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Special Issue "Environmental Tobacco Smoke: Exposure and Effects"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 July 2018).

Special Issue Editors

Guest Editor
Prof. Dr. Matteo Vitali

Department of Public Health and Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
Website 1 | Website 2 | E-Mail
Interests: environmental pollution; environmental chemistry; environmental tobacco smoke (ETS); public health; human biomonitoring; risk assessment; hospital hygiene
Guest Editor
Dr. Carmela Protano

Department of Public Health and Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
Website | E-Mail
Interests: environmental pollution; environmental chemistry; environmental tobacco smoke (ETS); public health; environmental epidemiology; human biomonitoring; risk assessment

Special Issue Information

Dear Colleagues,

The involuntary exposure to passive smoking, also called Environmental Tobacco Smoke (ETS), has devastating health, social, environmental, and economic consequences, as reported in the brochure “Tobacco threatens us all” (WHO) for the World No Tobacco Day 2017. Despite a great amount of research carried out on this issue, many critical research agendas on ETS exposure and effects remain, and new evidence is needed.

For example, ETS has been recently demonstrated to result from the combination of two phenomena: Secondhand smoke (SHS) and thirdhand smoke (THS), which are, respectively, the environmental smoke near people who are smoking or just finished smoking, and the environmental smoke that persists long after the clearing of secondhand smoke. Studies performed to evaluate ETS chemistry, human exposure, and health effects should assess the independent contribution of both SHS and THS.

To further complicate this scenario, in the last years electronic (e-cig) and heat-not-burn smoking devices has become commonplace among smokers and non-smokers. Several studies evidenced that passive exposure generated by e-devices does occur, but further investigation is needed for better characterize these new exposure scenarios.

The focus of this Special Issue is aimed on ETS chemistry, exposure and effects gap, both for traditional combustion smoking products and for electronic and heat-not-burn devices. Authors are invited to submit original articles, systematic reviews and meta-analysis, critical reviews and short communications addressing all the issues relevant to highlight any recent advance in ETS exposure and their impact in individual and public health.

Prof. Dr. Matteo Vitali
Dr. Carmela Protano
Guest Editors

Manuscript Submission Information

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Keywords

  • Environmental Tobacco Smoke (ETS)
  • Secondhand Smoke (SHS) and Thirdhand Smoke (THS)
  • Human exposure
  • Adverse health effects
  • ETS chemistry
  • Human biomonitoring
  • Environmental monitoring
  • Traditional smoking devices
  • Electronic cigarette (e-cig) and heat-not-burn devices
  • Risk assessment

Published Papers (20 papers)

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Open AccessArticle
Environmental Electronic Vape Exposure from Four Different Generations of Electronic Cigarettes: Airborne Particulate Matter Levels
Int. J. Environ. Res. Public Health 2018, 15(10), 2172; https://doi.org/10.3390/ijerph15102172
Received: 27 July 2018 / Revised: 28 September 2018 / Accepted: 29 September 2018 / Published: 3 October 2018
Cited by 3 | PDF Full-text (1299 KB) | HTML Full-text | XML Full-text
Abstract
Electronic cigarettes (e-cigs) were introduced into the market in 2006 and their technological features have evolved substantially over time. Currently, there are four different generations of e-cigs that are broadly considered less harmful than the use of combusted tobacco products although passive exposure [...] Read more.
Electronic cigarettes (e-cigs) were introduced into the market in 2006 and their technological features have evolved substantially over time. Currently, there are four different generations of e-cigs that are broadly considered less harmful than the use of combusted tobacco products although passive exposure to aerosols often occurs in public spaces and indoor environments. The study aim was to evaluate the levels of airborne particulate matter (PM) emitted during the use of all the four generations of e-cigs, testing different use modalities. PM10, PM4, PM2.5 and PM1 were measured through a Dusttrak ™ II Aerosol Monitor, for a total of 20 independent experiments. All tested e-cigs devices produced PM during their use, and PM10 was almost made of PM1 size fraction. In addition, we observed a progressive increase in PM emission from the first to the fourth generation, and an upward trend of PM1 emitted by the fourth generation e-cig with an increase in the operating power. The results showed that, whatever the model adopted, passive vaping does occur. This finding supports the need for legislative interventions to regulate the e-cigs use in public places and other enclosed environments, in order to protect the health of any subject who is potentially exposed. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessFeature PaperArticle
Passive Smoking Indicators in Italy: Does the Gross Domestic Product Matter?
Int. J. Environ. Res. Public Health 2018, 15(9), 2045; https://doi.org/10.3390/ijerph15092045
Received: 7 August 2018 / Revised: 3 September 2018 / Accepted: 14 September 2018 / Published: 18 September 2018
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Abstract
Background: The aim of this study is to analyse the correlation between regional values of Gross Domestic Product (GDP) and passive smoking in Italy. Methods: The outcome measures were smoking ban respect in public places, workplaces and at home, derived from the PASSI [...] Read more.
Background: The aim of this study is to analyse the correlation between regional values of Gross Domestic Product (GDP) and passive smoking in Italy. Methods: The outcome measures were smoking ban respect in public places, workplaces and at home, derived from the PASSI surveillance for the period 2011–2017. The explanatory variable was GDP per capita. The statistical analysis was carried out using bivariate and linear regression analyses, taking into consideration two different periods, Years 2011–2014 and 2014–2017. Results: GDP is showed to be positively correlated with smoking ban respect in public places (r = 0.779 p < 0.001; r = 0.723 p < 0.001 in the two periods, respectively), as well as smoking ban respect in the workplace (r = 0.662 p = 0.001; r = 0.603 p = 0.004) and no smoking at home adherence (r = 0.424 p = 0.056; r = 0.362 p = 0.107). In multiple linear regression GDP is significantly associated to smoking ban respect in public places (adjusted β = 0.730 p < 0.001; β = 0.698 p < 0.001 in the two periods, respectively), smoking ban in workplaces (adjusted β = 0.525 p = 0.020; β = 0.570 p = 0.009) and no smoking at home (adjusted β = 0.332 p = 0.070; β = 0.362 p = 0.052). Conclusions: Smoking ban is more respected in Regions with higher GDP. For a better health promotion, systematic vigilance and sanctions should be maintained and strengthened, particularly in regions with low compliance with smoking bans. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
Open AccessArticle
Discrepancy between Self-Reported and Urine Cotinine-Verified Environmental Tobacco Smoke Exposure among Rural Pregnant Women in China
Int. J. Environ. Res. Public Health 2018, 15(7), 1499; https://doi.org/10.3390/ijerph15071499
Received: 25 June 2018 / Revised: 10 July 2018 / Accepted: 12 July 2018 / Published: 16 July 2018
Cited by 2 | PDF Full-text (311 KB) | HTML Full-text | XML Full-text
Abstract
Prenatal exposure to environmental tobacco smoke (ETS) is the most modifiable risk factor associated with adverse child-health outcomes. However, few longitudinal studies are implemented to compare the rates of discrepancy between self-reported (SR) and urinary cotinine (UC)-verified ETS exposure during the three trimesters [...] Read more.
Prenatal exposure to environmental tobacco smoke (ETS) is the most modifiable risk factor associated with adverse child-health outcomes. However, few longitudinal studies are implemented to compare the rates of discrepancy between self-reported (SR) and urinary cotinine (UC)-verified ETS exposure during the three trimesters of pregnancy, especially in rural areas. The objectives of this study were to assess the discrepancy between SR and UC-verified ETS exposure among rural women employing three measures throughout pregnancy, and to explore predictors related to these differences. This study used a prospective prenatal cohort consisting of 420 pregnant women whose ETS exposure was entirely evaluated by both SR and UC verification across three trimesters of pregnancy. Environmental tobacco exposure was assessed via SR verification, and was validated using the limit of detection for UC. The discrepancy rates were determined for each trimester. Multivariate logistic regression was used to assess the predictors associated with these differences. The discrepancy rates between SR and UC verification were 25.2%, 17.1%, and 20.5% (first, second, and third trimester, respectively). The highest inconsistency occurred in the first trimester. After adjusting for confounding factors, the following variables were found to have statistically significant associations with the discrepancy rate between SR and UC-verified ETS exposure: the number of smokers in the family and household income for all three trimesters, township site for the second and third trimester, and gravidity for the last trimester. The SR rate of ETS exposure among rural pregnant women is underreported, while the UC-verified rate is higher. More smokers in the family and gravidity may increase the risk of ETS exposure for pregnant women. Biochemical validation is warranted throughout pregnancy for the adoption of home-smoking bans and the promotion of community-based smoke-free programs. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
Open AccessArticle
Gender Difference in the Association between Environmental Tobacco Smoke and Birth Weight in Africa
Int. J. Environ. Res. Public Health 2018, 15(7), 1409; https://doi.org/10.3390/ijerph15071409
Received: 12 June 2018 / Revised: 27 June 2018 / Accepted: 30 June 2018 / Published: 4 July 2018
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Abstract
The adverse health effects of exposure to environmental tobacco smoke (ETS) on children are well-documented, and yet, gender difference in low birthweight among newborns whose mothers were exposed to ETS during pregnancy still remains contentious. We therefore explored the association between ETS exposure [...] Read more.
The adverse health effects of exposure to environmental tobacco smoke (ETS) on children are well-documented, and yet, gender difference in low birthweight among newborns whose mothers were exposed to ETS during pregnancy still remains contentious. We therefore explored the association between ETS exposure and risk of low birthweight, and further determined the gender difference in the association between exposure to ETS during pregnancy and birth weight in Africa. The Demographic Health Surveys of 23 African countries with information on 208,027 newborns were used. The associations between exposure to ETS and birth weight was estimated using multiple logistic regression models. Exposure to ETS increased the risk of low birthweight in Africa (adjusted odds ratio (OR) = 1.06; 95% Confidence Interval (CI): 1.02–1.10). A stratified analysis, by gender, revealed that male newborns whose mothers were exposed to ETS were 1.08 (95% CI: 1.02–1.14) times more likely to be low in birthweight than those whose mothers were not exposed, with those exposed weekly (adjusted OR = 1.17; 95% CI: 1.01–1.35) and daily (adjusted OR = 1.06; 95% CI: 1.01–1.12) being more likely to have low birthweight. Exposure to ETS is significantly associated with low birthweight in Africa, mainly among male newborns. Gender could possibly be a modifier, and hence, research on biological plausibility is necessary. Moreover, a public health promotion on behavioral changes is likely to have a positive impact on newborns’ health. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
Open AccessArticle
A Cross-Sectional Study of Smoking Behaviors and Attitudes of Parents in Pediatric Primary Care Settings
Int. J. Environ. Res. Public Health 2018, 15(7), 1384; https://doi.org/10.3390/ijerph15071384
Received: 26 April 2018 / Revised: 17 June 2018 / Accepted: 19 June 2018 / Published: 2 July 2018
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Abstract
Environmental tobacco smoke (ETS) exposure is considered an important public health issue in pediatric population. In this study, we aimed to investigate parents’ knowledge on side effects of passive smoking and counseling for parental smoking among pediatricians and family practitioners. Participants were biological [...] Read more.
Environmental tobacco smoke (ETS) exposure is considered an important public health issue in pediatric population. In this study, we aimed to investigate parents’ knowledge on side effects of passive smoking and counseling for parental smoking among pediatricians and family practitioners. Participants were biological parents of pediatric patients up to the age of 18 years old who attended Pediatric Hospital of Medical University of Warsaw. The questionnaire included 28 questions and queries on environmental tobacco smoke in children’s environment. Medical students identified potential subjects and handed out previously created questionnaires. In total, 506 parents of children aged 0–18 years old were interviewed; 41% (207/506) of parents were smokers, 23% (114/506) were asked about ETS exposure by their pediatricians and 41% (205/506) by family physicians during routine visits. Only a minority of the respondents confirmed having “no smoking” policy in their car 31% (157/506) or in their households 24% (121/506). All parents believed that passive smoking could cause at least one harmful effect: most common were more frequent respiratory infections (43%), asthma (40%), and low birth weight (37%). Among smoking parents, 38% (78/207) has tried to quit smoking for their child’s health sake; 63% (131/207) of smokers have never been asked to quit smoking by their doctor. Parents’ understanding of passive smoking among children differs from current medical knowledge. Rates of screening and counseling for parental smoking in pediatric and family practices are still unsatisfactory. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessArticle
Exposure to Environmental Tobacco Smoke in Relation to Behavioral, Emotional, Social and Health Indicators of Slovak School Children
Int. J. Environ. Res. Public Health 2018, 15(7), 1374; https://doi.org/10.3390/ijerph15071374
Received: 5 May 2018 / Revised: 23 June 2018 / Accepted: 26 June 2018 / Published: 30 June 2018
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Abstract
Environmental tobacco smoke (ETS) exposure has been shown in general as a major environmental risk factor and deserves attention in vulnerable population groups. The aim of the project is to analyze the relationships among the ETS and behavior and health in 6−15-year-old children [...] Read more.
Environmental tobacco smoke (ETS) exposure has been shown in general as a major environmental risk factor and deserves attention in vulnerable population groups. The aim of the project is to analyze the relationships among the ETS and behavior and health in 6−15-year-old children in Slovakia. The status of physical and mental health of children in relation to exposure to tobacco smoke was examined in a representative group of 1478 school children. The methods used, included anonymous questionnaires filled in by parents, Columbia Impairment Scale (CIS), Behavior Problem Index (BPI) and anthropometry. The prevalence of ETS exposure is the highest in the capital (27%) and southern cities. A significant association was found between ETS and age, socio-economic status, incompleteness of the family, level of mother’s education and a higher prevalence of respiratory diseases (26.7%). The relationships of ETS with emotional (CIS scores ≥ 16) and behavioral functions (BPI score ≥ 14) were significant in children exposed to mother’s or father’s smoking at home. In the multivariate analysis these associations were not significant; the factors such as income and completeness of the family were dominant. The results showed mostly the predominant impact of social factors on the physical and mental health status of Slovak school children. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
Open AccessArticle
ETS Exposure and PAH Body Burden in Nonsmoking Italian Adults
Int. J. Environ. Res. Public Health 2018, 15(6), 1156; https://doi.org/10.3390/ijerph15061156
Received: 30 March 2018 / Revised: 28 May 2018 / Accepted: 29 May 2018 / Published: 1 June 2018
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Abstract
Active smoking is associated with increased body burden of polycyclic aromatic hydrocarbons (PAHs); the aim of this study was to assess whether environmental tobacco smoking (ETS) increases the internal dose of PAHs. In 344 nonsmoking Italian adults, out of 497 individuals selected as [...] Read more.
Active smoking is associated with increased body burden of polycyclic aromatic hydrocarbons (PAHs); the aim of this study was to assess whether environmental tobacco smoking (ETS) increases the internal dose of PAHs. In 344 nonsmoking Italian adults, out of 497 individuals selected as representative of the population of the town of Modena, ETS exposure was evaluated by a self-administered questionnaire and by the measurement of urinary cotinine (COT-U). PAH exposure was assessed by the measurement of urinary 1-hydroxypyrene (1-OHPYR) and of ten urinary PAHs. In all subjects, median (5th–95th percentile) COT-U was 0.47 (<0.1–3.91) µg/L. While 58 subjects reported to be ETS exposed (ETSQUEST), 38 individuals were identified as ETS exposed on the basis of a COT-U value of 1.78 (90% confidence interval 1.75–1.80) µg/L, previously derived as an upper reference value in not ETS exposed Italian adults (ETSCOT). Median COT-U levels were 1.38 (<0.1–9.06) and 3.63 (1.80–17.39) µg/L in ETSQUEST and in ETSCOT subjects, respectively. Significant correlations between COT-U and 1-OHPYR, and urinary anthracene, fluoranthene, pyrene, and chrysene were found among all subjects. Significantly higher levels of 1-OHPYR, and urinary fluorene, anthracene, and pyrene were found in ETSCOT individuals. The results of multiple linear regression analyses, taking into consideration diet and other sources of PAHs exposures such as the residence area/characteristics and traffic, confirmed that 1-OHPYR and urinary fluorene were affected by ETS exposure, even if ETS played a minor role. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessArticle
Self-Reported Environmental Tobacco Smoke Exposure and Avoidance Compared with Cotinine Confirmed Tobacco Smoke Exposure among Pregnant Women and Their Infants
Int. J. Environ. Res. Public Health 2018, 15(5), 871; https://doi.org/10.3390/ijerph15050871
Received: 29 March 2018 / Revised: 23 April 2018 / Accepted: 24 April 2018 / Published: 27 April 2018
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Abstract
Background: Exposure to environmental tobacco smoke (ETS) presents substantial health risks for pregnant women and newborn infants. Measurements of ETS include invasive and expensive biochemical tests, as well as less invasive and lower-cost, self-reported exposure and avoidance measures. Better understanding of self-report measures [...] Read more.
Background: Exposure to environmental tobacco smoke (ETS) presents substantial health risks for pregnant women and newborn infants. Measurements of ETS include invasive and expensive biochemical tests, as well as less invasive and lower-cost, self-reported exposure and avoidance measures. Better understanding of self-report measures will help to select ETS assessments for evaluation. Methods: This analysis was conducted within the context of a tailored video intervention to reduce tobacco smoking and ETS exposure during pregnancy and after delivery in the control group sample of 147 nonsmoking women. Measurements of salivary cotinine concentration, self-reported ETS exposure, and avoidance behaviors were captured at 32 weeks’ gestation and 6 months postpartum. Results: Salivary cotinine concentration was significantly related to ETS avoidance among pregnant nonsmokers at 32 weeks’ gestation, but not ETS exposure. At 6 months postpartum, both the reported ETS exposure of the infant and maternal avoidance behaviors to reduce her infant’s exposure were associated with the infant’s salivary cotinine concentration. At 32 weeks’ gestation and 6 months postpartum, avoidance behaviors decreased as exposure increased. Discussion: This study suggests that for nonsmoking women during pregnancy, reports of tobacco smoke avoidance are more valid than reports of exposure. After delivery, self-reported ETS exposure or avoidance are associated with each other and the biochemical measurement of salivary cotinine. These results provide researchers and clinicians with evidence to support the inclusion of avoidance behaviors in the selection of ETS measures. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
Open AccessArticle
Reference Intervals for Urinary Cotinine Levels and the Influence of Sampling Time and Other Predictors on Its Excretion Among Italian Schoolchildren
Int. J. Environ. Res. Public Health 2018, 15(4), 817; https://doi.org/10.3390/ijerph15040817
Received: 20 March 2018 / Revised: 12 April 2018 / Accepted: 17 April 2018 / Published: 21 April 2018
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Abstract
(1) Background: Environmental Tobacco Smoke (ETS) exposure remains a public health problem worldwide. The aims are to establish urinary (u-) cotinine reference values for healthy Italian children, to evaluate the role of the sampling time and of other factors on children’s u-cotinine excretion. [...] Read more.
(1) Background: Environmental Tobacco Smoke (ETS) exposure remains a public health problem worldwide. The aims are to establish urinary (u-) cotinine reference values for healthy Italian children, to evaluate the role of the sampling time and of other factors on children’s u-cotinine excretion. (2) Methods: A cross-sectional study was performed on 330 children. Information on participants was gathered by a questionnaire and u-cotinine was determined in two samples for each child, collected during the evening and the next morning. (3) Results: Reference intervals (as the 2.5th and 97.5th percentiles of the distribution) in evening and morning samples were respectively equal to 0.98–4.29 and 0.91–4.50 µg L−1 (ETS unexposed) and 1.39–16.34 and 1.49–20.95 µg L−1 (ETS exposed). No statistical differences were recovered between median values found in evening and morning samples, both in ETS unexposed and exposed. Significant predictors of u-cotinine excretions were ponderal status according to body mass index of children (β = 0.202; p-value = 0.041 for evening samples; β = 0.169; p-value = 0.039 for morning samples) and paternal educational level (β = −0.258; p-value = 0.010; for evening samples; β = −0.013; p-value = 0.003 for morning samples). (4) Conclusions: The results evidenced the need of further studies for assessing the role of confounding factors on ETS exposure, and the necessity of educational interventions on smokers for rising their awareness about ETS. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessArticle
Urinary Cotinine Concentration and Self-Reported Smoking Status in 1075 Subjects Living in Central Italy
Int. J. Environ. Res. Public Health 2018, 15(4), 804; https://doi.org/10.3390/ijerph15040804
Received: 6 March 2018 / Revised: 13 April 2018 / Accepted: 17 April 2018 / Published: 19 April 2018
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Abstract
Background: Urinary cotinine, a metabolite of nicotine, is a marker of tobacco smoke exposure. A cutoff value for cotinine concentration can be set to distinguish smokers from non-smokers, independently from self-declared status. Method: Cotinine was determined by isotopic dilution High Performance Liquid Chromatography [...] Read more.
Background: Urinary cotinine, a metabolite of nicotine, is a marker of tobacco smoke exposure. A cutoff value for cotinine concentration can be set to distinguish smokers from non-smokers, independently from self-declared status. Method: Cotinine was determined by isotopic dilution High Performance Liquid Chromatography coupled to tandem mass spectrometry (HPLC-MS/MS) between 2013 and 2014 on urine samples of a population of 1075 subjects. Results: 296 subjects have a cotinine level higher than 100 μg/g of creatinine (cutoff), with a median cotinine concentration of 1504.70 μg/g of creatinine. The mean is 27.5% of smokers and 60.5% in this group are females. The median value for non-smokers is 5.6 μg/g of creatinine. Two hundred and seventy-five subjects declared to be smokers in the questionnaire, but 6 (2.2%) present urinary cotinine levels lower than cutoff; 800 subjects declared to be non-smokers, but 26 of them presented urinary cotinine levels that were higher than the cutoff (3.3%). Conclusion: Using the cutoff of 100 μg/g, the misclassification of smokers resulted to be 2.2%, indicating that the selected value is suitable for studying the human exposures to environmental and occupational pollutants, including those produced by smoking. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessArticle
A Stratified Meta-Analysis of the Association between Exposure to Environmental Tobacco Smoke during Childhood and Adulthood and Urothelial Bladder Cancer Risk
Int. J. Environ. Res. Public Health 2018, 15(4), 569; https://doi.org/10.3390/ijerph15040569
Received: 22 February 2018 / Revised: 17 March 2018 / Accepted: 19 March 2018 / Published: 22 March 2018
Cited by 2 | PDF Full-text (7981 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Background: Active smoking is a major risk factor for urothelial bladder cancer (UBC). However, the evidence that exposure to environmental tobacco smoke (ETS) either in childhood or adult life is also associated with UBC risk is ambiguous. With this meta-analysis, we aim [...] Read more.
Background: Active smoking is a major risk factor for urothelial bladder cancer (UBC). However, the evidence that exposure to environmental tobacco smoke (ETS) either in childhood or adult life is also associated with UBC risk is ambiguous. With this meta-analysis, we aim to summarise how exposure to ETS is associated with UBC risk. Methods: In total, 11 studies (3 cohort studies, 8 case-control studies) were included in this meta-analysis and summary odds ratios (SORs) for UBC risk were calculated for never smokers who were exposed to ETS during childhood at home, during adulthood at home, or during adulthood in a work environment compared to never smokers who were never exposed to ETS. Sensitivity analyses were conducted to test the robustness of findings. Results: Never smokers exposed to ETS during childhood (SOR = 1.04, 95% confidence interval (CI) = 0.82–1.26), during adulthood at work (SOR = 0.98, 95% CI = 0.78–1.18) or at home (SOR = 0.99, 95% CI = 0.83–1.15) were at a similar risk of UBC compared to never smokers who were never exposed to ETS. Results for males and females were similar. Also, when pooling all estimates during both childhood and adulthood, no effect was observed (SOR = 1.00, 95% CI = 0.89–1.10). Conclusions: Although measurement of exposure to ETS was imprecise, there does not seem to be an association between UBC risk and exposure to ETS during childhood or adulthood. However, the current body of evidence mostly overlooks the duration and intensity of exposure to ETS. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessArticle
Living with Smoker(s) and Smoking Cessation in Chinese Adult Smokers: Cross-Sectional and Prospective Evidence from Hong Kong Population Health Survey
Int. J. Environ. Res. Public Health 2018, 15(1), 74; https://doi.org/10.3390/ijerph15010074
Received: 19 November 2017 / Revised: 23 December 2017 / Accepted: 27 December 2017 / Published: 5 January 2018
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Abstract
Background: Results on the environmental influence on unassisted quitting are scarce. We investigated the associations of living with smoker(s) with quitting in Chinese adult smokers. Methods: We examined both cross-sectional and prospective data in the Hong Kong Population Health Survey recruited [...] Read more.
Background: Results on the environmental influence on unassisted quitting are scarce. We investigated the associations of living with smoker(s) with quitting in Chinese adult smokers. Methods: We examined both cross-sectional and prospective data in the Hong Kong Population Health Survey recruited participants in 2003/04, and followed up to 2006. Unconditional logistic regression yielded adjusted odds ratios (AORs) of (i) planning to quit, (ii) ex-smoking (cross-sectional), and quitting (prospective) for living with smoker(s). 1679 ever smokers aged 18+ years at baseline, and 323 of them who were successfully followed-up were included in the cross-sectional, and prospective analysis. Results: At baseline, living with smoker(s) was significantly associated with lower odds of planning to quit in current smokers (AOR 0.41, 95% CI 0.25–0.68), and lower odds of ex-smoking (AOR 0.45, 95% CI 0.34–0.58), particularly if the smoker(s) smoked inside home (AOR 0.35, 95% CI 0.26–0.47). Prospectively, living with smoker(s) non-significantly predicted lower odds of new quitting (AOR 0.48, 95% CI 0.13–1.78). Conclusions: Our study has provided the first evidence in a Chinese general population that living with smoker(s) is an important barrier against smoking cessation. To boost quit rate in nonusers of smoking cessation services, smoking at home should be banned, especially for populations living in crowed urban environments that are typical of economically developed cities in China. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessArticle
Nicotine Component of Cigarette Smoke Extract (CSE) Decreases the Cytotoxicity of CSE in BEAS-2B Cells Stably Expressing Human Cytochrome P450 2A13
Int. J. Environ. Res. Public Health 2017, 14(10), 1221; https://doi.org/10.3390/ijerph14101221
Received: 29 July 2017 / Revised: 6 October 2017 / Accepted: 9 October 2017 / Published: 13 October 2017
Cited by 1 | PDF Full-text (4547 KB) | HTML Full-text | XML Full-text
Abstract
Cytochrome P450 2A13 (CYP2A13), an extrahepatic enzyme mainly expressed in the human respiratory system, has been reported to mediate the metabolism and toxicity of cigarette smoke. We previously found that nicotine inhibited 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) metabolism by CYP2A13, but its influence on other components [...] Read more.
Cytochrome P450 2A13 (CYP2A13), an extrahepatic enzyme mainly expressed in the human respiratory system, has been reported to mediate the metabolism and toxicity of cigarette smoke. We previously found that nicotine inhibited 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) metabolism by CYP2A13, but its influence on other components of cigarette smoke remains unclear. The nicotine component of cigarette smoke extract (CSE) was separated, purified, and identified using high-performance liquid chromatography (HPLC) and ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS), splitting CSE into a nicotine section (CSE-N) and nicotine-free section (CSE-O). Cell viability and apoptosis by Cell Counting Kit-8 (CCK-8) and flow cytometry assays were conducted on immortalized human bronchial epithelial (BEAS-2B) cells stably expressing CYP2A13 (B-2A13) or vector (B-V), respectively. Interestingly, CSE and CSE-O were toxic to BEAS-2B cells whereas CSE-N showed less cytotoxicity. CSE-O was more toxic to B-2A13 cells than to B-V cells (IC50 of 2.49% vs. 7.06%), which was flatted by 8-methoxypsoralen (8-MOP), a CYP inhibitor. CSE-O rather than CSE or CSE-N increased apoptosis of B-2A13 cells rather than B-V cells. Accordingly, compared to CSE-N and CSE, CSE-O significantly changed the expression of three pairs of pro- and anti-apoptotic proteins, Bcl-2 Associated X Protein/B cell lymphoma-2 (Bax/Bcl-2), Cleaved Poly (Adenosine Diphosphate-Ribose) Polymerase/Poly (Adenosine Diphosphate-Ribose) Polymerase (C-PARP/PARP), and C-caspase-3/caspase-3, in B-2A13 cells. In addition, recombination of CSE-N and CSE-O (CSE-O/N) showed similar cytotoxicity and apoptosis to the original CSE. These results demonstrate that the nicotine component decreases the metabolic activation of CYP2A13 to CSE and aids in understanding the critical role of CYP2A13 in human respiratory diseases caused by cigarette smoking. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessArticle
Environmental Tobacco Smoke Exposure at Home and High-Sensitivity C-Reactive Protein Levels in Three-to-Five-Year-Old Children
Int. J. Environ. Res. Public Health 2017, 14(10), 1105; https://doi.org/10.3390/ijerph14101105
Received: 8 August 2017 / Revised: 15 September 2017 / Accepted: 19 September 2017 / Published: 23 September 2017
Cited by 1 | PDF Full-text (308 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Exposure to harmful environmental factors is particularly detrimental to younger children. We investigated the relationship between environmental tobacco smoke (ETS) exposure in pre-schoolers at home and the level of high-sensitivity C-reactive protein (hs-CRP), a predictive factor for cardiovascular disease. This study was conducted [...] Read more.
Exposure to harmful environmental factors is particularly detrimental to younger children. We investigated the relationship between environmental tobacco smoke (ETS) exposure in pre-schoolers at home and the level of high-sensitivity C-reactive protein (hs-CRP), a predictive factor for cardiovascular disease. This study was conducted in 2014 and was based on the data of preschool children from the Korean Environmental Health Survey in Children and Adolescents (2012 to 2014), a nationally representative sample. Of 577 children, aged three to five years, 482 were eventually selected for the analysis after excluding those with missing variables, or whose hs-CRP level exceeded the reference value. The proportion of pre-school children exposed to ETS at home was 14.8%. The odd ratios (OR)s of hs-CRP > 1mg/L were 4.90 (95% Confidence Interval (CI) = 1.04–23.17) and 11.66 (95% CI = 1.90–71.65) in the groups exposed to ETS 3–4 times and ≥5 times daily, respectively, compared to the non-exposed group. The risk of elevated levels of hs-CRP showed an increasing trend proportionally to the increase in ETS exposure frequency (p for trend = 0.03). Anti-smoking educational programs for parents and guardians may be helpful to reduce ETS exposure at home. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)

Review

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Open AccessReview
Environmental Tobacco Smoke and Cardiovascular Disease
Int. J. Environ. Res. Public Health 2019, 16(1), 96; https://doi.org/10.3390/ijerph16010096
Received: 7 December 2018 / Revised: 24 December 2018 / Accepted: 24 December 2018 / Published: 31 December 2018
Cited by 1 | PDF Full-text (507 KB) | HTML Full-text | XML Full-text
Abstract
Environmental tobacco smoke (ETS) and its sequelae are among the largest economic and healthcare burdens in the United States and worldwide. The relationship between active smoking and atherosclerosis is well-described in the literature. However, the specific mechanisms by which ETS influences atherosclerosis are [...] Read more.
Environmental tobacco smoke (ETS) and its sequelae are among the largest economic and healthcare burdens in the United States and worldwide. The relationship between active smoking and atherosclerosis is well-described in the literature. However, the specific mechanisms by which ETS influences atherosclerosis are incompletely understood. In this paper, we highlight the definition and chemical constituents of ETS, review the existing literature outlining the effects of ETS on atherogenesis and thrombosis in both animal and human models, and briefly outline the public health implications of ETS based on these data. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessReview
Biomarkers of Exposure to Secondhand and Thirdhand Tobacco Smoke: Recent Advances and Future Perspectives
Int. J. Environ. Res. Public Health 2018, 15(12), 2693; https://doi.org/10.3390/ijerph15122693
Received: 31 August 2018 / Revised: 19 November 2018 / Accepted: 22 November 2018 / Published: 29 November 2018
Cited by 5 | PDF Full-text (1343 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Smoking is the leading preventable disease worldwide and passive smoking is estimated to be the cause of about 1.0% of worldwide mortality. The determination of tobacco smoke biomarkers in human biological matrices is key to assess the health effects related to the exposure [...] Read more.
Smoking is the leading preventable disease worldwide and passive smoking is estimated to be the cause of about 1.0% of worldwide mortality. The determination of tobacco smoke biomarkers in human biological matrices is key to assess the health effects related to the exposure to environmental tobacco smoke. The biomonitoring of cotinine, the main nicotine metabolite, in human biofluids—including urine, serum or saliva—has been extensively used to assess this exposure. However, the simultaneous determination of cotinine together with other tobacco biomarkers and the selection of alternative biological matrices, such as hair, skin or exhaled breath, would enable a better characterization of the kind and extent of tobacco exposure. This review aims to perform a critical analysis of the up-to-date literature focused on the simultaneous determination of multiple tobacco smoke biomarkers studied in different biological matrices, due to the exposure to secondhand smoke (SHS) and thirdhand smoke (THS). Target biomarkers included both tobacco-specific biomarkers—nicotine and tobacco specific nitrosamine biomarkers—and tobacco-related biomarkers, such as those from polycyclic aromatic hydrocarbons, volatile organic compounds, metals and carbon monoxide. To conclude, we discuss the suitability of determining multiple biomarkers through several relevant examples of SHS and THS exposure. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessReview
Meta-Analysis and Systematic Review in Environmental Tobacco Smoke Risk of Female Lung Cancer by Research Type
Int. J. Environ. Res. Public Health 2018, 15(7), 1348; https://doi.org/10.3390/ijerph15071348
Received: 6 June 2018 / Revised: 23 June 2018 / Accepted: 25 June 2018 / Published: 27 June 2018
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Abstract
More than 50% of women worldwide are exposed to Environmental Tobacco Smoke (ETS). The impact of ETS on lung cancer remains unclear. Cohort studies since the late 1990s have provided new evidence of female lung cancer risk due to ETS. The objective of [...] Read more.
More than 50% of women worldwide are exposed to Environmental Tobacco Smoke (ETS). The impact of ETS on lung cancer remains unclear. Cohort studies since the late 1990s have provided new evidence of female lung cancer risk due to ETS. The objective of this meta-analysis and systematic review was to analyze the association of ETS with female lung cancer risk from 1997 to 2017, organised based on research design. According to our applied inclusion and exclusion criteria, 41 published studies were included. The relative risk (RR) from the cohort studies or odds ratio (OR) from case-control studies were extracted to calculate the pooled risks based on the type of study. The summary risks of ETS were further explored with the modulators of ETS exposure sources and doses. The pooled risks of lung cancer in non-smoking women exposed to ETS were 1.35 (95% CI: 1.17–1.56), 1.17 (95% CI: 0.94–1.44), and 1.33 (95% CI: 1.17–1.51) for case-control studies, cohort studies, and both types of studies, respectively. The summary RR estimate of the cohort studies was not statistically significant, but the RR increased with increasing doses of ETS exposure (p trend < 0.05). Based on the results of this study, ETS might be an important risk factor of female lung cancer in non-smokers. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessReview
Tobacco Smoke Induces and Alters Immune Responses in the Lung Triggering Inflammation, Allergy, Asthma and Other Lung Diseases: A Mechanistic Review
Int. J. Environ. Res. Public Health 2018, 15(5), 1033; https://doi.org/10.3390/ijerph15051033
Received: 16 April 2018 / Revised: 8 May 2018 / Accepted: 9 May 2018 / Published: 21 May 2018
Cited by 12 | PDF Full-text (1583 KB) | HTML Full-text | XML Full-text
Abstract
Many studies have been undertaken to reveal how tobacco smoke skews immune responses contributing to the development of chronic obstructive pulmonary disease (COPD) and other lung diseases. Recently, environmental tobacco smoke (ETS) has been linked with asthma and allergic diseases in children. This [...] Read more.
Many studies have been undertaken to reveal how tobacco smoke skews immune responses contributing to the development of chronic obstructive pulmonary disease (COPD) and other lung diseases. Recently, environmental tobacco smoke (ETS) has been linked with asthma and allergic diseases in children. This review presents the most actual knowledge on exact molecular mechanisms responsible for the skewed inflammatory profile that aggravates inflammation, promotes infections, induces tissue damage, and may promote the development of allergy in individuals exposed to ETS. We demonstrate how the imbalance between oxidants and antioxidants resulting from exposure to tobacco smoke leads to oxidative stress, increased mucosal inflammation, and increased expression of inflammatory cytokines (such as interleukin (IL)-8, IL-6 and tumor necrosis factor α ([TNF]-α). Direct cellular effects of ETS on epithelial cells results in increased permeability, mucus overproduction, impaired mucociliary clearance, increased release of proinflammatory cytokines and chemokines, enhanced recruitment of macrophages and neutrophils and disturbed lymphocyte balance towards Th2. The plethora of presented phenomena fully justifies a restrictive policy aiming at limiting the domestic and public exposure to ETS. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Open AccessReview
Clinical Effects of Cigarette Smoking: Epidemiologic Impact and Review of Pharmacotherapy Options
Int. J. Environ. Res. Public Health 2017, 14(10), 1147; https://doi.org/10.3390/ijerph14101147
Received: 27 July 2017 / Revised: 21 September 2017 / Accepted: 22 September 2017 / Published: 28 September 2017
Cited by 6 | PDF Full-text (675 KB) | HTML Full-text | XML Full-text
Abstract
Cigarette smoking—a crucial modifiable risk factor for organ system diseases and cancer—remains prevalent in the United States and globally. In this literature review, we aim to summarize the epidemiology of cigarette smoking and tobacco use in the United States, pharmacology of nicotine—the active [...] Read more.
Cigarette smoking—a crucial modifiable risk factor for organ system diseases and cancer—remains prevalent in the United States and globally. In this literature review, we aim to summarize the epidemiology of cigarette smoking and tobacco use in the United States, pharmacology of nicotine—the active constituent of tobacco, and health consequence of cigarette smoking. This article also reviews behavioral and pharmacologic interventions for cigarette smokers and provides cost estimates for approved pharmacologic interventions in the United States. A literature search was conducted on Google Scholar, EBSCOhost, ClinicalKey, and PubMed databases using the following headings in combination or separately: cigarette smoking, tobacco smoking, epidemiology in the United States, health consequences of cigarette smoking, pharmacologic therapy for cigarette smoking, and non-pharmacologic therapy for cigarette smoking. This review found that efficacious non-pharmacologic interventions and pharmacologic therapy are available for cessation of cigarette smoking. Given the availability of efficacious interventions for cigarette smoking cessation, concerted efforts should be made by healthcare providers and public health professionals to promote smoking cessation as a valuable approach for reducing non-smokers’ exposure to environmental tobacco smoke. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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Other

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Open AccessCommentary
New Challenges: Developing Gendered and Equitable Responses to Involuntary Exposures to Electronic Nicotine Delivery Systems (ENDS) and Cannabis Vaping
Int. J. Environ. Res. Public Health 2018, 15(10), 2097; https://doi.org/10.3390/ijerph15102097
Received: 31 July 2018 / Revised: 12 September 2018 / Accepted: 18 September 2018 / Published: 25 September 2018
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Abstract
Recreational cannabis use is in the process of being legalized in Canada, and new products and devices for both nicotine and cannabis vaping are being introduced. Yet, research on the harms of involuntary exposure to electronic nicotine delivery systems (ENDSs) and cannabis vaping [...] Read more.
Recreational cannabis use is in the process of being legalized in Canada, and new products and devices for both nicotine and cannabis vaping are being introduced. Yet, research on the harms of involuntary exposure to electronic nicotine delivery systems (ENDSs) and cannabis vaping is in its infancy, and there is a lack of investigation on sex-specific health effects and gendered patterns of exposure and use. We argue that responses to ENDS and cannabis vaping exposures should align with policy and progress on restricting exposure to tobacco secondhand smoke (SHS). Furthermore, we argue that sex, gender, and equity considerations should be integrated in both research and policy to benefit all Canadians. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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