Passive smoking, NAT2 polymorphism, and breast cancer risk in Israeli Arab women: a case-control study.

BACKGROUND: The effect of passive smoking (PS) on breast cancer (BC) is controversial, and may be modified by polymorphism of the N-Acetyl-transferase (NAT) 2 enzyme which is involved in tobacco carcinogen metabolism. We aimed to evaluate the relationship between PS and BC by NAT2 variants in Arab-Israeli women, a unique population with low active smoking rates, and high exposure to PS. METHODS: A population-based case-control study was carried out on non-smoking 137 prevalent breast cancer patients and 274 population-based controls, aged 30-70 years. Data on past and current PS, sociodemographic, and other characteristics were retrieved through interviews, and buccal smears were provided for NAT2 analyses. Logistic regression models adjusting for potential confounders assessed the odds ratios (ORs) and 95% confidence intervals (95% CI) of the association between PS and BC. RESULTS: Ever PS was associated with increased BC risk: OR = 2.22, 95% CI 1.28-3.87. Higher lifetime PS exposure was associated with higher BC risk: Compared to never exposed women, women exposed to PS most of their lives had a threefold higher BC risk (OR = 3.16, 95% CI 1.70-5.87, P trend < 0.001). NAT2 polymorphism did not modify these associations. CONCLUSIONS: PS exposure in non-smoking Israeli Arab women is significantly associated with increased risk for BC, potentially allowing for specific intervention; NAT2 polymorphism does not modify this association.

Assessing exposure to secondhand smoke in restaurants and bars 2 years after the smoking regulations in Beijing, China.

UNLABELLED: Field observation of patron smoking behaviors and multiple sampling approaches were conducted in 79 restaurants and bars in Beijing, 2010, 2 years after implementing the governmental smoking regulations. Smoking was observed in 30 visits to 22 of the 37 nominal non-smoking venues during peak patronage times and six visits to four of the 14 nominal non-smoking sections. The median area secondhand smoke (SHS) concentrations during peak patronage time were 27, 15, 43, and 40 µg/m(3) in nominal non-smoking venues, non-smoking sections, smoking sections, and smoking venues, respectively, as indicated by the difference between indoor and outdoor PM2.5 levels; and 1.4, 0.6, 1.7, and 2.7 µg/m(3) , respectively, as indicated by airborne nicotine. In the 27 venues with sampling of different approaches and over different time periods, the median nicotine concentration was 1.8 µg/m(3) by one-hour peak patronage-time sampling, 1.1 µg/m(3) by 1-day active area sampling, 2.5 µg/m(3) by 1-day personal sampling, and 2.3 µg/m(3) by week-long passive sampling. No significant differences in nicotine levels were observed among venues/sections with different nominal smoking policies by all sampling approaches except during peak patronage time. This study showed that the 2008 Beijing governmental smoking restriction has been poorly implemented, and SHS exposures in Beijing restaurants and bars remain high. PRACTICAL IMPLICATIONS: The 2008 Beijing governmental smoking restriction requires large restaurants to designate no less than 50% of their dining area as non-smoking, without defining 'large' or specifying how the designated smoking sections and non-smoking sections should be separated. Two years after its implementation, smoking is still commonly observed in nominally non-smoking restaurants and bars and in designated non-smoking sections, and both patrons and servers are exposed to high concentrations of secondhand smoke. These results indicate that the Beijing governmental regulation fails to protect the population from SHS exposure in restaurants and bars and that more efforts are needed to pass stronger smoking regulations and ensure better compliance in Beijing, China.

Feasibility and efficacy of an intervention to reduce secondhand smoke exposure among infants discharged from a neonatal intensive care unit.

OBJECTIVE: To examine the feasibility and efficacy of a hospital-based, motivational intervention to reduce secondhand smoke exposure (SHSe) with mothers of infants in a neonatal intensive care unit (NICU). STUDY DESIGN: One-hundred and forty-four mothers with infants ( ≤ 1500 g at birth or ≥ 12 h ventilation) in a NICU who reported a smoker in the household were randomized to two sessions of motivational interviewing (MI) conducted in the hospital, usual care (UC) or usual care-reduced measurement (UC-RM); follow-up occurred at 1- and 6-months post discharge. RESULT: For households that did not have a total smoking ban at baseline, 63.6% of those in the MI group instituted a ban by 1-month post discharge compared with 20% of the UC group, P<0.02. Six months post discharge, fewer smoking bans were noted in the UC-RM group relative to MI and UC, P<0.01. CONCLUSION: A need for SHSe interventions among NICU parents exists and initial evidence suggests MI can impact SHSe after discharge.

Secondhand smoke transfer and reductions by air sealing and ventilation in multiunit buildings: PFT and nicotine verification.

UNLABELLED: Surveys suggest that transfer of secondhand smoke (SHS) between units in multiunit residential buildings is common, but measured data are rare. This study was undertaken to quantify bulk air transfer between units and document transfer of SHS species before and after treatments that sealed boundaries between units and provided a minimum amount of continuous exhaust ventilation of each unit. Six buildings in Minnesota were studied. Treatments were performed in clusters of up to eight units in each building, including zero to two units occupied by smokers. Bulk air transfer was quantified through passive perfluorocarbon tracer (PFT) gas tests. SHS transfer was evaluated using passive nicotine sampling. The median fraction of air entering a unit that came from other units tagged with PFTs ranged from 0.021 in a new condominium building to 0.353 in a 1930s duplex, with an overall median of 0.041. Treatments provided a median decrease of 29% in the fraction of transferred air and reduced PFT concentrations by about 40%, because of increased ventilation of both source and target apartments. Nicotine was transferred at only one-sixth the rate of PFTs. Involuntary exposure to SHS can be reduced but not eliminated by modifying existing, occupied multiunit buildings. PRACTICAL IMPLICATIONS: Recent studies of secondhand smoke exposure in multiunit housing indicate transmission of SHS constituents from smokers' units to those occupied by nonsmokers. A straightforward solution for this problem is to eliminate air leakage transfer between these units. This study describes a 2-year investigation of air sealing and ventilation improvements in six multiunit buildings located in a heating-dominated climate region of the US. The results quantify the reduction in interunit transfer of air between smokers' and nonsmokers' units. While it is possible to reduce the transfer when done with care, it is extremely difficult to eliminate these flows unless the buildings are vacated and extensively rebuilt. Eliminating air leakage between smokers' and nonsmokers' units is not a practical means of solving SHS transmission in an existing building.

Indoor concentrations of nicotine in low-income, multi-unit housing: associations with smoking behaviours and housing characteristics.

OBJECTIVE: An analysis of airborne nicotine measurements collected in 49 low-income, multi-unit residences across the Greater Boston Area. METHODS: Nicotine concentrations were determined using passive monitors placed in homes over a one-week sampling period and air exchange rates (AER) were sampled using the perfluorocarbon tracer technique. Residents were surveyed through a questionnaire about smoking behaviour and a visual inspection was conducted to collect information on housing characteristics contributing to secondhand smoke (SHS) exposure. Using a mass balance model to account for the air exchange rate, volume of the home and sorption and re-emission of nicotine on indoor surfaces, the effective smoking rate (SR(eff)) was determined for each residence. RESULTS: Nicotine levels ranged from the limit of detection to 26.92 microg/m(3), with a mean of 2.20 microg/m(3) and median of 0.13 microg/m(3). Nicotine measurements were significantly associated with the number of smokers in the household and the number of cigarettes smoked in the home. The results of this study suggest that questionnaire reports can provide a valid estimate of residential exposure to tobacco smoke. In addition, this study found evidence that tobacco smoke contamination in low-income housing developments is not limited to homes with smokers (either residing in the home or visiting). The frequent report of tobacco smoke odour coming from other apartments or hallways resulted in increased levels of nicotine concentrations and SR(eff) in non-smoking homes, suggestive of SHS infiltration from neighbouring units. CONCLUSION: These findings have important implications for smoking regulations in multi-unit homes and highlight the need to reduce involuntary exposure to tobacco smoke among low-income housing residents.

The scientific basis of tobacco product regulation.

This report presents the conclusions and recommendations of TobReg from its fourth meeting, where the Study Group deliberated on a number of topics in the field of tobacco product regulation and produced the following advisory notes and recommendations: an advisory note on smokeless tobacco products: health effects, implications for harm reduction and research needs; an advisory note on 'fire safer' cigarettes: approaches to reduced ignition propensity; a recommendation on mandated lowering of toxicants in cigarette smoke: tobacco-specific nitrosamines and selected other constituents; and a recommendation on cigarette machine smoking regimens. The four sections of this report address these four issues, and the Study Group's recommendations are set out at the end of each section. Its overall recommendations are summarized in section 5.

Secondhand smoke exposure and risk following the Irish smoking ban: an assessment of salivary cotinine concentrations in hotel workers and air nicotine levels in bars.

OBJECTIVE: To investigate whether the Irish smoking ban has had an impact on secondhand smoke (SHS) exposures for hospitality workers. DESIGN, SETTING, AND PARTICIPANTS: Before and after the smoking ban a cohort of workers (n = 35) from a sample of city hotels (n = 15) were tested for saliva cotinine concentrations and completed questionnaires. Additionally, a random sample (n = 20) of city centre bars stratified by size (range 400-5000 square feet), were tested for air nicotine concentrations using passive samplers before and after the ban. MAIN OUTCOME MEASURES: Salivary cotinine concentrations (ng/ml), duration of self reported exposures to secondhand smoke, air nicotine (microg/cubic metre). RESULTS: Cotinine concentrations reduced by 69%, from 1.6 ng/ml to 0.5 ng/ml median (SD 1.29; p < 0.005). Overall 74% of subjects experienced decreases (range 16-99%), with 60% showing a halving of exposure levels at follow up. Self reported exposure to SHS at work showed a significant reduction from a median 30 hours a week to zero (p < 0.001). There was an 83% reduction in air nicotine concentrations from median 35.5 microg/m3 to 5.95 microg/m3 (p < 0.001). At baseline, three bars (16%) were below the 6.8 microg/m3 air nicotine significant risk level for lung cancer alone; at follow up this increased to 10 (53%). CONCLUSIONS: Passive smoking and associated risks were significantly reduced but not totally eliminated. Exposure to SHS is still possible for those working where smoking is still allowed and those working where smoke may migrate from outdoor areas. Further research is required to assess the true extent and magnitude of these exposures.

Directly measured second hand smoke exposure and asthma health outcomes.

BACKGROUND: Because they have chronic airway inflammation, adults with asthma could have symptomatic exacerbation after exposure to second hand smoke (SHS). Surprisingly, data on the effects of SHS exposure in adults with asthma are quite limited. Most previous epidemiological studies used self-reported SHS exposure which could be biased by inaccurate reporting. In a prospective cohort study of adult non-smokers recently admitted to hospital for asthma, the impact of SHS exposure on asthma health outcomes was examined. METHODS: Recent SHS exposure during the previous 7 days was directly measured using a personal nicotine badge (n = 189) and exposure during the previous 3 months was estimated using hair nicotine and cotinine levels (n = 138). Asthma severity and health status were ascertained during telephone interviews, and subsequent admission to hospital for asthma was determined from computerised utilisation databases. RESULTS: Most of the adults with asthma were exposed to SHS, with estimates ranging from 60% to 83% depending on the time frame and methodology. The highest level of recent SHS exposure, as measured by the personal nicotine badge, was related to greater asthma severity (mean score increment for highest tertile of nicotine level 1.56 points; 95% CI 0.18 to 2.95), controlling for sociodemographic covariates and previous smoking history. Moreover, the second and third tertiles of hair nicotine exposure during the previous month were associated with a greater baseline prospective risk of hospital admission for asthma (HR 3.73; 95% CI 1.04 to 13.30 and HR 3.61; 95% CI 1.0 to 12.9, respectively). CONCLUSIONS: Directly measured SHS exposure appears to be associated with poorer asthma outcomes. In public health terms, these results support efforts to prohibit smoking in public places.

Environmental tobacco smoke exposure in public places of European cities.

BACKGROUND: Exposure to environmental tobacco smoke (ETS) has important public health implications. The results of the first European multi-centre study that measured ETS exposure in a range of public places (transport, educational settings, and leisure facilities such as bars and restaurants) are presented. METHOD: Nicotine vapour phase was measured using ETS passive samplers containing a filter treated with sodium bisulfate. RESULTS: Bars and discos are the places with the highest concentrations of nicotine from ETS, median ranging from 19 to 122 microg/m(3). Restaurants had the next highest values. Concentrations of nicotine generally range from 0.1-5 microg/m(3) in airports, and from 0.5-10 microg/m(3) in train stations. Nicotine was also found in schools and universities, yet schools tended to have the lowest concentrations compared to all the other public places sampled. In hospitals levels were generally below 5 microg/m(3). CONCLUSIONS: Although there is some variability between cities, this study shows that tobacco smoke is present in most of the studied public places. The study also showed that in areas where smoking is prohibited, concentrations of nicotine are lower than in areas where smoking is allowed but they are not zero. The results of this study indicate that policies should be implemented that would effectively reduce levels of tobacco smoke in public areas.

Measurement of environmental tobacco smoke exposure among adults with asthma.

Because the morbidity and mortality from adult asthma have been increasing, the identification of modifiable environmental exposures that exacerbate asthma has become a priority. Limited evidence suggests that exposure to environmental tobacco smoke (ETS) may adversely affect adults with asthma. To study the effects of ETS better, we developed a survey instrument to measure ETS exposure in a cohort of adults with asthma living in northern California, where public indoor smoking is limited. To validate this survey instrument, we used a passive badge monitor that measures actual exposure to ambient nicotine, a direct and specific measure of ETS. In this validation study, we recruited 50 subjects from an ongoing longitudinal asthma cohort study who had a positive screening question for ETS exposure or potential exposure. Each subject wore a passive nicotine badge monitor for 7 days. After the personal monitoring period, we readministered the ETS exposure survey instrument. Based on the survey, self-reported total ETS exposure duration ranged from 0 to 70 hr during the previous 7 days. Based on the upper-range boundary, bars or nightclubs (55 hr) and the home (50 hr) were the sites associated with greatest maximal self-reported exposure. As measured by the personal nicotine badge monitors, the overall median 7-day nicotine concentration was 0.03 microg/m(3) (25th-75th interquartile range 0-3.69 microg/m(3)). Measured nicotine concentrations were highest among persons who reported home exposure (median 0.61 microg/m(3)), followed by work exposure (0.03 microg/m(3)), other (outdoor) exposure (0.025 microg/m(3)), and no exposure (0 microg/m(3); p = 0.03). The Spearman rank correlation coefficient between self-reported ETS exposure duration and directly measured personal nicotine concentration during the same 7-day period was 0.47, supporting the survey's validity (p = 0.0006). Compared to persons with no measured exposure, lower-level [odds ratio (OR) 1.9; 95% confidence interval (CI), 0.4-8.8] and higher-level ETS exposures (OR 6.8; 95% CI, 1.4-32.3) were associated with increased risk of respiratory symptoms. A brief, validated survey instrument can be used to assess ETS exposure among adults with asthma, even with low levels of exposure. This instrument could be a valuable tool for studying the effect of ETS exposure on adult asthma health outcomes.

A randomized trial to reduce passive smoke exposure in low-income households with young children.

OBJECTIVE: Passive smoke exposure among children is widespread in the United States; estimates suggest that almost 40% of children who are younger than 5 years live with a smoker. Few randomized studies of passive smoke exposure reduction among children have been conducted, and the impact of interventions that have been evaluated has been limited. The objective of this study was to determine whether a motivational intervention for smoking parents of young children will lead to reduced household passive smoke exposure. METHODS: Project KISS (Keeping Infants Safe From Smoke), a theory-driven exposure reduction intervention targeting low-income families with young children, was a randomized controlled study in which participants-smoking parents/caregivers (N = 291) who had children who were younger than 3 years and who were recruited through primary care settings-were randomly assigned to either the motivational intervention (MI) or a self-help (SH) comparison condition was used. Follow-up assessments were conducted at 3 and 6 months. The MI condition consisted of a 30- to 45-minute motivational interviewing session at the participant's home with a trained health educator and 4 follow-up telephone counseling calls. Feedback from baseline household air nicotine assessments and assessment of the participant's carbon monoxide level was provided as part of the intervention. Participants in the SH group received a copy of the smoking cessation manual, the passive smoke reduction tip sheet, and the resource guide in the mail. Household nicotine levels were measured by a passive diffusion monitor. RESULTS: The 6-month nicotine levels were significantly lower in MI households. Repeated measures analysis of variance across baseline, 3-month, and 6-month time points showed a significant time-by-treatment interaction, whereby nicotine levels for the MI group decreased significantly and nicotine levels for the SH group increased but were not significantly different from baseline. CONCLUSIONS: This study targeted a large sample of racially and ethnically diverse low-income families, in whom both exposure and disease burden is likely to be significant. This is the first study to our knowledge that has been effective in reducing objective measures of passive smoke exposure in households with healthy children. These findings have important implications for pediatric health care providers, who play an important role in working with parents to protect children's health. Providers can help parents work toward reducing household passive smoke exposure using motivational strategies and providing a menu of approaches regardless of whether the parents are ready to quit.

Intervention and policy issues related to children's exposure to environmental tobacco smoke.

BACKGROUND: Children's exposure to environmental tobacco smoke (ETS) is unacceptably high; almost 40% of children in the United States are regularly exposed to ETS. METHODS: This paper presents a review of the literature that evaluates interventions designed to reduce ETS exposure among young children. In addition, it presents the study design for Project KISS (Keeping Infants Safe from Smoke), an intervention designed to utilize exposure-related feedback to increase parents' motivation for ETS reduction and to reduce household ETS levels. Baseline data are presented to illustrate factors that should be addressed in ETS interventions. RESULTS: The literature review demonstrates the dearth of studies in the literature targeting ETS reduction among children. Participants in Project KISS believed that smoking had affected their children's health and were in later stages of motivational readiness to quit smoking than is typically observed. However, they face a number of challenges to smoking, such as high prevalence of nicotine dependence, high prevalence of living with other smokers, and socioeconomic and stress-related barriers. CONCLUSIONS: The policy implications of this research are discussed, and recommendations are made for future research.

Prevention of lead poisoning in construction workers: a new public health approach.

BACKGROUND: In 1990, Yale University, the Connecticut Departments of Health Services and of Transportation, the Connecticut Construction Industries Association, and the state's construction trade unions created the Connecticut Road Industry Surveillance Project (CRISP). METHODS: Data from 90 bridge projects from 1991 to 1995 and approximately 2,000 workers were evaluated. The distribution of peak lead concentrations in the blood for CRISP workers classified into five groups were compared to that from workers outside of Connecticut. RESULTS: This demonstration project was instrumental in lowering bridge worker blood lead levels. After 1992, only the painting contract employees experienced peak blood lead levels with < or = 2% exceeding 50 microg/dl. Compared to similar workers in other states, Connecticut workers had significantly lower peak blood lead levels. CONCLUSIONS: Two thousand workers and over 120 contractors benefited directly from CRISP. Two key features of the CRISP model differed from the 1993 OSHA standard: a contract-specified lead health protection program and a centralized system of medical monitoring. These differences may account for the improved protection observed between the CRISP and non-Connecticut cohorts.

Measuring secondhand smoke exposure in babies: the reliability and validity of mother reports in a sample of low-income families.

The reliability and validity of mother's reports of their infants' exposure to secondhand smoke (SHS) were examined in an ethnically diverse sample of low-income, low-education families (N = 141 mothers). At baseline and posttest, smoking mothers reported about their infants' SHS exposure at different locations and by different sources during the previous week. Findings show that mothers can give reliable accounts of the degree to which they contribute to their babies' SHS exposure. Mothers are able to differentiate between their own smoking behavior and the extent to which they expose their infants. Consistent with the overall exposure pattern, exposure caused by the mother and exposure occurring at home showed the strongest associations with biological and environmental measures. These findings suggest that smoking mothers can provide reliable and valid reports of the degree to which their infants are exposed to SHS.

Personal fluoride and solvent exposures, and their determinants, in semiconductor manufacturing.

Personal air sampling for fluorides and solvents was done at 35 semiconductor fabrication facilities in the United States. Fluoride compounds were used in etching and cleaning operations, and solvents were used in photoresist and developing operations. All personal solvent and fluoride levels were less than 2 percent of current Occupational Safety and Health Administration (OSHA) standards. Statistical models of the exposure determinants for the target agents found production level, as indicated by number of semiconductor wafer cassettes loaded/unloaded from the target machines or baths, was predictive of fluoride, xylene and 1-methoxy-2-propyl acetate exposures. The percent of fresh air ventilation and the percent of xylene in the photoresist were also significant determinants in the statistical model predicting personal xylene exposure levels.

Peer reviewed: managing the health impacts of waste incineration.

The current framework used to assess incinerator health effects considers local populations, but often excludes workers and regional populations.

Exposure of U.S. workers to environmental tobacco smoke.

The concentrations of environmental tobacco smoke (ETS) to which workers are exposed have been measured, using nicotine or other tracers, in diverse workplaces. Policies restricting workplace smoking to a few designated areas have been shown to reduce concentrations of ETS, although the effectiveness of such policies varies among work sites. Policies that ban smoking in the workplace are the most effective and generally lower all nicotine concentrations to less than 1 microg/m3; by contrast, mean concentrations measured in workplaces that allow smoking generally range from 2 to 6 microg/m3 in offices, from 3 to 8 microg/m3 in restaurants, and from 1 to 6 microg/m3 in the workplaces of blue-collar workers. Mean nicotine concentrations from 1 to 3 microg/m3 have been measured in the homes of smokers. Furthermore, workplace concentrations are highly variable, and some concentrations are more than 10 times higher than the average home levels, which have been established to cause lung cancer, heart disease, and other adverse health effects. For the approximately 30% of workers exposed to ETS in the workplace but not in the home, workplace exposure is the principal source of ETS. Among those with home exposures, exposures at work may exceed those resulting from home. We conclude that a significant number of U.S. workers are exposed to hazardous levels of ETS.