公共场所和工作场所环境烟草烟雾暴露及其控制措施研究进展

近年,公共场所和工作场所的环境烟草烟雾暴露已成为目前重要的公共卫生和职业健康问题,本文综述了环境烟草烟雾对健康的影响,公共场所和工作场所环境烟草烟雾的暴露问题,禁烟法规对减少烟草烟雾暴露的作用效果及我国烟草暴露的现状,并对今后需进一步研究的领域进行探讨.     

How many deaths will it take? A death from asthma associated with work‐related environmental tobacco smoke

BACKGROUND: Despite epidemiologic, experimental and observational data on the association of environmental tobacco smoke (ETS) and adverse health effects, bar and restaurant workers remain exposed to ETS in the majority of states and countries. METHODS: Three public health surveillance systems were used to identify and conduct a follow-up investigation of a reported acute asthma death of a young waitress in a bar. RESULTS: The waitress collapsed at the bar where she worked and was declared dead shortly thereafter. Evaluation of the circumstances of her death and her medical history concluded that her death was from acute asthma due to environmental tobacco smoke at work. CONCLUSIONS: This is the first reported acute asthma death associated with work-related ETS. Recent studies of asthma among bar and restaurant workers before and after smoking bans support this association. This death dramatizes the need to enact legal protections for workers in the hospitality industry from secondhand smoke.     

The smoke you don't see: uncovering tobacco industry scientific strategies aimed against environmental tobacco smoke policies

OBJECTIVES: This review details the tobacco industry's scientific campaign aimed against policies addressing environmental tobacco smoke (ETS) and efforts to undermine US regulatory agencies from approximately 1988 to 1993. METHODS: The public availability of more than 40 million internal, once-secret tobacco company documents allowed an unedited and historical look at tobacco industry strategies. RESULTS: The analysis showed that the tobacco industry went to great lengths to battle the ETS issue worldwide by camouflaging its involvement and creating an impression of legitimate, unbiased scientific research. CONCLUSIONS: There is a need for further international monitoring of industry-produced science and for significant improvements in tobacco document accessibility.     

Salient Environmental and Perceptual Correlates of Current and Established Smoking for 2 Representative Cohorts of Indiana Adolescents

PURPOSE:  A secondary analysis of 2000 and 2004 Indiana Youth Tobacco Survey (IYTS) data was conducted to investigate salient environmental and perceptual correlates of adolescents' current and established smoking while controlling for demographic variables such as gender, grade, and race/ethnicity and to compare the pattern of significant correlates between the years.
METHODS:  The IYTS was an anonymous school-based survey regarding tobacco use; familiarity with pro- and anti-tobacco media messages; exposure to environmental tobacco smoke (ETS); minors' access to tobacco products; and general knowledge, attitudes, and beliefs about tobacco. In 2000, a representative sample of 1416 public high school students in grades 9-12 and 1516 public middle school students in grades 6-8 (71.44% and 72.53% response rates, respectively) were surveyed. In 2004, 3433 public high school students and 1990 public middle school students (63.04% and 65.44 % response rates, respectively) were surveyed.
RESULTS:  Significant predictors of adolescents' current and established smoking habits included exposure to ETS either in homes or in cars, exposure to pro-tobacco messages, perceived benefit of smoking, and perceived peer acceptance of smoking. The influence of exposure to pro-tobacco messages greatly outweighed exposure to any anti-tobacco messages.
CONCLUSIONS:  The findings of this study warrant that more efforts and resources be placed on preventing youth from being exposed to ETS, and to control pro-tobacco marketing and improve the tobacco counter-marketing messages. The perceived benefits of smoking found here indicate that smoking for relaxation and weight control may be major influencing factors on adolescent smoking.     

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     

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.     

云南省三城市学生被动吸烟现况调查

目的了解云南省学生被动吸烟暴露状况,为政府及相关部门制定控烟干预政策、措施提供依据。方法于2007年在云南省3个城市采用多阶段分层随机抽样,随机抽取大学或大专院校、中学、小学在校学生779人进行问卷调查。调查内容包括调查对象一般情况、吸烟情况、家内外被动吸烟情况等。结果被调查学生吸烟率为8.64%,尝试吸烟率为30.7%。学生家庭中父亲吸烟的占72.7%;男生、高年级学生通过朋友接触烟草烟雾的机会较高;在家内、家外、家内和(或)家外被动吸烟率分别为53.3%,54.0%和70.6%。结论云南省学生环境烟草烟雾暴露状况较严重,应加强公众吸烟危害知识宣传教育,尽快在公共场所立法禁烟,为学生健康成长创造无烟环境。     

Household smoking behaviours and exposure to environmental tobacco smoke among infants: are current strategies effectively protecting our young?

Objective: To determine the prevalence of infant exposure to environmental tobacco smoke (ETS) among infants attending child health clinics in regional NSW; the association between such exposure and household smoking behaviours; and the factors associated with smoking restrictions in households with infants. Methods: Parents completed a computer‐based questionnaire and infant urine samples were collected. Information was obtained regarding the smoking behaviours of household members and samples were analysed for cotinine. Results: Twenty seven per cent of infants had detectable levels of cotinine. Infant ETS exposure was significantly associated with the smoking status of household members, absence of complete smoking bans in smoking households and having more than one smoker in the home. Smoking households were significantly less likely to have a complete smoking ban in place. Conclusions: This study suggests that a significant proportion of the population group most vulnerable to ETS were exposed. Implications: Future efforts to reduce children's exposure to ETS need to target cessation by smoking parents, and smoking bans in households of infants where parents are smokers if desired reductions in childhood ETS‐related illness are to be realised.     

上海部分餐馆室内空气PM2.5浓度监测及禁烟措施调查

目的了解上海餐厅禁烟措施的实施情况,分析不同禁烟规定对减少餐厅就餐区烟草烟雾浓度的效果。方法电话调查餐厅的控烟类型,现场观察禁烟措施的落实情况,并采用AM510型个人智能防爆粉尘检测仪对餐厅室外、非吸烟区、吸烟区细颗粒物PM2.5的浓度进行检测,分析餐厅内3类监测点之间、不同禁烟规定的餐厅之间的烟草烟雾浓度差异。结果电话调查100家餐厅中,21家不禁烟,48家部分禁烟,27家完全禁烟。排除室外PM2.5浓度的影响,完全禁烟餐厅的非吸烟区PM2.5浓度(56.83μg/m3)低于部分禁烟餐厅(66.46μg/m3,F=5.424,P<0.05);部分禁烟餐厅中,非吸烟区PM2.5浓度(84.90μg/m3)低于吸烟区(130.67μg/m3,t=-3.154,P<0.01),吸烟区PM2.5浓度低于不禁烟餐厅(t=2.386,P<0.05)。结论餐厅控烟法规执行有待加强,餐厅分区能在一定程度上减少非吸烟区受吸烟区烟草烟雾的影响,但其效果明显小于完全禁烟,餐厅采取完全禁烟措施非常必要。     

Tobacco industry efforts at discrediting scientific knowledge of environmental tobacco smoke: a review of internal industry documents

STUDY OBJECTIVE: Using tobacco industry internal documents to investigate the use of tobacco industry consulting scientists to discredit scientific knowledge of environmental tobacco smoke (ETS). DESIGN: Basic and advanced searches were performed on the Philip Morris, Tobacco Institute, R J Reynolds, Brown and Williamson, Lorillard, and the Council for Tobacco Research document web sites, with a concentration on the years 1985-1995. Guildford depository files located on the Canadian Council on Tobacco Control website were also searched. The documents were found in searches undertaken between 1 March and 30 June 2000. MAIN RESULTS: The industry built up networks of scientists sympathetic to its position that ETS is an insignificant health risk. Industry lawyers had a large role in determining what science would be pursued. The industry funded independent organisations to produce research that appeared separate from the industry and would boost its credibility. Industry organised symposiums were used to publish non-peer reviewed research. Unfavourable research conducted or proposed by industry scientists was prevented from becoming public. CONCLUSIONS: Industry documents illustrate a deliberate strategy to use scientific consultants to discredit the science on ETS.     

Legislation on smoking in enclosed public places in Scotland: how will we evaluate the impact?

BACKGROUND: From 26 March 2006, smoking will be prohibited in wholly and substantially enclosed public places in Scotland, and it will be an offence to permit smoking or to smoke in no-smoking premises. We anticipate that implementation of the smoke-free legislation will result in significant health gains associated with reductions in exposure to both environmental tobacco smoke (ETS) and personal tobacco consumption as well as other social and economic impacts. METHODS: Health Scotland in conjunction with the Information Services Division (ISD) Scotland and the Scottish Executive have developed a comprehensive evaluation strategy to assess the expected short-term, intermediate and long-term outcomes. Using routine health, behavioural and economic data and commissioned research, we will assess the impact of the smoke-free legislation in eight key outcome areas--knowledge and attitudes, ETS exposure, compliance, culture, smoking prevalence and tobacco consumption, tobacco-related morbidity and mortality, economic impacts on the hospitality sector and health inequalities. CONCLUSION: The findings from this evaluation will make a significant contribution to the international understanding of the health effects of exposure to ETS and the broader social, cultural and economic impacts of smoke-free legislation.     

Clearing the air: the evolution of organized labor's role in tobacco control in the United States.

As efforts to make U.S. worksites smoke-free took shape in the 1980s, the tobacco industry sought to defeat them by forming alliances with organized labor. The alliance between the tobacco industry and organized labor was based on framing the regulation of environmental tobacco smoke (ETS) as a threat to jobs, an example of management unilateralism, and an issue that divided smoking and nonsmoking union members. The dynamics of organized labor and tobacco control began to change in the late 1980s with attempts to ban smoking on airlines and in the hospitality industry. Flight attendants, bar and restaurant workers, and casino dealers-all subject to ETS in their work environments-confronted ETS as an occupational health issue. Against the backdrop of increasing awareness of the hazards of ETS, and the acceptance of tobacco control policy, this framing changed the basis of organized labor's role in tobacco control. Because service workers share the workplace with the general public, their occupational health issues are also public health issues. This fact presents new opportunities for coalition building to protect the health of service workers and the public alike.     

Asociación entre determinantes socioeconómicos y exposición al humo ambiental del tabaco en niños

ObjectiveTo assess the association between exposure to environmental tobacco smoke (ETS) and different socioeconomic determinants among Spanish children.MethodWe analyzed the data of 5495 children included in the 2011-2012 Spanish National Health Survey. We estimated the prevalence of exposure to ETS and adjusted logistic regression models to identify variables related to exposure to ETS: total exposure and exposure in the home in addition to ETS exposure in enclosed public places/transport.ResultsTotal exposure to ETS among children aged 15 and younger was 11.8%, 11.5% of whom were exposed at home and 0.8% in enclosed public places/transport. The prevalence odds ratio (POR) of exposure at home increased with age (6-9 years: 2.19; 10-14 years: 2.28), in children with parents of low or medium education levels (1.97 and 1.29), of social class IV-VI (1.42), among those living in a household with a composition other than a “couple with children” (1.43), and in smaller-sized homes (1.39). Total exposure results were similar to home exposure results.ConclusionThe prevalence of ETS is higher among children younger than 15 years with a more difficult economic situation. These inequalities must be considered in the establishment and development of public health policies.     

Increased burden of respiratory disease in the first six months of life due to prenatal environmental tobacco smoke: Krakow birth cohort study

The main purpose of our study was to assess the effects of prenatal tobacco smoke on respiratory symptoms and on doctor consultations in a birth cohort of 445 infants who had no smoking mothers and who had no postnatal exposure to environmental tobacco smoke (ETS). Before and after delivery, questionnaires and interviews with mothers were administered to solicit information on prenatal and postnatal ETS exposure. Newborns were followed-up over six months of life, and respiratory outcomes such as runny or stuffed nose, cough with or without cold, difficult (puffed) breathing, wheezing or whistling in the chest irrespective of respiratory infection were considered. In addition, medical visits related to the occurrence of respiratory symptoms were recorded for each child over a six-month study period. In the multivariate Poisson regression analysis, a set of potential confounders has been taken into account such as gender of child, season of birth, gestational age, maternal education, maternal atopy, presence of moulds in households and prenatal level of personal exposure to fine particles. The adjusted rate ratio (RR) estimated for the occurrence of episodes of running nose was significantly higher in infants exposed to prenatal ETS (1.40; 95% confidence interval [CI]: 1.11-1.68) and the corresponding RR estimates for cough, difficult breathing and wheezing were 1.49 (95% CI: 1.15-1.93), 1.96 (95% CI: 1.22-3.16) and 5.12 (95% CI: 2.86-9.16). The rate ratios of doctor consultations attributable to prenatal ETS because of cough was 1.94 (95% CI: 1.49-2.54). The risk estimate for consultations due to difficult breathing was 2.77 (95% CI: 1.76-4.36), and that for wheezing was 5.86 (95% CI: 3.56-9.64). The data strongly support the view about the impact of the in-utero effect of passive smoking on children's respiratory health. Higher utilization rates of doctor consultations in infants attributable to prenatal ETS exposure demand the revision of public health policy, which should be focused also on cessation of smoking practices by all household members during and after the pregnancy period.     

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.     

Parental smoking behaviour and effects of tobacco smoke on children's health in Finland and Russia

BACKGROUND: There is little information on potential differences in smoking behaviour of parents between Finland and Russia and on the effects of environmental tobacco smoke (ETS) exposure on allergic and respiratory diseases among Finnish and Russian children. The aim of the study was to compare the smoking behaviour of parents and school children and to assess the relations of tobacco smoke exposure during pregnancy and childhood with occurrence of allergic diseases and respiratory infections among school children. METHODS: We conducted a population-based cross-sectional study in the neighbour towns across the border of Imatra in Finland and Svetogorsk in Russia. The study population consisted of 512 Finnish and 581 Russian school children aged 7-16 years (response rate 79%). RESULTS: Children's tobacco smoke exposure differed markedly between Finland and Russia. The risk of asthma was particularly related to high maternal smoking exposure during pregnancy (adjusted OR 3.51, 95% CI 1.00-12.3), infancy (3.34, 1.23-9.07) and currently (3.27, 1.26-8.48), and the risk of common cold was related to high combined parental smoking during infancy (1.83, 1.06-3.17) in Finnish children. Among Russian children allergic conjunctivitis was related to maternal smoking during infancy (4.53, 1.49-13.8) and currently (2.82, 1.07-7.44). CONCLUSIONS: Smoking behaviour of parents and ETS exposure during childhood differed markedly between Finland and Russia. Asthma was particularly increased in relation to high exposure to maternal smoking in Finland. The results suggest that more efforts should be directed to reducing tobacco smoke exposure of children in both Finland and Russia. (250 words).     

公共场所和工作场所环境空气中烟草烟雾污染状况的研究

目的 了解北京市东城区公共场所和工作场所环境中烟草烟雾的暴露情况及其影响因素.方法 于2004年1-2月选取北京市东城区14家公共场所和工作场所,采用被动式尼古丁采样器对场所环境空气中的尼古丁水平进行监测.应用多元线性回归方程对影响尼古丁浓度的因素进行分析.结果 14家公共场所和工作场所中的所有采样点均检测到了尼古丁,其浓度中位数为3.01 μg/m3,浓度范围为0.03～28.72 μg/m3.完全禁烟场所检测到的尼古丁浓度中位数最低,而在无禁烟规定的场所中检测到的尼古丁浓度中位数最高.影响室内空气中尼古丁浓度的因素较多,包括禁烟规定、吸烟人数和房屋面积等,其中吸烟人数是最重要的因素.结论 目前,公共场所和工作场所的环境烟草烟雾暴露已成为重要的公共卫生和职业健康问题,吸烟人数对空气中尼古丁浓度的影响最大.     

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.     

青少年二手烟草烟雾暴露影响因素及干预措施

目的 了解国内外青少年二手烟暴露的流行情况、影响因素和控烟策略,为减少目标人群二手烟暴露提供依据。方法 检索CNKI、万方、PubMed数据库,查阅相关文献,就青少年二手烟暴露的状况、影响因素和国内外控烟策略进行综述。结果 青少年二手烟草烟雾暴露与多种影响因素有关,公共禁烟政策和基于家庭的个人干预都能有效减少青少年二手烟暴露。 结论 目前青少年二手烟暴露率仍然居高,但针对相关影响因素采取控烟策略,可减少青少年环境烟草暴露伤害。     

Exposure to Environmental Tobacco Smoke among Infants in Southern Thailand: A Study of Urinary Cotinine

We performed a survey to assess the exposure to environmental tobacco smoke (ETS) in 1-year-old infants in Thailand. Of the 725 infants, it was reported that 73.3% had household smoking and 40.7% had detectable urinary cotinine. Twenty-five infants (3.4%) had urinary cotinine in the range of adult heavy smokers. The prevalence of ETS exposure was significantly higher in infants with a father whose education was ≤ grade 6 than in those with father’s education >6 years (44.0% vs. 36.0%, p = 0.039). Data on the exposure to ETS among infants will provide prevalence information and identify population subgroups at increased risk for exposure.