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OBJECTIVE: To determine the association between indoor air pollution and respiratory morbidities in children with bronchopulmonary dysplasia (BPD) recruited from the multicenter BPD Collaborative. STUDY DESIGN: A cross-sectional study was performed among participants <3 years old in the BPD Collaborative Outpatient Registry. Indoor air pollution was defined as any reported exposure to tobacco or marijuana smoke, electronic cigarette emissions, gas stoves, and/or wood stoves. Clinical data included acute care use and chronic respiratory symptoms in the past 4 weeks. RESULTS: A total of 1011 participants born at a mean gestational age of 26.4 ± 2.2 weeks were included. Most (66.6%) had severe BPD. More than 40% of participants were exposed to ≥1 source of indoor air pollution. The odds of reporting an emergency department visit (OR, 1.7; 95% CI, 1.18-2.45), antibiotic use (OR, 1.9; 95% CI, 1.12-3.21), or a systemic steroid course (OR, 2.18; 95% CI, 1.24-3.84) were significantly higher in participants reporting exposure to secondhand smoke (SHS) compared with those without SHS exposure. Participants reporting exposure to air pollution (not including SHS) also had a significantly greater odds (OR, 1.48; 95% CI, 1.08-2.03) of antibiotic use as well. Indoor air pollution exposure (including SHS) was not associated with chronic respiratory symptoms or rescue medication use. CONCLUSIONS: Exposure to indoor air pollution, especially SHS, was associated with acute respiratory morbidities, including emergency department visits, antibiotics for respiratory illnesses, and systemic steroid use.
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Smoking and exposure to secondhand smoke pose a significant risk to the health of populations. Although this evidence is not new, the commitment of countries to implement laws aimed at controlling consumption and eliminating exposure to secondhand smoke is uneven. Thus, in North America or in Europe, locations like California or Ireland, are pioneers in establishing policies aimed at protecting the population against smoking and secondhand smoke. Identifying measures that have worked would help control this important Public Health problem in other countries that are further behind in tobacco control policies. In Spain, there has been almost 15 years of little political action in legislation oriented to control the tobacco epidemic. If we want to achieve the tobacco endgame, new legislative measures must be implemented. In this paper, we have elucidated tobacco control policies that could be implemented and show how different countries have done so.
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Política de Saúde , Poluição por Fumaça de Tabaco , Humanos , Espanha/epidemiologia , Poluição por Fumaça de Tabaco/prevenção & controle , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Poluição por Fumaça de Tabaco/efeitos adversos , Política de Saúde/legislação & jurisprudência , Fumar/legislação & jurisprudência , Fumar/epidemiologia , Fumar/efeitos adversos , Prevenção do Hábito de Fumar/legislação & jurisprudência , Abandono do Hábito de Fumar/legislação & jurisprudência , Política Antifumo/legislação & jurisprudência , Controle do TabagismoRESUMO
Cadmium (Cd), a carcinogenic metal also related to reproductive and cardiovascular diseases, is contained in tobacco and elevated concentrations of it in humans have been consistently associated with first-hand tobacco smoke; however, there is scarce and inconclusive evidence of the relationship between Cd and secondhand smoke (SHS) exposure. Our aim was to evaluate the association between exposure to tobacco, both active and SHS, with urinary Cd concentrations in Mexican women. In a cross-sectional analysis that included 998 women living in northern Mexico, we measured the concentration of creatinine-adjusted urinary Cd (µg-cadmium/g-creatinine) using inductively coupled plasma triple quadrupole (ICP-QQQ) in tandem mass spectrometry mode (MS/MS). We gathered tobacco smoking information through an in-person interview and formed seven groups: non-smokers without SHS exposure; non-smokers with SHS exposure; ex-smokers without SHS exposure <1 year of quitting; ex-smokers without SHS exposure ≥1 year of quitting, ex-smokers with SHS exposure <1 year of quitting; ex-smokers with SHS exposure ≥1 year of quitting and current smokers. The interview also yielded sociodemographic characteristics. We used linear multivariable regression models to estimate the association between Cd concentrations and tobacco smoke exposure. Compared to non-smokers without SHS exposure, we found higher Cd concentrations in ex-smokers with SHS exposure <1 year of quitting and current smokers (adjusted geometric means 0.51 vs. 1.01 and 0.69 µg-cadmium/g-creatinine, respectively). Our results do not support a conclusion that SHS exposure is a source of Cd body burden.
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Cádmio , Poluição por Fumaça de Tabaco , Estudos Transversais , Feminino , Humanos , México , Espectrometria de Massas em Tandem , Poluição por Fumaça de Tabaco/efeitos adversos , Poluição por Fumaça de Tabaco/análiseRESUMO
OBJECTIVE: To assess the national level of compliance with the Chilean comprehensive smoke-free legislation by observing healthcare facilities, education centres, government offices, hospitality venues and private workplaces, by type of area within workplaces and public places: enclosed, semiopen and open. METHODOLOGY: In this cross-sectional observational study, we studied a national representative sample of 3253 venues obtained through a two-stage cluster sampling design. First, 57 municipalities were randomly selected, proportionally to the total number of venues of interest. Second, within each selected municipality, a maximum of 12 venues of each sector was selected systematically from a list of existing sites. We determined the non-compliance level by estimating the percentage of the visited venues where smoking was observed or suspected in banned areas of the premises. RESULTS: Smoking or suspicion thereof was not observed in any enclosed area of any establishment. However, smoking violations were observed in semiopen areas ranging from less than 0.5% of schools and healthcare centres to around 10% of hospitality venues or 23.0% of higher education centres. Smoking violations were also observed in outdoor areas of 6.7% and 1.6% of the health centres and schools, respectively. DISCUSSION: The stark contrast in compliance with the smoking ban between the enclosed areas and the semiopen areas may be a consequence of the complex definition of semiopen areas in the regulations. The study also reflects the need to improve the overall enforcement of the smoke-free law, particularly in universities and hospitality venues.
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Poluição do Ar em Ambientes Fechados , Política Antifumo , Poluição por Fumaça de Tabaco , Poluição do Ar em Ambientes Fechados/análise , Chile , Estudos Transversais , Restaurantes , Poluição por Fumaça de Tabaco/análise , Local de TrabalhoRESUMO
INTRODUCTION: The aim of the study is to assess the national level of compliance with the Chilean smoke-free legislation in the urban public transportation system. METHODS: In this cross-sectional observational study, we studied a national representative sample of 475 vehicles obtained through a two-stage cluster sampling design in 2018. First, 57 municipalities were randomly selected, proportionally to the total number of public transportation vehicles. Second, within each municipality, a convenience sample of up to 4 taxis, 4 buses, and 2 metro coaches was observed. We determined the non-compliance level by systematic direct observation of smoking inside the cabin of the vehicle. We estimated the percentage of the visited vehicles where smoking was observed inside the cabin of the vehicle. RESULTS: The observation of metros, buses and taxis was completed in 24, 52, and 48, of the 57 sampled municipalities, respectively. Smoking was observed inside of about 2% of buses and 7% of taxis. Smoking was not observed in metro carriages. Overall, smoking was observed in almost 3% of the vehicles studied. A 3% noncompliance could expose a significant number of persons in public transportation to secondhand smoke, given that every 100 inhabitants results in about 84 rides a day of almost one hour duration. There are few comparable studies to put in an international context our results. In 2018, the year in which we collected the data, WHO considered that compliance with the law in public transportation was maximum. Our compliance estimate was lower, however WHO used a different methodology and its scope also included the inter-urban mobility, which we did not. CONCLUSIONS: The study highlights the need to improve the enforcement of the smoke-free law in the transportation system in Chile, which presently is almost non-existent.
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OBJECTIVE: To evaluate the impact of exposure to indoor air pollution on respiratory health outcomes (healthcare utilization, symptoms, medication use) in infants and children with bronchopulmonary dysplasia (BPD). STUDY DESIGN: A total of 244 subjects were included from the Johns Hopkins Bronchopulmonary Dysplasia registry. Parents completed an environmental exposure questionnaire including secondhand smoke and indoor combustion (gas/propane heat, gas or wood stove, gas/wood burning fireplace) exposures in the home. Respiratory symptoms, both acute (healthcare utilization, steroid/antibiotic use) and chronic (cough/wheeze, nocturnal cough, use of beta-agonists, tolerance of physical activity), were also collected. RESULTS: Three-quarters of the infants were exposed to at least 1 combustible source of air pollution in the home, and this exposure was associated with an increased risk of hospitalization in infants and children on home respiratory support. Only 14% of the study population reported secondhand smoke exposure, but we found that this was associated with chronic respiratory symptoms, including activity limitation and nocturnal cough. Infants on respiratory support also had increased daytime cough and wheezing. Approximately one-third reported having an air purifier in the home, and its presence attenuated the effect of secondhand smoke exposure on reported activity limitation. CONCLUSIONS: Exposure to combustible sources of indoor air pollution was associated with increased respiratory morbidity in a group of high risk of infants with BPD. Our results support that indoor air pollution is a modifiable risk factor for respiratory health in infants with BPD.
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Poluição do Ar em Ambientes Fechados/efeitos adversos , Displasia Broncopulmonar/complicações , Tosse/etiologia , Transtornos Respiratórios/etiologia , Sons Respiratórios/etiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , MasculinoRESUMO
OBJECTIVE: To explore the associations between prenatal exposure to tobacco and neurocognitive development, in the absence of prematurity or low birth weight. STUDY DESIGN: We followed mother-child pairs within Healthy Start through 6 years of age. Children were born at ≥37 weeks of gestation with a birth weight of ≥2500 g. Parents completed the Third Edition Ages and Stages Questionnaire (n = 246) and children completed a subset of the National Institutes of Health Toolbox Cognition Battery (n = 200). The Ages and Stages Questionnaire domains were dichotomized as fail/monitor and pass. Maternal urinary cotinine was measured at approximately 27 weeks of gestation. Separate logistic regression models estimated associations between prenatal exposure to tobacco (cotinine below vs above the limit of detection) and the Ages and Stages Questionnaire domains. Separate linear regression models estimated associations between prenatal exposure to tobacco and fully corrected T-scores for inhibitory control, cognitive flexibility, and receptive language, as assessed by the National Institutes of Health Toolbox. A priori covariates included sex, maternal age, maternal education, daily caloric intake during pregnancy, race/ethnicity, household income, maternal psychiatric disorders, and, in secondary models, postnatal exposure to tobacco. RESULTS: Compared with unexposed offspring, exposed offspring were more likely to receive a fail/monitor score for fine motor skills (OR, 3.9; 95% CI, 1.5-10.3) and decreased inhibitory control (B: -3.0; 95% CI, -6.1 to -0.7). After adjusting for postnatal exposure, only the association with fine motor skills persisted. CONCLUSIONS: Prenatal and postnatal exposures to tobacco may influence neurocognitive development, in the absence of preterm delivery or low birth weight. Increased developmental screening may be warranted for exposed children.
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Desenvolvimento Infantil , Cognição/fisiologia , Exposição Materna/efeitos adversos , Transtornos do Neurodesenvolvimento/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Criança , Pré-Escolar , Colorado/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Gravidez , Fatores de RiscoRESUMO
OBJECTIVE: To examine the associations of partial and comprehensive smoke-free legislation with neonatal and infant mortality in Brazil using a quasi-experimental study design. DESIGN: Monthly longitudinal (panel) ecological study from January 2000 to December 2016. SETTING: All Brazilian municipalities (n=5565). PARTICIPANTS: Infant populations. INTERVENTION: Smoke-free legislation in effect in each municipality and month. Legislation was encoded as basic (allowing smoking areas), partial (segregated smoking rooms) or comprehensive (no smoking in public buildings). Associations were quantified by immediate step and longer term slope/trend changes in outcomes. STATISTICAL ANALYSES: Municipal-level linear fixed-effects regression models. MAIN OUTCOMES MEASURES: Infant and neonatal mortality. RESULTS: Implementation of partial smoke-free legislation was associated with a -3.3 % (95% CI -6.2% to -0.4%) step reduction in the municipal infant mortality rate, but no step change in neonatal mortality. Comprehensive smoke-free legislation implementation was associated with -5.2 % (95% CI -8.3% to -2.1%) and -3.4 % (95% CI -6.7% to -0.1%) step reductions in infant and neonatal mortality, respectively, and a -0.36 (95% CI -0.66 to-0.06) annual decline in the infant mortality rate. We estimated that had all smoke-free legislation introduced since 2004 been comprehensive, an additional 10 091 infant deaths (95% CI 1196 to 21 761) could have been averted. CONCLUSIONS: Strengthening smoke-free legislation in Brazil is associated with improvements in infant health outcomes-particularly under comprehensive legislation. Governments should accelerate implementation of comprehensive smoke-free legislation to protect infant health and achieve the United Nation's Sustainable Development Goal three.
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Morte do Lactente/etiologia , Mortalidade Infantil , Morte Perinatal/etiologia , Política Antifumo/legislação & jurisprudência , Prevenção do Hábito de Fumar/métodos , Fumar/legislação & jurisprudência , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Feminino , Humanos , Lactente , Saúde do Lactente , Recém-Nascido , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Gravidez , Fumaça/efeitos adversos , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar/legislação & jurisprudência , Produtos do Tabaco/legislação & jurisprudência , Poluição por Fumaça de Tabaco/efeitos adversosRESUMO
OBJECTIVE: To evaluate a hospital-initiated intervention to reduce tobacco smoke exposure in infants in the neonatal intensive care unit. STUDY DESIGN: A randomized, controlled trial compared motivational interviewing plus financial incentives with conventional care on infant urine cotinine at 1 and 4 months' follow-up. Mothers of infants in the neonatal intensive care unit (N = 360) who reported a smoker living in the home were enrolled. Motivational interviewing sessions were delivered in both the hospital and the home. Financial incentives followed session attendance and negative infant cotinine tests postdischarge. RESULTS: The intervention effect on infant cotinine was not significant, except among mothers who reported high baseline readiness/ability to protect their infant (P ≤ .01) and mothers who completed the study within 6 months postdischarge (per protocol; P ≤ .05). Fewer mothers in the motivational interviewing plus financial incentives condition were smoking postdischarge (P ≤ .01). More mothers in the motivational interviewing plus financial incentives group reported a total home and car smoking ban at follow-up (P ≤ .05). CONCLUSIONS: Motivational interviewing combined with financial incentives reduced infant tobacco smoke exposure in a subset of women who were ready/able to protect their infant. The intervention also resulted in less maternal smoking postpartum. More robust interventions that include maternal and partner/household smoking cessation are likely needed to reduce the costly effects of tobacco smoke exposure on children and their families. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01726062.
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Assistência ao Convalescente/métodos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Entrevista Motivacional/métodos , Abandono do Hábito de Fumar/métodos , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
Introducción: proteger a la población del humo de segunda mano (HSM) es uno de los principios de la Organización Mundial de la Salud en el marco del control del tabaco. Existen pocos datos acerca de la exposición de HSM en vehículos en América del Sur. Este estudio tuvo como objetivo determinar el nivel de dicha exposición. Materiales y método: se midieron niveles de micropartículas de materia de 2,5 micras de diámetro (PM2,5) que vehiculizan el HSM en la vía aérea, en modelos experimentales en autos de fumadores y no fumadores. Resultados: la media de la concentración de PM2,5 fue de 181 µg/m3 en los autos de fumadores y de 0 µg/m3 en los autos de no fumadores (p <0,001). La máxima concentración fue de 2.900 µg/m3 en un auto de fumador estacionado con la ventanilla del conductor parcialmente abierta. Conclusiones: las concentraciones de PM2,5 en vehículos en los que se fuma alcanzó niveles altos, similares a los que se encuentran en ciertos países con políticas de control de tabaco débiles. Este hecho determina la necesidad de nuevas políticas públicas para eliminar el HSM de los vehículos para proteger la salud pública. (AU)
Introduction: Protection from second-hand smoke (SHS) is one of the main principles of the World Health Organization Framework Convention for Tobacco Control. Limited data is available on SHS exposure in vehicles in South America. This study aimed to assess the levels of exposure. Methods: Levels of respirable and fine suspended particles with 2.5 micrometres or less (PM2.5) diameter were measured in different models in smokers' and non-smoker´s vehicles. Results: Median PM2.5 concentration was 181 µg/m3 in "smoking vehicles" and 0 µg/m3 in "non-smoking vehicles" (p<0.001). The highest concentration reached 2.900 µg/m3 in a parked car with the driver's window partially open. Conclusions: Concentration of PM2.5 in vehicles reached high levels, similar to those at certain sites in countries with weak tobacco control policies. These facts underscore a need for new public policies to eliminate SHS in vehicles to protect public health.
Introdução: um dos princípios da Organização Mundial da Saúde no contexto do controle do tabaquismo é proteger a população da fumaça de segunda-mão (HSM). Existem poucos dados sobre a exposição de HSM em veículos na América do Sul. O objetivo deste estudo foi identificar um mecanismo para determinar o nível desta exposição. Materiais e métodos: utilizando modelos experimentais em veículos de fumantes e não fumantes foram medidos os níveis de micropartículas de matéria de 2,5 micras de diâmetro (PM2,5) transportados pela HSM na via aérea. Resultados: á concentração média de PM2,5 foi 181 µg/m3 nos automóveis de fumantes e 0 µg/m3 nos automóveis de não fumantes (p<0.001). A concentração máxima de 2.900 µg/m3 foi encontrada no automóvel estacionado de um fumante com a janela do motorista parcialmente aberta. Conclusões: as concentrações de PM2,5 em veículos de fumantes alcançou níveis altos, similares aos encontrados em alguns países com políticas de controle de tabaco débeis. Este fato determina a necessidade de novas políticas públicas para eliminar a HSM dos veículos para proteger a saúde pública.
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Automóveis , Poluição por Fumaça de Tabaco , TabagismoRESUMO
INTRODUCTION: Protection from secondhand smoke (SHS) is one of the fundamental principles of the WHO Framework Convention for Tobacco Control. Objective data on SHS exposure in vehicles in South America is scarce. This study aimed to estimate prevalence of smoking inside vehicles. METHODS: The point prevalence of smoking in vehicles was observed, and a method for estimating smoking prevalence was piloted. RESULTS: We observed 10 011 vehicles. In 219 (2.2%; 95% CI 1.91 to 2.49) of them, smoking was observed, and in 29.2% of these, another person was exposed to SHS. According to the 'expansion factor' we constructed, direct observation detected one of six to one to nine vehicles in which smoking occurred. The observed prevalence of smoking in vehicles (2.2%) could reflect a real prevalence between 12% and 19%. In 29.2% (95% CI 23.6 to 35.5) and 4.6% (95% CI 2.2 to 8.3) of vehicles in which smoking was observed, another adult or a child, respectively, was exposed to SHS. CONCLUSIONS: Smoking was estimated to occur in 12%-19% of vehicles, with involuntary exposure in one of three of vehicles observed. These data underscore a need for new public policies to eliminate SHS in vehicles to protect public health.
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Automóveis , Fumar/epidemiologia , Poluição por Fumaça de Tabaco/análise , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Humanos , Projetos Piloto , Prevalência , Uruguai/epidemiologiaRESUMO
OBJECTIVE: To explore correlates of high compliance with smoking bans in a cross-sectional data set from the 41 countries with national comprehensive smoke-free laws in 2014 and complete data on compliance and enforcement. METHODS: Outcome variable: compliance with a national comprehensive smoke-free law in each country was obtained for 2014 from the WHO global report on the global tobacco epidemic. Explanatory variables: legal enforcement requirements, penalties, infrastructure and strategy were obtained through a separate survey of governments. Also, country socioeconomic and demographic characteristics including the level of corruption control were included. ANALYSIS: an initial bivariate analysis determined the significance of each potentially relevant explanatory variable of high compliance. Differences in compliance were tested using the exact logistic regression. RESULTS: High compliance with the national comprehensive smoke-free law was associated with the involvement of the local jurisdictions in providing training and/or guidance for inspections (OR=10.3, 95% CI 1.7 to 117.7) and a perception of high corruption control efforts in the country (OR=7.2, 95% CI 1.1 to 85.8). DISCUSSION: The results show the importance of the depth of the enforcement infrastructure and effort represented by the degree to which the local government is involved in enforcement. They also show the significance of fighting corruption in the enforcement process, including the attempts of the tobacco industry to undermine the process, to achieve high levels of compliance with the law. The results point out to the need to invest minimal but essential enforcement resources given that national comprehensive smoke-free laws are self-enforcing in many but not all countries and sectors.
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INTRODUCTION: The workplace remains a significant source of secondhand smoke (SHS) exposure. This pollutant is known to be associated with respiratory and cardiovascular problems, but its effects on specific pulmonary function parameters remain largely unexplored. The objectives of this study were to measure SHS exposure among non-smoking employees of bar and restaurants in Santiago, Chile and to evaluate the effects of such exposure on pulmonary function. METHODS: Cross-sectional design. The study sample included non-smoking workers from 57 restaurants and bars in Santiago, Chile. The outcome variable was pulmonary function and the exposure variables were urine cotinine concentration, a biomarker for current SHS exposure, and years of SHS exposure in the workplace as proxy of chronic exposure. Personal and occupational variables were also recorded. Data analysis was performed using linear regression models adjusted by confounders. RESULTS: The median age of the workers was 35 years and the median employment duration at the analysed venues was 1 year. Workers in smoking facilities reported greater SHS exposure (36 hours per week) than workers in smoke-free locations (4 hours per week). Urine cotinine levels were inversely correlated with forced vital capacity, but the finding was not statistically significant (ß=-0.0002; 95% CI -0.007 to 0.006). Years of exposure to SHS showed to be significantly associated with forced expiratory flow25/75 (ß=-0.006; 95% CI -0.010 to -0.0004). CONCLUSION: These findings suggest that cumulative exposure to SHS at work may contribute to deterioration of pulmonary function in non-smoking employees.
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Poluentes Atmosféricos/efeitos adversos , Poluição do Ar em Ambientes Fechados/efeitos adversos , Pulmão/efeitos dos fármacos , Exposição Ocupacional , Restaurantes , Poluição por Fumaça de Tabaco/efeitos adversos , Local de Trabalho , Adulto , Chile , Cotinina/urina , Estudos Transversais , Feminino , Humanos , Pulmão/fisiologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Testes de Função Respiratória , Fumaça/efeitos adversos , Nicotiana , Capacidade Vital , Adulto JovemRESUMO
OBJECTIVES: Multi-unit housing environments remain significant sources of secondhand smoke (SHS) exposure, especially for vulnerable populations in subsidized housing. In Philadelphia, the largest US housing authority to implement smoke-free policies, we measured baseline resident smoking-related behaviors and attitudes, and longitudinal exposures to airborne nicotine, during policy development and implementation. METHODS: In 4 communities, we collected data in 2013, 2014, and 2016, before and after introduction of comprehensive smoke-free policies, interviewing persons in 172 households, and monitoring air-borne nicotine in non-smoking homes and public areas. Average nicotine level differences across years were estimated with multi-level models. RESULTS: Fifty-six percent of respondents smoked. Only 37% of households were smoke-free, with another 41% restricting smoking by area or time of day. The number of locations with detectable nicotine did not differ before and after policy implementation, with approximately 20% of non-smoking homes and 70%-80% of public areas having detectable nicotine. However, public area nicotine levels were lower in 2016, after policy implementation, than in 2013 and 2014 (-0.19 µg/m3, p = .03). CONCLUSIONS: Findings suggest that initial policy implementation was associated with reduced SHS exposure in Philadelphia. As HUD strengthens smoke-free policies, SHS monitoring can be useful to educate stakeholders and build support for policy enforcement.
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OBJECTIVE: To investigate relationships between secondhand smoke exposure in young children and several preclinical markers of cardiovascular risk that have been established as relevant to adult populations. STUDY DESIGN: There were 139 children, 2-5 years of age, enrolled in a cross-sectional study. Secondhand smoke exposure was objectively determined by hair nicotine level; a comprehensive panel of clinical markers (morning blood pressure, fasting glucose and insulin, lipid profiles, inflammation) and research markers (markers of oxidation, endothelial stress, and endothelial repair) of cardiovascular risk status were assessed. Univariate and multivariate linear regression were used to evaluate relationships between secondhand smoke exposure and cardiovascular risk markers. RESULTS: Hair nicotine levels were correlated directly with blood pressure and serum C-reactive protein, and inversely correlated with serum high-density lipoprotein cholesterol and endothelial cell progenitor cell prevalence. In multivariate analyses, these relationships remained when controlled for age, sex, body mass index z-score, maternal education, and method of payment. Additionally, in multivariate analyses, hair nicotine level was significantly negatively correlated with total antioxidant capacity. CONCLUSIONS: These results support the view that secondhand smoke exposure in the very young has a detectable relationship with several markers of cardiovascular risk, long before the emergence of clinical disease. Further studies to define mechanisms and strategies to prevent and mitigate these risks early in life are warranted.
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Biomarcadores/análise , Doenças Cardiovasculares/sangue , Nicotina/análise , Poluição por Fumaça de Tabaco/análise , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Análise de Regressão , Fatores de Risco , Poluição por Fumaça de Tabaco/efeitos adversosRESUMO
OBJECTIVE: To examine whether a family-based intervention targeting both smoking fathers and nonsmoking mothers in well-child health clinics is effective in increasing fathers' abstinence from cigarette smoking. STUDY DESIGN: This parallel 2-arm randomized controlled trial recruited a total of 1158 families with a daily-smoking father, a nonsmoking mother, and a child aged 0-18 months from the 22 maternal and child health centers in Hong Kong. The intervention group received the family-based intervention, including 6 nurse-led individual face-to-face and telephone counseling sessions within 1 month after recruitment and a voluntary face-to-face family counseling session (FCS). The control group received a leaflet, a self-help booklet, and brief quitting advice only. Father-reported 7-day and 6-month abstinence, smoking reduction, quit attempts, mother-reported help and support, and child salivary cotinine level were assessed at 12 months. Generalized estimating equation models were used to compare these outcomes between the 2 study groups. RESULTS: Compared with the control group, the intervention group reported a greater prevalence of 7-day (13.7% vs 8.0%; OR, 1.92; 95% CI, 1.16-3.17; P < .01) and 6-month self-reported abstinence (13.4% vs. 7.5%; OR, 2.10; 95% CI, 1.30-3.40; P < .01). Within the intervention group, compared with receipt of individual counseling only, participation in the FCS was associated with increases in fathers' self-reported abstinence (20.2% vs 12.3%; P = .02), mothers' help (66.1% vs 43.8%; P < .01), and support to the fathers (55.0% vs 45.4%; P < .01). CONCLUSIONS: The family-based smoking cessation intervention for the families in the well-child healthcare setting was effective in increasing the fathers' self-reported abstinence. Additional participation in the FCS increased mothers' help and support to the fathers. TRIAL REGISTRATION: Controlled-trials.com: ISRCTN99111655; Hkuctr.com: HKUCTR-465.
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Cotinina/análise , Pais/educação , Abandono do Hábito de Fumar/métodos , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/prevenção & controle , Adulto , Aconselhamento/métodos , Pai/educação , Feminino , Seguimentos , Promoção da Saúde , Hong Kong , Humanos , Lactente , Masculino , Mães/educação , Medição de Risco , Método Simples-Cego , Abandono do Hábito de Fumar/psicologia , Poluição por Fumaça de Tabaco/efeitos adversosRESUMO
BACKGROUND: Smoking restriction laws have spread worldwide during the last decade. Previous studies have shown a decline in the community rates of myocardial infarction after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in hospitality venues. OBJECTIVE: To evaluate whether the 2009 implementation of a comprehensive smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction. METHODS: We performed a time-series study of monthly rates of mortality and hospital admissions for acute myocardial infarction from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modelled by environmental variables and atmospheric pollutants to evaluate the effect of smoking ban law in mortality and hospital admission rate. We also used Interrupted Time Series Analysis (ITSA) to make a comparison between the period pre and post smoking ban law. RESULTS: We observed a reduction in mortality rate (-11.9% in the first 17â months after the law) and in hospital admission rate (-5.4% in the first 3â months after the law) for myocardial infarction after the implementation of the smoking ban law. CONCLUSIONS: Hospital admissions and mortality rate for myocardial infarction were reduced in the first months after the comprehensive smoking ban law was implemented.
Assuntos
Hospitalização/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/mortalidade , Política Antifumo/legislação & jurisprudência , Poluentes Atmosféricos/análise , Brasil/epidemiologia , Humanos , Modelos EstatísticosRESUMO
Estudos divulgados recentemente, alguns com até 5 décadas de observações, concluíram com alto grau de evidências, que a exposição involuntária e sistemática à fumaça do cigarro tem implicações genéticas em gerações. Vai muito além do risco do "exposto primário". Ficaram evidentes riscos de doenças tabaco relacionadas em descendentes até a 3ª. geração, isto é, de avós para netos, mesmo que estes não sejam expostos à Poluição Tabagística Ambiental (PTA). As leis que controlam o tabagismo em locais públicos ou privados com circulação de pessoas trouxeram grandes benefícios para toda a coletividade, porém, no ambiente domiciliar, no interior do carro ou a exposição de "gestante/feto" a realidade é outra
Recently published studies, some with up to five decades of observations, have concluded with a high degree of evidence that involuntary and systematic exposure to cigarette smoke has genetic implications in generations. It goes far beyond the risk of the "primary exposed". There have been evident risks of tobacco-related diseases in descendants to the third generation, even if they had never been exposed to "Environmental Tobacco Pollution". Laws that control smoking in public or private places, with circulation of people, have brought great benefits to the whole community, However, regarding places such as the home environment, in the car or the exposure of fetus during pregnancy, have shown different results
RESUMO
Argentina and Uruguay have a high prevalence of smoking during pregnancy, as well as of secondhand smoke (SHS) exposure. In this secondary analysis of a trial to implement brief smoking cessation counseling during antenatal care in Argentina and Uruguay, we aim to evaluate the effects of the intervention on the rates of self-reported SHS exposure at home and at work, and on attitudes recalled by non-smoker women enrolled in the intervention group compared with the control group. We randomly assigned (1:1) 20 antenatal care clusters in Argentina and Uruguay to receive a multifaceted intervention to implement brief smoking cessation counseling, which also included questions and counseling regarding SHS exposure, or to receive the standard of care. There was not a statistically significant difference between groups of the intervention's effect (reduction of exposure to SHS) on any of the three exposure outcome measures (exposure at home, work or other indoor areas) or on the attitudes of women regarding exposure (avoiding breathing SHS and having rooms where smoking is forbidden). This analysis shows that we should not expect reductions in SHS exposure with this modest intervention alone. To achieve such reductions, strategies engaging partners and other household members may be more effective.
Assuntos
Educação em Saúde , Exposição Materna/prevenção & controle , Poluição por Fumaça de Tabaco , Adulto , Argentina , Feminino , Humanos , Gravidez , Gestantes , Cuidado Pré-Natal , Distribuição Aleatória , Autorrelato , Fumar , Abandono do Hábito de Fumar , UruguaiRESUMO
OBJECTIVES: To create and evaluate the feasibility, acceptability, and usability of a clinical decision support (CDS) tool within the electronic health record (EHR) to help pediatricians provide smoking cessation counseling and treatment to parents of hospitalized children exposed to secondhand smoke (SHS). METHODS: Mixed method study of first-year pediatric residents on one inpatient unit. Residents received training in smoking cessation counseling, nicotine replacement therapy (NRT) prescribing, and use of a CDS tool to aid in this process. The tool, which alerted when a patient was identified as exposed to SHS based on the history taken on admission or during a prior encounter, had the following capabilities: adding SHS exposure to the patient's problem list; referral to Free Quitline through discharge instructions; and linking to a printable NRT prescription form. We measured feasibility by EHR utilization data. We measured acceptability and usability of the tool by administering questionnaires to residents. RESULTS: From June-August 2015, the alert triggered for 106 patients, and the tool was used for 52 (49%) patients. 41 (39%) patients had SHS exposure added to the problem list, 34 (32%) parents were referred to the Quitline through discharge instructions, and 15 (14%) parents were prescribed NRT. 10 out of 15 (67%) eligible pediatricians used the tool. All clinicians surveyed (9 out of 10) found the tool acceptable and rated its usability good to excellent (average System Usability Scale score was 85 out of 100, 95% CI, 76-93). CONCLUSIONS: A non-interruptive CDS tool to help residents provide smoking cessation counseling in the hospital was feasible, acceptable, and usable. Future work will investigate impacts on patient outcomes.