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.     

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.     

孕妇被动吸烟对妊娠结局及后代健康的危害

我国妇女主动吸烟率较低,但被动吸烟率却较高。孕妇被动吸烟不仅会危害自身健康,还会影响胚胎发育,出现流产、死胎、宫内发育迟缓、早产、免疫功能低下、出生缺陷、智力低下等不良妊娠结局,远期还会造成子代对哮喘、癌症、心理疾病等病症易感性增加。为了唤起人们对孕妇被动吸烟更多的关注,本文主要从近期及远期两方面来综述孕妇被动吸烟的危害。     

The exposure of nonsmoking and smoking mothers to environmental tobacco smoke during different gestational phases and fetal growth

We studied the impact of maternal exposure to environmental tobacco smoke (ETS) on birth weight (BW), low birth weight (LBW), and intrauterine growth retardation (IUGR) according to self-reported maternal smoking habits in a sample of 6,866 singleton births. We obtained data about parental characteristics and maternal active smoking (AS) and passive smoking at delivery via maternal questionnaires and medical records. We used three categories of smoking habits (nonsmokers and those who smoked 1-10 or >10 cigarettes per day) and defined ETS exposure as greater than or equal to 5 cigarettes per day smoked by others in the mother's presence. We used multiple regression and logistic regression procedures with adjustment for many associated covariates. We observed a significant reduction of the mean BW in infants of AS mothers. This reduction was only marginal for mothers who stopped smoking after recognizing their pregnancy. ETS exposure in 1,797 of 5,507 nonsmoking mothers reduced the mean BW of their infants by 53 g [95% confidence interval (CI), 24-82 g]. ETS exposure also significantly reduced BW in babies of AS mothers by 92 g (CI, 21-113 g) compared with BW of ETS-nonexposed AS mothers. The adjusted odds ratio (AOR) of LBW for ETS-exposed AS mothers was two times the LBW risk of ETS-nonexposed AS mothers(2.02; CI, 1.11-3.67); the AOR of ETS-exposed nonsmoking mothers was 1.51 (CI, 1.02-2.26). The AOR of IUGR for this group did not differ from unity (1.08; CI, 0.82-1.43). However, ETS exposure increased the AOR of IUGR for AS mothers from 1.64 (CI, 1.06-2.53) to 2.13 (CI, 1.70-2.67). ETS exposure reduced the BW of infants of nonsmoking mothers and contributed to additional BW reduction in infants of AS mothers. ETS exposure increased the risk of LBW but not that of IUGR in babies of nonsmoking mothers.     

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.     

Prevalence of maternal smoking and environmental tobacco smoke exposure during pregnancy and impact on birth weight: retrospective study using Millennium Cohort

Background  

Meta-analyses of studies investigating the impact of maternal environmental tobacco smoke (ETS) on birth weight have not produced robust findings. Although, ante natal ETS exposure probably reduces infant's birth weights, the scale of this exposure remains unknown. We conducted a large, cohort study to assess the impact of ETS exposure on birth weight whilst adjusting for the many factors known to influence this.     

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.     

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.     

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.     

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.     

Indoor exposure to environmental tobacco smoke and dampness: respiratory symptoms in Sardinian children--DRIAS study

Indoor exposures at home, environmental tobacco smoke (ETS) and mould/dampness adversely affect respiratory health of children. Disturbi Respiratori nell’Infanzia e Ambiente in Sardegna (DRIAS) (Respiratory Symptoms in children and the Environment in Sardegna, Italy) aims at relating the prevalence of respiratory and allergic symptoms to indoor exposures in Sardinian children.DRIAS, a cross-sectional investigation of respiratory symptoms/diseases, used a modified version of ISAAC questionnaire, included 4122 children attending 29 primary schools in the school year 2004-2005.If both parents smoke the prevalence for current wheeze and current asthma is almost doubled in comparison with never smokers, for persistent cough and phlegm a role is suggested when only mother smokes. Among mothers smoking in pregnancy, the prevalence of current wheeze and current asthma is increased. Exposure to ETS and family atopy have a joint effect resulting in an almost tripling of prevalence for current wheeze and more than four times for current asthma. Exposure to “dampness” (mould or dampness) both during the first year of life and currently is associated with increased prevalence of current wheeze, persistent cough or phlegm and current rhino-conjunctivitis; if exposure is only during the first year of life a doubling or more of prevalence is observed for current wheeze, current asthma, and persistent cough or phlegm.DRIAS results add evidence to the causal role of childhood exposure to ETS in the development of respiratory symptoms (cough, phlegm, and wheezing) and asthma. The joint effect of ETS and family atopy is corroborated. The results strengthen the evidence for a causal association between “dampness” and respiratory health, pointing to its possible independent role in causing asthma, a long-lasting exposure entails a doubled prevalence for both asthmatic and bronchitis symptoms.     

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.     

Environmental tobacco smoke exposure during infancy.

We collected information about household smoking habits from 518 mothers when they made their first well child visit with a 6 to 8-week old infant. A urine sample was also collected from the infant, the cotinine concentration measured, and the measurement correlated with data provided by the mother. Eight percent of the infant urine cotinine values fell at or above 10 micrograms/L in the 305 households where no smoking was reported. Corresponding rates were 44 percent in the 96 households where a member other than the mother smoked, 91 percent in the 43 households where only the mother smoked, and 96 percent in the 74 households where both the mother and another household member smoked. In households where the mother smoked, infant urine cotinine levels were lower in the summer, and higher when the infant was breast-fed. A screening question about family smoking habits in conjunction with well child care could effectively define a group of infants exposed to environmental tobacco smoke and thus be at greater risk for respiratory diseases.     

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.     

Maternal smoking during pregnancy and smoking by adolescent daughters.

OBJECTIVES. Since cigarette smoking in adolescence represents a crucial entry point in the progression to illicit drugs, risk factors for adolescent smoking have public health implications. The influence of mothers on children's smoking appears to be greater than that of fathers. To explain the selective influence of mothers, we examined the consequences of maternal smoking during pregnancy in two longitudinal samples. METHODS. Analyses were conducted on follow-up interview data from two dyadic samples of mothers and firstborn adolescents for whom data on maternal smoking during and after pregnancy were available (192 mother-child pairs originating from New York State and 797 dyads from a national sample). RESULTS. In both samples, maternal smoking during pregnancy, when postnatal smoking was controlled, selectively increased the probability that female children would smoke and would persist in smoking (adjusted odds ratios of about 4). CONCLUSIONS. The findings suggest that nicotine or other substances released by maternal smoking can affect the fetus, perhaps through the nicotinic input to the dopaminergic motivational system, so as to predispose the brain in a critical period of its development to the subsequent addictive influence of nicotine consumed more than a decade later in life.     

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.     

Acute exposure to environmental tobacco smoke and heart rate variability

Environmental tobacco smoke (ETS) has been associated with cardiovascular mortality. Pathophysiologic pathways leading from ETS exposure to cardiopulmonary disease are still being explored. Reduced cardiac autonomic function, as measured by heart rate variability (HRV), has been associated with cardiac vulnerability and may represent an important pathophysiologic mechanism linking ETS and risk of cardiac mortality. In this study we evaluated acute ETS exposure in a commercial airport with changes in HRV in 16 adult nonsmokers. We conducted ambulatory electrocardiographic (ECG) monitoring for 8-hr periods while participants alternated 2 hr in nonsmoking and smoking areas. Nicotine and respirable suspended particle concentrations and participants' blood oxygen saturation were also monitored. We calculated time and frequency domain measures of HRV for periods in and out of the smoking area, and we evaluated associations with ETS using comparative statistics and regression modeling. ETS exposure was negatively associated with all measures of HRV. During exposure periods, we observed an average decrement of approximately 12% in the standard deviation of all normal-to-normal heart beat intervals (an estimate of overall HRV). ETS exposures were not associated with mean heart rate or blood oxygen saturation. Altered cardiac autonomic function, assessed by decrements in HRV, is associated with acute exposure to ETS and may be part of the pathophysiologic mechanisms linking ETS exposure and increased cardiac vulnerability.