Analytical Approaches and Trends in the Determination of Psychoactive Drugs in Air

Understanding of the levels of psychoactive drugs in air is important for assessing both occupational and environmental exposure. Intelligence on the usage and manufacture of illegal drugs can also be gained. Environmental analysis and determination of air quality has recently expanded from its traditional focus to new pollutant categories that include illicit and psychoactive drugs. This is attributed to a greater part on the development of new, advanced techniques, such as liquid chromatography/mass spectrometry (LC/MS), allowing for the trace determination of such compounds down to the parts-per-trillion (ng/L) levels generally reported in air. Studies have also investigated the effects of firsthand and secondhand smoking of drugs, such as cocaine, cannabis and opium. Generally, these have shown secondhand smoke effects to be limited, apart from in the case of opium. Some studies have highlighted ill effects resulting through the exposure of vapors and dusts from the storage of drugs, but this has been shown to result from mould and other fungal contaminates. Investigations into the possible occupational exposures resulting from the use of anesthetic drugs in surgery and accident and emergency have focused on nitrous oxide, sevoflurane, methoxyflurane, isoflurane, propofol and fentanyl. This review focuses on developments and applications for the determination of psychoactive drugs in air.

Parental Perceptions and Behaviors about Children’s Exposure to Secondhand Smoke in Portugal

One of the sustainable development goals adopted by the United Nations is to ensure healthy lives and promote well-being for all. Tobacco consumption is a serious health problem that affects smokers and non-smokers exposed to secondhand smoke (SHS), particularly children. This study aims to describe parental perceptions of smoke-free rules, to analyze parental awareness about health risks associated with children’s exposure to SHS, and to describe the prevalence of avoidance behaviors related to tobacco smoke, according to parental smoking status. This study includes 1175 parents from a representative sample of 1511 Portuguese children aged 4 to 9 years old in 2016. Parents who were non-smokers reported a higher level of agreement regarding smoke-free rules at home, inside the car, at playgrounds, and near the school entrance than smokers. A higher percentage of nonsmoking parents agreed that children whose parents smoke at home are more likely to become smokers themselves. Nonsmoking parents reported adopting more avoidance behaviors regarding exposure to SHS. The findings indicate that parental exposure perceptions and avoidance behaviors towards SHS were lower and less frequent among smokers. Health education, smoking cessation programs and smoking bans are needed to raise parental awareness and to protect children from SHS exposure.

Secondhand Smoke Exposure during Childhood and Cancer Mortality in Adulthood among Never Smokers: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk

We examined whether secondhand smoke exposure during childhood was associated with cancer mortality in adulthood among never smokers. In the Japan Collaborative Cohort Study, we analyzed data from 45,722 Japanese lifetime non-smokers who were aged 40–79 years with no history of cancer at the baseline (1988–1990) and completed a lifestyle questionnaire including the number of family members who smoked at home during their childhood (0/1/2/3+ members). The Cox proportional hazards model and competing risk regression were used to calculate the multivariable hazard ratios (HRs) and subdistribution hazard ratios (SHRs) with 95% confidence intervals (CIs) of all and site-specific cancer mortality, according to the number of smoking family members during the participant’s childhood after adjusting for potential confounding factors. During the median follow-up of 19.2 years, a total of 2,356 deaths from cancer were documented. Secondhand smoke exposure was positively associated with the risk of mortality from pancreatic cancer in adulthood; the multivariable HR of 3+ smoking family members was 2.32 (95% CI: 1.14, 4.72), compared with 0 members. The associations were not evident for the risks of total or other types of smoking-related cancers. In conclusion, secondhand smoke exposure during childhood was associated with an increased risk of mortality from pancreatic cancer in adulthood.

Machine learning models of tobacco susceptibility and current use among adolescents from 97 countries in the Global Youth Tobacco Survey, 2013-2017

Adolescents are particularly vulnerable to tobacco initiation and escalation. Identifying factors associated with adolescent tobacco susceptibility and use can guide tobacco prevention efforts. Novel machine learning (ML) approaches efficiently identify interactive relations among factors of tobacco risks and identify high-risk subpopulations that may benefit from targeted prevention interventions. Nationally representative cross-sectional 2013–2017 Global Youth Tobacco Survey (GYTS) data from 97 countries (28 high-income and 69 low-and middle-income countries) from 342,481 adolescents aged 13–15 years (weighted N = 52,817,455) were analyzed using ML regression tree models, accounting for sampling weights. Predictors included demographics (sex, age), geography (region, country-income), and self-reported exposure to tobacco marketing, secondhand smoke, and tobacco control policies. 11.9% (95% CI 11.1%-12.6%) of tobacco-naïve adolescents were susceptible to tobacco use and 11.7% (11.0%-12.5%) of adolescents reported using any tobacco product (cigarettes, other smoked tobacco, smokeless tobacco) in the past 30 days. Regression tree models found that exposure or receptivity to tobacco industry promotions and secondhand smoke exposure predicted increased risks of susceptibility and use, while support for smoke-free air policies predicted decreased risks of tobacco susceptibility and use. Anti-tobacco school education and health warning messages on product packs predicted susceptibility or use, but their protective effects were not evident across all adolescent subgroups. Sex, region, and country-income moderated the effects of tobacco promotion and control factors on susceptibility or use, showing higher rates of susceptibility and use in males and high-income countries, Africa and the Americas (susceptibility), and Europe and Southeast Asia (use). Tobacco policy-related factors robustly predicted both tobacco susceptibility and use in global adolescents, and interacted with adolescent characteristics and other environments in complex ways that stratified adolescents based on their tobacco risk. These findings emphasize the importance of efficient ML modeling of interactions in tobacco risk prediction and suggest a role for targeted prevention strategies for high-risk adolescents.

Quality Improvement Approach to Increase Inpatient Pediatric Secondhand Smoke Exposure Screening

BACKGROUND: Secondhand smoke exposure (SHSe) is highly prevalent among children and has numerous adverse health effects. Consistent screening for SHSe is an essential first step to helping families break the toxic cycle of smoking. METHODS: With this quality improvement project, we evaluated a SHSe screening and cessation resource distribution protocol in a general pediatrics inpatient unit of a safety-net hospital. Our primary outcome measure was the percent of admissions screened for SHSe, with a goal of increasing our documented rate of SHSe screening from 0% to 70% within 6 months of implementation. Our secondary outcome measure was the percent of those who screened positive for SHSe who were offered smoking cessation resources. Process measures included tracking nurse confidence in screening and compliance with new workflow training. Balancing measures were nurse satisfaction and brevity of screening. RESULTS: From May 1, 2019, to April 30, 2020, nurses screened 97.2% of the 394 patients admitted to the pediatric unit for SHSe. Of the patients screened, 15.7% were exposed to cigarettes or other tobacco products, 5.6% to e-cigarettes, and 6.5% to marijuana. Nurses documented offering “Quit Kits” with cessation materials to 45 caregivers (72.6% of positive screen results) and offering 33 referrals to the California Smokers' Helpline (53.2% of positive screen results). CONCLUSION: In this project, we successfully implemented a screening protocol for SHSe to tobacco, e-cigarettes, and marijuana and a workflow for cessation resource distribution in an inpatient pediatric setting that far exceeded goals. Requiring minimal maintenance and using just a simple paper-based format, the workflow could be adopted at other institutions.

Factors Related to Adolescent Smoking: A Nationally Representative Cross-Sectional Study in Thailand

Objective: This study aimed to explore the individual, familial, and social factors associated with different smoking status in Thai adolescents from the 2017 Cigarette Smoking and Alcohol Drinking Behavior Survey (CSAD) Methods: The nationally representative sample of 6046 adolescents aged 15-19 years who took part in the 2017 CSAD in Thailand. Multinomial logistic regression analysis was conducted to explore the associations between the individual, familial, and social factors and different smoking status. Results: The daily smoking and occasional smoking was 6.4% and 3.3%, respectively. Gender, alcohol use, substance use, attitudes toward smoking, exposure to secondhand smoke at home, anti-smoking social media campaign, and graphic warning labels were related to both daily and occasional smoking. Daily smoking was associated with exposure to secondhand smoke at school, restaurant, and public transport, and exposure to tobacco advertising. Conclusion: These findings suggest that smoking prevention intervention should particularly focus on these factors and also need to develop the anti-smoking policies for smoking prevention among adolescents.