Exposure to environmental tobacco smoke at work and at home: a population based survey

Trends and patterns of second-hand smoke exposure amongst the non-smokers in India-A secondary data analysis from the Global Adult Tobacco Survey (GATS) I & II

Objectives

The primary objective of the present study was to compare the prevalence and patterns of second-hand smoke (SHS) exposure in the home, workplace, public places, and at all three places amongst the non-smoker respondents between the two rounds of Global Adult Tobacco Survey (GATS) in India. The secondary objectives were to assess the differences in various factors associated with SHS exposure among non-smokers.

Study design

This secondary data analysis incorporated data generated from the previous two rounds of the cross-sectional, nationally representative GATS India, which covered 69,296 and 74,037 individuals aged 15 years and above. Exposure to the SHS at home, workplace, and public places amongst the non-smokers were the primary outcome variables. Standard definitions of the surveys were used.

Results

The overall weighted prevalence of exposure to SHS amongst the non-smokers inside the home and public places reduced. In contrast, the prevalence in the workplace increased marginally in round II compared to I. The proportion of adults who were exposed to SHS at all three places did not change much in two rounds of surveys. A decrease in the knowledge of the respondents exposed to SHS at home and public places was observed about the harmful effects of smoking in round II. Age, gender, occupation, place, and region of respondents were found to be significant determinants of SHS exposure at all the three places on multinomial logistic regression analysis.

Conclusions

The study calls for focused interventions in India and stringent implementation of anti-tobacco legislation, especially in the workplaces for reducing the exposure to SHS amongst the non-smokers and to produce encouraging and motivating results by next round of the survey.

Smoking Among Spanish Workers After Smoking Regulation

The aim of this study was to determine the prevalence of smoking among Spanish workers after a new smoking regulation became law. The researchers conducted a retrospective study with a worker sample. Information was collected via health examinations of 185 adults with a mean age of 35.93 ± 9.13 for men and 36.16 ± 9.52 for women who agreed to participate in the study in 2010, 2011, and 2012. The percentages of occasional smokers, light smokers, moderate smokers, and heavy smokers were compared by year for men and women. In 2010, 18% of women smokers were occasional, 45% light, 27% moderate, and 10% heavy smokers. Twenty-two percent of male smokers were occasional, 16% light, 28% moderate, and 34% heavy smokers. In 2011, 12% of ex-smokers were women and 14% were men. In 2012, 30% of ex-smokers were women and 22% were men. In conclusion, the percentage of ex-smokers has increased in this sample after the anti-smoking law was enacted.

Correlates of exposure to secondhand smoke (SHS) at home among non-smoking adults in Bangladesh: findings from the ITC Bangladesh survey

Background

Exposure to secondhand smoke (SHS) is a serious global public health problem. Understanding the correlates of SHS exposure could guide the development of evidence based SHS exposure reduction interventions. The purpose of this study is to describe the pattern of and factors associated with SHS exposure among non-smoking adults in Bangladesh.

Methods

Data come from adult non-smokers who participated in the second wave (2010) of the International Tobacco Control Policy (ITC) Evaluation Bangladesh Survey conducted in all six administrative divisions of Bangladesh. A structured questionnaire gathered information on participants’ demographic characteristics, pattern of SHS exposure, SHS knowledge, and attitudes towards tobacco control. Exposure to SHS at home was defined as non-smokers who lived with at least one smoker in their household and who reported having no home smoking ban. The data were analyzed using chi-square tests and logistic regression procedures.

Results

The SHS exposure rate at home among the participants (N = 2813) was 43%. Several sociodemographic and attitudinal factors were associated with SHS exposure. Logistic regression analyses identified eight predictors of SHS exposure: being female (OR = 2.35), being aged 15–24 (OR = 2.17), being recruited from Dhaka slums (OR = 5.19) or non-tribal/non-border areas outside Dhaka (OR = 2.19) or tribal/border area (OR = 4.36), having lower education (1–8 years: OR = 2.45; illiterate: OR = 3.00, having higher monthly household income (5000 to <10,000 Taka: OR = 2.34; 10,000 Taka or more: OR = 2.28), having a father who smoked in the past or currently smokes (OR = 2.09), having lower concern about the harms of tobacco on children (unconcerned OR = 3.99; moderate concern OR = 2.26), and not knowing the fact that SHS causes lung cancer in non-smokers (OR = 2.04).

Conclusions

Almost half of non-smoking Bangladeshi adults are exposed to SHS at home. The findings suggest the need for comprehensive tobacco control measures that would improve public understanding about health hazards of SHS exposure at home and encourage educational initiatives to promote smoke-free homes. Interventions should deliver targeted messages to reach those in the low socioeconomic status group.

A population based study on the prevalence of cigarette smoking and smokers' characteristics at osogbo, Nigeria

Background

Cigarette smoking has been linked to several cancers worldwide. The characteristics of smokers have not been well documented among Nigerians.

Objective

This study assessed the prevalence and characteristics of cigarette smokers among the residents of Osogbo, in southwestern Nigeria.

Method

The study, a population based cross-sectional study of randomly selected consenting adult residents of Osogbo, was conducted in September of 2011. Data was collected using a semi-structured interviewer administered questionnaire on cigarette smoking.

Results

A total of 759 respondents were interviewed. Mean age was 42.1 ± 12.5 years. There were 364 (48%) males and 395 (52%) females. About 22% had ever smoked while 8.7% were current smokers, smoking an average of 22.9 ± 10.1 cigarettes per day. Males constituted the majority of current smokers. Most smokers (71%) were introduced to smoking by friends and ill health was the most often reported reason for quitting.

Conclusion

Cigarette smoking is commonly practiced among males in the studied population and awareness creation and advocacy should be conducted throughout the city in order to inform current smokers about the hazards and cumulative effects inherent in smoking.

Exposure to environmental tobacco smoke among South Korean adults: a cross-sectional study of the 2005 Korea National Health and Nutrition Examination Survey

BACKGROUND

Studies have identified that environmental tobacco smoke exposure is associated with sociodemographic factors such as age, sex, and socioeconomic status, but few studies have been conducted in South Korea. In this study, the authors investigated the extent of environmental tobacco smoke exposure and factors related in a nationally representative sample of Korean adults.

METHODS

The data of 7,801 adults aged 19 years and over collected during the 2005 Korea National Health and Nutrition Examination Survey were analyzed. Information on smoking habits and exposure to environmental tobacco smoke was obtained by self-reports using a standardized questionnaire. Risks of environmental tobacco smoke exposure conferred by sociodemographic variables and behavioral risk factors were evaluated using logistic regression methods.

RESULTS

Overall, 36.1% of nonsmokers (defined as those not currently smoking) and 50.1% of current smokers were found to be exposed to environmental tobacco smoke either at work or at home. Among the nonsmokers, women were more likely to be exposed to environmental tobacco smoke at home (OR = 5.22, 95%CI, 4.08-6.67). Furthermore, an inverse relationship was found between education level and the risk of environmental tobacco smoke exposure at home (OR = 1.73, 95%CI, 1.38-2.17 for those with a high school education; OR = 2.30, 95%CI, 1.68-3.16 for those with a middle school education; and OR = 2.58, 95%CI, 1.85-3.59 for those with less than an elementary school education vs. those with a college education or more). In addition, those with office, sales service, or manual labor jobs were found to be at significantly higher risk of environmental tobacco smoke exposure at work than those with professional, administrative, or managerial jobs. Also, the risk of environmental tobacco smoke exposure in the workplace was significantly higher for alcohol drinkers than non-drinkers (OR = 1.23, 95%CI, 1.07-1.47). After adjusting for age, sex and education, it was found that those exposed to environmental tobacco smoke at home were more likely to have been admitted to hospital during the previous year (OR 1.29, 95%CI, 1.002-1.66).

CONCLUSIONS

In this study of Korean adults, exposure to environmental tobacco smoke at home or work was found to be affected by sex, age, marital status, educational level, and type of occupation. Accordingly, these factors should be given appropriate consideration by those developing policies or interventions designed to control exposure to environmental tobacco smoke.

Passive smoking in babies: the BIBE study (Brief Intervention in babies. Effectiveness)

BACKGROUND

There is evidence that exposure to passive smoking in general, and in babies in particular, is an important cause of morbimortality. Passive smoking is related to an increased risk of pediatric diseases such as sudden death syndrome, acute respiratory diseases, worsening of asthma, acute-chronic middle ear disease and slowing of lung growth.The objective of this article is to describe the BIBE study protocol. The BIBE study aims to determine the effectiveness of a brief intervention within the context of Primary Care, directed to mothers and fathers that smoke, in order to reduce the exposure of babies to passive smoking (ETS).

METHODS/DESIGN

Cluster randomized field trial (control and intervention group), multicentric and open.

SUBJECT

Fathers and/or mothers who are smokers and their babies (under 18 months) that attend pediatric services in Primary Care in Catalonia.The measurements will be taken at three points in time, in each of the fathers and/or mothers who respond to a questionnaire regarding their baby's clinical background and characteristics of the baby's exposure, together with variables related to the parents' tobacco consumption. A hair sample of the baby will be taken at the beginning of the study and at six months after the initial visit (biological determination of nicotine). The intervention group will apply a brief intervention in passive smoking after specific training and the control group will apply the habitual care.

DISCUSSION

Exposure to ETS is an avoidable factor related to infant morbimortality. Interventions to reduce exposure to ETS in babies are potentially beneficial for their health.The BIBE study evaluates an intervention to reduce exposure to ETS that takes advantage of pediatric visits. Interventions in the form of advice, conducted by pediatric professionals, are an excellent opportunity for prevention and protection of infants against the harmful effects of ETS.

TRIAL REGISTRATION

Clinical Trials.gov Identifier: NCT00788996.

Exposure to second-hand smoke in primary health care centres in Catalonia, Spain (2006)

The aim of this study was to assess the exposure to second-hand smoke (SHS) in 90 primary health care centres in Catalonia, Spain. We conducted a cross-sectional study between March and October 2006. We measured vapour-phase nicotine as a marker of SHS in main halls, staff rooms, direction areas, and continued care. Sampler devices were exposed for 7 days, and samples were analysed by gas chromatography/mass spectrometry. We compared the median airborne nicotine concentrations with the non-parametric test for medians by sanitary region, sampled location, affiliation to the Smoke-free Primary Health Care Programme, and urban-rural area. From 300 sampler devices installed, 4 were lost, and detectable levels of nicotine were found in 89 samples (30.0%) in 48 different centres (53.3%). The overall median was 0.01 microg/m(3), with an interquartile range (IQR) of 0.01-0.07 microg/m(3). Median nicotine levels by locations were: reception hall 0.01 microg/m(3) (IQR: 0.01-0.06); staff room 0.01 microg/m(3) (IQR: 0.01-0.08); direction area 0.01 microg/m(3) (IQR: 0.01-0.01); continued care 0.01 microg/m(3) (IQR: 0.01-0.07). Results showed that airborne nicotine levels were very low, with 46.7% of primary health centres being free of SHS.

Assessment of exposure to secondhand smoke by questionnaire and salivary cotinine in the general population of Barcelona, Spain (2004-2005)

OBJECTIVES

To estimate the prevalence of self-reported exposure to secondhand smoke (SHS) in different settings and to describe salivary cotinine concentration and its determinants among non-smokers.

METHODS

Cross-sectional study of a representative sample (N=775) of adult non-smokers in Barcelona, Spain (years 2004-2005). We assessed exposure to SHS using a questionnaire and measurement of salivary cotinine concentration. We calculated prevalence rates of self-reported exposure and medians and geometric means of salivary cotinine concentration. We adjusted for potential confounding factors with multinomial logistic regression models.

RESULTS

The prevalence rate of self-reported exposure to SHS among non-smokers in any setting was 75.7% (95% CI: 72.7%-78.8%). The prevalence of exposure to SHS tended to decrease with age. The geometric mean of cotinine concentrations among non-smokers was 1.49 ng/ml (95% CI: 1.39-1.60 ng/ml) among all subjects, and 1.80 ng/ml (95% CI: 1.37-2.35 ng/ml) in subjects who reported exposure to SHS in all settings. In bivariate and multivariate analyses, the cotinine concentration increased with the number of smokers and the number of cigarettes smoked per day in the presence of non-smokers in the household.

CONCLUSIONS

In this population, self-reported exposure to SHS is very high. Salivary cotinine concentrations in non-smokers are associated with exposure at home.

Mortality attributable to passive smoking in Spain, 2002

OBJECTIVE

Exposure to environmental tobacco smoke (ETS) is associated with a variety of health effects, including lung cancer and ischaemic heart disease. The objective of this study was to estimate the number of deaths caused by exposure to ETS among non-smokers in Spain during the year 2002

METHODS

Prevalence of ETS exposure among never smokers was gathered from three region based health interview surveys. The relative risks of lung cancer and ischaemic heart diseases were selected from three meta-analyses. Population attributable risk (PAR) was computed using a range of prevalences (minimum-maximum). The number of deaths attributable to ETS was calculated by applying PARs to mortality not attributable to active smoking in 2002. The analyses were stratified by sex, age and source of exposure (home, workplace and both combined). In addition, a sensitivity analysis was performed for different scenarios.

RESULTS

Among men, deaths attributable to ETS ranged from 408 to 1703. From 247 to 1434 of these deaths would be caused by the exposure only at home, 136-196 by exposure only in the workplace and 25-73 by exposure at both home and the workplace. Among women, the number of attributable deaths ranged from 820 to 1534. Between 807 and 1477 of these deaths would be caused by exposure only at home, 9-32 by exposure only in the workplace and 4-25 by exposure both at home and in the workplace.

CONCLUSION

Exposure to ETS at home and at work in Spain could be responsible for 1228-3237 of deaths from lung cancer and ischaemic heart disease. These data confirm that passive smoking is an important public health problem in Spain that needs urgent attention.

Exposure to environmental tobacco smoke in the nonsmoking population of Cambodia

OBJECTIVE

To estimate the extent of environmental tobacco smoke (ETS) exposure among nonsmokers in the adult population of Cambodia.

METHODS

A cross-sectional survey was conducted on a nationally representative sample of 13,988 Cambodian adults in 2005. Information on smoking and exposure to ETS was obtained by trained interviewers using a standard questionnaire.

RESULTS

Overall, 37.4% of the 10,263 nonsmoking responders, or an estimated 1,629,700 nonsmoking Cambodians, were exposed to ETS. One third of pregnant women (31.4%) were exposed to ETS at home. In both unadjusted and adjusted models, men were less likely to be exposed to ETS at home (OR=0.34; 95% CI=0.29-0.41) and more likely to be exposed to ETS at work and in public places (OR=3.08; 95% CI=2.14-4.43 and OR=2.17; 95% CI=1.82-2.59, respectively). Education was inversely related to ETS exposure at home (OR=0.51; 95% CI=0.27-0.96 for 10 years of education vs 5 years or less). Legislators, senior officials, and managers were less likely to be exposed to ETS at home than professionals (OR=0.13; 95% CI=0.04-0.46), but more likely to be exposed at work or in public places. Rural residence was associated with higher ETS exposure in the home (OR=2.52; 95% CI=1.71-3.71) and lower ETS exposure at work (OR=0.42; 95% CI=0.24-0.76) compared to urban residence.

CONCLUSIONS

The high prevalence of ETS exposure among adult Cambodians indicates an urgent need for specific measures such as public awareness campaigns, policies, and regulations to protect nonsmokers in Cambodia.

Correlates of exposure to second-hand smoke in an urban Mediterranean population

BACKGROUND

To describe the socio-demographic factors associated with exposure to second-hand smoke (SHS) in different settings (home, leisure, and workplace).

METHODS

We analysed cross-sectional data on self-reported SHS exposure in 1059 non-daily smokers interviewed in the Cornellà Health Interview Survey Follow-up Study in 2002. We calculated age-adjusted prevalence rates and prevalence rate ratios of SHS exposure at home, at the workplace, during leisure time, and in any of these settings.

RESULTS

The age-standardized prevalence rate of SHS exposure in any setting was 69.5% in men and 62.9% in women. Among men, 25.9% reported passive smoking at home, 55.1% during leisure time, and 34.0% at the workplace. Among women, prevalence rates in these settings were 34.1%, 44.3% and 30.1%, respectively. Overall exposure to SHS decreased with age in both men and women. In men, SHS exposure was related to marital status, physical activity, smoking, and alcohol intake. In women, SHS exposure was related to educational level, marital status, occupational status, self-perceived health, smoking-related illness, and alcohol intake.

CONCLUSION

The prevalence of SHS exposure in this population was high. The strongest association with exposure were found for age and occupational status in men, and age and educational level in women.

Exposure to environmental tobacco smoke in a general population

AIMS

To estimate how the level of exposure to environmental tobacco smoke (ETS) in pregnancy, childhood and adulthood vary with personal characteristics in a general population.

METHODS

In 1996/1997, a community sample of 3181 adults, aged 26-82, received a mailed questionnaire, to which 2819 subjects responded. The prevalences of ETS exposure were estimated according to sex, age, educational level, smoking, occupational dust or gas exposure and exposure to moulds. Logistic regression was used to estimate the adjusted odds ratios for the different ETS exposures with respect to these covariates.

RESULTS

Altogether 9% reported exposure to maternal smoking in foetal life and 23% in childhood. Fourteen percent reported current domestic ETS exposure, while 13% reported current occupational ETS. Occupational ETS exposure was more frequent among men (16%) than women (10%). The oldest subjects (61-82 years) reported less ETS exposures than the younger subjects. Current smokers and subjects with occupational dust or fumes exposure had a higher prevalence for all the ETS exposures compared to ex- and never smokers and subjects without occupational exposure, respectively.

CONCLUSION

From a general population sample male sex, younger age, current smoking, and occupational dust or fumes exposure were associated with higher level of ETS exposure.

[Estimation of the excess of lung cancer mortality risk associated to environmental tobacco smoke exposure of hospitality workers]

BACKGROUND AND OBJECTIVE

To estimate the excess lung cancer mortality risk associated with environmental tobacco (ETS) smoke exposure among hospitality workers. The estimation was done using objective measures in several hospitality settings in Barcelona.

METHOD

Vapour phase nicotine was measured in several hospitality settings. These measurements were used to estimate the excess lung cancer mortality risk associated with ETS exposure for a 40 year working life, using the formula developed by Repace and Lowrey.

RESULTS

Excess lung cancer mortality risk associated with ETS exposure was higher than 145 deaths per 100,000 workers in all places studied, except for cafeterias in hospitals, where excess lung cancer mortality risk was 22 per 100,000. In discoteques, for comparison, excess lung cancer mortality risk is 1,733 deaths per 100,000 workers.

CONCLUSION

Hospitality workers are exposed to ETS levels related to a very high excess lung cancer mortality risk. These data confirm that ETS control measures are needed to protect hospital workers.

[Measurement of exposure to environmental tobacco smoke in education centers, health centers, transport facilities and leisure places]

OBJECTIVES

To describe levels of exposure to environmental tobacco smoke (ETS) in various public places in Barcelona (Spain).

MATERIAL AND METHOD

Vapor-phase nicotine was measured with passive samplers containing a sodium bisulfate treated filter with a 37 mm diameter. The places sampled were primary and secondary schools, hospitals, primary care centers, train stations, subways, universities, airports, restaurants and discotheques.

RESULTS

Primary and secondary schools and health centers had the lowest levels of ETS exposure, with mean concentrations of less than 1 microg/m3. The mean values found in transport and universities were 2.16 microg/m3 in train stations, 3.30 microg/m3 in subways, 4.30 microg/m3 in airports and 4.97 microg/m3 in universities. The highest concentrations were found in restaurants and discotheques, with mean values of 12.36 microg/m3 in restaurants and 130.65 microg/m3 in discotheques. All samples taken from primary and secondary schools, airports, subways, restaurants and discotheques contained ETS. Likewise, 90% of the samples taken from train stations and 96% of those from universities contained ETS. Seventy-nine percent of the samples from hospitals and 58% of those from primary care centers contained ETS.

CONCLUSIONS

The results confirm that passive smoking is an important public health problem in Spain and that greater efforts are needed to enforce smoke-free policies in public spaces and workplaces.

[Prevalence of exposure to environmental tobacco smoke in a urban population]

BACKGROUND AND OBJECTIVE

We decided to assess the overall prevalence of exposure to environmental tobacco smoke (ETS) both in general and according to the settings of exposure (home, workplace and leisure time).

SUBJECTS AND METHOD

We analyzed cross-sectional data of ETS exposure in 1,059 non-smokers included in the Cornellà Health Interview Survey Follow-up (CHIS-FU) study. We calculated the crude and age-standardized prevalence of ETS exposure in general and in the different settings.

RESULTS

69.5% (confidence interval [CI] 95%, 64.5%-74.4%) of men and 62.9% (CI 95%, 58.1%-67.6%) of women of the sample studied were exposed to ETS. We observed a decreasing trend of ETS exposure by age in both sexes. The age-standardized prevalence rates of ETS exposure according to the environment and sex were: 25.9% (95% CI, 21.8%-30.1%) at home, 55.1% (95% CI, 50.8%-59.4%) during leisure time and 34.0% (95% CI, 23.5%-45.6%) in the workplace in men, and 34.1% (95% CI, 29.8%-38.5%), 44.3% (95% CI, 40.5%-48.2%) and 30.1% (95% CI, 18.9%-41.3%), respectively, in women.

CONCLUSION

In this study, more than half of non-smokers were exposed to ETS.