We present a theoretical framework for assessment of exposure to environmental tobacco smoke (ETS), and review current methods in order to provide guidelines for different types of studies. Exposure assessment should include both a quantitative dimension and consideration of time-specificity of exposure. The ultimate aim is to measure the concentrations of ETS encountered by an individual for different time periods in various microenvironments. The first step is to identify an indicator of ETS. Personal monitoring of air nicotine and respirable suspended particulates (RSPs) are the most direct assessment methods. Indirect assessment methods include stationary measurements of tobacco smoke constituents in different microenvironments and/or questionnaire-derived information, modelled with time-activity information. Biomarkers, such as nicotine and/or cotinine in body fluids or hair, can be used as surrogate measures of dose, although they are usually affected by individual processes in the body after exposure. The best approach to assess ETS exposure will depend on the aim of the study, the health outcome, and the resources. Personal monitoring of nicotine or RSPs is the best method in studies of short-term health effects with small study samples. Stationary measurements of indoor air nicotine or RSPs are suitable for overall monitoring of ETS in different microenvironments over time. Questionnaires and interviews are suitable when studying health outcomes with a long latency period and rare diseases requiring large study populations. Cotinine in body fluids and nicotine concentration in hair can be used to assess cumulative exposure over days or months, respectively. A combination of different methods is often the best approach.
The evidence of an association between passive smoking and occurrence of respiratory symptoms is relatively strong in children, whereas studies conducted in adult populations have provided inconsistent results. The objective of the present study was to examine the relations between exposure to environmental tobacco smoke (ETS) and development of respiratory symptoms in young adults during a study period of 8 years, with emphasis on the evaluation of potential dose-response pattern of the relations. The study population consisted of 117 "never smokers," who were 15 to 40 years of age at the time of initial examination, when they answered a standardized questionnaire on respiratory health, and who were reexamined 8 years later. ETS exposure at home and at work during the study period was recorded at the 8-year examination with a structured questionnaire. The symptoms studied as outcomes included wheezing, dyspnea, cough, and phlegm production. The relations between ETS exposure and development of respiratory symptoms were studied in multivariate logistic regression models controlling for age, gender, atopy, and the presence of other respiratory symptoms. Cumulative incidences of the respiratory symptoms, except of phlegm production, were consistently greater among subjects exposed to ETS compared with the reference group. A significant dose-related increase in the risk of developing dyspnea was observed in relation to ETS exposure, with an OR of 2.37 for an average exposure of 10 cigarettes/day (95% confidence interval, 1.25-4.51). The risk of developing other respiratory symptoms, apart from phlegm, was also related to ETS exposure, but these relations did not achieve statistical significance. The results provide evidence of adverse respiratory effects of ETS exposure in the home and office work environments in young adults. These findings emphasize the need for effective measures in the prevention of involuntary smoking during young adulthood.
Immunoglobulin G (IgG) antibodies against microbes related to indoor dampness problems have been used as potential biomarkers of fungal exposure in clinical investigations. There is limited information on their relation to asthma. We conducted a population-based incident case-control study to assess the risk of asthma in relation to specific IgG antibodies to eight dampness-related microbes: Aspergillus fumigatus, A. versicolor, Cladosporium cladosporioides, Fusarium oxysporum, Sporobolomyces salmonicolor, Stachybotrys chartarum, Streptomyces albus and Trichoderma citrinoviride. We recruited systematically all new cases of asthma during a 2.5-year study period and randomly selected controls from a source population of adults 21-63 years of age living in the Pirkanmaa Hospital District, South Finland. The clinically diagnosed case series consisted of 521 adults with newly diagnosed asthma and the control series of 932 controls selected randomly from the source population. IgG antibodies were analysed with ELISA. An increased risk of developing asthma in adulthood was significantly related to IgG antibodies to T. citrinoviride, but not to the other moulds. There was no evidence of a dose-response relation between the IgG antibody level and the risk of asthma. T. citrinoviride may play a role in the aetiology of adult-onset asthma or serve as an indicator of other causal factors.
Cites: Am J Epidemiol. 1999 Dec 1;150(11):1223-810588083
Cites: Inflamm Res. 1998;47 Suppl 1:S5-69561390
Cites: Occup Environ Med. 2000 Jul;57(7):458-6410854498
Cites: Indoor Air. 2000 Sep;10(3):138-4510979195
Cites: Environ Health Perspect. 2002 May;110(5):543-712003761
This article aimed to estimate the mortality from exposure to passive smoking at work in Finland. The estimation used statistics on causes of death, exposure prevalences, and risk ratios from epidemiologic studies. The attributable fractions of cause-specific mortality from passive smoking at work were 2.8% for lung cancer, 1.1% for chronic obstructive pulmonary disease, 4.5% for asthma, 3.4% for ischemic heart disease, and 9.4% for cerebrovascular stroke. Altogether, about 250 fatalities were estimated to have occurred in 1996. This is approximately 0.9% of the total mortality in the Finnish population in the relevant disease and age categories. The magnitude of mortality related to past occupational exposure to passive smoking is considerable. Preventive measures to reduce environmental tobacco smoke in the workplace will be a powerful means of reducing the high burden of respiratory and cardiovascular diseases.
The Helsinki Office Environment Study, a population-based cross-sectional study was carried out in Finland in 1991 among 2,678 workers in 41 randomly selected office buildings. The aim was to evaluate the relations between work with office equipment and supplies and the occurrence of eye, nasopharyngeal, skin, and general symptoms (often denoted as sick building syndrome (SBS)), chronic respiratory symptoms, and respiratory infections. Work with self-copying paper was significantly related to weekly work-related eye, nasopharyngeal, and skin symptoms, headache and lethargy, as well as to the occurrence of wheezing, cough, mucus production, sinusitis, and acute bronchitis. Photocopying was related to nasal irritation, and video display terminal work to eye symptoms, headache, and lethargy.
Comment In: Am J Epidemiol. 2000 Sep 15;152(6):593-410997550
The purpose of this study was to examine the relation between development of respiratory symptoms and the rate of change in ventilatory lung function in young adults during a study period of 8 yr. The study population consisted of 391 subjects who were 15 to 40 yr of age at initial examination, when they underwent spirometry and an interviewer-administered ATS-DLD-78-A questionnaire on respiratory health, and who were reexamined 8 yr later. The association between the development of symptoms and the rate of change in FEV1 over time (delta FEV1, ml/yr) was studied in a linear regression model that included the potential confounders and other determinants of the outcome. The presence of modification by such factors as smoking, childhood exposure to environmental tobacco smoke, gender, or atopy was assessed by the significance of interaction terms between potential modifiers and incident symptoms. Subjects who developed wheezing and dyspnea and in whom a doctor diagnosed asthma had a significantly greater average annual change in FEV1 compared with those without respiratory symptoms or asthma (-12.3 ml/yr, SE 5.0; -16.2 ml/yr, SE 5.5; and -42.6 ml/yr, SE 11.5, respectively). When focusing on subjects without a diagnosis of asthma, the associations with appearance of wheezing and dyspnea remained significant. The associations were in general stronger in never smokers compared with smokers and were strongest in ex-smokers. The presence of atopy was a significant modifier, so that in subjects with atopy there was a stronger negative association between the onset of cough and asthma and delta FEV1 than in those without.(ABSTRACT TRUNCATED AT 250 WORDS)
We studied the effects of age, body mass index (BMI) and some common laboratory test results on several pulmonary CT/HRCT signs. Five hundred twenty-eight construction workers (age 38-80, mean 63 years) were imaged with spiral and high resolution CT. Images were scored by three radiologists for solitary pulmonary nodules, signs indicative of fibrosis and emphysema, ground glass opacities, bronchial wall thickness and bronchiectasis. Multivariate statistical analyses were adjusted for smoking and asbestos exposure. Increasing age, blood haemoglobin value and erythrocyte sedimentation rate correlated positively with several HRCT signs. Increasing BMI was associated with a decrease in several signs, especially parenchymal bands, honeycombing, all kinds of emphysema and bronchiectasis. The latter finding might be due to the suboptimal image quality in obese individuals, which may cause suspicious findings to be overlooked. Background data, including patient's age and body constitution, should be considered when CT/HRCT images are interpreted.
This study sought to evaluate the short-term impact of national smoke-free workplace legislation on employee exposure to environmental tobacco smoke at work and on employee smoking habits.
We performed 2 cross-sectional studies in 9 medium-sized and large Finnish workplaces, before and after implementation of national smoke-free workplace legislation. We assessed tobacco smoke exposure via questionnaire and indoor air nicotine measurements.
Exposure to environmental tobacco smoke declined considerably after the legislation was implemented. Tobacco consumption among smokers diminished. Nicotine concentrations fell significantly.
Legislation was more efficient than voluntary workplace-specific smoking restrictions in reducing passive smoking and cigarette consumption.
This study examined determinants of and trends in smoking during pregnancy in Finland from 1987 through 1997.
A repeated cross-sectional investigation of 694,926 women was conducted.
The prevalence of smoking during pregnancy remained similar from 1987 through 1997 (at 15%). In 1997, prevalences of smoking were alarmingly high among young (37%), single (30%), and less educated (25%) women and among women living in northern (20%) and eastern (19%) Finland. These determinants were persistent over time, with the exception of an increase in regional differences.
Despite increasing knowledge of adverse effects, smoking during pregnancy has not declined in Finland over the past decade.
Cites: BMJ. 1998 Sep 12;317(7160):7289732341
Cites: Bull World Health Organ. 1987;65(5):663-7373322602