Cigarette smoking and exposure to environmental tobacco smoke in China: the international collaborative study of cardiovascular disease in Asia

Assessing second-hand smoke exposure among non-smoking youth in India: Insights from GATS I & II

Background & objectives This study aimed to compare the prevalence and identify the patterns of second-hand smoke (SHS) exposure among non-smoking Indian youth (ages 15-24 and 25-29 yr) in various settings-homes, workplaces, public places, and a combination of these locations-based on sociodemographic factors and knowledge about the health implications of smoking. The purpose of the study was to identify the factors influencing SHS exposure in India between the Global Adult Tobacco Survey (GATS) I and II. Methods Secondary data analysis was conducted utilising GATS I and II data to analyse the prevalence and patterns of SHS exposure at home, workplace, public place and all the places combined among non-smoking youths aged 15-29 yr. The study sample included 20,604 and 20,927 individuals for GATS I and II, respectively. The predictor variables included the sociodemographic variables and the knowledge regarding the ill effects of smoking. Weighted prevalence was calculated using survey weights, and multivariate logistic regression analyses were utilised to examine the adjusted relationships between SHS exposure and predictors. Results Between GATS I and II, there was a notable decline in the weighted prevalence of SHS exposure at home and in public places among non-smoking youth aged 15-29 yr. The study also indicates an increase in workplace SHS exposure between the two rounds of GATS among non-smoking youth who had knowledge about the ill effects of SHS exposure on health. Multivariate regression analyses revealed significant associations between SHS exposure and gender, education level, employment status, place of residence, and wealth index, affecting exposure in one or more locations. Interpretation & conclusions Our secondary analysis of GATS data from 2009-10 to 2016-17 reveals a decline in SHS exposure at home and public places but an increase in workplaces among non-smoking youth. Factors like female gender, higher education, and wealth were linked to lower SHS exposure, while rural residence and self-employment indicated higher risks. These findings underscore the need for targeted, community-based interventions and stricter enforcement of anti-tobacco laws to protect non-smoking youth in India.

Impact of Cardiovascular and Cerebrovascular Diseases Mortality on Life Expectancy in Tianjin, 2004 and 2020

This study aimed to analyze the impact of cardiovascular and cerebrovascular diseases (CCVDs) mortality on Tianjin's life expectancy (LE) in 2004 compared with 2020 using Arriaga's decomposition method. The LE increment for Tianjin residents due to the decrease in CCVDs mortality was 1.54 years (38.7%). Males, females, urban residents, and rural residents contributed 1.29 years (36.83%), 1.76 years (40.25%), 2.11 years (44.41%), and 0.71 years (25.06%), respectively. A total of 38.2% of the LE increment was attributed to deaths from CCVDs in people aged ≥65 years. Cerebral infarction, intracerebral hemorrhage, acute myocardial infarction, and other heart diseases contributed positively to the increase in LE (24.8%, 22.68%, 16.66%, and 11.3%). Sequelae of cerebrovascular disease and other coronary heart diseases contributed negatively to the increase in LE (-25.2% and -17.92%). Therefore, we need to control the risk factors of the elderly, males, rural residents, sequelae of cerebrovascular disease, and other coronary heart diseases.

Machine-learning model for predicting depression in second-hand smokers in cross-sectional data using the Korea National Health and Nutrition Examination Survey

Objective

Depression among non-smokers at risk of second-hand smoke (SHS) exposure has been a neglected public health concern despite their vulnerability. The objective of this study was to develop high-performance machine-learning (ML) models for the prediction of depression in non-smokers and to identify important predictors of depression for second-hand smokers.

Methods

ML algorithms were created using demographic and clinical data from the Korea National Health and Nutrition Examination Survey (KNHANES) participants from 2014, 2016, and 2018 (N = 11,463). The Patient Health Questionnaire was used to diagnose depression with a total score of 10 or higher. The final model was selected according to the area under the curve (AUC) or sensitivity. Shapley additive explanations (SHAP) were used to identify influential features.

Results

The light gradient boosting machine (LGBM) with the highest positive predictive value (PPV; 0.646) was selected as the best model among the ML algorithms, whereas the support vector machine (SVM) had the highest AUC (0.900). The most influential factors identified using the LGBM were stress perception, followed by subjective health status and quality of life. Among the smoking-related features, urine cotinine levels were the most important, and no linear relationship existed between the smoking-related features and the values of SHAP.

Conclusions

Compared with the previously developed ML models, our LGBM models achieved excellent and even superior performance in predicting depression among non-smokers at risk of SHS exposure, suggesting potential goals for depression-preventive interventions for non-smokers during public health crises.

Inter-relationships among neutrophilic inflammation, air trapping and future exacerbation in COPD: an analysis of ECOPD study

BACKGROUND

The inter-relationships among neutrophilic airway inflammation, air trapping and future exacerbation in chronic obstructive pulmonary disease (COPD) remain unclear.

OBJECTIVE

To evaluate the associations between sputum neutrophil proportions and future exacerbation in COPD and to determine whether these associations are modified by significant air trapping.

METHODS

Participants with completed data were included and followed up to the first year in the Early Chronic Obstructive Pulmonary Disease study (n=582). Sputum neutrophil proportions and high-resolution CT-related markers were measured at baseline. Sputum neutrophil proportions were dichotomised based on their median (86.2%) to low and high levels. In addition, subjects were divided into the air trapping or non-air trapping group. Outcomes of interest included COPD exacerbation (separately any, severe and frequent exacerbation, occurring in the first year of follow-up). Multivariable logistic regressions were performed to examine the risk of severe exacerbation and frequent exacerbation with either neutrophilic airway inflammation groups or air trapping groups.

RESULTS

There was no significant difference between high and low levels of sputum neutrophil proportions in the exacerbation in the preceding year. After the first year of follow-up, subjects with high sputum neutrophil proportions had increased risks of severe exacerbation (OR=1.68, 95% CI: 1.09 to 2.62, p=0.020). Subjects with high sputum neutrophil proportions and significant air trapping had increased odds of having frequent exacerbation (OR=3.29, 95% CI: 1.30 to 9.37, p=0.017) and having severe exacerbation (OR=2.72, 95% CI: 1.42 to 5.43, p=0.003) when compared with those who had low sputum neutrophil proportions and non-air trapping.

CONCLUSIONS

We found that subjects with high sputum neutrophil proportions and significant air trapping are prone to future exacerbation of COPD. It may be a helpful predictor of future exacerbation.

Effects of acute aerobic exercise on food-reward mechanisms in smoking-addicted individuals: An fNIRS study

PURPOSE

In addition to its toxic effects on the human cardiovascular and respiratory systems, tobacco dependence also causes damage to brain function and cognitive activity. Therefore, the main objective of this study was to investigate the effects of acute aerobic exercise on food-reward function and its food-cued prefrontal brain activation in tobacco-dependent individuals.

METHOD

Ninety-three participants who met the study criteria were randomly divided into a moderate-intensity exercise group (65%-75% HRmax), a high-intensity exercise group (75%-85% HRmax), and a quiet control group (n = 31 in each group). Participants were asked to perform a 35-minute target-intensity exercise or rest. The participants took the Leeds Food Preference Questionnaire and the Visual Food Cues Paradigm Task immediately before the experiment and immediately after completing the exercise or control intervention, and oxyhemoglobin concentrations in each prefrontal brain region were measured at the same time as the Visual Food Cues Paradigm Task.

RESULTS

Acute aerobic exercise significantly increased implicit cravings for low-calorie sweets in nicotine-dependent individuals (high: p = 0.040; moderate: p = 0.001), while acute moderate-intensity aerobic exercise also significantly increased the activation levels of the left dorsolateral prefrontal cortex (DLPFC: CH15: p = 0.030; CH22: p = 0.003) as well as the left orbitofrontal area (OFC: CH21: p = 0.007) in the food-reward brain region in nicotine-dependent individuals.

CONCLUSION

Acute aerobic exercise improves food-reward function and effectively increases activation levels in the DLPFC and OFC cerebral cortex in tobacco-dependent individuals, facilitating restoration of sensitivity to their drug-hijacked natural reward circuits.

Associations of air pollutants with pneumonia hospital admissions in Qingdao, China: a prospective cohort study

Studies about the pneumonia morbidity effects of various air pollution exposure are still limited in China. We aimed to explore the short-term effect of air pollutants exposure on pneumonia admission and identify the vulnerable groups in Qingdao, China. From January 2015 to October 2017, a prospective cohort involving 433,032 participants across 3 counties in Qingdao were enrolled in the study. Distributed lag nonlinear model (DLNM) was applied to assess the associations between air pollutants and pneumonia hospitalizations. There were 636 cases of pneumonia, with an annual incidence density of 54.33 per 100,000 person-years (95% CI: 50.11, 58.56). A 10 μg/m³ increment of sulfur dioxide (SO₂) distributed at a 4-week lag in Qingdao was associated with increased pneumonia hospitalizations, with a risk ratio of 2.10 (95% CI: 1.06, 4.13). Subgroup analyses indicate that PM ≤ 2.5 μm in aerodynamic diameter and SO₂ showed stronger effects on pneumonia in females than males, whereas people in urban regions were more vulnerable to nitrogen dioxide and ozone (O₃) than the others. We also observed distinct acute effects and harvesting effects of SO₂ and O₃ on pneumonia in urban areas. Strategies should be taken to further reduce levels of ambient PM_2.5, SO₂, and O₃.

Association of Total Airway Count on Computed Tomography with Pulmonary Function Decline in Early-Stage COPD: A Population-Based Prospective Cohort Study

Background

It has been found that the degree of terminal bronchiole destruction is associated with the severity of COPD. However, total airway count (TAC) of CT-visible and its relationship with COPD lung function severity and pulmonary function decline remains controversial. The present study aimed to determine whether TAC is significantly reduced in early-stage COPD (GOLD stage I–II) compared with healthy control subjects and whether TAC is associated with annual decline in pulmonary function in Chinese patients with early-stage COPD.

Methods

A total of 176 participants were enrolled in this study, of which 139 participants had undergone at least two spirometry measurements within 7 years (average 5.5 [standard deviation 0.8] years) after baseline data acquisition. CT-visible TAC was measured by summing all airway segments using semi-automated software. Average lumen diameter, average inner area, emphysema index, air trapping, and inspiratory Pi10 were also measured. Multivariable linear analysis was performed to evaluate variables that were significantly related to pulmonary function parameters and to evaluate the correlation between TAC and annual decline in longitudinal pulmonary function.

Results

Compared with healthy control subjects, CT-visible TAC was significantly reduced by 51% in GOLD II and by 31% in GOLD I after adjustment. TAC had the greatest impact on pre-bronchodilator FEV₁, pre-bronchodilator FVC, post-bronchodilator FEV₁, and post-bronchodilator FEV₁/FVC (both p<0.001) among all CT indicators measured. TAC has the best correlation with inspiratory Pi10 (ρ=−0.751, p<0.001), an evaluation indicator of the degree of airway remodeling. TAC was independently associated with annual decline in pre-bronchodilator FEV₁ (p=0.023), post-bronchodilator FEV₁ (p=0.018), and post-bronchodilator FEV₁/FVC (p<0.001).

Conclusion

This finding suggests that CT-visible TAC may be an evaluation indicator of the degree of airway remodeling, and was diminished in greater COPD lung function severity, and independently associated with disease progression. Early-stage COPD patients have already occurred lung structural changes and early intervention may be needed to ameliorate the progression of disease.

Clinical Trial Registration

ChiCTR-OO-14004264.

Non-Smoker's Exposure to Second-Hand Smoke in South Africa during 2017

Current South African tobacco control law allows for 25% designated smoking areas in some indoor public places. This study investigates non-smokers’ exposure to second-hand smoke (SHS) in workplaces, homes, cafés/restaurants, and shebeens (local bars) using data from the 2017 South African Social Attitude Survey. Factors associated with any level of exposure were explored using multiple-variable-adjusted logistic regression analysis. The sample of 3063 participants (16+ years old), comprised 51.7% females and 78.5% Black Africans. The current smoking prevalence from this study was 21.5%. About 47% of non-smokers reported exposure to SHS in at least one location. Females were significantly less likely to be exposed to SHS in all locations except at home compared to males. Adjusted logistic regression analysis showed that females, adults aged 45–54 years, 55–64 years, and 65+ years were significantly less likely to be exposed to SHS (adjusted odds ratio (AOR) = 0.63, 0.60, 0.55, and 0.24, respectively) than males and those aged 16–24 years. Those who identified as Coloureds were significantly more likely to be exposed to SHS (AOR = 1.69) than Black Africans. This study found that nearly half of non-smokers reported exposure to SHS. A 100% smoke-free policy consistent with the World Health Organisation (WHO) Framework Convention on Tobacco Control would protect more people from exposure to SHS in South Africa.

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.

Exposure to second hand smoke and 10-year (2002-2012) incidence of cardiovascular disease in never smokers: The ATTICA cohort study

BACKGROUND

Despite WHO Framework Convention of Tobacco Control (FCTC) adoption, effective implementation of national smoking bans remains pending in several countries. This study quantified the association of second hand smoke (SHS) exposure and 10-year cardiovascular disease (CVD) among never smokers in such settings.

METHODS

In 2001-2002, a sample of 1514 males and 1528 females (range: 18-89 years old) were randomly selected in Greece. Frequency and duration of SHS exposure (i.e. exposure extending >30 min/day) within the home and/or workplace were assessed by interview. Following a 10-year follow-up period (2002-2012), incidence of non-fatal and fatal CVD (ICD-10) was evaluated among n = 2020 participants. The analytic study sample consisted of all never smokers (n = 910).

RESULTS

Despite national smoking ban implementation (2009), 44.6% (n = 406) of never smokers reported SHS exposure. While SHS exposed never smokers exhibited a more favorable profile of CVD-related risk factors at baseline, they subsequently developed similar 10-year CVD incidence rates, at a younger mean age (p = 0.001), than their non-exposed counterparts. Following adjustment for several lifestyle and clinical factors, SHS exposed never smokers exhibited a two-fold elevated 10-year CVD risk (adj. HR: 2.04, 95% CI: 1.43-2.92), particularly among women (adj. HR: 2.45, 95% CI: 1.45-4.06). SHS exposure accounted for 32% excess Population Attributable Risk (PAR) for 10-year CVD events in never smokers, with highest rates (PAR: 52%) being among those exposed in the workplace.

CONCLUSION

The prevention of SHS associated CVD and related healthcare costs mandates additional strategies for securing the effective implementation of comprehensive WHO FCTC based national smoking bans.

Profiles of Impulsivity in Problematic Internet Users and Cigarette Smokers

Problematic Internet use (PIU) has been gradually recognized as a mental health issue among adolescents and young students. PIU shows many similarities with substance use disorders, but the shared and distinct mechanisms underlying them are unclear. The purpose of the current study was to explore the relationships between impulsive traits and PIU as well as cigarette smoking behaviors among young adults. Two independent samples of university students (N 1 = 1281, N 2 = 1034, respectively) over 3 years were assessed with multiple measurements of impulsivity, including the Barratt Impulsiveness Scale-11 (BIS-11), the UPPSP Impulsive Behaviors Scale (UPPSP), and the Delay-discounting Test (DDT). Logistic regression models revealed that across the two independent samples, BIS-11 Attentional Impulsiveness was the common trait positively predicting both PIU and cigarette smoking. While BIS-11 Motor Impulsiveness as well as UPPSP Lack of Perseverance, Lack of Premeditation, and Negative Urgency were the typical traits linked to PIU as positive predictors, UPPSP Sensation Seeking was the unique trait linked to cigarette smoking as a positive predictor. These results suggested that specific dimensions of impulsivity might be concurrently implicated in PIU and cigarette smoking among young adults, putatively representing important trait marks for addictive behaviors.

Evidence for an Association between Macular Degeneration and Thyroid Cancer in the Aged Population

Direct evidence of whether thyroid cancer patients have a higher risk of age-related macular degeneration (AMD) has yet to be investigated. Patients older than 50 years-old and newly diagnosed with thyroid cancer between 2000 and 2008 were identified from the national health insurance research database (NHIRD). We applied time-varying Cox proportional hazard models to assess the association between thyroid cancer and AMD. The multivariable models included conventional cardiovascular risk factors, myopia, vitreous floaters, hypothyroidism, hyperthyroidism, and treatment modality of thyroid cancer. The analysis process was stratified by age, gender, and comorbidity. In this study, 5253 patients were included in a thyroid cancer cohort (men 24.5%; median age 59.1 years (53.7–67.4 years), and 21,012 matched controls were included in a non-thyroid cancer cohort. The AMD incidence was 40.7 per 10,000 person/year in the thyroid cancer cohort. The thyroid cancer cohort had a higher risk (adjusted hazard ratio (aHR) = 1.38, 95% confidence interval, CI = 1.09–1.75) of AMD than the non-thyroid cohort. Thyroid cancer patients had a higher risk of AMD, especially the male patients (aHR = 1.92, 95% CI = 1.38–3.14) and the patients with comorbidities (aHR = 1.38, 95% CI = 1.09–1.74). In conclusion, thyroid cancer patients older than 50 years-old have increased risk of AMD.

Female non-smokers' environmental tobacco smoking exposure by public transportation mode

Background

This study aimed to analyze environmental tobacco smoking exposure in female nonsmokers by public transportation mode using representative data of Koreans.

Methods

Data from the Second Korean National Environmental Health Survey (2012–2014) were analyzed. Urine cotinine was analyzed by public transport behavior, secondhand smoke exposure, socioeconomic factors, and health-related factors. Participants were 1322 adult females; those with the top 75% urine cotinine concentrations were assigned to the high exposure group. A logistic regression analysis was performed considering appropriate weights and stratification according to the sample design of the Second Korean National Environmental Health Survey.

Results

The geometric mean of urine cotinine concentrations differed according to public transportation modes: subway (1.66 μg/g creatinine) bus (1.77 μg/g creatinine), and taxi (1.94 μg/g creatinine). The odds ratio [OR] was calculated for the high exposure group. The OR of the taxi (2.39; 95% confidence interval, 1.00–5.69) was statistically significantly higher than the subway value (reference), and marginally significant after adjusted with life style, sociodemographic factors and involuntary smoking frequency (2.42, 95% confidence interval, 0.97–6.04).

Conclusions

The odds ratio of passengers who mainly used taxis was marginally significantly higher than those of passengers who used subways and buses after adjusted with life style and sociodemographic factors. Implementation of supplementary measures and further studies on exposure to environmental tobacco smoking in taxis are warranted.

Correlates of secondhand smoke exposure among nonsmoking youth (15-24 years) in India: Secondary analysis from Global Adult Tobacco Survey, 2009-10

Introduction:

Nonsmoking youth form a high-risk group and are at increased risk of ill-effects caused due to secondhand smoke (SHS). The objective is to determine the prevalence and correlates of SHS exposure among the nonsmoking youth in India from global adult tobacco survey (GATS), 2009–10.

Methods:

Secondary data analysis of GATS, 2009–10 was done to find the correlates of SHS at three different settings – house, workplace - indoor, and public place. All the sociodemographic variables were tested for association with SHS exposure using multivariate analysis. Prevalence ratio with 95% confidence interval [CI] was used to report the risk.

Results:

The prevalence of SHS was 48.6% (95% CI: 47.7%–49.5%) at house, 25.5% (95% CI: 23.5%–27.6%) at workplace - indoors, and 42.7% (95% CI: 41.7%–43.7%) at public places. SHS exposure among females was found to be higher at house; youth living in rural area were found at increased risk to SHS at both household and public places; and inverse relationship was seen between SHS exposure and education level at both household and workplace - indoors. Overall, the study showed that smokeless tobacco users were at increased risk of SHS exposure at all the three settings.

Conclusion:

Being female, living in rural area, lower education status, lower socioeconomic status, and use of smokeless tobacco were found to be associated with SHS exposure among nonsmoking youth in India.

Impacts of undetected and inadequately treated hypertension on incident stroke in China

OBJECTIVES

China carries the greatest burden of stroke given its largest volume of people with hypertension. This study assessed the impacts of suboptimal controls of hypertension on incident stroke and projected the number of patients with stroke saved after the control of blood pressure improved in population.

SETTING

Anhui, China.

PARTICIPANTS

We examined data from the Anhui cohort of 2001-2011, consisting of 3336 participants aged ≥60 years who were randomly recruited from the urban and rural Anhui. 2852 participants (89.2%) had hypertensive status measured and no stroke at baseline, and were followed up until 2011 in three surveys using a standard method of interview.

RESULTS

At baseline, 1646 participants (57.7%) were identified to have hypertension, among whom 912 (55.4%) were previously undetected, 115 (7.0%) detected but not treated, 452 (27.5%) treated but not controlled and only 127 (7.7%) controlled. During the 10-year follow-up, 211 incident stroke cases (12.8/1000 person-years) occurred. Compared with normotensive individuals at baseline, multivariate adjusted HR for having stroke increased in those with undetected hypertension by 1.63 (95%CI 1.15 to 2.32), untreated by 2.21 (1.26-3.85) and uncontrolled hypertension by 3.34 (2.28-4.88), but did not differ from those with controlled hypertension (1.34; 0.60-2.99). Based on a two-fold increase in the detection and management of current levels of hypertension and algorithms on the current situation in China, approximately 250 000 incident stroke cases could be prevented annually.

CONCLUSIONS

In China, hypertension is frequently undetected or inadequately treated. With appropriate management of hypertension, a substantial number of people could be saved form stroke.

Prevalence, Patterns, and Correlates of Physical Activity Among the Adult Population in Latin America: Cross-Sectional Results from the CESCAS I Study

BACKGROUND

Few data are available on population level regarding domain-specific correlates of physical activity (PA) in Latin America.

OBJECTIVE

The aim of this study was to examine the relationships among PA patterns and their main sociodemographic determinants and cardiovascular risk factors in the Southern Cone of Latin America.

METHODS

CESCAS I is a population-based prospective cohort study with a 4-stage stratified sampling of a general population of 7,524 adults aged 35 to 74 years from 4 midsized cities in Argentina, Chile, and Uruguay. PA was assessed using the transcultural adaptation of the International Physical Activity Questionnaire long form. The questionnaire asked about frequency (days per week) and duration (minutes per day) of moderate and vigorous intensity activities in 3 different domains: work, leisure time, and active transportation (walking and bicycling). PA levels of ≥600 metabolic equivalent tasks (MET) minutes per week was considered sufficiently active. Odds ratios for associations of sufficiently active status with sociodemographic determinants and cardiovascular risk factors were obtained using multivariable-adjusted logistic regression models.

CONCLUSIONS

Almost 65%) of the participants reported ≥600 MET minutes per week. The lowest prevalence of sufficiently active individuals was seen in Temuco, Chile (58.0%), among women (58.7%), older individuals (55.4%), those with higher educational level (61.6%), and homemakers (53.4%). Approximately 22.8% of the population reported no PA. In multivariable analysis, PA levels were lower among women, individuals who were older, obese, university educated, with clerical work, retired/unemployed or homemakers, and those with physical limitations. Future interventions to increase PA levels in the Southern Cone of Latin America must take into account disparities by gender and socioeconomic status. The promotion of PA during leisure time in women--unemployed and homemakers--and of active transportation for those performing office or clerical work should be a priority in this population.

Prevalence of Cigarette Smoking and Nicotine Dependence in Men and Women Residing in Two Provinces in China

AIMS

Although it is known that there is a high smoking prevalence among Chinese, key issues such as social and environmental factors impacting smoking initiation and persistence, the percentage of smokers considered nicotine dependence (ND), and the availability and use of ND treatments have rarely been investigated.

METHODS

To address these issues, from 2012 to 2014, we conducted a large-scale study in the Zhejiang and Shanxi provinces of China using the Fagerström Test for Nicotine Dependence and other validated questionnaires.

RESULTS

Of the 17,057 subjects, consisting of 13,476 males and 3,581 females aged 15 years or older, the prevalence of male smoking was 66.1% [95% confidence interval (CI) 65.5%, 66.9%] and that of female smoking was 3.2% (95% CI 3.0%, 3.8%). Among males, 25.8% (95% CI 25.0%, 26.5%) were low-to-moderate ND, and 11.8% (95% CI 11.2%, 12.3%) were high ND (H-ND), persons who have significant difficulty quitting without treatment. The degrees of ND were related to age, extent of education, and annual family income. The social-environmental factors examined conveyed a higher risk for smoking initiation, which is particularly true for the influence of smoking by friends. Furthermore, current smokers had a significantly higher risk of suffering respiratory and digestive symptoms.

CONCLUSION

These data not only show a high smoking prevalence in Chinese men but also reveal that a relatively large number of smokers are H-ND. Considering that few Chinese smokers seek ND treatment, a comprehensive smoking prevention and treatment program designed specifically for Chinese is greatly needed.

Spatiotemporal Variations in Lung Cancer Mortality in China between 2006 and 2012: A Multilevel Analysis

We investigated temporal trends and geographical variations in lung cancer mortality in China from 2006 to 2012. Lung cancer mortality counts for people aged over 40 years were extracted from the China Mortality Surveillance System for 161 disease surveillance points. Negative binomial regression was used to investigate potential spatiotemporal variation and correlations with age, gender, urbanization, and region. Lung cancer mortality increased in China over the study period from 78.77 to 85.63 (1/100,000), with higher mortality rates evident in men compared to women. Median rate ratios (MRRs) indicated important geographical variation in lung cancer mortality between provinces (MRR = 1.622) and counties/districts (MRR = 1.447). On average, lung cancer mortality increased over time and was positively associated with county-level urbanization (relative risk (RR) = 1.15). Lung cancer mortality seemed to decrease in urban and increase in rural areas. Compared to the northwest, mortality was higher in the north (RR = 1.98), east (RR = 1.87), central (RR = 1.87), and northeast (RR = 2.44). Regional differences and county-level urbanization accounted for 49.4% and 8.7% of provincial and county variation, respectively. Reductions in lung cancer mortality in urban areas may reflect improvements in access to preventive healthcare and treatment services. Rising mortality in rural areas may reflect a clustering of risk factors associated with rapid urbanization.

The Association between Smoking and Epiretinal Membrane

We conducted a meta-analysis of analytic and observational studies to evaluate the association between smoking and epiretinal membrane (ERM). The pertinent studies were identified via a literature search using three databases (MEDLINE, Cochrane Library, Embase) and the reference lists of retrieved studies. Cohort, case-control and cross-sectional studies meeting the predefined criteria were included. We extracted the odds ratios (OR) and 95% confidence intervals (CI) from each study. Overall risk estimates were pooled using random-effects models. Subgroup analyses based on several stratified factors were also performed. Two cohort studies and six cross-sectional studies involving 46,837 subjects were included. The pooled effect of all eight studies showed an unexpected significant decreased association between smoking and the occurrence of ERM (OR, 0.72; 95% CI 0.61–0.84; p = 0.29, I² = 17.9%). Subgroup analyses supported this finding, except for the age-unadjusted group (OR, 0.87; 95% CI 0.63–1.22), the ERM classification group (cellophane macular reflex (CMR) OR, 0.93; 95% CI 0.68–1.28; preretinal macular fibrosis (PMF) OR, 0.74; 95% CI 0.41–1.32), the Asian group (OR, 0.75; 95% CI 0.52–1.09) and the past smoker group (OR, 1.02; 95% CI 0.85–1.22). The pooled effects from the current literature suggested a declining association between smoking and ERM, which requires further studies to confirm.

Affecting Factors of Secondhand Smoke Exposure in Korea: Focused on Different Exposure Locations

Exposure to secondhand smoke (SHS) not only can cause serious illness, but is also an economic and social burden. Contextual and individual factors of non-smoker exposure to SHS depend on location. However, studies focusing on this subject are lacking. In this study, we described and compared the factors related to SHS exposure according to location in Korea. Regarding individual factors related to SHS exposure, a common individual variable model and location-specific variable model was used to evaluate SHS exposure at home/work/public locations based on sex. In common individual variables, such as age, and smoking status showed different relationships with SHS exposure in different locations. Among home-related variables, housing type and family with a single father and unmarried children showed the strongest positive relationships with SHS exposure in both males and females. In the workplace, service and sales workers, blue-collar workers, and manual laborers showed the strongest positive association with SHS exposure in males and females. For multilevel analysis in public places, only SHS exposure in females was positively related with cancer screening rate. Exposure to SHS in public places showed a positive relationship with drinking rate and single-parent family in males and females. The problem of SHS embodies social policies and interactions between individuals and social contextual factors. Policy makers should consider the contextual factors of specific locations and regional and individual context, along with differences between males and females, to develop effective strategies for reducing SHS exposure.

Experiences of Cigarette Smoking among Iranian Educated Women: A Qualitative Study

Background:

Smoking is a well-known public health problem in women as well as men. In many countries including Iran, there is an increase in tobacco use among women. Exploring the experience of smoking by educated women in order to develop effective tobacco prevention programs in these women is necessary. This study aimed to explore the experiences of smoking among Iranian educated women.

Methods:

This study used a method of qualitative content analysis with the deep individual, semi-structured interviews on a sample of 14 educated female smokers, selected purposefully. Data were analyzed using qualitative content analysis with conventional approach while being collected.

Results:

The data analysis led to 16 subcategories which were divided into four main categories: (1) Personal factors including subcategories of imitation, show-off and independence, inexperience and curiosity, personal interest and desire, improved mood, and social defiance; (2) family factors including smokers in the family, intrafamily conflicts, and family strictures and limitations; (3) social factors including subcategories of effects of work and school environment, gender equality symbols, peer pressure, and acceptance among friends; and (4) negative consequences of smoking including subcategories of a sense of being physically hurt, psychological and emotional stress, and being looked upon in a negative and judgmental manner.

Conclusions:

The findings of this study showed that smoking among Iranian educated women is a multifactorial problem. Thus, it is necessary to address smoking among educated women in a holistic approach that focuses on different determinants including personal, family, and social factors particularly the gender roles and stereotypes.

Sex Difference in Chronic Obstructive Lung Disease. Does it Matter? A Concise Review

Chronic obstructive lung disease (COPD) primarily affects men; however, its epidemiology has been changing because more women have become smokers. Recently, investigators found that although women and men were exposed to the same amount of smoke fume, women tended to have more severe disease and higher mortality rate. They also complain of more dyspnoea and may experience more severe exacerbations than men. This led to the question of whether sex has an impact on COPD course and whether women have a higher susceptibility to smoke fumes than men. That may be explained by multiple complex factors highlighting the relationship between sex, epidemiology, method of diagnostics and the clinical course of the disease. In this review, sex differences in epidemiology, clinical presentation, exacerbation, co-morbidities and treatment are covered.

A comparison of the prevalence and clustering of major cardiovascular risk factors in the Netherlands and China

BACKGROUND

Cardiovascular risk factors tend to be clustered. Variations in clusters across populations have not been widely investigated. This study aims to compare the prevalence and clustering of major cardiovascular risk factors between adults in the Netherlands and China.

METHODS

A total of 6542 Dutch adults was recruited from 2001 to 2006 for the Utrecht Health Project, an ongoing cohort study among inhabitants of a newly developing area near Utrecht, the Netherlands. A total of 37,141 Chinese employees who received health screening in Changchun City, China was enrolled from 2003 to 2010, and 3850 residents from Dehui, another city from northeast China, were enrolled in 2007.

RESULTS

The Dutch and Chinese populations shared similar patterns with increasing prevalence with age for most cardiovascular risk factors. Age-specific levels of body mass index, blood pressure and total cholesterol were higher in the Dutch than in the Chinese population. An exception to this was young men (18-44 years old): Chinese young men had similar body mass index levels compared to their Dutch counterparts. The age-standardised prevalence of current smoking was much higher in Chinese men compared to Dutch men (P < 0.05). The clustering patterns of risk factors differed between the Dutch and Chinese with the smoking-heavy drinking cluster while smoking-hypercholesterolemia was more common in both Dutch young men and women.

CONCLUSIONS

Cardiovascular risk profiles and clustering patterns differ between the Dutch and the Chinese and seem to differ between men and women. This calls for race and sex-specific targeted prevention programmes.

Voluntary pulmonary function screening identifies high rates of undiagnosed asymptomatic chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is projected to be the third leading cause of death by 2020. Early detection and screening may alter the course and prognosis associated with lung disease. We investigated the effectiveness of a voluntary public lung function screening program and factors that had a predictive value for asymptomatic COPD in Xi'an, China. Pulmonary function testing (PFT) was conducted on volunteers recruited from four community centers in Xi'an, China, between July and August 2012. Participants underwent three forced vital capacity maneuvers. The maneuver with the best forced expiratory volume in first second was retained. Participants filled out a medical history and environmental exposure survey before undergoing the PFT. Patients who self-reported lung disease on the health survey were excluded from the analysis. Logistical regression was used to determine associations with airway obstruction. A total of 803 volunteers participated in this study, and 33 subjects were excluded as the participants did not meet the requirements of PFT. Of the 770 volunteers, 44 participants had been diagnosed with chronic respiratory diseases previously, and 144 participants (18.7%) met COPD criteria. Four hundred forty-four participants did not self-report any respiratory symptoms, and the remaining 282 participants self-reported respiratory symptoms. Of the asymptomatic participants, 98 volunteers had PFT results that were consistent with COPD and 68.1% of asymptomatic participants were undiagnosed. A greater percentage of women than men had moderate or severe airway obstruction (p = 0.004).Only smoking status (odds ratio = 2.64, 95% confidence interval 1.20-6.04) was associated with asymptomatic COPD. Voluntary public lung function screening programs in China are likely to identify a large number of undiagnosed, asymptomatic COPD. Smoking status is associated with airway obstruction and a greater percentage of women than men had moderate or severe airway obstruction.

Incidence and survival of non-small cell lung cancer in Shanghai: a population-based cohort study

OBJECTIVES

Large population-based studies on the incidence and outcome of non-small cell lung cancer (NSCLC) are lacking in mainland China. This study aimed to investigate the NSCLC incidence, demographic features and survival as well as factors affecting survival of patients with NSCLC in Shanghai.

DESIGN

Prospective observational cohort study.

SETTING

Baseline information was collected from Shanghai Health Information Network, which is based on the Health Information Systems from all the comprehensive hospitals and specialist hospitals qualified for cancer diagnosis in the Shanghai metropolitan area.

PARTICIPANTS

All NSCLC cases identified from the database between 2011 and 2013 were recruited (15,020 patients).

MAIN RESULTS

The crude and age-adjusted incidences of NSCLC were 54.20 per 100,000 people (55.90 per 100,000 for men, 52.39 per 100,000 for women) and 39.05 per 100,000 people (41.43 per 100,000 for men and 37.13 per 100,000 for women), respectively. The median survival time was 22.7 months (95% CI 21.8 to 24.2 months) with an overall 1-year survival rate of 71.8% (95% CI 69.8% to 73.8%). The 1-year survival rate was 96.5% (95% CI 94.0% to 98.6%) in patients with stage I NSCLC, 89.1% (95% CI 83.3% to 94.9%) in patients with stage II NSCLC, 78.8% (95% CI 74.1% to 83.5%) in patients with stage IIIa NSCLC and 58.9% (95% CI 56.1% to 61.7%) in patients with stage IIIb/IV NSCLC. Multivariate analysis showed surgical resection (HR=0.607, 95% CI 0.511 to 0.722) and chemotherapy (HR=0.838, 95% CI 0.709 to 0.991) significantly improved survival. Factors associated with poor survival included older age, male sex, larger tumour size, lymph node metastasis, distant metastasis and squamous cell carcinoma.

CONCLUSIONS

A higher incidence and better survival rates for patients with NSCLC were identified when compared with previously published studies, which may provide evidence on the incidence and survival of NSCLC in China.

Secondhand Smoke Exposure Reduction Intervention in Chinese Households of Young Children: A Randomized Controlled Trial

OBJECTIVE

To assess whether a theory-based, community health worker-delivered intervention for household smokers will lead to reduced secondhand smoke exposure to children in Chinese families.

METHODS

Smoking parents or caregivers who had a child aged 5 years or younger at home were randomized to the intervention group (n = 164) to receive smoking hygiene intervention or to the comparison group (n = 154). The intervention was delivered by trained community health workers. Outcomes were assessed at 2- and 6- month follow-up.

RESULTS

Of the 318 families randomized, 98 (60%) of 164 intervention group and 82 (53%) of 154 of controls completed 6-month follow-up assessment. At the 6-month follow-up, 62% of intervention and 45% of comparison group households adopted complete smoking restrictions at home (P = .022); total exposure (mean number of cigarettes per week ± standard deviation) from all smokers at home in the past 7 days was significantly lower among children in the intervention (3.29 ± 9.06) than the comparison (7.41 ± 14.63) group (P = .021); and mean urine cotinine level (ng/mL) was significantly lower in the intervention (0.030 ± .065) than the comparison (0.087 ± .027) group, P < .001). Participants rating of the overall usefulness of the intervention was 4.8 + 0.8 (1 standard deviation) on the 5 point scale (1 not at all and 5 = very useful).

CONCLUSIONS

The findings of this very first study in China showed that smoking hygiene intervention was effective in reducing children's exposure to secondhand smoke. These findings have implications for the development of primary health care-based secondhand smoke exposure reduction and family oriented smoking cessation interventions as China moves toward a smoke-free society.

Decline in non-smoking workers' urine cotinine levels after increased smoking regulation in Korea

OBJECTIVES

To identify any association between implementing smoking regulation policies and workers' urine cotinine concentration levels in Korea.

METHODS

From the first stage of the Korean National Environmental Health Survey conducted by the National Institute of Environmental Research from 2009 to 2011, 2,475 non-smoking workers selected. We analyzed the trend in the changes of cotinine concentration in urine using the general linear model and linear regression, in various jobs as categorized by the National Center for Health Statistics (NCHS) and Korea Standard Classification of Occupations (KSCO).

RESULTS

The urine cotinine concentration tended to decrease every year (2.91 ng/ml in 2009, 2.12 ng/ml in 2010, and 1.31 ng/ml in 2011), showing a decreasing trend (P < 0.001). The total subjects' decreased cotinine concentration in urine between 2009 and 2011 was 2.72 ng/ml (54.1 % relative decrease). The changes in each subgroup's urine cotinine concentration ranged from 1.59 to 6.03 ng/ml (33.2 to 77.5 %). All groups except for the managerial group (n = 49), which had a small sample size, had statistically significant negative regression coefficients (p < 0.05). The ranges of the decrease in urine cotinine were 2.75 ng/ml (53.6 %) for males and 2.72 ng/ml (54.9 %) for females. The negative slope in urine cotinine level was statistically significantly greater in men than women. The changes in urine cotinine by occupation as classified by the NCHS occupational categories ranged from 2.43 to 3.36 ng/ml (46.6 to 61.5 % relative decrease). The negative slopes in urine cotinine levels of the white-collar and farm workers were statistically significantly greater than those of the service workers and blue-collar workers. The change by occupation as classified by the KSCO ranged from 1.59 to 6.03 ng/ml (a 33.2 to 77.5 % relative decrease). The negative slopes in urine cotinine levels of the professionals and related workers and clerks were statistically significantly greater than those of the service workers and plant and machine operators and assemblers.

CONCLUSIONS

The cotinine concentration in urine among non-smoking worker groups tended to decline from 2009 to 2011. Such a result may be an indirect indicator of the effectiveness of smoking regulation policies including the revision of the National Health Promotion Act.

Do females behave differently in COPD exacerbation?

INTRODUCTION

Little is known about whether there is any sex effect on chronic obstructive lung disease (COPD) exacerbations. This study is intended to describe the possible sex-associated differences in exacerbation profile in COPD patients.

METHODS

A total of 384 COPD patients who were hospitalized due to exacerbation were evaluated retrospectively for their demographics and previous and current exacerbation characteristics.

RESULTS

The study was conducted on 109 (28%) female patients and 275 (72%) male patients. The mean age was 68.30±10.46 years. Although females had better forced expiratory volume in 1 second and near-normal forced vital capacity, they had much impaired arterial blood gas levels (partial oxygen pressure [PO2] was 36.28 mmHg vs 57.93 mmHg; partial carbon dioxide pressure [PCO2] was 45.97 mmHg vs 42.49 mmHg; P=0.001), indicating severe exacerbation with respiratory failure. More females had two exacerbations and two hospitalizations, while more men had one exacerbation and one hospitalization. Low adherence to treatment and pulmonary embolism were more frequent in females. Females had longer time from the onset of symptoms till the admission and longer hospitalization duration than males. Comorbidities were less in number and different in women (P<0.05). Women were undertreated and using more oral corticosteroids.

CONCLUSION

Current data showed that female COPD patients might be more prone to have severe exacerbations, a higher number of hospitalizations, and prolonged length of stay for hospitalization. They have a different comorbidity profile and might be undertreated for COPD.

The effect of preventive educational program in cigarette smoking: Extended Parallel Process Model

BACKGROUND

Cigarette smoking is one of the preventable causes of diseases and deaths. The most important preventive measure is technique to resist against peer pressure. Any educational program should design with an emphasis upon theories of behavioral change and based on effective educational program. To investigate the interventions through educational program in prevention of cigarette smoking, this paper has used the Extended Parallel Process Model (EPPM).

MATERIALS AND METHODS

This study is a quasi-experimental study. Two middle schools were randomly selected from male students in Shiraz. Therefore, we randomly selected 120 students for the experimental group and 120 students for the control group. After diagnostic evaluation, educational interventions on the consequences of smoking and preventive skills were applied.

RESULTS

Our results indicated that there was a significant difference between students in the control and experimental groups in the means of perceived susceptibility (P < 0.000, t = 6.84), perceived severity (P < 0.000, t = -11.46), perceived response efficacy (P < 0.000, t = -7.07), perceived self-efficacy (P < 0.000, t = -11.64), and preventive behavior (P < 0.000, t = -24.36).

CONCLUSIONS

EPPM along with educating skills necessary to resist against peer pressure had significant level of efficiency in improving preventive behavior of cigarette smoking among adolescents. However, this study recommends further studies on ways of increasing perceived susceptibility in cigarette smoking among adolescents.

Reducing environmental tobacco smoke exposure of preschool children: a randomized controlled trial of class-based health education and smoking cessation counseling for caregivers

OBJECTIVES

To assess counseling to caregivers and classroom health education interventions to reduce environmental tobacco smoke exposure of children aged 5-6 years in China.

METHODS

In a randomized controlled trial in two preschools in Changsha, China, 65 children aged 5-6 years old and their smoker caregivers (65) were randomly assigned to intervention (n = 33) and control (no intervention) groups (n = 32). In the intervention group, caregivers received self-help materials and smoking cessation counseling from a trained counselor, while their children were given classroom-based participatory health education. Children's urinary cotinine level and the point prevalence of caregiver quitting were measured at baseline and after 6 months.

RESULTS

At the 6-month follow-up, children's urinary cotinine was significantly lower (Z = -3.136; p = 0.002) and caregivers' 7-day quit rate was significantly higher (34.4% versus 0%) (p < 0.001; adjusted OR = 1.13; 95% CI: 1.02-1.26) in the intervention than control group.

CONCLUSIONS

Helping caregivers quitting smoke combined with classroom-based health education was effective in reducing children's environmental tobacco smoke exposure. Larger-scale trials are warranted.

Does falling testosterone with age among men underlie the increase in ischaemic heart disease

BACKGROUND

Observationally, testosterone falls with age among men and ischaemic heart disease (IHD) increases with age, so testosterone is commonly assumed to protect against IHD. Here we examined whether IHD mortality rates among men increased faster with age in the USA than China, where testosterone in men remains stable throughout adulthood, and also whether the increase with age in mortality rates for IHD is faster than for other causes of death.

METHODS

Age-specific mortality rates from all causes, IHD, pneumonia and prostate cancer for men in the USA and China from 1991 to 1995 were obtained from the WHO, and considered in age groups because of non-linearity.

RESULTS

The risk of death from IHD in US men increased with age at the same rate as the risk of death from any cause. In China, the risk of death from IHD increased with age faster than the risk of death from any cause.

CONCLUSION

The data are not consistent with the assumption that a fall in testosterone with age causes IHD.

Relationship between caregivers' smoking at home and urinary levels of cotinine in children

Objective: To assess the impact of different smoking behaviors of caregivers on environmental tobacco smoke (ETS) exposure in children aged 5–6 years in Changsha, China. Methods: We conducted a cross-sectional, random digit-dial telephone survey of caregivers (n = 543) between August and October 2013. Caregivers’ smoking behaviors were collected by a questionnaire. Exposure assessment was based upon determination of urinary cotinine levels in children employing gas chromatography–triple quadrupole mass spectrometry (GC-MS/MS). Results: In children not living with a smoker, children living with one smoker, and children living with more than one smoker at home, median urinary cotinine concentrations (ng/mL) were 0.72, 2.97, and 4.46, respectively. For children living with one smoker, median urinary cotinine levels of children exposed to ETS were associated with caregiver smoking behaviors, i.e., if a caregiver consumed more cigarettes (>20 compared with ≤10; 7.73 versus 2.29 ng/mL, respectively). Conclusions: The magnitude of ETS exposure in children is correlated with the smoking behaviors of the caregiver. Counseling for smoking cessation and educational interventions are needed urgently for smoking caregivers to increase their awareness about ETS exposure and to encourage smoking cessation at home or to take precautions to protect children’s health.

Tolerance for and potential indicators of second-hand smoke exposure among nonsmokers: a comparison of self-reported and cotinine verified second-hand smoke exposure based on nationally representative data

OBJECTIVE

We assessed the extent to which self-reported exposure to SHS underestimates the actual exposure to SHS and what factors are associated with a tolerance for SHS exposure in the Korean setting where the smoke-free policy is incomplete.

METHODS

Information on socio-demographic characteristics, alcohol drinking and smoking was collected for 7948 nonsmokers aged ≥ 19 years from the fourth Korea National Health and Nutrition Examination Survey, 2008-2009. Self-reported and cotinine verified SHS exposures were compared. Potential factors associated with cotinine verified but not self-reported SHS exposures were assessed using a logistic regression model.

RESULTS

Self-reported SHS exposure significantly underestimated the actual SHS exposure as determined by cotinine verification (kappa coefficient: 0.1066). At younger age, frequent alcohol drinking in females and a longer smoking duration in males were positively associated with cotinine verified exposure but not with the self-reported SHS exposure; they were also positively associated with cotinine verified exposure irrespective of self-reported SHS exposure.

CONCLUSIONS

Our findings show a tolerance for smoking in Korea. The current partial ban on smoking does not fully protect people from exposure to SHS. Smoking should be banned in all public places. In addition, efforts to de-normalize smoking in the Korean culture need to be strengthened.

Policy effects of secondhand smoke exposure in public places in the Republic of Korea: evidence from PM2.5 levels and air nicotine concentrations

OBJECTIVE

The purpose of this study was to evaluate secondhand smoke (SHS) exposure inside selected public places to provide basic data for the development and promotion of smoke-free policies.

METHODS

Between March and May 2009, an SHS exposure survey was conducted. PM2.5 levels and air nicotine concentrations were measured in hospitals (n=5), government buildings (4), restaurants (10) and entertainment venues (10) in Seoul, Republic of Korea, using a common protocol. Field researchers completed an observational questionnaire to document evidence of active smoking (the smell of cigarette smoke, presence of cigarette butts and witnessing people smoking) and administered a questionnaire regarding building characteristics and smoking policy.

RESULTS

Indoor PM2.5 levels and air nicotine concentrations were relatively higher in monitoring sites where smoking is not prohibited by law. Entertainment venues had the highest values of PM2.5(μg/m3) and air nicotine concentration(μg/m3), which were 7.6 and 67.9 fold higher than those of hospitals, respectively, where the values were the lowest. When evidence of active smoking was present, the mean PM2.5 level was 104.9 μg/m3, i.e., more than 4-fold the level determined by the World Health Organization for 24-hr exposure (25 μg/m3). Mean indoor air nicotine concentration at monitoring sites with evidence of active smoking was 59-fold higher than at sites without this evidence (2.94 μg/m3 vs. 0.05 μg/m3). The results were similar at all specific monitoring sites except restaurants, where mean indoor PM2.5 levels did not differ at sites with and without active smoking evidence and indoor air nicotine concentrations were higher in sites without evidence of smoking.

CONCLUSION

Nicotine was detected in most of our monitoring sites, including those where smoking is prohibited by law, such as hospitals, demonstrating that enforcement and compliance with current smoke-free policies in Korea is not adequate to protect against SHS exposure.

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.

Passive smoking exposure from partners as a risk factor for ER+/PR+ double positive breast cancer in never-smoking Chinese urban women: a hospital-based matched case control study

Background

The relationship between passive smoking exposure (PSE) and breast cancer risk is of major interest.

Objective

To evaluate the relationship between PSE from partners and breast cancer risk stratified by hormone-receptor (HR) status in Chinese urban women population.

Design

Hospital-based matched case control study.

Setting

Chinese urban breast cancer patients without current or previous active smoking history in China Medical University 1st Hospital, Liaoning Province, China between Jan 2009 and Nov 2009.

Patients

Each breast cancer patient was matched 1∶1 with healthy controls by gender and age (±2 years) from the same hospital.

Measurements

The authors used unconditional logistic regression analyses to estimate odds ratio for women with PSE from partners and breast cancer risk.

Results

312 pairs were included in the study. Women who endured PSE had significantly increased risk of breast cancer (adjusted OR: 1.46; 95% CI: 1.05–2.03; P = 0.027), comparing with unexposed women. Women who exposed to >5 cigarettes/day also had significant increased risk (adjusted OR: 1.99; 95% CI: 1.28–3.10; P = 0.002), as were women exposed to passive smoke for 16–25 years (adjusted OR: 1.87 95% CI: 1.22–2.86; P = 0.004), and those exposed to > 4 pack-years (adjusted OR: 1.71 95% CI: 1.17–2.50; P = 0.004). Similar trends were significant for estrogen receptor (ER)/progesterone receptor (PR) double positive subgroup(adjusted OR: 1.71; 2.20; 1.99; 1.92, respectively), but not for ER+/PR−, ER−/PR+, or ER−/PR− subgroups.

Limitations

limitations of the hospital-based retrospective study, lack of information on entire lifetime PSE and low statistical power.

Conclusions

Our findings provide further evidence that PSE from partners contributes to increased risk of breast cancer, especially for ER/PR double positive breast cancer, in Chinese urban women.

The economic burden of smoking and secondhand smoke exposure in rural South-West China

OBJECTIVE

To estimate the direct and indirect costs of chronic diseases attributed to smoking and exposure to secondhand smoke (SHS) in a given year (2011) in rural southwest China.

METHODS

A prevalence-based, disease-specific attributable-risk approach was used to estimate the economic burden of chronic diseases attributable to both smoking and exposure to secondhand smoke (SHS). A cross-sectional questionnaire survey of 17 158 consenting adults aged ≥18 years was used to derive prevalence of smoking and exposure to SHS, as well as direct and indirect costs of chronic diseases.

RESULTS

In the study population, the prevalence rates of smoking and exposure to SHS are 73.1 and 38.2% for males and 1.4 and 43.4% for females, respectively. The total costs of illness are $25.85 million for COPD, $18.80 million for asthma, $37.25 million for CHD, $17.91 million for stroke, $264.35 million for hypertension and $17.11 million for peptic ulcer. The estimated costs attributable to smoking and exposure to SHS are $95.51 million and $79.35 million, accounting for 7.15 and 5.94% of local healthcare costs, respectively. Of the total costs of tobacco, direct costs and indirect costs are $94.66 million and $0.85 million for smoking, and $78.22 million and $1.36 million for exposure to SHS. Smoking contributes more cost of illness than exposure to SHS in men, whereas exposure to SHS contributes more cost of illness than smoking in women.

CONCLUSIONS

Smoking and exposure to SHS produce substantial economic burden as well as have a considerable public health impact in rural southwest China.

Effect of occupational mobility and health status on life satisfaction of Chinese residents of different occupations: logistic diagonal mobility models analysis of cross-sectional data on eight Chinese provinces

Background

Life satisfaction research in China is in development, requiring new perspectives for enrichment. In China, occupational mobility is accompanied by changes in economic liberalization and the emergence of occupational stratification. On the whole, however, occupational mobility has rarely been used as an independent variable. Health status is always used as the observed or dependent variable in studies of the phenomenon and its influencing factors. A research gap still exists for enriching this field.

Methods

The data used in this study were obtained from the China Health and Nutrition Survey (CHNS). The study included nine provinces in China. The survey was conducted from 1989 to 2009.Every survey involved approximately 4400 families or 19,000 individual samples and parts of community data.

Results

First, we built a 5 × 5 social mobility table and calculated life satisfaction of Chinese residents of different occupations in each table. Second, gender, age, marital status, education level, annual income and hukou, health status, occupational mobility were used as independent variables. Lastly, we used logistic diagonal mobility models to analyze the relationship between life satisfaction and the variables. Model 1 was the basic model, which consisted of the standard model and controlled variables and excluded drift variables. Model 2 was the total model, which consisted of all variables of interest in this study. Model 3 was the screening model, which excluded the insignificant drift effect index in Model 2.

Conclusion

From the perspective of the analysis of controlled variables, health conditions, direction, and distance of occupational mobility significantly affected life satisfaction of Chinese residents of different occupations. (1) From the perspective of health status, respondents who have not been sick or injured had better life satisfaction than those who had been sick or injured. (2) From the perspective of occupational mobility direction, the coefficients of occupational mobility in the models are less than 0, which means that upward mobility negatively affects life satisfaction. (3) From the perspective of distance, when analyzing mobility distance in Models 2 and 3, a greater distance indicates better life satisfaction.

Evidence of gene-environment interaction for two genes on chromosome 4 and environmental tobacco smoke in controlling the risk of nonsyndromic cleft palate

Nonsyndromic cleft palate (CP) is one of the most common human birth defects and both genetic and environmental risk factors contribute to its etiology. We conducted a genome-wide association study (GWAS) using 550 CP case-parent trios ascertained in an international consortium. Stratified analysis among trios with different ancestries was performed to test for GxE interactions with common maternal exposures using conditional logistic regression models. While no single nucleotide polymorphism (SNP) achieved genome-wide significance when considered alone, markers in SLC2A9 and the neighboring WDR1 on chromosome 4p16.1 gave suggestive evidence of gene-environment interaction with environmental tobacco smoke (ETS) among 259 Asian trios when the models included a term for GxE interaction. Multiple SNPs in these two genes were associated with increased risk of nonsyndromic CP if the mother was exposed to ETS during the peri-conceptual period (3 months prior to conception through the first trimester). When maternal ETS was considered, fifteen of 135 SNPs mapping to SLC2A9 and 9 of 59 SNPs in WDR1 gave P values approaching genome-wide significance (10(-6)<P<10(-4)) in a test for GxETS interaction. SNPs rs3733585 and rs12508991 in SLC2A9 yielded P = 2.26×10(-7) in a test for GxETS interaction. SNPs rs6820756 and rs7699512 in WDR1 also yielded P = 1.79×10(-7) and P = 1.98×10(-7) in a 1 df test for GxE interaction. Although further replication studies are critical to confirming these findings, these results illustrate how genetic associations for nonsyndromic CP can be missed if potential GxE interaction is not taken into account, and this study suggest SLC2A9 and WDR1 should be considered as candidate genes for CP.

The many faces of tobacco use among women

Smoking is still considered to be mainly a male problem. However, it is estimated that there are approximately 250 million women worldwide who smoke cigarettes and millions more women who use smokeless tobacco products. This article addresses the many facets of tobacco use among women. The aim of the paper is to increase recognition among clinicians and researchers of the specific characteristics of female tobacco use. Together with providing epidemiological data on the distribution of tobacco use among women and data from population-based analyses on sociocultural factors that influence it, the article presents tobacco use during pregnancy as a particularly important public health problem. Further, the article points out sex-related differences (ie, physiological, psychological, or behavioral) between male and female tobacco use. A special focus is on the important role of ovarian hormones. Adverse effects of tobacco use to women and their children as well as tobacco-related morbidities and comorbidities are presented, and women's greater susceptibility to tobacco constituents as compared to men is stressed. Awareness of these differences can contribute to improvement of the effectiveness of smoking cessation programs addressed both to the specific female population and to an individual smoking woman.

Contributions of major smoking-related diseases to reduction in life expectancy associated with smoking in Chinese adults: a cross-sectional study

BACKGROUND

Cigarette smoking is a prominent risk factor for a wide range of diseases. The current study aimed to evaluate the impact of smoking on deaths from major smoking-related diseases (neoplasms, vascular diseases and respiratory diseases) in Chinese adults by estimating the potential gains in life expectancy (LE) that would accrue from eliminating deaths from these diseases, and to determine the contribution of each disease to the reduction in LE associated with smoking.

METHODS

Two cohorts of Chinese smokers and non-smokers were constructed from a retrospective national mortality survey that had been conducted in 1989-1991 and included one million all-cause deaths among adults during 1986-1988 in 103 geographical regions. For each cohort, potential gains in LE by eliminating deaths from each major smoking-related disease were estimated. The contributions of each disease to smoking-associated reduction in LE were assessed using the LE decomposition approach.

RESULTS

Among the major smoking-related diseases, it was estimated that elimination of vascular diseases would provide the greatest potential gain in LE (years), regardless of smoking status. The gains for smokers versus non-smokers in populations of urban men, urban women, rural men and rural women aged 35 years were 3.5 vs. 4.3, 3.8 vs. 4.1, 2.4 vs. 3.0, and 2.6 vs. 2.9 years, respectively. Respiratory diseases contributed most to smoking-associated LE reductions in urban women, rural men and rural women of 43.6%, 46.4%, and 62.9%, respectively. In urban men, neoplasms contributed most to smoking-associated LE reduction, their contribution being estimated as 45.8%.

CONCLUSIONS

Respiratory disease has the greatest influence on the LE reduction associated with smoking. Thus, smoking prevention could significantly reduce deaths from respiratory disease and improve LE.

The China Patient-Centered Evaluative Assessment of Cardiac Events (China PEACE) retrospective study of acute myocardial infarction: study design

BACKGROUND

Cardiovascular diseases are rising as a cause of death and disability in China. To improve outcomes for patients with these conditions, the Chinese government, academic researchers, clinicians, and >200 hospitals have created China Patient-Centered Evaluative Assessment of Cardiac Events (China PEACE), a national network for research and performance improvement. The first study from China PEACE, the Retrospective Study of Acute Myocardial Infarction (China PEACE-Retrospective AMI Study), is designed to promote improvements in acute myocardial infarction (AMI) quality of care by generating knowledge about the characteristics, treatments, and outcomes of patients hospitalized with AMI across a representative sample of Chinese hospitals during the past decade.

METHODS AND RESULTS

The China PEACE-Retrospective AMI Study will examine >18 000 patient records from 162 hospitals identified using a 2-stage cluster sampling design within economic-geographic regions. Records were chosen from 2001, 2006, and 2011 to identify temporal trends. Data quality will be monitored by a central coordinating center and will, in particular, address case ascertainment, data abstraction, and data management. Analyses will examine patient characteristics, diagnostic testing patterns, in-hospital treatments, in-hospital outcomes, and variation in results by time and site of care. In addition to publications, data will be shared with participating hospitals and the Chinese government to develop strategies to promote quality improvement.

CONCLUSIONS

The China PEACE-Retrospective AMI Study is the first to leverage the China PEACE platform to better understand AMI across representative sites of care and during the past decade in China. The China PEACE collaboration among government, academicians, clinicians, and hospitals is poised to translate research about trends and patterns of AMI practices and outcomes into improved care for patients.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01624883.

Assessment of Risk Factor for Cardiovascular Disease Using Heart Rate Variability in Postmenopausal Women: A Comparative Study between Urban and Rural Indian Women

Cardiovascular diseases are important causes of morbidity and mortality in postmenopausal women. A major determinant of cardiovascular health is the status of autonomic nervous system and assessment of Heart Rate Variability (HRV). Heart Rate Variability is a noninvasive and sensitive technique to evaluate cardiovascular autonomic control. Reduced HRV is an independent risk factor for the development of heart disease. This study evaluated the risk factors for cardiovascular diseases using HRV, between urban and rural Indian postmenopausal women ranging in age from 40 to 75 years. Findings of the analysis of HRV have showed that the total power which reflects overall modulation of cardiac autonomic activity (759 ± 100  versus 444 ± 65), the absolute power of high frequency which is surrogate of cardiovagal activity (247 ± 41  versus 163 ± 45), and low frequency that reflects cardiac sympathetic activity (205 ± 26  versus 127 ± 18) were significantly higher in urban women than that of their rural counterparts. Further, among the anthropometric measures, waist circumference was significantly correlated with indices of HRV. The study concludes that rural Indian women are associated with an additional risk beyond that of ageing and postmenopausal status when compared to the urban women. The higher central obesity could be the contributing factor for developing higher risk for cardiovascular disease among the rural women.

Non-smoking-related chronic obstructive pulmonary disease: a neglected entity?

Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide, and it has been strongly correlated to tobacco smoking. While a number of studies have concentrated on smokers only, recent published data demonstrate that at least one fourth of patients with COPD are non-smokers, and that the burden of COPD in non-smokers is also higher than previously believed. Risk factors of COPD in non-smokers may include genetic factors, long-standing asthma, outdoor air pollution (from traffic and other sources), environmental smoke exposure (ETS), biomass smoke, occupational exposure, diet, recurrent respiratory infection in early childhood, tuberculosis and so on. In Asian region, indoor/outdoor air pollution and poor socioeconomic status may play important roles in the pathogenesis of non-smoking-related COPD. The prevalence of COPD among never smokers varies widely across nations. Such a variation may arise from several aspects, including study design, definition of COPD, diagnostic criteria, age and gender distribution of the studied population, local risk factors and socioeconomic status. More investigations and efforts are required to elucidate the involved factors and their shared contributions to non-smoking-related COPD so as to achieve better estimation and reduction of the burden of this neglected entity worldwide.