Second-Hand Smoke Exposure and Risk of Lung Cancer Among Nonsmokers in the United States: A Systematic Review and Meta-Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Inclusion Criteria
2.3. Study Selection
2.4. Data Extraction and Quality Assessment
2.5. Data Analysis
3. Results
3.1. Study Identification
3.2. Study and Participant Characteristics for the Systematic Review
3.3. Quality Assessment for the Systematic Review
3.4. Systematic Review Findings on the Risk of Lung Cancer per Exposure Area to SHS
3.4.1. Lung Cancer Risk Associated with Overall Exposure to SHS (All Sources Together)
3.4.2. Lung Cancer Risk Associated with Childhood Exposure to SHS
Both Parents Smoking
Mothers or Fathers Smoking
3.4.3. Lung Cancer Risk Associated with Household Exposure to SHS
3.4.4. Lung Cancer Risk Associated with Workplace Exposure to SHS
3.5. Meta-Analysis Results
3.5.1. Lung Cancer Risk Associated with Overall Exposure to SHS
3.5.2. Lung Cancer Risk Associated with Childhood Exposure to SHS
3.5.3. Lung Cancer Risk Associated with Household Exposure to SHS
3.5.4. Lung Cancer Risk Associated with Work Exposure to SHS
4. Discussion
4.1. Childhood Exposure to SHS as a Risk of Lung Cancer
4.2. Household Exposure to SHS as a Risk of Lung Cancer
4.3. Workplace Exposure to SHS as a Risk of Lung Cancer
4.4. Practical Implications
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A. Search Query Mesh Words Used
Appendix B. Data Extraction Form
Variable | Definition | |
---|---|---|
Study details | Title | Title of the study/research paper. |
Year | The year the study was published. | |
Objective | The primary goals or questions the study aimed to address. | |
Study design | The methodology or approach used in the study (e.g., randomized controlled trial, cohort study, case–control study). | |
Sample size | The number of non-smoking participants or observations included in the study. | |
Participants demographics | Age | The age range of the study nonsmoking participants. |
Gender | The gender distribution of the study participants (e.g., male, female, other). | |
Race | The racial or ethnic composition of the study participants. | |
Socioeconomic status | The social and economic characteristics of the study population are often measured by income, education, and occupation. | |
Exposure details | Exposure areas | Exposure to second-hand smoke (household: spouses and co-habitants, childhood: parents or siblings, workplace, overall). |
Duration of exposure | The length of time participants were exposed to SHS. | |
Intensity of exposure | The degree or amount of exposure to the risk factor. | |
Health outcomes | Stage of lung cancer | The lung cancer stage, typically stages I–IV or death, indicates the severity and spread of the cancer. |
Lung cancer types | The specific type of lung cancer diagnosed. | |
Geographic information | City or cities, region or regions where the study took place. | |
Key findings | The main results or conclusions drawn from the study. |
Appendix C. Systematic Review Results
Study Details | Participant’s Details | Exposure Details | Health Outcomes | City, State | Key Findings | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Ref | Objectives | Study Design | Sample Size | Age Range | Gender | Race | Socioeconomic Status | Household | Childhood | Work | Duration of Exposure | Intensity of Exposure | Stage of Lung Cancer | Type of Lung Cancer | ||
[23] | Determine the smoking habits of the parents and spouses of individuals diagnosed with lung cancer (smokers versus nonsmokers | Case–control study | 1338 lung cancer patients | Not reported | Non-smoking participants -Males: 241 -Females: 151 | Not reported | Married: -Male: 188 -Female: 155 | X | X | long-term | Not reported | Not reported | Not reported | Louisiana, New Orleans | Nonsmokers married to heavy smokers and individuals with smoking mothers had a higher risk of lung cancer. However, there was no apparent link between paternal and maternal smoking among nonsmokers and the risk of lung cancer. | |
[54] | Investigate the impacts of long-term passive smoking among nonsmoking women (working vs. nonworking) dead of lung cancer by interviewing their relatives | Retrospective study based on interviews and review of death notices | 537 nonsmoking women | Median age 71.8 | Female wives | Not reported | Middle-income group, with the average family income for 1970 listed as $93,809 (in Erie County, Pennsylvania) | X | long-term | Not reported | Death | Not reported | Pennsylvania | Exposure to second-hand smoke over a long period results in an increased risk of cancer-related deaths among nonsmokers who are exposed. Working women were more contaminated than women staying at home, an exposure hazard in the workplace. Results may be biased by external exposure to SHS that is not accounted for. | ||
[24] | Examine the effects of second-hand smoke on the development of lung cancer. All individuals involved in the study were carefully confirmed through histologic examination of samples, and their non-smoking status and exposure to second-hand smoke were validated through interviews. | A case–control study was conducted in four hospitals. | 134 nonsmoking women | 40–59 years (33) 60–79 years (72) 80 or above (29) | women | Not reported | Middle class 75 Upper class 6 Lowe class 53 | X | 5-year and 25-year exposure | Based on the number of cigarettes | Microscopic proof of lung cancer | Adenocarcinoma was the most common type among cases, followed by large, squamous, and mixed or other cells. | New Jersey and Ohio | The research findings indicate a strong correlation between increased risk of lung cancer and prolonged exposure to spousal smoking at home. This correlation holds true even when adjusting for factors such as age, hospital, socioeconomic status, and year of diagnosis. Women married to spouses who smoke 40 or more cigarettes a day or who are exposed to the smoke of at least 20 cigarettes a day at home face a risk of lung cancer twice as high as those not exposed at all. Interestingly, the comparison of women based on the number of hours exposed to smoke in the last five years and in the last 25 years showed no significant increase in the risk of lung cancer. | ||
[25] | Determine the link between the risk of lung cancer and tobacco smoke exposure within the household | Case–control study and interviews | 191 patients | Not reported | 45 males 146 females | Not reported | Not reported | X | X | Childhood and adolescence, adulthood exposure, and lifetime exposure | Based on years and number of cigarettes | Diagnosis | Not reported | New York | Exposure to second-hand smoke (SHS) during childhood and adolescence for 25 years or more doubles the risk of lung cancer in the early decades of life (up to 21 years). However, exposure to SHS for fewer years showed no significant association with lung cancer. Additionally, exposure to a spouse’s smoking during adulthood did not appear to be linked to a diagnosis of lung cancer. Although data on exposure at work was collected, no significant results were observed. | |
[32] | Examine the correlation between exposure to environmental tobacco smoke and lung cancer risk among non-smoking women | Case–control study and interviews | 210 patients | 65% of adults under 65 years old and the rest above 65 years | Women | 93% White among case patients; | 51% were married/65% were above 12 grades education, and 18% were less than 8th grade | X | X | Childhood, adolescence, and adulthood years | Based on years and number of cigarettes | Diagnosis | Adenocarcinoma was the most common type among cases, followed by squamous cell and small-cell carcinoma. | Central Florida, Florida | It has been observed that the risk of lung cancer is higher among women who have never smoked in their lifetime but live in households with smokers. The elevated risks were consistently observed when exposure to household smoke occurred during adulthood. Women with non-adenocarcinoma lung cancers who reported high levels of exposure to household smoke had the most significant increase in risk. Additionally, there is suggestive evidence that prolonged exposure to tobacco smoke during childhood and adolescence may also be linked to an increased risk of lung cancer. | |
[26] | Analyze the connection between lung cancer and exposure to second-hand smoke during childhood and adulthood. | Case–control study and interviews | 432 nonsmokers | 30 to 84 years | women | White (due to small numbers of other racial/ethnic groups) | Not reported | X | X | Detailed for childhood (17 years and younger) and adulthood (18 years and older) | Based on years and number of cigarettes | Diagnosis | Adenocarcinoma was the predominant type; other types included squamous cell carcinoma, bronchioalveolar carcinoma, and small cell carcinoma. | Missouri | Exposure to high levels of environmental tobacco smoke in adulthood has been shown to increase the risk of lung cancer among nonsmokers by around 30%. However, there does not appear to be a consistently elevated risk associated with childhood exposure or exposure in the workplace. | |
[40] | Determine the population-attributable risks (PAR) for lung cancer in nonsmoking and long-term ex-smoking women, considering various risk factors such as environmental tobacco smoke, dietary intake, and other exposures. | Population-based case–control study | 618 patients | 30 to 84 years, with people between 75 and 84 years (48%) | women | White | 47% married/39% less than 12th grade | X | X | Not reported | Not reported | Diagnosis | The major cell type was adenocarcinoma, followed by squamous cell, bronchoalveolar, small cell, and other types. | Missouri | SHS is the 2nd most predicted cause of lung cancer diagnosis in nonsmokers | |
[34] | Explore the impact of environmental tobacco smoke (ETS) on lung cancer mortality prospectively in the US. | Prospective cohort study | 114,286 female and 19,549 male never-smokers married to smokers, compared with about 77,000 female and 77,000 male never-smokers whose spouses did not smoke. | 30 years and above | Female and male | 95.4% white | Education (11.1% have less 12th grade levels) | X | long-term | Number of cigarettes, years in marriage (exposure) and pack-years of exposure | Death | lung cancer of all types | nationwide in the United States, encompassing participants from all 50 states, the District of Columbia, and Puerto Rico. | Women whose husbands ever smoked had a 20% higher risk of lung cancer death compared to those married to never-smokers, with a relative risk (RR) of 1.2. For men who never smoked and had wives who smoked, the relative risk was 1.1 (CI = 0.6–1.8). These findings align with the EPA’s estimate that spousal smoking increases lung cancer risk by around 20% in never-smoking women. | ||
[31] | Examine parental smoking behaviors and parent-reported exposure to Environmental Tobacco Smoke (ETS) among children treated for cancer. | Surveys | 47 children and their parents | 10 and 18 years. | 57.4% male, 42.6% female. | 78.7% Caucasian, 21.3% African American. | 38.3% from upper-middle and 61.7% from lower-middle socioeconomic levels | Current and historical exposure as reported by parents | number of cigarettes smoked around the child | Diagnosis | Not reported | Memphis, Tennessee | According to this study, nearly 72% of parents admitted to smoking around their children, and almost 58% smoked inside their homes. The study also found that children who smoked or had a history of smoking had more exposure to environmental tobacco smoke (ETS) compared to non-smoking children. Additionally, older and Caucasian children were found to have higher levels of ETS exposure. | |||
[33] | Describe patterns of ETS exposure and its association with lung cancer in women | Interviews and Cohort study | 810 patients | 31 to 91 years | Women | 94% caucasian | Not reported | X | X | X | Mean years of exposure were 27 from a spouse, 19 from parents, and 15 from co-workers. | pack-years, divided into light, moderate, and heavy based on the number of cigarettes smoked by the source | Diagnosis | Adenocarcinoma, followed by squamous cell and carcinoid | Rochester, Minnesota | Over 95% of the women were exposed to tobacco smoke either personally or through ETS. There was significant exposure among nonsmokers, especially from spouses and parents. The study highlighted significant associations between ETS exposure and lung cancer among nonsmokers. |
[27] | Examine the population-attributable risks (PAR) for various factors contributing to lung cancer among nonsmoking women and long-term ex-smokers | Population-based case–control study. | 665 patients | 20 to 79 years | women | Not reported | 66.3% had higher education, and 16.5% had very low educational levels | X | X | X | long-term | Number of cigarettes and years of exposure | Diagnosis/death (next of kin) | Adenocarcinoma (76.1%), squamous cell (9.8%) and others | 5 metropolitan areas: Atlanta, Georgia, New Orleans, Louisiana, Houston, Texas, Los Angeles, California, and San Francisco Bay Area, California. | Exposure to second-hand smoke and occupational hazards has been linked to an increased risk of being diagnosed with lung cancer. Research has shown that all three sources of exposure can lead to a higher risk of developing both adenocarcinoma and squamous/small cell carcinomas. When all three sources of exposure are considered together, a clear pattern of increased risk with a longer duration of exposure is evident for both types of lung cancer, with squamous and small cell carcinomas carrying a higher risk. |
[39] | Study the correlation between SHS exposure and lung cancer, particularly focusing on the timing of the first exposure in relation to the participant’s age and adjusting for active smoking variables. | Case–control study | 138 patients | mean 62 years old | 56 makes and 82 females | 129 whites and 9 other | Not reported | X | X | X | long-term | Number of exposure types (home, leisure, or work) | stage 1 and 2 (57) and stages 3 and 4 (75) | Adenocarcinoma, followed by squamous cells and others | Boston, Massachusetts | People who are exposed to second-hand smoke (SHS) before the age of 25 are at a greater risk of developing lung cancer compared to those who are first exposed to SHS after the age of 25. Research indicates that exposure to SHS during the period when the lungs are still developing up to the age of 25 has a significant impact. |
[30] | Investigate the correlation between SHS exposure and lung cancer risk, particularly the impact of age at exposure, hypothesizing greater risk for exposures during lung growth period (0–25 years) compared to after age 25 | A case–control study using self-reported SHS exposure | 796 patients | mean 63 years old | 369 males and 427 females | Not reported | 151 had less than high school levels, and 57 had graduate degrees | X | X | X | Variable, categorized by age at first exposure (up to age 25, after age 25). | Number of exposure types (home, leisure, or work) and heaviness of the exposure (low, moderate, heavy) | Diagnosis | Not reported | Massachusetts | Individuals exposed to SHS, especially < 25, have a higher risk of lung cancer compared to those first exposed after age 25. The study supports the hypothesis that SHS exposure during lung growth periods leads to a greater risk of lung cancer in adulthood. Findings suggest a potential dose–response relationship, with higher risk associated with exposure in both work and leisure settings compared to one or none. |
[28] | Investigate the connection between the occurrence of lung cancer and exposure to passive smoking during childhood, adulthood at home, and in the workplace. | Prospective cohort study | 36135 patients | 50 to 79 years | Not reported | 83.37% Whites, 7% Black, 3.88% Hispanic, 4.23% Asian | 4.49% had less than a high school degree, and 35.78% had some college | X | X | Mean years of exposure were 27 from a smoking spouse, 19 from parents, and 15 from co-workers. | Categorized based on the source smoker’s consumption (light: less than one-half pack per day; moderate: one-half to one pack per day; and heavy: more than one pack per day). | Stages III and IV for some proxy interviews to reduce survival bias. | Adenocarcinoma, squamous cells, unclassified non-small cell lung cancer (NSCLC), small cells, or carcinoids. | Rochester, Minnesota | In individuals who have never smoked but have been exposed to environmental tobacco smoke (ETS), the rates of exposure were found to be high from various sources, including 27 years from a spouse, 19 from parents, and 15 from co-workers. ETS exposure was found to be significant across all major subtypes of lung cancer in nonsmokers. There were statistically significant trends for adenocarcinoma, squamous, and small cell carcinoma among never-smokers with ETS exposure, showing a notable increase in adenocarcinoma and carcinoid tumors compared to those who have ever smoked. This study highlights the public health impact of tobacco smoke exposure and emphasizes the importance of eliminating smoking in both public and private spaces to reduce ETS exposure and the associated risks of lung cancer. | |
[29] | Examine the disparities in lung cancer rates in women veterans and non-veterans resulting from exposure to active and passive smoking. | longitudinal demographic, clinical, and laboratory data | 983 veteran nonsmokers and 41632 non-veteran nonsmokers | 50 to 79 years | women | veterans Whites 87% and veterans whites 84% veterans Hispanic 4% and non-veterans Hispanic 2.3% veterans black 9.1% and non-veterans black 7.1% | married non-veterans 62.2% and veterans 48.6%/college graduates veterans 46.8% and non-veterans 39.5%/income 75k or more veterans 14.2% and non-veterans 17.8% | X | X | X | long-term | Number of years and number of sources of exposure | Diagnosis | Not reported | All USA | Women who are Veterans had higher rates of passive smoking exposure; however, they did not demonstrate a higher adjusted risk for lung cancer compared to non-Veterans. |
[38] | Identify the impact of SHS on lung cancer incidence and mortality among never smokers. | Cross-sectional baseline survey | 49,569 participants. | 55 to 74 years | Both sexes, the majority female (61.2%). | Mostly white (87.9%). | Not reported | X | X | long-term | Type of exposure | Diagnosis | Includes small-cell carcinoma, adenocarcinoma, bronchoalveolar carcinoma, squamous-cell carcinoma, and large-cell carcinoma | All USA | People who have never smoked but were exposed to second-hand smoke as adults are at a higher risk of being diagnosed with lung cancer later in life. Additionally, nonsmokers with a history of adult second-hand smoke exposure have a greater likelihood of dying from lung cancer. | |
[55] | Explore the cancer mortality risks associated with exposure to SHS. | Longitudinal, population-based, nationally representative health survey linked to mortality rates from the National Death Index database. | While specific for nonsmokers is not directly mentioned, the study evaluated a cohort of 25,794 US residents older than 19 years. Among them, 6508 (25%) had no exposure to tobacco smoke, which includes nonsmokers. | 19 years and more (low exposure age mean 47.3, high exposure age mean 42.8) | The demographics included both males and females, but specific proportions were not provided in the text. | Race/ethnicity was categorized into five categories by NHANES investigators, but specific distribution was not detailed in the provided text. | Socioeconomic status was inferred through education and poverty-income ratio. | X | X | Not reported | Divided into two groups based on serum cotinine levels: low exposure (0.015 to 10 ng/mL) and high exposure (≥10 ng/mL). | Death | Not reported | All USA | Exposure to high levels of second-hand smoke (serum cotinine level ≥ 10) is significantly linked to higher mortality risks from several types of cancer, particularly lung cancer. However, low exposure to second-hand smoke has not shown a statistically significant association with cancer mortality. | |
[36] | To investigate the correlation between neighborhood disadvantage and lung cancer risk in Black never-smoking women. | Prospective cohort study using data from the Black Women’s Health Study. | 37,650 never-smoker black women | 20 to 70 years. | Females | Black/African American | Studied at both individual and neighborhood levels; specific socioeconomic data collected included individual income and educational attainment, alongside neighborhood socioeconomic status (SES) and neighborhood concentrated disadvantage. | X | X | Follow-up from 1995 to 2018. | Second-hand smoke exposure was quantified as being in a room with a smoker for at least one hour per day for 12 consecutive months; PM2.5 exposure and neighborhood-level exposures were based on residence data. | Diagnosis | Not reported | All USA | In this study, involving 37,650 individuals who had never smoked, 77 were found to have developed lung cancer during the follow-up period. The research revealed that for every ten-unit increase in the neighborhood concentrated disadvantage index, there was a 30% rise in the incidence of lung cancer (sHR = 1.30, 95% CI: 1.04, 1.63, p = 0.023). Exposure to second-hand smoke at work was found to elevate the risk of lung cancer significantly (sHR = 1.93, 95% CI: 1.21, 3.10, p = 0.006), whereas exposure at home and PM2.5 did not show significant associations with the disease. | |
[37] | Compare the total number of second primary lung cancer cases in lung cancer survivors who have never smoked with those who have ever smoked. | Population-based prospective cohort study using data from the Multiethnic Cohort Study (MEC) with follow-up through the Surveillance, Epidemiology, and End Results registry. | 7161 participants had had initial lung cancer diagnosis, and 163 had secondary lung cancer | 45 to 75 years | Among those who already had initial lung cancer, 4031 (56.3%) were male, and 3131 (43.7%) were female. | African American (16.3%) overall and 25.9% had initial lung cancer//white overall 23.1% and Initial lung cancer patients23.9% and 28.8% had secondary lung cancer. | Not reported | X | X | Not reported | Smoking status only | Diagnosis | initial primary lung cancer (IPLC) and second primary lung cancer (SPLC) | California and Hawaii | The cumulative 10-year incidence of second primary lung cancer (SPLC) after initial primary lung cancer (IPLC) was found to be equally high among survivors who never smoked and those who ever smoked. The standardized incidence ratio (SIR) for SPLC was significantly higher for never-smokers (14.50; 95% CI, 8.73–22.65) compared to ever-smokers (3.50; 95% CI, 2.95–4.12), indicating a notable risk of SPLC among never-smoking lung cancer survivors. |
Appendix D. JBI Results for Risk of Bias
Similar Two Groups Recruited from the Same Population | Exposures Are Measured Similarly to Assign People to Exposed and Unexposed Groups | Exposure Measured in a Valid and Reliable Way | Confounding Factors Identified | Strategies to Deal with Confounding Factors Stated | Participants Free of the Outcome at the Start of the Study | Outcomes Measured in a Valid and Reliable Way | Follow-up Time Reported and Sufficient for Outcomes to Occur | Follow-up Was Complete, and if Not, Reasons Were Described and Explored | Utilized Strategies to Address Incomplete Follow-Up | The Analysis Used is Appropriate | Score | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
(Correa, 1983) [23] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 9 |
(Miller, 1984) [54] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 9 |
(Garfinkel,1985) [24] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 11 |
(Janerich, 1990) [25] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Stockwell, 1992) [32] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Brownson, 1992) [26] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Alanja, 1995) [40] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Cardenas, 1997) [34] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Tyc, 2004) [31] | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 8 |
(De Andrade, 2004) [33] | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 8 |
(Brennan, 2004) [27] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Asomaning, 2008) [39] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Olivo, 2009) [30] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Liu, 2014) [35] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Wang, 2015) [28] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Bastian, 2016) [29] | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 8 |
(Abdelrahman, 2020) [38] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Zhang, 2023) [55] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Erhunmwunsee, 2022) [36] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
(Choi, 2023) [37] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 10 |
Appendix E. Meta-Analysis Findings
Reference | Sample Size | Effect Size | CI Lower | CI Upper | Ses | Weights | Stats | |
---|---|---|---|---|---|---|---|---|
Overall exposure | (Correa, 1983) [23] | 1338 | 3.11 | 1.02 | 6.45 | 0.47 | 4.52 | Combined effect size 1.08 (0.96–1.22) Number of studies 8 Degrees of freedom 7 p-value 0.003 Cochran’s Q 21.26 I2 (heterogeneity) 67.08% |
(Garfinkel, 1985) [24] | 134 | 1.28 | 1.04 | 3.22 | 0.29 | 12.03 | ||
(Janerich, 1990) [25] | 191 | 1.14 | 1.08 | 2.29 | 0.19 | 27.20 | ||
(Brownson, 1992) [26] | 432 | 0.8 | 0.66 | 1.01 | 0.11 | 84.89 | ||
(Alavanja, 1995) [40] | 618 | 1.6 | 1.11 | 2.20 | 0.35 | 8.35 | ||
(Brennan, 2004) [27] | 665 | 1.32 | 1.19 | 2.82 | 0.22 | 20.64 | ||
(Wang, 2015) [28] | 36135 | 1.74 | 1.02 | 3.65 | 0.33 | 9.45 | ||
(Zhang, 2023) [55] | 6508 | 1.045 | 0.84 | 1.29 | 0.19 | 27.42 | ||
Household exposure | (Correa, 1983) [23] | 1338 | 2.07 | 1.63 | 2.63 | 0.12 | 67.14 | Combined effect size 1.41 (1.31–1.52) Number of studies 11 Degrees of freedom 10 p-value <.001 Cochran’s Q 51.57 I2 (heterogeneity) 80.61% |
(Garfinkel,1985) [24] | 134 | 1.31 | 1.01 | 1.70 | 0.13 | 56.68 | ||
(Janerich, 1990) [25] | 191 | 0.89 | 0.67 | 1.18 | 0.14 | 47.97 | ||
(Stockwell, 1992) [32] | 210 | 1.60 | 1.25 | 2.05 | 0.13 | 62.79 | ||
(Brownson, 1992) [26] | 432 | 0.70 | 0.52 | 0.95 | 0.15 | 42.31 | ||
(Alavanja, 1995) [40] | 618 | 1.80 | 1.41 | 2.30 | 0.12 | 64.18 | ||
(Cardenas, 1997) [34] | 19549 | 1.50 | 1.16 | 1.93 | 0.13 | 59.29 | ||
(Brennan, 2004) [27] | 665 | 1.24 | 0.95 | 1.61 | 0.13 | 55.22 | ||
(Asomaning, 2008) [39] | 138 | 1.29 | 0.99 | 1.67 | 0.13 | 56.21 | ||
(Abdel-Rahman, 2020) [38] | 49569 | 1.81 | 1.42 | 2.31 | 0.12 | 64.90 | ||
(Brennan, 2004) [27] | 37650 | 1.40 | 1.08 | 1.81 | 0.13 | 57.63 | ||
Work exposure | (Brennan, 2004) [27] | 665 | 1.26 | 1.01 | 1.9 | 0.16 | 38.48 | Combined effect size 1.24 (1.15–1.34) Number of studies 4; Degrees of freedom 3 p-value 0.165; Cochran’s Q 5.09 I2 (heterogeneity) 41.05% |
(Liu 2014) [35] | 650 | 1.22 | 1.17 | 1.37 | 0.04 | 617.05 | ||
(Abdel-Rahman, 2020) [38] | 49569 | 2.04 | 1.31 | 3.164 | 0.22 | 19.76 | ||
(Erhunmwunsee, 2022) [36] | 37650 | 1.29 | 0.74 | 2.26 | 0.28 | 12.32 | ||
Childhood exposure (both) | (Janerich, 1990) [25] | 191 | 2.07 | 1.4 | 3.06 | 0.20 | 25.13 | Combined effect size 1.40 (1.15–1.70) Number of studies 4; Degrees of freedom 3 p-value 0.0002; Cochran’s Q 19.69 I2 (heterogeneity) 84.77% |
(Brownson, 1992) [26] | 432 | 0.8 | 0.54 | 1.18 | 0.20 | 25.15 | ||
(Olivo, 2009) [30] | 796 | 2.25 | 1.52 | 3.33 | 0.20 | 24.98 | ||
(Liu, 2014) [35] | 49569 | 1.028 | 0.69 | 1.52 | 0.21 | 24.64 | ||
Exposure (mother) | (Correa, 1983) [23] | 1338 | 1.66 | 1.03 | 1.94 | 0.161 | 38.33 | Combined effect size 1.73 (1.40–2.14) Number of studies 3; Degrees of freedom 2 p-value 0.24; Cochran’s Q 2.80 I2 (heterogeneity) 28.48% |
(Stockwell, 1992) [32] | 210 | 1.6 | 0.99 | 1.85 | 0.159 | 39.31 | ||
(Olivo, 2009) [30] | 796 | 2.92 | 1.12 | 4.11 | 0.331 | 9.09 | ||
Exposure (father) | (Correa, 1983) [23] | 1338 | 1.04 | 0.85 | 1.55 | 0.15 | 42.57 | Combined effect size 1.22 (1.01–1.55) Number of studies 3; Degrees of freedom 2 p-value 0.02; Cochran’s Q 7.15 I2 (heterogeneity) 72.04% |
(Stockwell, 1992) [32] | 210 | 1.2 | 0.64 | 1.89 | 0.27 | 13.1 | ||
(Olivo, 2009) [30] | 796 | 2.89 | 1.12 | 4.42 | 0.35 | 8.15 |
References
- Nadhiroh, S.R.; Djokosujono, K.; Utari, D.M. The association between secondhand smoke exposure and growth outcomes of children: A systematic literature review. Tob. Induc. Dis. 2020, 18, 12. [Google Scholar] [CrossRef] [PubMed]
- Brody, D.J.; Lu, Z.; Tsai, J. Secondhand Smoke Exposure Among Nonsmoking Youth: United States, 2013–2016; U.S. Department of Health and Human Services: Washington, DC, USA, 2019.
- Board on Population Health; Public Health Practice; Committee on Secondhand Smoke Exposure; Acute Coronary Events. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence; National Academies Press: Washington, DC, USA, 2010. [Google Scholar]
- Oliveira, L.; Oliveira, M.; Ardenghi, T.; Zanatta, F. Is secondhand smoke exposure associated with poor periodontal status in children and adolescents? A systematic review and meta-analysis. Eur. Arch. Paediatr. Dent. 2022, 23, 513–525. [Google Scholar] [CrossRef]
- National Cancer Institute. Secondhand Smoke Exposure; National Cancer Institute: Bethesda, MD, USA, 2023.
- Štěpánek, L.; Ševčíková, J.; Horáková, D.; Patel, M.S.; Durďáková, R. Public health burden of secondhand smoking: Case reports of lung cancer and a literature review. Int. J. Environ. Res. Public Health 2022, 19, 13152. [Google Scholar] [CrossRef] [PubMed]
- Semple, S.; Dobson, R.; O’Donnell, R.; Abidin, E.Z.; Tigova, O.; Okello, G.; Fernández, E. Smoke-free spaces: A decade of progress, a need for more? Tob. Control 2022, 31, 250–256. [Google Scholar] [CrossRef]
- Nwosu, C.; Angus, K.; Cheeseman, H.; Semple, S. Reducing secondhand smoke exposure among nonsmoking pregnant women: A systematic review. Nicotine Tob. Res. 2020, 22, 2127–2133. [Google Scholar] [CrossRef] [PubMed]
- Tan, G.P.P.; Teo, O.; van der Eijk, Y. Residential secondhand smoke in a densely populated urban setting: A qualitative exploration of psychosocial impacts, views and experiences. BMC Public Health 2022, 22, 1–11. [Google Scholar] [CrossRef]
- van der Eijk, Y.; Tan, G.P.P.; Teo, O. Systems and policies to reduce secondhand smoke in multiunit housing in Singapore: A qualitative study. Tob. Control 2022, 33, 52–58. [Google Scholar] [CrossRef]
- Besaratinia, A.; Pfeifer, G.P. Second-hand smoke and human lung cancer. Lancet Oncol. 2008, 9, 657–666. [Google Scholar] [CrossRef]
- Hori, M.; Tanaka, H.; Wakai, K.; Sasazuki, S.; Katanoda, K. Secondhand smoke exposure and risk of lung cancer in Japan: A systematic review and meta-analysis of epidemiologic studies. Jpn. J. Clin. Oncol. 2016, 46, 942–951. [Google Scholar] [CrossRef]
- Parums, D.V. Review articles, systematic reviews, meta-analysis, and the updated preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Med. Sci. Monit. Int. Med. J. Exp. Clin. Res. 2021, 27, e934475. [Google Scholar] [CrossRef]
- Mak, S.; Thomas, A. Steps for conducting a scoping review. J. Grad. Med. Educ. 2022, 14, 565–567. [Google Scholar] [CrossRef]
- Wohlin, C.; Kalinowski, M.; Felizardo, K.R.; Mendes, E. Successful combination of database search and snowballing for identification of primary studies in systematic literature studies. Inf. Softw. Technol. 2022, 147, 106908. [Google Scholar] [CrossRef]
- Bui, H.; Chau, V.S.; Degl’Innocenti, M.; Leone, L.; Vicentini, F. The resilient organisation: A meta-analysis of the effect of communication on team diversity and team performance. Appl. Psychol. 2019, 68, 621–657. [Google Scholar] [CrossRef]
- Moola, S.; Munn, Z.; Tufanaru, C.; Aromataris, E.; Sears, K.; Sfetcu, R.; Currie, M.; Qureshi, R.; Mattis, P.; Lisy, K. Chapter 7: Systematic reviews of etiology and risk. JBI Man. Evid. Synth. JBI 2020, 10, 217–269. [Google Scholar]
- Masoumi, S.; Shahraz, S. Meta-analysis using Python: A hands-on tutorial. BMC Med. Res. Methodol. 2022, 22, 193. [Google Scholar] [CrossRef]
- Schwarzer, G.; Carpenter, J.R.; Rücker, G. Meta-Analysis with R.; Springer: Berlin/Heidelberg, Germany, 2015; Volume 4784. [Google Scholar]
- Viechtbauer, W. Conducting meta-analyses in R with the metafor package. J. Stat. Softw. 2010, 36, 1–48. [Google Scholar] [CrossRef]
- Egger, M.; Smith, G.D.; Schneider, M.; Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997, 315, 629–634. [Google Scholar] [CrossRef]
- Cheng, E.; Kirley, J.; Cespedes Feliciano, E.M.; Caan, B.J. Adiposity and cancer survival: A systematic review and meta-analysis. Cancer Causes Control 2022, 33, 1219–1246. [Google Scholar] [CrossRef]
- Correa, P.; Fontham, E.; Pickle, L.W.; Lin, Y.; Haenszel, W. Passive smoking and lung cancer. Lancet 1983, 322, 595–597. [Google Scholar] [CrossRef]
- Garfinkel, L.; Auerbach, O.; Joubert, L. Involuntary smoking and lung cancer: A case-control study. J. Natl. Cancer Inst. 1985, 75, 463–469. [Google Scholar]
- Janerich, D.T.; Thompson, W.D.; Varela, L.R.; Greenwald, P.; Chorost, S.; Tucci, C.; Zaman, M.B.; Melamed, M.R.; Kiely, M.; McKneally, M.F. Lung cancer and exposure to tobacco smoke in the household. N. Engl. J. Med. 1990, 323, 632–636. [Google Scholar] [CrossRef] [PubMed]
- Brownson, R.C.; Alavanja, M.; Hock, E.T.; Loy, T.S. Passive smoking and lung cancer in nonsmoking women. Am. J. Public Health 1992, 82, 1525–1530. [Google Scholar] [CrossRef]
- Brennan, P.; Buffler, P.A.; Reynolds, P.; Wu, A.H.; Wichmann, H.E.; Agudo, A.; Pershagen, G.; Jöckel, K.H.; Benhamou, S.; Greenberg, R.S. Secondhand smoke exposure in adulthood and risk of lung cancer among never smokers: A pooled analysis of two large studies. Int. J. Cancer 2004, 109, 125–131. [Google Scholar] [CrossRef]
- Wang, A.; Kubo, J.; Luo, J.; Desai, M.; Hedlin, H.; Henderson, M.; Chlebowski, R.; Tindle, H.; Chen, C.; Gomez, S. Active and passive smoking in relation to lung cancer incidence in the Women’s Health Initiative Observational Study prospective cohort. Ann. Oncol. 2015, 26, 221–230. [Google Scholar] [CrossRef] [PubMed]
- Bastian, L.A.; Gray, K.E.; DeRycke, E.; Mirza, S.; Gierisch, J.M.; Haskell, S.G.; Magruder, K.M.; Wakelee, H.A.; Wang, A.; Ho, G.Y. Differences in active and passive smoking exposures and lung cancer incidence between veterans and non-veterans in the women’s health initiative. Gerontologist 2016, 56, S102–S111. [Google Scholar] [CrossRef] [PubMed]
- Olivo-Marston, S.E.; Yang, P.; Mechanic, L.E.; Bowman, E.D.; Pine, S.R.; Loffredo, C.A.; Alberg, A.J.; Caporaso, N.; Shields, P.G.; Chanock, S. Childhood exposure to secondhand smoke and functional mannose binding lectin polymorphisms are associated with increased lung cancer risk. Cancer Epidemiol. Biomark. Prev. 2009, 18, 3375–3383. [Google Scholar] [CrossRef]
- Tyc, V.L.; Klosky, J.; Throckmorton-Belzer, L.; Lensing, S.; Rai, S.N. Parent-reported environmental tobacco smoke exposure among preadolescents and adolescents treated for cancer. Psycho-Oncol. J. Psychol. Soc. Behav. Dimens. Cancer 2004, 13, 537–546. [Google Scholar] [CrossRef]
- Stockwell, H.G.; Goldman, A.L.; Lyman, G.H.; Noss, C.I.; Armstrong, A.W.; Pinkham, P.A.; Candelora, E.C.; Brusa, M.R. Enviromental tobacco smoke and lung cancer risk in nonsmoking women. JNCI J. Natl. Cancer Inst. 1992, 84, 1417–1422. [Google Scholar] [CrossRef]
- De Andrade, M.; Ebbert, J.; Wampfler, J.; Miller, D.; Marks, R.; Croghan, G.; Jatoi, A.; Finke, E.; Sellers, T.; Yang, P. Environmental tobacco smoke exposure in women with lung cancer. Lung Cancer 2004, 43, 127–134. [Google Scholar] [CrossRef]
- Cardenas, V.M.; Thun, M.J.; Austin, H.; Lally, C.A.; Clark, W.S.; Greenberg, R.S.; Heath, C.W. Environmental tobacco smoke and lung cancer mortality in the American Cancer Society’s Cancer Prevention Study II. Cancer Causes Control 1997, 8, 57–64. [Google Scholar] [CrossRef]
- Liu, R.; Bohac, D.L.; Gundel, L.A.; Hewett, M.J.; Apte, M.G.; Hammond, S.K. Assessment of risk for asthma initiation and cancer and heart disease deaths among patrons and servers due to secondhand smoke exposure in restaurants and bars. Tob. Control 2014, 23, 332–338. [Google Scholar] [CrossRef] [PubMed]
- Erhunmwunsee, L.; Wing, S.E.; Zou, X.; Coogan, P.; Palmer, J.R.; Wong, F.L. Neighborhood disadvantage and lung cancer risk in a national cohort of never smoking Black women. Lung Cancer 2022, 173, 21–27. [Google Scholar] [CrossRef] [PubMed]
- Choi, E.; Su, C.C.; Wu, J.T.; Aredo, J.V.; Neal, J.W.; Leung, A.N.; Backhus, L.M.; Lui, N.S.; Le Marchand, L.; Stram, D.O. Second Primary Lung Cancer Among Lung Cancer Survivors Who Never Smoked. JAMA Netw. Open 2023, 6, e2343278. [Google Scholar] [CrossRef]
- Abdel-Rahman, O. Incidence and Mortality of lung cancer among never smokers in relationship to secondhand smoking: Findings from the PLCO trial. Clin. Lung Cancer 2020, 21, 415–420.e2. [Google Scholar] [CrossRef]
- Asomaning, K.; Miller, D.P.; Liu, G.; Wain, J.C.; Lynch, T.J.; Su, L.; Christiani, D.C. Second hand smoke, age of exposure and lung cancer risk. Lung Cancer 2008, 61, 13–20. [Google Scholar] [CrossRef]
- Alavanja, M.C.; Brownson, R.C.; Benichou, J.; Swanson, C.; Boice, J.D. Attributable risk of lung cancer in lifetime nonsmokers and long-term ex-smokers (Missouri, United States). Cancer Causes Control 1995, 6, 209–216. [Google Scholar] [CrossRef] [PubMed]
- Zhou, W.; Heist, R.S.; Liu, G.; Asomaning, K.; Miller, D.P.; Neuberg, D.S.; Wain, J.C.; Lynch, T.J.; Christiani, D.C. Second hand smoke exposure and survival in early-stage non–small-cell lung cancer patients. Clin. Cancer Res. 2006, 12, 7187–7193. [Google Scholar] [CrossRef]
- Pattenden, S.; Antova, T.; Neuberger, M.; Nikiforov, B.; De Sario, M.; Grize, L.; Heinrich, J.; Hruba, F.; Janssen, N.; Luttmann-Gibson, H. Parental smoking and children’s respiratory health: Independent effects of prenatal and postnatal exposure. Tob. Control 2006, 15, 294–301. [Google Scholar] [CrossRef]
- Zhuge, Y.; Qian, H.; Zheng, X.; Huang, C.; Zhang, Y.; Li, B.; Zhao, Z.; Deng, Q.; Yang, X.; Sun, Y. Effects of parental smoking and indoor tobacco smoke exposure on respiratory outcomes in children. Sci. Rep. 2020, 10, 4311. [Google Scholar] [CrossRef]
- Sayer, L.C.; Bianchi, S.M.; Robinson, J.P. Are parents investing less in children? Trends in mothers’ and fathers’ time with children. Am. J. Sociol. 2004, 110, 1–43. [Google Scholar] [CrossRef]
- Li, D.; Guo, X. The effect of the time parents spend with children on children’s well-being. Front. Psychol. 2023, 14, 1096128. [Google Scholar] [CrossRef]
- Collins, C.C.; Lippmann, B.M.; Lo, S.J.; Moolchan, E.T. Time spent with smoking parents and smoking topography in adolescents. Addict. Behav. 2008, 33, 1594–1597. [Google Scholar] [CrossRef] [PubMed]
- Hackshaw, A.K.; Law, M.R.; Wald, N.J. The accumulated evidence on lung cancer and environmental tobacco smoke. BMJ 1997, 315, 980–988. [Google Scholar] [CrossRef] [PubMed]
- May, L.; Shows, K.; Nana-Sinkam, P.; Li, H.; Landry, J.W. Sex Differences in Lung Cancer. Cancers 2023, 15, 3111. [Google Scholar] [CrossRef] [PubMed]
- Avila-Tang, E.; Elf, J.L.; Cummings, K.M.; Fong, G.T.; Hovell, M.F.; Klein, J.D.; McMillen, R.; Winickoff, J.P.; Samet, J.M. Assessing secondhand smoke exposure with reported measures. Tob. Control 2013, 22, 156–163. [Google Scholar] [CrossRef]
- Pron, G.E.; Burch, J.D.; Howe, G.R.; Miller, A.B. The reliability of passive smoking histories reported in a case-control study of lung cancer. Am. J. Epidemiol. 1988, 127, 267–273. [Google Scholar] [CrossRef]
- Patrick, D.L.; Cheadle, A.; Thompson, D.C.; Diehr, P.; Koepsell, T.; Kinne, S. The validity of self-reported smoking: A review and meta-analysis. Am. J. Public Health 1994, 84, 1086–1093. [Google Scholar] [CrossRef]
- Willemsen, M.C.; Brug, J.; Uges, D.R.; de Wael, M.L.V. Validity and reliability of self-reported exposure to environmental tobacco smoke in work offices. J. Occup. Environ. Med. 1997, 39, 1111–1114. [Google Scholar] [CrossRef]
- Park, H.; Cho, S.-i.; Lee, C. Second hand smoke exposure in workplace by job status and occupations. Ann. Occup. Environ. Med. 2019, 31, 1–9. [Google Scholar] [CrossRef]
- Miller, G. Cancer, passive smoking and nonemployed and employed wives. West. J. Med. 1984, 140, 632. [Google Scholar]
- Zhang, Z.; Li, Z.; Zhang, X.; Ye, W.; Chen, J.; Wang, L.; Lin, Z.; Li, J.; Li, Z. Association between secondhand smoke and cancers in adults in the US population. J. Cancer Res. Clin. Oncol. 2023, 149, 3447–3455. [Google Scholar] [CrossRef] [PubMed]
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Elkefi, S.; Zeinoun, G.; Tounsi, A.; Bruzzese, J.-M.; Lelutiu-Weinberger, C.; Matthews, A.K. Second-Hand Smoke Exposure and Risk of Lung Cancer Among Nonsmokers in the United States: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2025, 22, 595. https://doi.org/10.3390/ijerph22040595
Elkefi S, Zeinoun G, Tounsi A, Bruzzese J-M, Lelutiu-Weinberger C, Matthews AK. Second-Hand Smoke Exposure and Risk of Lung Cancer Among Nonsmokers in the United States: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2025; 22(4):595. https://doi.org/10.3390/ijerph22040595
Chicago/Turabian StyleElkefi, Safa, Gabriel Zeinoun, Achraf Tounsi, Jean-Marie Bruzzese, Corina Lelutiu-Weinberger, and Alicia K. Matthews. 2025. "Second-Hand Smoke Exposure and Risk of Lung Cancer Among Nonsmokers in the United States: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 22, no. 4: 595. https://doi.org/10.3390/ijerph22040595
APA StyleElkefi, S., Zeinoun, G., Tounsi, A., Bruzzese, J.-M., Lelutiu-Weinberger, C., & Matthews, A. K. (2025). Second-Hand Smoke Exposure and Risk of Lung Cancer Among Nonsmokers in the United States: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 22(4), 595. https://doi.org/10.3390/ijerph22040595