise is mediated by noise annoyance.     

Secondhand smoke exposure and respiratory symptoms among casino, club, and office workers in Victoria, Australia

OBJECTIVE: To examine the association between smoke-free policies, exposure to secondhand smoke (SHS) at work, and self-reported respiratory and sensory symptoms of workers. METHOD: Ninety-one nonsmoking workers recruited from three workplaces with varying smoking policies completed a telephone-administered questionnaire and provided saliva samples (before and after usual work shift) for cotinine analysis. RESULTS: Mean before-after shift saliva cotinine per hour worked was significantly higher among club (0.42 ng/mL/hr worked) than casino workers (0.18 ng/mL/hr worked) (P < 0.001), club than office workers (0.03 ng/mL/hr worked) (P < 0.001), and casino than office workers (P < 0.001). Casino and club workers reported similar levels of respiratory morbidity and were more likely to have sore eyes (odds ratio [OR] = 5.5, P < 0.01) and a sore throat (OR = 4.3, P < 0.05) compared with office employees. CONCLUSION: Air-conditioning interventions reduce, but fail to eliminate, exposure of hospitality workers to SHS. Such exposure is associated with measurable increases in the risk of respiratory symptoms.     

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.     

Secondhand smoke exposure and inflammatory markers in nonsmokers in the trucking industry

Background: Few studies have directly assessed the association of secondhand smoke (SHS) with cardiovascular disease–related inflammatory markers, and the findings are inconsistent.Objectives: We assessed the association between SHS exposure and the inflammatory markers high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and soluble intercellular adhesion molecule-1 (sICAM-1) in 199 nonsmoking U.S. trucking industry workers.Methods: Participants provided blood samples either by mail (blood drawn at local health care provider near home) or at the work site (blood drawn by research staff on-site) and completed a health and work history questionnaire at the time of blood draw. Exposure to SHS was measured by plasma cotinine concentrations. We used multivariate regression analyses to assess the associations between levels of cotinine and inflammatory markers.Results: The median cotinine level was 0.10 ng/mL (interquartile range, 0.04–0.23 ng/mL). The odds ratios of elevated hs-CRP (above highest CRP tertile, 1.5 mg/L) were 2.85 [95% confidence interval (CI), 1.03–7.89] for the high-cotinine group (> 0.215 ng/mL) and 2.80 (95% CI, 1.11–7.10) for the moderate-cotinine group (0.05–0.215 ng/mL), compared with the low-cotinine group (< 0.05 ng/mL), adjusting for age, sex, race, educational level, obesity, previous smoking history, job title, and medical history. Plasma cotinine levels were not associated with IL-6 or sICAM-1.Conclusions: SHS exposure, as assessed by plasma cotinine, was positively associated with hs-CRP in this group of blue-collar workers. The strength of the association with hs-CRP depended on the cut points selected for analysis.     

Perceived racial/ethnic discrimination,smoking and alcohol consumption in the Multi-Ethnic Study of Atherosclerosis (MESA)

ObjectiveTo examine the association of perceived racial/ethnic discrimination with smoking and alcohol consumption in adults participating in the Multi-Ethnic Study of Atherosclerosis.MethodsData on 6680 black, Chinese, Hispanic and white adults aged 45 to 84 years of age recruited from Illinois, New York, Maryland, North Carolina, Minnesota and California during 2000 and 2002 were used for this analysis. Logistic regression was used to estimate the association of perceived racial/ethnic discrimination with smoking status and alcohol consumption for each racial/ethnic group separately.ResultsBlacks were more likely to experience racial/ethnic discrimination (43%) than Hispanics (19%), Chinese participants (10%) or whites (4%, P < 0.0001). In the fully-adjusted model, blacks reporting racial/ethnic discrimination had 34% and 51% greater odds of reporting smoking and drinking, respectively, than blacks who did not report racial/ethnic discrimination. Hispanics reporting racial/ethnic discrimination had 62% greater odds of heavy drinking. Whites reporting racial/ethnic discrimination had 88% greater odds of reporting being current smokers than whites who did not report racial/ethnic discrimination.ConclusionsOur findings suggest that the experience of discrimination is associated with greater prevalence of unhealthy behaviors. Specifically, the use of smoking and alcohol may be patterned by experience of discrimination.