Association between second hand smoke (SHS) exposure and caregiver stress in children with poorly controlled asthma
JOURNAL OF ASTHMA
Authors: Butz, Arlene M.; Tsoukleris, Mona; Bollinger, Mary Elizabeth; Jassal, Mandeep; Bellin, Melissa H.; Kub, Joan; Mudd, Shawna; Ogborn, C. Jean; Lewis-Land, Cassia; Thompson, Richard E.
Abstract
Objective: Urban children with asthma experience high rates of second hand smoke (SHS) exposure. The objective was to examine whether SHS exposure is associated with symptom frequency in children with poorly controlled asthma. Methods: Children were enrolled in a RCT to test the efficacy of an environmental control behavioral intervention versus an attention control group and followed over 12 months. SHS exposure assessed using salivary cotinine measurement. Frequency of child asthma symptoms, healthcare utilization, household smoking and caregiver daily life stress were obtained via caregiver report. Time of enrollment was recorded to assess seasonal factors. Symptom days and nights were the primary outcomes. Multivariable models and odds ratios examined factors that best predicted increased frequency of daytime/nighttime symptoms. Results: Children (n = 222) with a mean age of 6.3 (SD 2.7) years, were primarily male (65%), African American (94%), Medicaid insured (94%), and had poorly controlled asthma (54%). The final multivariable model indicated symptoms in the fall (OR 2.78; 95% CI 1.16, 6.52) and increased caregiver daily life stress (OR 1.13, 95% CI 1.02, 1.25) were significantly associated with increased symptom days when controlling for cotinine level, intervention status, child age and home and car smoking restrictions. Conclusions: There was no impact of SHS exposure on increased symptom frequency. High caregiver daily life stress and symptoms in fall season may place children with asthma at risk for increased day/nighttime symptoms. Close monitoring of symptoms and medication use during the fall season and intervening on caregiver life stress may decrease asthma morbidity in children with poorly controlled asthma.
Dose-related effect of secondhand smoke on cardiovascular disease in nonsmokers: Systematic review and meta-analysis
INTERNATIONAL JOURNAL OF HYGIENE AND ENVIRONMENTAL HEALTH
Authors: Zhang, Dongdong; Liu, Yiming; Cheng, Cheng; Wang, Yan; Xue, Yuan; Li, Wenjie; Li, Xing
Abstract
Background: Despite the positive association between secondhand smoke (SHS) and cardiovascular diseases (CVD), no comprehensive assessment on the dose-response relationship between SHS and CVD has yet been reported. Therefore, a meta-analysis was conducted to update the binary association, and to elucidate the dose-response relationship of both self-reported and objectively measured SHS exposure with CVD. Methods: PubMed and Embase databases were searched for articles published up to November 12, 2019. Random-effects models were used to assess the summary odds ratios (ORs) of CVD with SHS exposure. Restricted cubic splines were used to fit the dose-response relationship. Results: Fifty-five eligible observational studies were included in this meta-analysis to investigate the association between SHS exposure and CVD. Based on the meta-analysis, the pooled OR of CVD was 1.22 (95% CI 1.17-1.28) for the self-reported SHS individuals as comparing to the non-exposed group. The result of restricted cubic splines showed a risk plateau of SHS exposure at 15 cigarettes per day (Pnon-linearity = 0.042), while other characteristics s of SHS exposure (amount, daily and cumulative duration, and cotinine) were in linear relationships with CVD (Pnon-linearity> 0.05). In addition, an estimated of 6.77% (95% CI: 5.31%-8.46%) of all CVD cases in men and 7.15% (95% CI: 5.62%-8.93%) in women might be attributed to SHS exposure worldwide. Conclusions: Exposure to SHS is associated with an increased risk of CVD regardless of the modes. And thus, well-enforced smoke-free laws could possibly reduce a substantial risk of CVD caused by SHS.