Exposure to environmental tobacco smoke and risk of lung cancer: the epidemiological evidence

Trédaniel, Jean; Boffetta, Paolo; Saracci, Rodolfo; Hirsch, A

doi:10.1183/09031936.94.07101877

Cited by 54 publications

(53 citation statements)

References 85 publications

(135 reference statements)

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“…The effects are further divided into established effects and those for which there is strong, limited or controversial evidence. This classification was decided upon by the authors on the basis of judgement in previous reviews [2,5,6,45,[75][76][77][78][79]. For some health outcomes, relevant evidence has been reported recently and, in these cases, more recent references have been included [46,47,[80][81][82].…”

Section: Health Effects Of Etsmentioning

confidence: 99%

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Assessment of exposure to environmental tobacco smoke

Jaakkola¹,

Jaakkola²

1997

Eur Respir J

237

221

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Since the early 1980s, there has been growing concern about potential adverse health effects related to exposure to environmental tobacco smoke (ETS). Evidence has accumulated on ill-health associated with ETS, and such exposure has now been documented among children and adults in many countries [1][2][3][4][5][6][7][8]. A major difficulty in studying the ill-health effects of ETS has been assessing exposure, since this may occur in multiple settings with highly variable concentrations and exposure profiles may vary considerably during different age periods. Accurate and precise exposure assessment is crucial, since health effects of ETS are likely to be relatively small in magnitude. Appropriate exposure assessment is also needed for inferring causality and for risk assessment. In addition, exposure assessment is obviously necessary for development of preventive strategies.The purpose of this paper is to present a theoretical framework for assessment of exposure to ETS, and to review current methods of exposure assessment in order to provide guidelines for choice of appropriate methods for different types of study. General definitions and concepts of exposure and its assessment will be presented, followed by definitions and components of ETS. The principles for assessment of ETS exposure will then be presented. Current methods of assessment will be reviewed in terms of their advantages and disadvantages, followed by a very brief summary of the ill-health effects of ETS. This allows the criteria for selection of the appropriate method of assessing ETS exposure to be set in context, and to be formulated as user guidelines. Definitions of concentration, exposure and dose ConcentrationConcentration is the amount of a contaminant at a particular location in a particular medium [9]. For example, for an air pollutant it is the amount of the material contained in a specified volume of air. Air pollutant concentrations are usually expressed as mass per unit volume, e.g. µg·m -3 , and gaseous pollutants may also be expressed as a mixing ratio with air, e.g. parts per million (ppm) by volume. Air pollutant concentrations vary in time and space. ExposureExposure is defined as the contact of pollutant with a susceptible surface of the human body [9][10][11]. For ETS, this means contact with the eyes, the epithelium of the nose, mouth and throat, and the lining of the airways and alveoli. With respect to time, there are a number of possible formulations, including instantaneous exposure, peak exposure, average exposure over a specified time period, and cumulative exposure [11]. 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 ...

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Section: Health Effects Of Etsmentioning

confidence: 99%

“…A considerable amount of evidence relating ETS exposure to adverse health effects has accumulated since the 1970s [2,5,6,[73][74][75][76][77][78][79]. Some health effects are fairly well established, whereas many suggested effects require further investigation.…”

Section: Health Effects Of Etsmentioning

confidence: 99%

Assessment of exposure to environmental tobacco smoke

Jaakkola¹,

Jaakkola²

1997

Eur Respir J

237

221

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“…3 Studies have reported that such passive smokers have their risk of developing lung cancer increased by 20 to 30 %. 4 The present study therefore had the aim of assessing the main obstetric and perinatal effects of active, passive or activepassive smoking occurring in the maternity ward of a public hospital in São Paulo.…”

Section: Introductionmentioning

confidence: 99%

Obstetric and perinatal effects of active and/or passive smoking during pregnancy

Nakamura¹,

Alexandre²,

Santos³

et al. 2004

Sao Paulo Med. J.

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CONTEXT: Cigarette smoke, whether inhaled voluntarily or not, causes damage to the mother-infant pair. The antenatal period may present the best opportunity for performing effective anti-smoking campaigns. OBJECTIVE: To study the obstetric and perinatal effects of smoking on pregnancy and the infant. TYPE OF STUDY: Prospective study, interviewing pregnant women who were randomly selected at the maternity hospital as they were being discharged after giving birth. SETTING: Hospital Municipal Vereador José Storópolli, São Paulo, Brazil. METHODS: 758 patients were interviewed regarding smoke inhalation before being discharged from the maternity hospital. The groups were formed by 42 active smokers, 272 passive smokers, 108 who inhaled smoke both actively and passively, and 336 non-smokers. The groups were compared regarding age, parity, school education, incidence of spontaneous abortion, rate of caesarian births, average gestational age at birth, rate of low birth weight and adequacy of weight in relation to the gestational age of newborn infants. For all variables we considered p < 0.05 as statistically significant. RESULTS: There was a high rate (55.7%) of pregnant smokers, including 5.5% active, 35.9% passive and 14.3% active-passive smokers. Active and active-passive smokers were older and had higher parity. Active smokers had lower education levels and higher rates of previous spontaneous abortion. The weights of newborn babies were lower for smoking mothers. DISCUSSION: The study was performed among patients that were mostly of low economic, social and cultural levels, thus possibly explaining the high incidence of smokers. Worse still was that 35.9% of the non-smokers were actually passive smokers. These rates we report were similar to those from the literature. The typical receptiveness of teenage girls to unrestricted advertising in the media contributes towards an early start to acquiring the habit of smoking, including during pregnancy in our country. We emphasize the difficulties in quantifying exposure to cigarettes even among active smokers. CONCLUSIONS: Cigarette smoke, whether inhaled voluntarily or not, has an unfavorable effect on the mother-infant pair.

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“…In this article, we consider exposure assessment for environmental tobacco smoke (ETS), with emphasis on occupational settings. Substantial research on the adverse health effects of ETS has already accumulated (1)(2)(3)(4). Many of the studies have been directed at exposures in residences and involve the effects of smoking in the household on nonsmoking spouses and children, whereas much less data are available on the effects ofoccupational ETS exposure.…”

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confidence: 99%

Occupational exposure to environmental tobacco smoke and health risk assessment.

Jaakkola

Samet

1999

Environ Health Perspect

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This article addresses concepts of environmental tobacco smoke (ETS) exposure assessment relevant for health risk assessment based on human studies. We present issues that should be considered when selecting a method for ETS exposure assessment for the purposes of health risk assessment and review data on ETS exposure levels in the workplace and in home environments. Two types of estimates are needed for a quantitative risk assessment of the health effects resulting from occupational ETS exposure: a) an unbiased estimate of the exposure-effect (or dose-response) relation between ETS and the health effect of interest, and b) estimates of the distribution of ETS exposure in different workplaces. By combining the estimated exposure-effect relation with information on exposure distribution for a population of interest, we can calculate the proportions of disease cases attributable to occupational ETS exposure as well as the excess number of cases due to specified exposure conditions. Several dimensions of the exposure profile should be considered when assessing ETS exposure for estimating the exposure-effect relation, including the magnitude of exposure and the biologically relevant time specificity of exposure. The magnitude of exposure is determined by the ETS source strength, environmental factors modifying concentrations, and duration of exposure. Time specificity considerations include the latency period for each health outcome of interest, the time-exposure profile relevant for different disease mechanisms, and the sensitive age period with regard to health effects. The most appropriate indicator of ETS exposure depends on these factors and on the time period that can be assessed with different methods. Key words: exposure assessment, risk assessment, tobacco smoke pollution, workplace exposure. -

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Exposure to environmental tobacco smoke and risk of lung cancer: the epidemiological evidence

Cited by 54 publications

References 85 publications

Assessment of exposure to environmental tobacco smoke

Assessment of exposure to environmental tobacco smoke

Obstetric and perinatal effects of active and/or passive smoking during pregnancy

Occupational exposure to environmental tobacco smoke and health risk assessment.

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