The Effect of Adult Smoking Behavior on Children's Exposure to Secondhand Smoke. An Analysis Based on Salivary Cotinine Levels Among Children in Dhaka and Karachi.

To explore trends in and predictors of second-hand smoke (SHS) exposure in children. To identify whether inequalities in SHS exposure are changing over time. Repeated cross-sectional study with data from eight annual surveys conducted over an 11-year period from 1996 to 2006. England. Nationally representative samples of children aged 4-15 years living in private households. Saliva cotinine (4-15-year-olds), current smoking status (8-15-year-olds), smoking status of parents and carers, smoking in the home, socio-demographic variables. The most important predictors of SHS exposure were modifiable factors-whether people smoke in the house on most days, whether the parents smoke and whether the children are looked after by carers who smoke. Children from more deprived households were more exposed and this remained the case even after parental smoking status has been controlled for. Exposure over time has fallen markedly among children (59% decline over 11 years in geometric mean cotinine), with the most marked decline observed in the period immediately preceding smoke-free legislation. Declines in exposure have generally been greater in children most exposed at the outset. For example, in children whose parents both smoke, median cotinine declined annually by 0.115 ng/ml compared with 0.019 ng/ml where neither parent smokes (P < 0.05). In the 11 years leading up to smoke-free legislation in England, the overall level of SHS exposure in children as well as absolute inequalities in exposure have been declining. Further efforts to encourage parents and carers to quit and to avoid smoking in the home would benefit child health.

Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006-2017 for the 28 European Union (EU) countries. Exposure to SHS was estimated using a multiple imputation procedure based on the Eurobarometer surveys, and SHS exposure burden was estimated with the comparative risk assessment method using meta-analytical relative risks. Data on deaths and disability-adjusted life years (DALYs) were collected from National statistics and from the Global Burden of Disease Study. Exposure to SHS and its attributable burden stalled in 2006-2017; in pregnant women, SHS exposure was 19.8% in 2006, 19.1% in 2010, and 21.0% in 2017; in children it was 10.1% in 2006, 9.6% in 2010, and 12.1% in 2017. In 2017, 35,633 DALYs among children were attributable to SHS exposure in the EU, mainly due to low birth weight. Comprehensive smoking bans up to 2010 contributed to reduce SHS exposure and its burden in children immediately after their implementation; however, SHS exposure still occurs, and in 2017, its burden in children was still relevant. Exposure to secondhand smoke at home and in pregnancy is a major cause of disease among children. Smoking legislation produced the adoption of voluntary smoking bans in homes; however, secondhand smoke exposure at home still occurs and its burden is substantial. In 2017, the number of deaths and disability-adjusted life years in children attributable to exposure to secondhand smoke in the European Union countries were, respectively, 335 and 35,633. Low birth weight caused by secondhand smoke exposure in pregnancy showed the largest burden. Eastern European Union countries showed the highest burden.

Exploring Children's Secondhand Smoke Exposure with Early Child Care Providers

To examine smoking restrictions in households of children with cancer and their effect on biological measures of children's secondhand smoke exposure (SHSe). A sample of 135 parents of nonsmoking children with cancer who lived with a smoker completed structured interviews. Approximately 43% of families prohibited smoking in the home. Children living in homes that prohibited smoking had median cotinine levels that were 71% and 52% lower than did those from homes with no and partial restrictions. Parents should be directed to completely ban all smoking from the home and car to best protect their children from SHSe.

ObjectiveTo describe the relationship of household secondhand smoke (SHS) exposure and cardiac structure and function.MethodsParticipants (n=1069; 68 % female; age 45–74 years) without history of tobacco use, coronary artery disease...

The accuracy of parental reports of youth secondhand smoke exposure has received limited attention in the research literature. Such reports were compared to serum cotinine levels among participants of the National Health and Nutrition Examination Survey III who were aged 4-16 years. Likely smokers with serum cotinine values of 14 ng/ml or more and self-reported tobacco users were excluded from the analysis (n = 87), leaving 2,524 youth participants. One adult guardian, typically the parent, was asked to identify household smokers and estimate the number of cigarettes smoked in the home. Using cotinine levels of at least 0.2 ng/ml as the criterion, we found the sensitivity and specificity of any reported smokers in the home to be .65 and .92, respectively. Spearman correlations between cotinine levels and the number of smokers and the number of cigarettes consumed in the household were .67 and .68, respectively, and varied little across subgroups, including age, gender, and ethnicity of the child as well as household poverty status and educational attainment of the parent. Parental reports of household smoking alone fail to capture all youth secondhand smoke exposures, but they correlate well with cotinine levels when expressed as the number of household smokers or the number of cigarettes smoked in the household. Additional research is needed to determine whether reliance on parental reports of secondhand smoke exposure leads to bias in studies examining health outcomes in children and adolescents. Also, additional research is needed to better determine the level of secondhand smoke exposure that is biologically important in children and adolescents.

IntroductionAmerican Indians and Alaska Natives face disproportionately high rates of smoking and secondhand smoke (SHS) exposure. The Cheyenne River Sioux Tribe (CRST) is among the few Tribal Nations controlling commercial...

Background No study has reported the relationship between secondhand smoke (SHS) exposure and metabolic syndrome (MetS) in self-reported never-smokers verified by nicotine metabolite. Purpose The aim of this study is to determine the relationship between SHS exposure and MetS in self-reported and cotinine-verified never-smokers. Methods A total of 118,609 self-reported and cotinine-verified never-smokers (38,385 men; age 34.8±7.1 years) who participated in Kangbuk Samsung Health Study (KSHS) and Kangbuk Samsung Cohort study (KSCS) between 2011 and 2016 were included. Cotinine-verified never-smoker was defined as individuals having urinary cotinine &lt;50 ng/mL. SHS exposure was defined as having experienced passive smoking indoors at home or the workplace. Results The prevalence of SHS exposure in the overall population was 22.6%, with rates of 27.4% for males and 20.3% for females (p&lt;0.001). The overall prevalence of MetS was 6.8%; the prevalence in males was higher than that in females (10.7% versus 4.9%, p&lt;0.001). In both males and females, the prevalence of MetS in group with SHS exposure was higher than that in group without SHS exposure (11.3% versus 10.4%, p=0.010 for males; 5.8% versus 4.6%, p&lt;0.001 for females). However, there was significant gender interaction for the relationships between SHS exposure and MetS (p for interaction=0.010). A multivariate regression model was adjusted for the baseline variables including age, body mass index, frequency of alcohol drinking and vigorous exercise, blood urea nitrogen, creatinine, uric acid, total cholesterol, LDL cholesterol, and hsCRP. The results showed that SHS exposure only in females was associated with MetS (odds ratio [95% confidence interval], 1.17 [1.06, 1.29] for females; 1.02 [0.94, 1.11] for males). In particular, females with SHS exposure of ≥1 hours/day, ≥3 times/week, and ≥10 years increased the prevalence of MetS compared to those without SHS exposure (1.21 [1.02, 1.45], 1.30 [1.14, 1.49], and 1.12 [0.99, 1.28], respectively. Conclusions This study showed that the SHS exposure in females was significantly associated with MetS in self-reported never-smokers with low urinary cotinine levels (&lt;50 ng/mL), suggesting that more active anti-smoking programs in the home and public are needed to reduce the risk of MetS.

Promoting smoke-free homes (SFHs) in Armenia and Georgia is timely given high smoking and secondhand smoke exposure (SHSe) rates and recent national smoke-free policy implementation. This study examined theoretical predictors (e.g. motives, barriers) of SFH status, and among those without SFHs, past 3-month SFH attempts and intent to establish SFHs in the next 3 months. Multilevel logistic regression analyzed these outcomes using 2022 survey data from 1467 adults (31.6% past-month smokers) in Armenia (n = 762) and Georgia (n = 705). Correlates of interest included SHSe reduction behaviors and SFH motives and barriers; models controlled for country, community, age, sex, smoking status and other smokers in the home. In this sample, 53.6% had SFHs (Armenia: 39.2%; Georgia: 69.2%). Among those without SFHs, one-fourth had partial restrictions, no smokers in the home and/or recent SFH attempts; 35.5% intended to establish SFHs; and ∼70% of multiunit housing residents supported smoke-free buildings. We documented common SHSe reduction behaviors (opening windows, limiting smoking areas), SFH motives (prevent smell, protect children/nonsmokers) and barriers (smokers' resistance). Correlates of SFHs were being from Georgia, other smokers in the home, fewer SHSe reduction behaviors, greater motives and fewer barriers. Among participants without SFHs, correlates of recent SFH attempts were other smokers in the home, greater SHSe reduction behaviors and SFH motives, and fewer barriers; correlates of SFH intentions were being female, greater SHSe reduction behaviors, greater motives, and fewer barriers. SFH interventions should address motives, barriers and misperceptions regarding SHSe reduction behaviors. Moreover, smoke-free multiunit housing could have a great population impact.

BackgroundGiven that higher smoking rates persist among lower socioeconomic populations, multiunit housing (MUH) environments may result in higher secondhand smoke (SHS) exposures among subsidised MUH residents. This cross-sectional assessment compares...

Although food insecurity is more prevalent in households with smokers, no studies have examined the misclassification of children's secondhand smoke (SHS) exposure by household food security status. Our population‐based sample included 8453 participants (3‐12y) in the National Health and Nutrition Examination Survey 1999‐2010. Food security status was assessed by the USDA 18‐item Food Security Survey Module. Self‐reported SHS exposure by household reference participants were compared to children's serum cotinine levels. Serum cotinine levels of 蠅0.05 ng/ml were indicative of SHS exposure. Logistic regression models were used to estimate the association between household food security status and misclassification of SHS exposure. Controlling for age, gender, and race/ethnicity, children who were food insecure (Odds Ratio 1.3; 95% CI, 1.1‐1.6) were more likely to have their SHS exposure misclassified, compared to their fully food secure counterparts. The association was attenuated when family income was included in the model. In conclusion, regardless of food security status, household reference participants' reports of SHS exposure among children, especially food insecure children, may be biased.

BackgroundIt is well-known that secondhand smoke exposure in childhood or adolescence is positively associated with morbidity and mortality. However, less is known about the current status of and most recent trends in secondhand smoke exposure among adolescents in China.ObjectiveWe aimed to assess recent changes in the prevalence of secondhand smoke exposure among adolescents in China using nationally representative data.MethodsWe used data from 2 repeated national cross-sectional surveys conducted in 2013-2014 and 2019. A total of 155,117 students (median age 13.5 years) in 2013-2014 and 147,270 students (median age 13.1 years) in 2019 were included in this study. Sociodemographic factors and secondhand smoke exposure information were collected via a standardized questionnaire. Exposure was defined as secondhand smoke exposure ≥1 day during the past 7 days at home or in public places. Other frequencies of secondhand smoke exposure (ie, ≥3 days, ≥5 days, and every day) during the past 7 days were also assessed. The weighted prevalence of secondhand smoke exposure was calculated according to the complex sample design for surveys.ResultsThe prevalence of secondhand smoke exposure in any place (home or public places ≥1 day during the past 7 days) decreased from 2013-2014 (72.9%, 95% CI 71.5%-74.3%) to 2019 (63.2%, 95% CI 62%-64.5%), as did exposure at home (2013-2014: 44.4%, 95% CI 43.1%-45.7%; 2019: 34.1%, 95% CI 33.1%-35.2%) and in public places (2013-2014: 68.3%, 95% CI 66.9%-69.6%; 2019: 57.3%, 95% CI 56%-58.6%). The prevalence of secondhand smoke exposure decreased with increased gross domestic product per capita in each of the 2 survey years irrespective of exposure frequency or location. The prevalence of exposure at other frequencies (ie, ≥3 days, ≥5 days, or every day during the past 7 days) also decreased in any place, at home, and in public places. Secondhand smoke exposure was associated with higher school grade level (ninth vs seventh grade: odds ratio [OR] 1.76, 95% CI 1.68-1.84), gender (boys vs girls: OR 1.18, 95% CI 1.15-1.22), urban status (urban vs rural: OR 1.10, 95% CI 1.01-1.19), and cigarette smoking (yes vs no: OR 6.67, 95% CI 5.83-7.62).ConclusionsAlthough the prevalence of secondhand smoke exposure among Chinese adolescents declined from 2013-2014 to 2019, it remains unacceptably high. More effective strategies and stronger action are needed in China to further, and dramatically, curb secondhand smoke exposure among adolescents.

Aging is an irreversible biological process significantly influenced by oxidative stress, which smoking exacerbates. While the impact of direct smoking on aging is well-documented, the association between secondhand smoke (SHS) exposure and biological aging remains less explored. This study examines the connection between SHS exposure in populations and biological aging, highlighting diabetes as a potential mediator due to its established links to both SHS exposure and accelerated aging through mechanisms such as oxidative stress and chronic inflammation. It further employs genetic tools to establish a causal relationship between SHS exposure and biological aging. This study combines secondary dataset analyses and Mendelian randomization analyses. Data from the NHANES 1999-2010 cycles were used, with serum cotinine levels indicating SHS exposure and phenotypic age, derived from age and clinical biomarkers reflecting inflammation, metabolism, and hematologic function, as the measure of biological aging. Multifactorial linear regression assessed associations, with restricted cubic splines used to explore nonlinear trends. Subgroup and mediation analyses were conducted to explore population-specific effects and the mediating role of diabetes. Two-sample Mendelian randomization (MR) using GWAS summary statistics on workplace SHS exposure (N=90168) and phenotypic age acceleration (N=6148) assessed causality. In the NHANES analysis, low SHS exposure was associated with a 0.37-year increase in biological aging (β=0.37; 95% CI: 0.04-0.70), while high exposure showed a 0.76-year increase (β=0.76; 95% CI: 0.23-1.29). A U-shaped association was found between log-transformed serum cotinine and biological aging (p<0.001), with a threshold at -1.53. Diabetes mediated 31.25% of this association. In the MR analysis, workplace SHS exposure was causally linked to a 3.05-year acceleration in aging (β=3.05; 95% CI: 0.24-5.85). SHS exposure accelerates biological aging, partly via diabetes. Genetic evidence supports a causal effect, emphasizing the need to minimize SHS exposure.

Reducing harm from secondhand smoke (SHS) exposure is especially critical for children. Current strategies aimed at reducing SHS exposure in workplaces and public spaces have been successful in reducing adult exposure, yet infants and children, who are greatly susceptible to the adverse health effects of SHS exposure, continue to be among the most exposed in the USA. Novel strategies are needed that can work in combination with those aimed at removing SHS exposure from children, our single highest priority. The overall aim of this monograph is to demonstrate how nutrition has the potential to ameliorate adverse SHS-related outcomes in children. This aim is accomplished by providing evidence for the following: susceptibility to SHS exposure is greatest during critical windows of lung and immune system development; dietary factors act on SHS mechanisms and have the potential to reduce the risk of related adverse outcomes; the key mechanisms of adverse SHS-related outcomes include reduced nutrient status, oxidative stress, compromised immune function, and chronic inflammation; identification of nutrition-related interventions for SHS-exposed populations is a timely issue and requires future research. Our primary aim should be to eliminate SHS exposure. Until infants and children are no longer exposed to SHS, however, we propose investigating nutrition-focused interventions as a method to reduce the risk of SHS-related health outcomes for infants and children.

BackgroundAlthough personal cigarette smoking is the most important cause and modulator of chronic obstructive pulmonary disease (COPD), secondhand smoke (SHS) exposure could influence the course of the disease. Despite the importance of this question, the impact of SHS exposure on COPD health outcomes remains unknown.MethodsWe used data from two waves of a population-based multiwave U.S. cohort study of adults with COPD. 77 non-smoking respondents with a diagnosis of COPD completed direct SHS monitoring based on urine cotinine and a personal badge that measures nicotine. We evaluated the longitudinal impact of SHS exposure on validated measures of COPD severity, physical health status, quality of life (QOL), and dyspnea measured at one year follow-up.ResultsThe highest level of SHS exposure, as measured by urine cotinine, was cross-sectionally associated with poorer COPD severity (mean score increment 4.7 pts; 95% CI 0.6 to 8.9) and dyspnea (1.0 pts; 95% CI 0.4 to 1.7) after controlling for covariates. In longitudinal analysis, the highest level of baseline cotinine was associated with worse COPD severity (4.7 points; 95% CI -0.1 to 9.4; p = 0.054), disease-specific QOL (2.9 pts; -0.16 to 5.9; p = 0.063), and dyspnea (0.9 pts; 95% CI 0.2 to 1.6 pts; p < 0.05), although the confidence intervals did not always exclude the no effect level.ConclusionDirectly measured SHS exposure appears to adversely influence health outcomes in COPD, independent of personal smoking. Because SHS is a modifiable risk factor, clinicians should assess SHS exposure in their patients and counsel its avoidance. In public health terms, the effects of SHS exposure on this vulnerable subpopulation provide a further rationale for laws prohibiting public smoking.