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Concept: Smoking ban

170

BACKGROUND: Despite efforts to reduce exposure to secondhand smoke (SHS), only 5% of the world’s population enjoy smoke-free restaurants and bars. METHODS: Lifetime excess risk (LER) of cancer death, ischaemic heart disease (IHD) death and asthma initiation among non-smoking restaurant and bar servers and patrons in Minnesota and the US were estimated using weighted field measurements of SHS constituents in Minnesota, existing data on tobacco use and multiple dose-response models. RESULTS: A continuous approach estimated a LER of lung cancer death (LCD) of 18×10(-6)(95% CI 13 to 23×10(-6)) for patrons visiting only designated non-smoking sections, 80×10(-6)(95% CI 66 to 95×10(-6)) for patrons visiting only smoking venues/sections and 802×10(-6)(95% CI 658 to 936×10(-6)) for servers in smoking-permitted venues. An attributable-risk (exposed/non-exposed) approach estimated a similar LER of LCD, a LER of IHD death about 10(-2) for non-smokers with average SHS exposure from all sources and a LER of asthma initiation about 5% for servers with SHS exposure at work only. These risks correspond to 214 LCDs and 3001 IHD deaths among the general non-smoking population and 1420 new asthma cases among non-smoking servers in the US each year due to SHS exposure in restaurants and bars alone. CONCLUSIONS: Health risks for patrons and servers from SHS exposure in restaurants and bars alone are well above the acceptable level. Restaurants and bars should be a priority for governments' effort to create smoke-free environments and should not be exempt from smoking bans.

Concepts: Cancer, Asthma, Lung cancer, Smoking, Tobacco, Tobacco smoking, Passive smoking, Smoking ban

31

Parental smoking is known to worsen asthma symptoms in children and make them refractory to asthma treatment, but the molecular mechanism is unclear. Recently, oxidative stress from tobacco smoke has been reported to impair histone deacetylase-2 (HDAC2) via phosphoinositide-3-kinase (PI3K)/Akt activation and thus to reduce corticosteroid sensitivity. The aim of this study is to investigate passive smoking dependent molecular abnormalities in alveolar macrophages by comparing passive smoke exposed children and non-passive smoke exposed children with uncontrolled severe asthma.

Concepts: Asthma, Lung cancer, Smoking, Tobacco, Tobacco smoking, Passive smoking, Nicotine, Smoking ban

27

This study examined nonsmokers' emotional responses and intentions to promote smoking cessation after exposure to a gain- or loss-framed antismoking public service announcement (PSA). Participants were 183 nonsmokers, and results reveal that gain- and loss-framed antismoking PSAs elicited different types and levels of affect as a function of the message theme for the antismoking PSA. Although secondhand smoke PSAs elicited higher levels of anger toward smokers and fear of secondhand smoke, smoking addiction PSAs tended to elicit more guilt among nonsmokers. Elicited emotions were significant predictors of intentions, and overall, loss-framed appeals worked better than gain-framed appeals at increasing nonsmokers' intentions to talk to friends who smoke about quitting.

Concepts: Smoking, Nicotine, Smoking cessation, Affect, Emotion, Public service announcement, Smoking ban, Emotions

27

ABSTRACT Multiple sclerosis (MS) is known to be influenced by various environmental factors including cigarette smoking. To identify the impact of smoking on conversion from clinically isolated syndrome (CIS) to clinically definite MS (CDMS), 95 consecutive uniformly-treated smoker (n = 31) and non-smoker (n = 64) CIS patients were evaluated retrospectively. The smoker CIS patients did not differ from non-smokers by means of demographic and clinical findings. In addition, there was no difference between the two groups with respect to rate and time of conversion to CDMS. However, white matter lesions were detected in MRIs of all smoking versus 54 of 64 (63.5%) non-smoking CIS patients (p = 0.02). Our results show that smoking does not predict conversion from CIS to CDMS. However, smoking may be associated with the appearance of white matter lesions on MRI at CIS onset.

Concepts: Smoking, Tobacco, Tobacco smoking, Cigarette, Nicotine, Multiple sclerosis, Clinically isolated syndrome, Smoking ban

24

Secondhand smoke (SHS) in US casinos is common, but little is known about the residue of tobacco smoke pollutants left behind in dust and on surfaces, commonly referred to as thirdhand smoke (THS). We examined SHS and THS pollution and exposure before and during a casino smoking ban and after smoking resumed.

Concepts: Smoking, Tobacco, Tobacco smoking, Passive smoking, Smoking ban

21

Every year, smoking kills more than 5 million people globally, including 440 000 people in the USA, where the long-term decline in smoking prevalence has slowed. The US Centers for Disease Control and Prevention (CDC) delivered a national, 3-month antismoking campaign called Tips From Former Smokers (Tips) that started in March, 2012, in which hard-hitting, emotionally evocative television advertising was featured, depicting smoking-related suffering in real people. We aimed to assess the effects of the Tips campaign.

Concepts: Public health, Effect, United States, Smoking, Effects unit, Mass media, Smoking ban, Tobacco control movement

21

BACKGROUND: Invasive meningococcal disease remains an important cause of serious morbidity and mortality in children and young people. There is a growing body of literature to suggest that exposure to passive smoke may play a role in the development of the disease, therefore we have performed a systematic review to provide a comprehensive estimate of the magnitude of this effect for smoking by any household member, by individual family members, and of maternal smoking before and after birth. METHODS: Four databases (Medline, Embase, PsychINFO and CAB Abstracts database) were searched to identify studies (to June 2012) and reference lists scanned for further studies. Titles, abstracts and full texts were checked for eligibility independently by two authors. Quality of included studies was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated using random effect models, with heterogeneity quantified using I2. RESULTS: We identified 18 studies which assessed the effects of SHS on the risk of invasive meningococcal disease in children. SHS in the home doubled the risk of invasive meningococcal disease (OR 2.18, 95% CI 1.63 to 2.92, I2 = 72%), with some evidence of an exposure-response gradient. The strongest effect was seen in children under 5 years (OR 2.48, 95% CI 1.51 to 4.09, I2 = 47%). Maternal smoking significantly increased the risk of invasive meningococcal disease by 3 times during pregnancy (OR 2.93, 95% CI 1.52-5.66) and by 2 times after birth (OR 2.26, 95% CI 1.54-3.31). CONCLUSIONS: SHS exposure, and particularly passive foetal exposure to maternal smoking during pregnancy, significantly increases the risk of childhood invasive meningococcal disease. It is likely that an extra 630 cases of invasive meningococcal disease annually in children under 16 are directly attributable to SHS exposure in UK homes.See related commentary: http://www.biomedcentral.com/1741-7015/10/160.

Concepts: Epidemiology, Smoking, Passive smoking, Effect size, Meta-analysis, Random effects model, Meningococcal disease, Smoking ban

16

Previous studies have shown decreases in cardiovascular mortality following the implementation of comprehensive smoking bans. It is not known whether cerebrovascular or respiratory mortality decreases post-ban. On March 29, 2004, the Republic of Ireland became the first country in the world to implement a national workplace smoking ban. The aim of this study was to assess the effect of this policy on all-cause and cause-specific, non-trauma mortality.

Concepts: Republic of Ireland, Republic, Smoking ban

15

Prenatal passive smoke exposure raises risk for negative birth outcomes. Legislation regulating public smoking has been shown to impact exposure levels, though fewer studies involving pregnant women have been conducted within the U.S. where bans are inconsistent across regions. This study examined the effect of a ban enacted in the southeastern U.S. on pregnant women’s cotinine levels. Additional analyses compared self-reported exposure to cotinine and identified characteristics associated with passive exposure. Pregnant women (N = 851) were recruited prospectively between 2005 and 2011 in North Carolina. Sociodemographic and health data were collected via surveys; maternal blood samples were assayed for cotinine. Among non-active smokers who provided self-report data regarding passive exposure (N = 503), 20% were inconsistent with corresponding cotinine. Among all non-smokers (N = 668), being unmarried, African American, and less educated were each associated with greater passive exposure. Controlling for covariates, mean cotinine was higher prior to the ban compared to after, F(1, 640) = 24.65, p < 0.001. Results suggest that banning smoking in public spaces may reduce passive smoke exposure for non-smoking pregnant women. These data are some of the first to examine the impact of legislation on passive smoke exposure in pregnant women within the U.S. using a biomarker and can inform policy in regions lacking comprehensive smoke-free legislation.

Concepts: Pregnancy, Childbirth, Uterus, Smoking, Passive smoking, North Carolina, Southern United States, Smoking ban

9

There has been a rapid increase in the use of waterpipe tobacco and non-tobacco based shisha in many countries. Understanding the impact and effects of second-hand smoke (SHS) from cigarette was a crucial factor in reducing cigarette use, leading to clean indoor air laws and smoking bans. This article reviews what is known about the effects of SHS exposure from waterpipes.

Concepts: Smoking, Tobacco, Tobacco smoking, Cigarette, Nicotine, Cigar, Hookah, Smoking ban