Secondhand Smoke Exposure in Lao People’s Democratic Republic: Results From the 2015 National Adult Tobacco Survey

Objectives: Second-hand smoke (SHS) exposure causes >600,000 deaths annually worldwide, however, information regarding SHS exposure in Lao People’s Democratic Republic (Lao PRD) is limited; we report SHS exposure prevalence at home, inside workplaces, and indoor public spaces in Lao PDR.Methods: Data were from the 2015 Lao National Adult Tobacco Survey, a nationally representative sample of 7,562 participants aged ≥15 years recruited through a stratified 2-stage cluster sampling approach.Results: 88.3% (83.9% of non-smokers) reported SHS exposure at home and 63.0% (54.0% of non-smokers) at workplaces. Among non-smokers, women had greater exposure at home than men (86.6 vs. 77.0%). Lower education levels were associated with exposure at home or the workplace. 99.2% reported SHS exposure at any public place; specifically for restaurants/food stores 57.7%, government offices 56.2%, public transport 31.6%, and health care facilities 11.7%.Conclusion: SHS exposure at home and workplace in Lao PDR is among the highest in South-East Asia. Comprehensive smoke-free policies at government-owned workplaces and facilities, stricter enforcement of these smoke-free policies, and strategies to encourage smoke-free environments at homes and in public places are urgently needed.

SMOKING BEHAVIORS AND ATTITUDES TOWARDS THE SMOKE-FREE CAMPUS POLICY: A SYSTEMATIC REVIEW

We conducted this systematic review to document the published literature related to smoking behaviors and attitudes towards the smoke-free campus policy. Studies on universities that had implemented the smoke-free campus policy were included in this review. The search for published articles from January 2010 to December 2020 involved three main electronic databases: Ovid MEDLINE, ScienceDirect, and Scopus. We searched the databases with the following Boolean string: [(smoke-free OR tobacco-free) AND (campus OR university OR college) AND (knowledge* OR attitude* OR practice*)]. Seventeen studies were included in this review. The majority (n = 8) were from the United States, followed by Saudi Arabia (n = 2) and one each from Israel, Lebanon, Australia, Canada, the United Kingdom, Spain, and China. Eight studies reported a positive impact of the policy on smoking behavior (plan to quit smoking, attempt to quit smoking, reduce smoking). However, 11 studies reported that respondents were still exposed to second-hand smoke and that cigarette butts were still scattered around the university area. Nine studies reported negative attitudes towards smoking, and seven of 12 studies reported positive attitudes towards the policy. Overall, the smoke-free campus policy had mixed impacts. Nevertheless, we found that attitude towards a smoke-free campus and smoking behavior has a good impact.

Association Between Second Hand Smoke (SHS) Exposure In Pregnant Women And Their Socioeconomic Status (SES) And Its Interaction With Age: A Cross-Sectional Study In Urban Areas

Background: The high rate of second hand smoke (SHS) exposure puts pregnant women at risk of various harms and identify relevant influence factors are vital for primary prevention. The study aimed to explore the effect of individual socioeconomic status (SES) on exposure to SHS exposure among pregnant women.Methods: A total of 678 non-smoker pregnant women from 14 communities of Hengyang city, Hunan province of China were recruited in this survey. A self-designed structural questionnaire was used to collect variables. Exposure to SHS was defined as self-reported smoking habit of spouse/partner. The individual SES consisted of martial status, educational attainment, employment and per-capita monthly income.Results: There were 238 (35.1%) participants suffered from SHS exposure during pregnancy. After adjusted for confounding variables, compared to the pregnant women who were employed, others were unemployed were more likely to suffer from SHS exposure (OR= 1.697; 95%CI: 1.102-2.614). Similarly, those women who had high school or technical secondary school education level were associated with SHS exposure compared with college or above education attachment (OR: 1.577, 95%CI: 1.020-2.437). The interaction effects between age and junior middle school or below educational attainment (OR: 1.131, 95%CI: 1.015-1.261), unstable marriage (OR: 1.380, 95%CI: 1.075-1.772) on SHS exposure was detected.Conclusion: Exposure to SHS was very common among pregnant women. Those pregnant women of low level of SES should considered as key population to implement public health intervention. Pregnant women of unstable martial status with older age were more likely to SHS exposure.

Second-hand smoking, hypertension and cardiovascular risk: findings from Peru

Background Second-hand smoking has not been detailedly studied in Peru, where smoking is prohibited in all indoor workplaces, public places, and public transportation. Second-hand smoke exposure may occur at home or any other places. This study aimed to estimate the prevalence of second-hand smoking and assess its association with hypertension and cardiovascular risk in Peru. Materials and methods Secondary analysis of a nationally-representative population-based survey including individuals aged 18–59 years. There were two outcomes: hypertension and 10-year cardiovascular risk using the Framingham and the 2019 World Health Organization (WHO) risk scores. The exposure was self-reported second-hand smoking during the 7 days before the survey. The association between second-hand smoking and hypertension was quantified with Poisson models reporting prevalence ratio (PR) and 95% confidence interval (95% CI); the association between second-hand smoking and cardiovascular risk was quantified with linear regressions reporting coefficients and their 95% CI. Results Data from 897 individuals, mean age: 38.2 (SD: 11.8) years, and 499 (55.7%) females, were analyzed, with 8.7% subjects reporting second-hand smoking at home and 8.3% at work or any other place. Thus, 144 (15.5%; 95% CI: 12.8%-18.6%) subjects reported any second-hand smoking. In multivariable model second-hand smoking was associated with hypertension (PR = 2.42; 95% CI: 1.25–4.67), and with 1.2% higher Framingham cardiovascular risk, and 0.2% higher 2019 WHO risk score. Conclusions There is an association between second-hand smoking and hypertension as well as with cardiovascular risk, and 15% of adults reported second-hand smoke exposure overall with half of them exposed at home. There is a need to guarantee smoking-free places to reduce cardiovascular risk.

Exposure to second-hand smoke during early life and subsequent sleep problems in children: a population-based cross-sectional study

Background Previous studies have revealed that current secondhand smoke exposure showed highly suggestive evidence for increased risk of simultaneous sleep problems in children. Data on the associations between early-life exposure to SHS with subsequent sleep problems in children were scarce. We aimed to evaluate the associations of early-life SHS exposure with sleep problems in children. Methods In this cross-sectional study, children were recruited from elementary and middle schools in Liaoning Province, China between April 2012 and January 2013. We assessed early-life SHS exposure (pregnancy and the first 2 years of life) via questionnaires. Sleep problems and different types of sleep-related symptoms were measured based on the validated tool of the Sleep Disturbance Scale for Children (SDSC). Generalized linear mixed models were applied to estimate the associations of early-life SHS exposure with sleep problems. Results We included a total of 45,562 children (22,657 [49.7%] males; mean [SD] age, 11.0 [2.6] years) and 6167 of them (13.5%) were exposed to early-life SHS during both pregnancy and the first 2 years of life. Compared with unexposed counterparts, children exposed to early-life SHS had higher total T-scores of SDSC (β = 4.32; 95%CI: 4.06, 4.58) and higher odds of increased sleep problems (OR = 2.14; 95%CI: 1.89, 2.42). When considering different sleep-related symptoms, the associations between early-life SHS exposure and symptom of sleep-wake transition disorders (i.e., bruxism) were the strongest in all analyses. Conclusions Early-life SHS exposure was associated with higher odds of global sleep problems and different sleep-related symptoms in children aged 6–18 years. Our findings highlight the importance to strengthen efforts to support the critical importance of maintaining a smoke-free environment especially in early life.

Mmp12 Is Upregulated by in utero Second-Hand Smoke Exposures and Is a Key Factor Contributing to Aggravated Lung Responses in Adult Emphysema, Asthma, and Lung Cancer Mouse Models

Matrix metalloproteinase-12 (Mmp12) is upregulated by cigarette smoke (CS) and plays a critical role in extracellular matrix remodeling, a key mechanism involved in physiological repair processes, and in the pathogenesis of emphysema, asthma, and lung cancer. While cigarette smoking is associated with the development of chronic obstructive pulmonary diseases (COPD) and lung cancer, in utero exposures to CS and second-hand smoke (SHS) are associated with asthma development in the offspring. SHS is an indoor air pollutant that causes known adverse health effects; however, the mechanisms by which in utero SHS exposures predispose to adult lung diseases, including COPD, asthma, and lung cancer, are poorly understood. In this study, we tested the hypothesis that in utero SHS exposure aggravates adult-induced emphysema, asthma, and lung cancer.Methods: Pregnant BALB/c mice were exposed from gestational days 6–19 to either 3 or 10mg/m3 of SHS or filtered air. At 10, 11, 16, or 17weeks of age, female offspring were treated with either saline for controls, elastase to induce emphysema, house-dust mite (HDM) to initiate asthma, or urethane to promote lung cancer. At sacrifice, specific disease-related lung responses including lung function, inflammation, gene, and protein expression were assessed.Results: In the elastase-induced emphysema model, in utero SHS-exposed mice had significantly enlarged airspaces and up-regulated expression of Mmp12 (10.3-fold compared to air-elastase controls). In the HDM-induced asthma model, in utero exposures to SHS produced eosinophilic lung inflammation and potentiated Mmp12 gene expression (5.7-fold compared to air-HDM controls). In the lung cancer model, in utero exposures to SHS significantly increased the number of intrapulmonary metastases at 58weeks of age and up-regulated Mmp12 (9.3-fold compared to air-urethane controls). In all lung disease models, Mmp12 upregulation was supported at the protein level.Conclusion: Our findings revealed that in utero SHS exposures exacerbate lung responses to adult-induced emphysema, asthma, and lung cancer. Our data show that MMP12 is up-regulated at the gene and protein levels in three distinct adult lung disease models following in utero SHS exposures, suggesting that MMP12 is central to in utero SHS-aggravated lung responses.

Second-Hand Smoke Exposure inside the House and Adverse Birth Outcomes in Indonesia: Evidence from Demographic and Health Survey 2017

Objectives: Second-hand Smoke (SHS) during pregnancy among non-smoking women associates with mortality and morbidity risks in their infants. However, little is known about the SHS inside the house and the adverse birth outcomes. This study aims to assess the prevalence, level, and frequency of SHS exposure inside the house and investigate their associations with birth outcomes. Methods: We use the Indonesian Demographic and Health Survey (IDHS) 2017, a large-scale nationally representative survey. Women aged 15 to 49 years who had given birth in the last five years before the study and their husbands were interviewed (n=19,935). Three dependent variables included Low Birth Weight (LBW), size at birth, and birth weight. Results: Seventy-eight percent of mothers exposed to SHS inside home, of whom 7.2% had LBW children. Compared to non-SHS exposure mothers, those exposed to SHS were younger, had first birth before 20 years old, married, lower educated, non-worker, lived in rural, grand multipara, had pollution from cooking fuel, cook in a separate building, had higher risk of delivering lower birth weight (aOR=1.16, 95% CI: 1.02, 1.33), and smaller baby (aOR=1.51, 95%CI: 1.35, 1.69), even after the controlling for the covariates. We identified the inverted U-shaped association for SHS exposure frequency. Similar risk was also observed among mothers exposed with SHS on a daily basis compared to those who are not exposed. Conclusion: Exposure to SHS inside home was significantly associated with LBW and size at birth. Given the high smoking prevalence, relevant policy and health promotion are needed.

Change in exposure of children to second-hand smoke with impact on children’s health and change in parental smoking habits after smoking ban in Bavaria – a multiple cross-sectional study

Background Concerns about smoking displacement from public places to private amenities aroused following smoking ban implementation in Bavaria in 2008. We analysed children’s exposure to second-hand smoke (SHS) before and after the ban, its effect on children’s health and prevalence of active smoking in adults. Methods Six cross-sectional surveys (n = 32,443) on pre-school children in Bavaria were analysed, two surveys before the smoking ban in years 2004 and 2005 (S1 and S2) and four after the ban in 2008, 2012, 2014 and 2016 (S4, S6, S7 and S8). Using multivariable logistic regression, we analysed change in children’s intra- and extrauterine SHS exposure and its adverse health effects (Asthma, wheezing, bronchitis and neurodermatitis) as well as change in parental active smoking. Results The response rates were 78% for S1, 73% for S2, 61% for S4, 62% for S6, 56% for S7 and 54% for S8. Odds of parents never smoked at home in presence of children increased significantly from before to after the ban with odds ratios (OR) 1.17 (CI95% 1.01–1.35), 1.65 (CI95% 1.39–1.95), 2.85 (CI95% 2.32–3.51), 2.24 (CI95% 1.84–2.72) and 3.66 (CI95% 2.89–4.63) for S2, S4, S6, S7 and S8, respectively with S1 as reference. Compared to S4, odds of parents who were not actively smoking is significantly higher in S7 (OR = 1.13 (CI95% 1.03–1.24)) and S8 (OR = 1.24 (CI95% 1.13–1.36)). The odds of mothers who never smoked during pregnancy increased over time with OR = 1.22 (CI95% 1.06–1.40) for S2 and 1.57 (CI95% 1.33–1.86) for S8 compared to S1. Adverse health effects related to children’s exposure to SHS are significantly less in S8 compared to S1. Conclusion After 11 years of smoking ban in Bavaria, smoking displacement to homes was disproved. Exposure of children to SHS intrauterine and at home is decreasing. Number of parents who are not actively smoking is increasing over time. Prevalence of health problems in children related to exposure to SHS is decreasing.

“Everything the hujur tells is very educative but if I can’t not apply those in my own life then there is no meaning”: A mixed-methods process evaluation of a smoke-free homes intervention in Bangladesh.

Background Exposure to second-hand smoke from tobacco is a major contributor to global morbidity and mortality. A cluster RCT in Bangladesh concluded a community-based smoke-free home (SFH) intervention delivered in mosques, with or without indoor air quality (IAQ) feedback to households was neither effective nor cost-effective compared to no intervention. This paper presents the process evaluation embedded within the trial. Methods A mixed method process evaluation comprising interviews with 30 household leads and six imams, brief questionnaire administered to 848 household leads, fidelity assessment of intervention delivery in six mosques and research team records. Data sets were triangulated using meta-themes informed by three process evaluation functions: implementation, mechanisms of impact and context. Results IMPLEMENTATION: The frequency of SFH intervention delivery was judged moderate to good. However there were mixed levels of intervention fidelity and poor reach. Ayahs-messages targeting SHS attitudes were most often fully implemented and had greatest reach (with social norms). Frequency and reach of IAQ feedback intervention were good. MECHANISMS OF IMPACT: Both interventions had good acceptability. However, views on usefulness of the interventions were mixed. Only half of households reported achieving a SFH home at 3-months follow-up. Individual drivers to behaviour change were new SFH knowledge with corresponding positive attitudes, social norms and intentions. Individual barriers were a lack of self-efficacy and plans. CONTEXT: Social context drivers to SFH intervention implementation in mosques were in place and important. No context barriers to implementation were reported. Social context drivers to SHS behaviour change were children’s requests. Barriers were a reluctance to request visitors to smoke outside. (Not) having somewhere to smoke outside was a physical context (barrier) and driver. Conclusions Despite detailed development and adaption work with relevant stakeholders, the SFH and IAQ interventions became educational interventions that were motivational but insufficient to overcome significant context barriers to SHS behaviour change. Embedding these interventions into community wide strategies that include practical cessation support and enforcement of SFH legislation is needed.