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BACKGROUND: In tobacco-exposed persons with preserved spirometry (active smoking or secondhand smoke [SHS] exposure), air trapping can identify a subset with worse symptoms and exercise capacity. The physiologic nature of air trapping in the absence of spirometric airflow obstruction remains unclear. The aim of this study was to examine the underlying pathophysiology of air trapping in the context of preserved spirometry and to determine the utility of bronchodilators in SHS tobacco-exposed persons with preserved spirometry and air trapping. METHODS: We performed a double-blinded placebo-controlled crossover randomized clinical trial in nonsmoking individuals at risk for COPD due to exposure to occupational SHS who had preserved spirometry and air trapping defined as either a residual volume-to-total lung capacity ratio (RV/TLC) > 0.35 or presence of expiratory flow limitation (EFL, overlap of tidal breathing on maximum expiratory flow-volume loop) on spirometry at rest or during cardiopulmonary exercise testing (CPET). Those with asthma or obesity were excluded. Participants underwent CPET at baseline and after 4-week trials of twice daily inhalation of 180 mcg of albuterol or placebo separated by a 2-week washout period. The primary outcome was peak oxygen consumption (VO2) on CPET. Data was analyzed by both intention-to-treat and per-protocol based on adherence to treatment prescribed. RESULTS: Overall, 42 participants completed the entire study (66 ± 8 years old, 91% female; forced expiratory volume in 1 s [FEV1] = 103 ± 16% predicted; FEV1 to forced vital capacity [FVC] ratio = 0.75 ± 0.05; RV/TLC = 0.39 ± 0.07; 85.7% with EFL). Adherence was high with 87% and 93% of prescribed doses taken in the treatment and placebo arms of the study, respectively (P = 0.349 for comparison between the two arms). There was no significant improvement in the primary or secondary outcomes by intention-to-treat or per-protocol analysis. In per-protocol subgroup analysis of those with RV/TLC > 0.35 and ≥ 90% adherence (n = 27), albuterol caused an improvement in peak VO2 (parameter estimate [95% confidence interval] = 0.108 [0.014, 0.202]; P = 0.037), tidal volume, minute ventilation, dynamic hyperinflation, and oxygen-pulse (all P

Abstract Background Prenatal or early childhood secondhand tobacco smoke (SHS) exposure increases obesity risk. However, the potential mechanisms underlying this association are unclear, but obesogenic eating behaviors are one pathway that components of SHS could perturb. Our aim was to assess associations of prenatal and early childhood SHS exposure with adolescent eating behaviors. Methods Data came from a prospective pregnancy and birth cohort (N = 207, Cincinnati, OH). With multiple informant models, we estimated associations of prenatal (mean of 16 and 26 weeks of gestation maternal serum cotinine concentrations) and early childhood cotinine (average concentration across ages 12, 24, 36, and 48 months) with eating behaviors at age 12 years (Child Eating Behaviors Questionnaire). We tested whether associations differed by exposure periods and adolescent’s sex. Models adjusted for maternal and child covariates. Results We found no statistically significant associations between cotinine measures and adolescent’s eating behaviors. Yet, in females, prenatal cotinine was associated with greater food responsiveness (β: 0.23; 95% CI: 0.08, 0.38) and lower satiety responsiveness (β: -0.14; 95% CI: -0.26, -0.02); in males, prenatal and postnatal cotinine was related to lower food responsiveness (prenatal: β: -0.25; 95% CI: -0.04, -0.06; postnatal: β: -0.36; 95% CI: -0.06, -0.11). No significant effect modification by sex or exposure window was found for other eating behaviors. Conclusion Prenatal and early childhood SHS exposures were not related to adolescent’s eating behavior in this cohort; however, biological sex may modify these associations.

Abstract Background In tobacco-exposed persons with preserved spirometry (active smoking or secondhand smoke [SHS] exposure), air trapping can identify a subset with worse symptoms and exercise capacity. The physiologic nature of air trapping in the absence of spirometric airflow obstruction remains unclear. The aim of this study was to examine the underlying pathophysiology of air trapping in the context of preserved spirometry and to determine the utility of bronchodilators in SHS tobacco-exposed persons with preserved spirometry and air trapping. Methods We performed a double-blinded placebo-controlled crossover randomized clinical trial in nonsmoking individuals at risk for COPD due to exposure to occupational SHS who had preserved spirometry and air trapping defined as either a residual volume-to-total lung capacity ratio (RV/TLC) > 0.35 or presence of expiratory flow limitation (EFL, overlap of tidal breathing on maximum expiratory flow-volume loop) on spirometry at rest or during cardiopulmonary exercise testing (CPET). Those with asthma or obesity were excluded. Participants underwent CPET at baseline and after 4-week trials of twice daily inhalation of 180 mcg of albuterol or placebo separated by a 2-week washout period. The primary outcome was peak oxygen consumption (VO2) on CPET. Data was analyzed by both intention-to-treat and per-protocol based on adherence to treatment prescribed. Results Overall, 42 participants completed the entire study (66 ± 8 years old, 91% female; forced expiratory volume in 1 s [FEV1] = 103 ± 16% predicted; FEV1 to forced vital capacity [FVC] ratio = 0.75 ± 0.05; RV/TLC = 0.39 ± 0.07; 85.7% with EFL). Adherence was high with 87% and 93% of prescribed doses taken in the treatment and placebo arms of the study, respectively (P = 0.349 for comparison between the two arms). There was no significant improvement in the primary or secondary outcomes by intention-to-treat or per-protocol analysis. In per-protocol subgroup analysis of those with RV/TLC > 0.35 and ≥ 90% adherence (n = 27), albuterol caused an improvement in peak VO2 (parameter estimate [95% confidence interval] = 0.108 [0.014, 0.202]; P = 0.037), tidal volume, minute ventilation, dynamic hyperinflation, and oxygen-pulse (all P

Abstract Background Prior findings relating secondhand tobacco smoke (SHS) exposure and internalizing problems, characterized by heightened anxiety and depression symptoms, have been equivocal; effects of SHS on neurodevelopment may depend on the presence of other neurotoxicants. Early life stress (ELS) is a known risk factor for internalizing symptoms and is also often concurrent with SHS exposure. To date the interactive effects of ELS and SHS on children’s internalizing symptoms are unknown. We hypothesize that children with higher exposure to both prenatal SHS and ELS will have the most internalizing symptoms during the preschool period and the slowest reductions in symptoms over time. Methods The present study leveraged a prospective, longitudinal birth cohort of 564 Black and Latinx mothers and their children, recruited between 1998 and 2006. Cotinine extracted from cord and maternal blood at birth served as a biomarker of prenatal SHS exposure. Parent-reported Child Behavior Checklist (CBCL) scores were examined at four timepoints between preschool and eleven years-old. ELS exposure was measured as a composite of six domains of maternal stress reported at child age five. Latent growth models examined associations between SHS, ELS, and their interaction term with trajectories of children’s internalizing symptoms. In follow-up analyses, weighted quintile sum regression examined contributions of components of the ELS mixture to children’s internalizing symptoms at each time point. Results ELS interacted with SHS exposure such that higher levels of ELS and SHS exposure were associated with more internalizing symptoms during the preschool period (β = 0.14, p = 0.03). The interaction between ELS and SHS was also associated with a less negative rate of change in internalizing symptoms over time (β=-0.02, p = 0.01). Weighted quintile sum regression revealed significant contributions of maternal demoralization and other components of the stress mixture to children’s internalizing problems at each age point (e.g., age 11 WQS β = 0.26, p

Abstract Background Lead is a major developmental neurotoxicant in children, and tobacco smoke has been suggested as a source of lead exposure in vulnerable populations. This study evaluates the contribution of secondhand tobacco smoke (SHS) to blood lead levels (BLLs) in children and adolescents. Methods We analyze data from 2,815 participants aged 6–19 years who participated in the National Health and Nutrition Examination Survey (2015–2018) to investigate the association between serum cotinine levels and BLLs. A multivariate linear regression was conducted to estimate geometric means (GMs) and the ratios of GMs after adjusting for all covariates. Results The geometric means of BLLs in study participants aged 6 − 19 years were 0.46 µg/dl (95% CI 0.44, 0.49). After adjusting for relevant participant characteristics, the geometric means of BLLs were 18% (BLL 0.48 µg/dl, 95% CI 0.45, 0.51) and 29% (BLL 0.52 µg/dl, 95% CI 0.46, 0.59) higher in participants who had intermediate serum cotinine levels (0.03 − 3 ng/mL) and those who had high serum cotinine levels (> 3 ng/mL) respectively, compared to participants who had low serum cotinine levels (BLL 0.41 µg/dl, 95% CI 0.38, 0.43). Conclusions SHS exposure may be a source of BLLs in US children and adolescents. Efforts to reduce lead exposure in children and adolescents should include strategies to reduce SHS exposure.

Background: Prior findings relating secondhand tobacco smoke (SHS) exposure and internalizing problems, characterized by heightened anxiety and depression symptoms, have been equivocal; effects of SHS on neurodevelopment may depend on the presence of other neurotoxicants. Early life stress (ELS) is a known risk factor for internalizing symptoms and is also often concurrent with SHS exposure. To date the interactive effects of ELS and SHS on children's internalizing symptoms are unknown. We hypothesize that children with higher exposure to both prenatal SHS and ELS will have the most internalizing symptoms during the preschool period and the slowest reductions in symptoms over time. Methods: The present study leveraged a prospective, longitudinal birth cohort of 564 Black and Latinx mothers and their children, recruited between 1998 and 2006. Cotinine extracted from cord and maternal blood at birth served as a biomarker of prenatal SHS exposure. Parent-reported Child Behavior Checklist (CBCL) scores were examined at four timepoints between preschool and eleven years-old. ELS exposure was measured as a composite of six domains of maternal stress reported at child age five. Latent growth models examined associations between SHS, ELS, and their interaction term with trajectories of children's internalizing symptoms. In follow-up analyses, weighted quintile sum regression examined contributions of components of the ELS mixture to children's internalizing symptoms at each time point. Results: ELS interacted with SHS exposure such that higher levels of ELS and SHS exposure were associated with more internalizing symptoms during the preschool period (β = 0.14, p = 0.03). The interaction between ELS and SHS was also associated with a less negative rate of change in internalizing symptoms over time (β=-0.02, p = 0.01). Weighted quintile sum regression revealed significant contributions of maternal demoralization and other components of the stress mixture to children's internalizing problems at each age point (e.g., age 11 WQS β = 0.26, p < 0.01). Conclusions: Our results suggest that prior inconsistencies in studies of SHS on behavior may derive from unmeasured factors that also influence behavior and co-occur with exposure, specifically maternal stress during children's early life. Findings point to modifiable targets for personalized prevention. [ABSTRACT FROM AUTHOR]

Background: Lead is a major developmental neurotoxicant in children, and tobacco smoke has been suggested as a source of lead exposure in vulnerable populations. This study evaluates the contribution of secondhand tobacco smoke (SHS) to blood lead levels (BLLs) in children and adolescents. Methods: We analyze data from 2,815 participants aged 6–19 years who participated in the National Health and Nutrition Examination Survey (2015–2018) to investigate the association between serum cotinine levels and BLLs. A multivariate linear regression was conducted to estimate geometric means (GMs) and the ratios of GMs after adjusting for all covariates. Results: The geometric means of BLLs in study participants aged 6 − 19 years were 0.46 µg/dl (95% CI 0.44, 0.49). After adjusting for relevant participant characteristics, the geometric means of BLLs were 18% (BLL 0.48 µg/dl, 95% CI 0.45, 0.51) and 29% (BLL 0.52 µg/dl, 95% CI 0.46, 0.59) higher in participants who had intermediate serum cotinine levels (0.03 − 3 ng/mL) and those who had high serum cotinine levels (> 3 ng/mL) respectively, compared to participants who had low serum cotinine levels (BLL 0.41 µg/dl, 95% CI 0.38, 0.43). Conclusions: SHS exposure may be a source of BLLs in US children and adolescents. Efforts to reduce lead exposure in children and adolescents should include strategies to reduce SHS exposure. [ABSTRACT FROM AUTHOR]

Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing childhood TSE and uptake of evidence-based smoking cessation programs has had limited reach in high-risk communities. Intervening in clinics delivering the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could address overlapping public health priorities essential for healthy child development—nutrition and smoke-free environments. The Babies Living Safe and Smokefree (BLiSS) trial addresses existing gaps by implementing and evaluating a WIC in-clinic evidence-based training based on Ask, Advise, and Refer (AAR) guidelines. WIC nutrition staff (n = 67) completed surveys pre- and post-training as part of the larger BLiSS trial. Staff sociodemographic data, knowledge, and attitudes about maternal smoking and child TSE prevention, and AAR practices in clinic were collected using self-administered surveys. Pre–post outcomes were assessed using bivariate statistics and multiple regression models. Controlling for baseline AAR-related practices and other covariates, nutrition managers were more likely to engage in post-training AAR practices than nutrition assistants. Sociodemographics and smoking status were not related to post-training AAR. Lower perceived barriers and higher reported frequency of tobacco intervention practices at baseline were associated with higher engagement in post-test AAR practices. WIC-system interventions aimed at reducing child TSE and maternal tobacco smoking may be more effective if nutrition management-level staff are involved in assessment and by addressing barriers related to TSE among nutrition assistants. Findings suggest that WIC in-clinic training may help to increase self-efficacy for staff engagement in brief screening, intervention, and referral practices. [ABSTRACT FROM AUTHOR]

Background. The high prevalence of smoking among adults suggests the almost inevitable effects of second-hand tobacco smoke (SHS) on children and adults who do not smoke. The negative effects of SHS are most pronounced in young children, especially in families where the mother is a smoker. The aim was to assess the effects of prenatal and postnatal exposure to SHS in children under five years of life. Materials and me­thods. The survey among 520 families with children was conducted ­using online self-reported questionnaire. Families with extremely and very preterm children and children with inherited diseases of bronchopulmonary system were excluded from the analysis. During the analysis, all children (n = 414; 55.07 % of boys and 44.93 % of girls, mean age — 36.38 ± 7.19 months) were divided according to SHS exposure. 186 children exposed to SHS were included in the main group, and 228 children without SHS exposure — in the control group. Results. 22.46 % of children were prenatally exposed to SHS. Maternal smoking ­during pregnancy significantly increased the risk of the intraute­rine growth retardation (IUGR) (OR 2.43 [95% CI 1.07–5.52]). Postnatal exposure to SHS was present in 56.52 % of children. These children were significantly more likely to be formula-fed (OR 1.75 [95% CI 1.15–2.65]). The frequency of formula fee­ding was significantly increased by mothers’ use of both traditional tobacco products and electronic nicotine delivery systems (OR 2.10 and 2.99, respectively). Exclusively maternal smoking in the family increased the risk of frequent acute respiratory viral infections (ARI) in 3 years old children more than 1.5 times (OR 1.60 [95% CI 1.01–2.60]). Household SHS exposure increased the probability of bronchial obstruction (BO) during ARI in a child in 1.61 times, while exclusively maternal smoking increased the risk in 2.88 times. An increased risk of frequent ARI (OR 3.25 [95% CI 1.68–6.28]) was also present in the subgroup of children whose mothers smoked electronic nicotine delivery devices. The use of traditional tobacco products and electronic nicotine delivery systems, both by mothers and other family members, has significantly affected the risk of developing BO in children with respiratory disease. Conclusions. Maternal smoking during pregnancy in the studied cohort is a proven risk factor for IUGR. Household smoking is statistically likely to affect the incidence and likelihood of developing BO in children of the first five years of life, regardless of the type of tobacco product. This risk is greatest among children whose mothers are smokers.

IntroductionExposure to secondhand smoke (SHS) is associated with occult obstructive lung disease as evident by abnormal airflow indices representing small airway disease despite having preserved spirometry (normal forced expiratory volume in 1 s-to-forced vital capacity ratio, FEV1/FVC). The significance of lung volumes that reflect air trapping in the presence of preserved spirometry is unclear.MethodsTo investigate whether lung volumes representing air trapping could determine susceptibility to respiratory morbidity in people with SHS exposure but without spirometric chronic obstructive pulmonary disease, we examined a cohort of 256 subjects with prolonged occupational SHS exposure and preserved spirometry. We elicited symptom prevalence by structured questionnaires, examined functional capacity (maximum oxygen uptake, VO2max) by exercise testing, and estimated associations of those outcomes with air trapping (plethysmography-measured residual volume-to-total lung capacity ratio, RV/TLC), and progressive air trapping with exertion (increase in fraction of tidal breathing that is flow limited on expiration during exercise (per cent of expiratory flow limitation, %EFL)).ResultsRV/TLC was within the predicted normal limits, but was highly variable spanning 22%±13% and 16%±8% across the increments of FEV1/FVC and FEV1, respectively. Respiratory complaints were prevalent (50.4%) with the most common symptom being ≥2 episodes of cough per year (44.5%). Higher RV/TLC was associated with higher OR of reporting respiratory symptoms (n=256; r2=0.03; p=0.011) and lower VO2max (n=179; r2=0.47; p=0.013), and %EFL was negatively associated with VO2max (n=32; r2=0.40; p=0.017).ConclusionsIn those at risk for obstruction due to SHS exposure but with preserved spirometry, higher RV/TLC identifies a subgroup with increased respiratory symptoms and lower exercise capacity.

Most casinos owned by sovereign American Indian nations allow smoking, even in U.S. states such as California where state laws restrict workplace smoking. Collaborations between casinos and public health workers are needed to promote smoke-free policies that protect workers and patrons from secondhand tobacco smoke (SHS) exposure and risks. Over seven years, a coalition of public health professionals provided technical assistance to the Redding Rancheria tribe in Redding, California in establishing a smoke-free policy at the Win-River Resort and Casino. The coalition provided information to the casino general manager that included site-specific measurement of employee and visitor PM2.5 personal exposure, area concentrations of airborne nicotine and PM2.5, visitor urinary cotinine, and patron and staff opinions (surveys, focus groups, and a Town Hall meeting). The manager communicated results to tribal membership, including evidence of high SHS exposures and support for a smoke-free policy. Subsequently, in concert with hotel expansion, the Redding Rancheria Tribal Council voted to accept a 100% restriction of smoking inside the casino, whereupon PM2.5 exposure in main smoking areas dropped by 98%. A 70% partial-smoke-free policy was instituted ~1 year later in the face of revenue loss. The success of the collaboration in promoting a smoke-free policy, and the key element of air quality feedback, which appeared to be a central driver, may provide a model for similar efforts.

BackgroundExposure to secondhand tobacco smoke (SHS) can be a risk factor for chronic obstructive pulmonary disease (COPD), but its role among relatively heavy smokers with potential co-exposure to workplace vapors, gas, dust, and fumes (VGDF) has not been studied.MethodsTo estimate the contribution of SHS exposure to COPD risk, taking into account smoking effects and work-related exposures to VGDF, we quantified SHS based on survey responses for 1400 ever-employed subjects enrolled in the COPDGene study, all current or former smokers with or without COPD. Occupational exposures to VGDF were quantified based on a job exposure matrix. The associations between SHS and COPD were tested in multivariate logistic regression analyses adjusted for age, sex, VGDF exposure, and cumulative smoking.Results and discussionExposures to SHS at work and at home during adulthood were associated with increased COPD risk: odds ratio (OR) = 1.12 (95% confidence interval [CI]: 1.02-1.23; p = 0.01) and OR = 1.09 (95%CI: 1.00-1.18; p = 0.04) per 10 years of exposure adjusted for smoking and other covariates, respectively. In addition, subjects with employment histories likely to entail exposure to VGDF were more likely to have COPD: OR = 1.52 (95%CI: 1.16-1.98; p < 0.01) (adjusted for other covariates). While adult home SHS COPD risk was attenuated among the heaviest smokers within the cohort, workplace SHS and job VGDF risks persisted in that stratum.ConclusionAmong smokers all with at least 10 pack-years, adult home and work SHS exposures and occupational VGDF exposure are all associated with COPD.

Background: Previous studies have shown the associations between smoking and failure to eradicate Helicobacter pylori (H. pylori), but less is known about the impact of secondhand tobacco smoke (SHS) on H. pylori eradication., Methods: Between July 2022 to July 2023, 646 patients who received proton pump inhibitor (PPIs) as first-line H. pylori eradication therapy were recruited for the study. Information was obtained via the hospital database and a telephone questionnaire. Univariate and multivariate regression analysis were used to examine risk factors of H. pylori eradication failure., Results: This was a single-center retrospective study consisting of 646 patients who received PPIs as first-line H. pylori eradication therapy. This included 122 smokers, 165 never-smokers with SHS, and 359 never-smokers with no SHS exposure. Compared with subjects in the "eradication success" group, those in the "eradication failure" group tended to have higher prevalence of smoke consumption and have higher prevalence of SHS exposure. In binary logistic regression analysis, smoking (OR 3.409, 95 % CI: 1.782- 6.522, P < 0.001) and SHS (OR 3.188, 95 % CI: 1.726-5.886, P < 0.001) were independent predictors of eradication failure. In addition, never-smokers with SHS exposure and smoking had similar effects on H. pylori eradication (OR, 0.893; 95 % CI, 0.464 to 1.717, P value = 0.734)., Conclusion: Both smoking and SHS are independent risk factors for H. pylori eradication failure. Furthermore, the impact of SHS is not inferior to smoking., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest. Human rights statement All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent to be included in the study, or the equivalent, was obtained from all patients., (Copyright © 2024. Published by Elsevier Masson SAS.)

Introduction Prevalence of paternal smoking is high in Asia and babies are vulnerable to secondhand tobacco smoke (SHS) exposure at home. This study assesses socioeconomic characteristics and paternal smoking in households and infants’ exposure to SHS. Methods A cross-sectional analysis of data collected as part of a prospective cohort study was conducted in Jakarta, Indonesia during 2017–2019. Participants were 156 mother-baby pairs whose babies reached the age of 6 months. Socioeconomic characteristics and smoking behaviour in the household were assessed by questionnaires. Factors related to paternal smoking and infants’ exposure to SHS were assessed using a multivariate logistic regression model. Results Almost two-thirds of infants lived with fathers who were smokers. Lower levels of paternal education (OR=2.59; 95% CI: 1.19–5.63; p=0.045) and infants with one sibling (OR=2.41; 95% CI: 1.02–5.67; p=0.044) increased the risk of paternal smoking in the household. Moreover, infants with one sibling (OR=3.09; 95% CI: 1.15–8.32; p=0.026), lower level of father education (OR=18.73; 95% CI: 1.54–227.93; p=0.022), and a high number of other household members who smoke (OR=4.54; 95% CI : 1.42–14.48; p=0.011) were the risk factors of SHS exposure among infants at home. Conclusions These findings demonstrate the significant influence of educational level, number of children and/or number of other smokers in the household on paternal smoking and SHS exposure among infants at home. Comprehensive tobacco control programmes to increase adoption of smoke-free homes are likely to be an effective way to reduce SHS exposure and promote decreased cigarette smoking in families with children.

Secondhand tobacco smoke (SHS) is a significant public health problem for all ages worldwide. Children are more vulnerable to the health effects of SHS because of the inhalation of more air per body volume compared to adults. The study aimed to assess neurobehavioral performance among SHS exposed Egyptian basic school children (10–12 years) and its relationship with urinary cotinine levels. Multistage cluster sampling was carried out, where 181 children (80 exposed and 101 non-exposed children) were recruited. A questionnaire on SHS exposure was sent to students' parents/caregivers. Urine samples were taken for assessment of cotinine levels by enzyme immunoassay. A Neurobehavioral test battery was measured. The exposed children had significantly lower performance in tests of attention (PASAT) [5.22 ± 5.10 vs. 6.98 ± 5.87, p = 0.035], visuomotor speed (Digit Symbol and Trail making A) [41.40 ± 18.01 vs. 46.53 ± 15.89 and 107.92 ± 44.34 vs. 92.44 ± 37.09; respectively] than non-exposed subjects. The neurobehavioral effects were correlated with urinary cotinine levels among children exposed to SHS compared to unexposed children. The study revealed poor performance in neurobehavioral domains of attention and visuomotor skills among children exposed to SHS. This necessitates the implementation of antismoking media awareness programs on the harmful effects of SHS and how to protect children from it. [ABSTRACT FROM AUTHOR]

INTRODUCTION Prevalence of paternal smoking is high in Asia and babies are vulnerable to secondhand tobacco smoke (SHS) exposure at home. This study assesses socioeconomic characteristics and paternal smoking in households and infants' exposure to SHS. METHODS A cross-sectional analysis of data collected as part of a prospective cohort study was conducted in Jakarta, Indonesia during 2017-2019. Participants were 156 mother-baby pairs whose babies reached the age of 6 months. Socioeconomic characteristics and smoking behaviour in the household were assessed by questionnaires. Factors related to paternal smoking and infants' exposure to SHS were assessed using a multivariate logistic regression model. RESULTS Almost two-thirds of infants lived with fathers who were smokers. Lower levels of paternal education (OR=2.59; 95% CI: 1.19-5.63; p=0.045) and infants with one sibling (OR=2.41; 95% CI: 1.02-5.67; p=0.044) increased the risk of paternal smoking in the household. Moreover, infants with one sibling (0R=3.09; 95% CI: 1.15-8.32; p=0.026), lower level of father education (0R=18.73; 95% CI: 1.54-227.93; p=0.022), and a high number of other household members who smoke (0R=4.54; 95% CI : 1.42-14.48; p=0.011) were the risk factors of SHS exposure among infants at home. CONCLUSIONS These findings demonstrate the significant influence of educational level, number of children and/or number of other smokers in the household on paternal smoking and SHS exposure among infants at home. Comprehensive tobacco control programmes to increase adoption of smoke-free homes are likely to be an effective way to reduce SHS exposure and promote decreased cigarette smoking in families with children. [ABSTRACT FROM AUTHOR]

BackgroundSince 1996, the tobacco industry has used the 16 Cities Study conclusions that workplace secondhand tobacco smoke (SHS) exposures are lower than home exposures to argue that workplace and other smoking restrictions are unnecessary.ObjectivesOur goal was to determine the origins and objectives of the 16 Cities Study through analysis of internal tobacco industry documents and regulatory agency and court records, and to evaluate the validity of the study's conclusions.ResultsThe tobacco industry's purpose in conducting the 16 Cities Study was to develop data showing that workplace SHS exposures were negligible, using these data to stop smoking restrictions by the U.S. Occupational Safety and Health Administration. The extensive involvement of R.J. Reynolds Tobacco Company and the tobacco industry's Center for Indoor Air Research in controlling the study was not fully disclosed. The study's definition of "smoking workplace" included workplaces where smoking was restricted to designated areas or where no smoking was observed. This definition substantially reduced the study's reported average SHS concentrations in "smoking workplaces" because SHS levels in unrestricted smoking workplaces are much greater than in workplaces with designated smoking areas or where no smoking occurred. Stratifying the data by home smoking status and comparing exposures by workplace smoking status, however, indicates that smoke-free workplaces would halve the total SHS exposure of those living with smokers and virtually eliminate SHS exposure for most others.ConclusionsData in the 16 Cities Study reveal that smoke-free workplaces would dramatically reduce total SHS exposure, providing significant worker and public health benefits.

Abstract Background Addressing children’s tobacco smoke exposure (TSE) remains a public health priority. However, there is low uptake and ineffectiveness of treatment, particularly in low-income populations that face numerous challenges to smoking behavior change. A multilevel intervention combining system-level health messaging and advice about TSE delivered at community clinics that disseminate the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), combined with nicotine replacement and intensive multimodal, individual-level behavioral intervention may improve TSE control efforts in such high-risk populations. Methods/Design This trial uses a randomized two-group design with three measurement points: baseline, 3-month and 12-month follow-up. The primary outcome is bioverified child TSE; the secondary outcome is bioverified maternal quit status. Smoking mothers of children less than 6 years old are recruited from WIC clinics. All participants receive WIC system-level intervention based on the “Ask, Advise, Refer (AAR)” best practices guidelines for pediatrics clinics. It includes training all WIC staff about the importance of maternal tobacco control; and detailing clinics with AAR intervention prompts in routine work flow to remind WIC nutrition counselors to ask all mothers about child TSE, advise about TSE harms and benefits of protection, and refer smokers to cessation services. After receiving the system intervention, mothers are randomized to receive 3 months of additional treatment or an attention control intervention: (1) The multimodal behavioral intervention (MBI) treatment includes telephone counseling sessions about child TSE reduction and smoking cessation, provision of nicotine replacement therapy, a mobile app to support cessation efforts, and multimedia text messages about TSE and smoking cessation; (2) The attention control intervention offers equivalent contact as the MBI and includes nutrition-focused telephone counseling, mobile app, and multimedia text messages about improving nutrition. The control condition also receives a referral to the state smoking cessation quitline. Discussion This study tests an innovative community-based, multilevel and integrated multimodal approach to reducing child TSE in a vulnerable, low-income population. The approach is sustainable and has potential for wide reach because WIC can integrate the tobacco intervention prompts into routine workflow and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines. Trial registration Clinicaltrials.gov NCT02602288 . Registered 9 November 2015.

Tobacco use and exposure to tobacco smoke remain major but avoidable causes of premature mortality and disease worldwide. Although the age-standardized prevalence of daily smoking has declined for both men and women in many countries, the number of smokers continues to increase because of global population growth. Although cigarettes are the most commonly used tobacco product, the tobacco epidemic has become tremendously complex with the emergence and popularity of alternative products such as waterpipes and electronic cigarettes (also known as e-cigarettes). Exposure sciences play a major role in characterizing the tobacco epidemic as well as in the promotion, enactment, and implementation of tobacco control initiatives including legislation and voluntary measures in countries worldwide. We reviewed several studies in Latin America and other regions, showing how high-quality exposure assessment has contributed to smoke-free policies. Although there are many toxicants in tobacco products, metals could be playing an important role in tobacco-related disease. Tobacco plants accumulate cadmium and lead from soil. In e-cigarettes, a metallic coil heats the e-liquid to produce the aerosol that is inhaled by the vaper, and studies have found high aerosol levels of nickel, chromium, lead, and zinc. Despite many tobacco control successes, including the enactment of the Framework Convention on Tobacco Control, which has been ratified by 181 countries, tobacco control faces many challenges globally. Given the continuing increase in the number of smokers worldwide and the rapid emergence of new tobacco products, additional creative efforts are needed to achieve a smoke-free world, help smokers to quit, and protect youth from initiating tobacco use. [ABSTRACT FROM AUTHOR]

Background: Addressing children's tobacco smoke exposure (TSE) remains a public health priority. However, there is low uptake and ineffectiveness of treatment, particularly in low-income populations that face numerous challenges to smoking behavior change. A multilevel intervention combining system-level health messaging and advice about TSE delivered at community clinics that disseminate the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), combined with nicotine replacement and intensive multimodal, individual-level behavioral intervention may improve TSE control efforts in such high-risk populations.Methods/design: This trial uses a randomized two-group design with three measurement points: baseline, 3-month and 12-month follow-up. The primary outcome is bioverified child TSE; the secondary outcome is bioverified maternal quit status. Smoking mothers of children less than 6 years old are recruited from WIC clinics. All participants receive WIC system-level intervention based on the "Ask, Advise, Refer (AAR)" best practices guidelines for pediatrics clinics. It includes training all WIC staff about the importance of maternal tobacco control; and detailing clinics with AAR intervention prompts in routine work flow to remind WIC nutrition counselors to ask all mothers about child TSE, advise about TSE harms and benefits of protection, and refer smokers to cessation services. After receiving the system intervention, mothers are randomized to receive 3 months of additional treatment or an attention control intervention: (1) The multimodal behavioral intervention (MBI) treatment includes telephone counseling sessions about child TSE reduction and smoking cessation, provision of nicotine replacement therapy, a mobile app to support cessation efforts, and multimedia text messages about TSE and smoking cessation; (2) The attention control intervention offers equivalent contact as the MBI and includes nutrition-focused telephone counseling, mobile app, and multimedia text messages about improving nutrition. The control condition also receives a referral to the state smoking cessation quitline.Discussion: This study tests an innovative community-based, multilevel and integrated multimodal approach to reducing child TSE in a vulnerable, low-income population. The approach is sustainable and has potential for wide reach because WIC can integrate the tobacco intervention prompts into routine workflow and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines.Trial Registration: Clinicaltrials.gov NCT02602288 . Registered 9 November 2015. [ABSTRACT FROM AUTHOR]

To identify periods of heightened susceptibility to the association of secondhand tobacco smoke (SHS) exposure with cardiometabolic (CM) risk at age 12 years. We used data from 212 adolescents from the HOME Study, a prospective pregnancy and birth cohort in Cincinnati, OH. Using multiple informant models, we estimated associations of maternal serum cotinine (mean of concentrations at 16 and 26 weeks of pregnancy) and children's serum cotinine concentrations (mean of concentrations at ages 1, 2, 3, and 4 years) with a CM risk summary score constructed of five risk components measured at age 12 years. We determined if these associations differed for pre- and postnatal exposure periods, and adolescent's sex. We found some evidence that the cotinine-outcome associations differed by exposure period and sex. Postnatal, but not prenatal, cotinine was associated with higher CM risk scores and individual CM risk component values (interaction p-values = 0.04 to 0.35). Each 10-fold increase in postnatal cotinine was associated with 0.57 (95% CI: 0.32, 1.45), 0.09 (95% CI: 0.13, 0.31), 0.14 (−0.08, 0.35), 0.07 (95% CI: 0.34, 0.48), and 0.11 (95% CI: 0.04, 0.27) higher CM risk, HOMA-IR, TG to HDL-C ratio, leptin to adiponectin ratio, and visceral fat area. Postnatal cotinine was associated with higher visceral fat area among females but not males (sex × period × cotinine interaction p-value = 0.01). Serum cotinine concentrations during the postnatal period had greater influence on adolescent's CM risk compared to the prenatal period, and these associations may be sex-specific. This study reinforces the need for ongoing public health interventions to minimize children's exposure to SHS. [Display omitted] • Cardiovascular disease is the leading cause of disability and death in the USA. • SHS exposure is associated with increased risk of CVD. • Postnatal cotinine is associated with higher CM risk during adolescence. • Associations between cotinine and CM risk components may be sex-specific. [ABSTRACT FROM AUTHOR]

Starting in 2002, regulations and legislative amendments in Germany focused on the non-smoker protection with several measures to reduce exposure to secondhand tobacco smoke (SHS). The present work aimed to evaluate the relationship between polycyclic aromatic hydrocarbons (PAHs) and SHS exposure and to determine to which extent enforced non-smoking regulations and smoking bans affected the exposure of the non-smoking population in Germany since their implementation in the early 2000s until today. For this purpose, cotinine and selected monohydroxylated PAHs (OH-PAHs) were analyzed by means of (UP)LC-MS/MS in 510 24-h-urine samples of the Environmental Specimen Bank collected over a time span of 24 years from 1995 to 2019. Median urinary cotinine levels were found to steadily and significantly decline by 82% from 1995 to 2019. A significant decrease of urinary 3-hydroxybenzo[a]pyrene (19%), 1-OH-pyrene (39%), 1-naphthol (66%), 1- (17%), 2- (25%), and 3-OH-phenanthrene (22%) was also observed throughout the same time span. The decline in urinary levels of cotinine and several OH-PAHs can most likely be attributed to smoking bans and regulations limiting SHS and PAH exposure. This study therefore emphasizes the relevance of human biomonitoring to investigate the exposure of humans to chemicals of concern, assess the effectiveness of regulatory measures, and help policies to enforce provisions to protect public health. [Display omitted] • HBM study assessing exposure to SHS and OH-PAHs over a 24-year period in Germany. • Descending trend of cotinine and OH-PAH in urine from 1995 to 2019. • Decline is attributed to regulations in Germany limiting SHS and PAH exposure. • Increasing trend for 2-naphthol indicating elevated exposure specific to 2-naphthol. • Study underlines the importance of nationwide HBM to monitor chemicals of concern and the success of implemented regulations. [ABSTRACT FROM AUTHOR]

Introduction: Despite the large amount that is known about the physical health effects of secondhand tobacco smoke (SHS) exposure, little is known about the behavioral health effects. Nicotine, the principle psychoactive substance in SHS, elicits subjective mood and physiological responses in nonsmokers. However, no studies have examined the subjective mood or physiological responses to nicotine in nonsmokers while accounting for prior chronic or acute SHS exposure. Methods: A 7-mg nicotine patch was administered to 17 adult nonsmokers for 2 hr. Main outcome measures obtained at ½ hr, 1 hr, and 2 hr were subjective behavioral drug effects (based on eleven 10-cm Visual Analog Scales [VASs]) and the physiological measures of heart rate, blood pressure, and serum nicotine levels. Analysis of outcome data was based on participants' chronic (using hair nicotine) or acute (using saliva cotinine) SHS exposure. Results: Greater chronic SHS exposure was negatively associated with pleasurable responses to nicotine administration ("drug feels good" score at 2-hr time point, Spearman's ρ = -.65, p <.004), whereas greater acute SHS exposure was associated with positive responses ("like feeling of drug" score at 2-hr time point, Spearman's ρ = .63, p <.01). There were no associations between chronic or acute exposure and physiological changes in response to nicotine administration. Discussion: The findings of this study may be useful in providing preliminary empirical data for future explorations of the mechanism whereby SHS exposure can influence behavioral outcomes in nonsmokers. Such studies can inform future interventions to reduce the physical and behavioral health risks associated with SHS exposure. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The association between parent-reported postnatal secondhand tobacco smoke exposure in the home and neurobehavioral disorders (attention-deficit/hyperactivity disorder, learning disabilities, and conduct disorders) among children younger than 12 years in the United States was examined using the 2007 National Survey on Children's Health. Excess neurobehavioral disorders attributable to secondhand smoke (SHS) exposure in the home in 2007 were further investigated. METHODS: The methods used in this study were multivariable logistic regression models that accounted for potential confounders and complex survey designs to evaluate associations. RESULTS: A total of 6% of 55 358 children (aged < 12 years), corresponding to a weighted total of 4.8 million children across the United States, were exposed to SHS in the home. The weighted prevalence and 95% confidence intervals of each of the children's neurobehavioral outcomes were 8.2% (7.5-8.8) with learning disabilities, 5.9% (5.5-6.4) with attention-deficit/hyperactivity disorder, and 3.6% (3.1-4.0) with behavioral and conduct disorders. Children exposed to SHS at home had a 50% increased odds of having ≥2 childhood neurobehavioral disorders compared with children who were not exposed to SHS. Boys had a significantly higher risk. Older children, especially those aged 9 to 11 years, and those living in households with the highest poverty levels were at greater risk. In absolute terms, 274 100 excess cases in total of these 3 disorders could have been prevented if children had not been exposed to SHS in their homes. CONCLUSIONS: The findings of the study, which are associational and not necessarily causal, underscore the health burden of childhood neurobehavioral disorders that may be attributable to SHS exposure in homes in the United States. [ABSTRACT FROM AUTHOR]

Background: Second-hand smoke contains several toxic chemicals that are known to pollute the air and harm people's health. In India, smoking in public places has been prohibited since October 2008 as a way to reduce second-hand smoke (SHS) exposure. The purpose of the present study was to assess the implementation of smoke-free policies and its impact on indoor air quality by measuring the PM2.5 levels in bars and restaurants, restaurants, country liquor bars, hookah restaurants and pubs in Mumbai. Materials and Methods: Air quality measurements at 50 venues were conducted by using a "SIDEPAK™ AM510 Personal Aerosol Monitor" during April to May 2009. Average concentration of PM2.5 (µg/m3) particles was calculated separately for each venue. Results: Smoking was observed in 36% of the surveyed venues during an hour of data collection. The PM2.5 levels ranged from 16.97 to 1101.76 µg/m3. The average level of PM2.5 among non-smoking venues was 97.19 µg/m3 and among smoking venues was 363.04 µg/m3. Conclusion: Considerable scope for improvement in implementation of smoke-free policies exists. The PM2.5 levels were exceedingly high in venues where smoking was observed. [ABSTRACT FROM AUTHOR]

Objective This study aimed to explore tobacco smoking in seven major cities of Latin America. Methods The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study is a cross-sectional epidemiological study of 11 550 adults between 25 and 64 years old in Barquisimeto, Venezuela; Bogota, Colombia; Buenos Aires, Argentina; Lima, Peru; Mexico City, Mexico; Quito, Ecuador; and Santiago, Chile. Tobacco smoking, including cigarettes, cigars and pipes, was surveyed among other cardiovascular risk factors. Results Santiago and Buenos Aires had the highest smoking prevalence (45.4% and 38.6%, respectively); male and female rates were similar. In other cities, men smoked more than women, most markedly in Quito (49.4% of men vs 10.5% of women). Peak male smoking prevalence occurred among the youngest two age groups (25-34 and 35-44 years old). Men and women of Buenos Aires smoked the highest number of cigarettes per day on average (15.7 and 12.4, respectively). Men initiated regular smoking earlier than women in each city (ranges 13.7-20.0 years vs 14.2-21.1 years, respectively). Exposure to secondhand tobacco smoke at workplace for more than 5 h per day was higher in Barquisimeto (28.7%), Buenos Aires (26.8%) and Santiago (21.5%). The highest prevalence of former smokers was found among men in Buenos Aires, Santiago and Lima (30.0%, 26.8% and 26.0% respectively). Conclusions Smoking prevalence was high in the seven CARMELA cities, although patterns of smoking varied among cities. A major health and economic burden is inevitable in urban Latin America unless effective comprehensive tobacco control measures recommended by the World Health Organisation Framework Convention on Tobacco Control are implemented. [ABSTRACT FROM AUTHOR]