Second-hand smoke exposure (SHSe) causes significant morbidity and mortality in children. A large proportion of children with smoking parents do not live in smoke-free homes, however, to date, little is known about the prevalence of partial smoking restrictions and their efficacy in reducing children’s SHSe. Given the lack of convincing evidence on how to achieve further reductions in children’s SHSe in the home, the identification of the modifiable factors associated with childhood SHSe is imperative to reduce the burden of disease resulting from childhood SHSe. Analysis of the Omnibus Survey (OS) revealed that the prevalence of smoke-free homes in England did not increase significantly between 2006 and 2008. Only 30% of smokers reported a smoke-free home in 2008. However, during the same time period, the proportion of smokers (who did not have a smoke-free home) reporting that they did not smoke when in the same room as a child increased significantly from 62.5% to 74.8%. Using the Health Survey for England, biologically validated self-reported measures of child SHSe revealed that in 2008 and 2009 approximately 50% of children living with a smoking parent were not exposed to SHSe in the home (0.30ng/ml, 95% confidence interval 0.27-0.32ng/ml). Of the 50% of children who remained exposed inside the home, 29% had a parent that smoked in one room only in the home. These children had significantly lower cotinine concentrations (1.13ng/ml, 95% CI 1.05-1.22) than the 21% of children with smoking parents who smoked in 2 or more rooms in the home (2.36ng/ml, 95% CI 2.08-2.68ng/ml). Although smoking in one room equates to lower risk it does not equate to no risk and so interventions are required to change indoor smoking to outdoor smoking. The OS data found that good knowledge of SHS-related illnesses was predictive of both full and partial smoking restrictions in the home. Increases in the proportion of respondents with good knowledge occurred during 2003-2006, a period when frequent anti-SHS mass media campaigns were aired. A case-study evaluation of a brief mass media campaign in the North West and North East of England, which aimed to move smoking parents to smoke outside, was found to have no statistically significant effect on home smoking behaviour in the short term, however knowledge that SHS caused both heart attack and Sudden Infant Death Syndrome increased in this region following the campaign whilst simultaneous decreases were found in the rest of England. Following the identification of those children most exposed to SHS, and the modifiable factors associated with this exposure, this thesis suggests that a comprehensive multi-level approach to tobacco control policy, which includes emotive media campaigns which include information on SHS-related illnesses, will contribute to the continued reduction of childhood SHSe.

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Background and Objectives: Environmental tobacco smoke (ETS) is widely recognized as a serious health hazard. No safe level of exposure to ETS has been identified (USDHHS, 2006; WHO, 2007). The importance of smoke-free spaces in improving health outcomes for both smokers and non-smokers is clearly understood and as such, many individuals living in Ontario have made their homes smoke-free. Although those living in units within multi-unit dwellings (MUDs) have the option of making their own unit smoke-free, they may still be involuntarily exposed to ETS drifting from smoking units to their unit. The present study explores tenant’s perceptions of this drifting ETS and the potential market for smoke-free rental housing. Methods: Anonymous surveys were sent to 3724 households within rented MUDs (apartments and row housing) with five or more units in Kitchener, Ontario. In addition to demographic questions, the survey addressed respondents’ experiences with, perceptions of, and reactions to drifting ETS and their views on smoke-free rental housing. Three hundred and five surveys were returned, and 291 met the final inclusion criteria to be included in the analysis. Survey data were weighted by age and education level. Descriptive analyses and logistic regression models were run to answer the research questions. Results: Over half of the respondents who do not smoke in their unit on a daily basis indicated they were exposed to drifting ETS in their home at least ‘sometimes’. Of those who were exposed, 89.5% were bothered and nearly half were bothered ‘a lot’. This suggests drifting ETS is a concern for many tenants living in MUDs. The majority of tenants indicated they did not live in a smoke-free building however there was a strong interest in smoke-free rental housing. Nearly 90% of tenants showed at least some interest in smoke-free rental housing, and many tenants would prefer to live in a building with the strongest possible restrictions on smoking in place. Younger tenants, non-smokers, those who spent less time at home on weekends and those who perceived indoor smoking as a fire risk were more likely to be interested in smoke-free rental housing. Conclusions and Significance: This study provides insight into the magnitude of the problem of drifting ETS in MUDs and can be used to inform policy on smoke-free MUDs. Many respondents indicated they were exposed to drifting ETS and the majority of those who were exposed were bothered by this exposure. There also appears to be a strong market for smoke-free rental housing. The response rate for this study was low at 8.5% and as such the results must be interpreted with caution. Future research should be completed in other jurisdictions and with larger sample sizes. Landlord surveys and air quality monitoring studies are also needed. While additional research is needed, the current study suggests this is an important public health issue, and provides additional evidence supporting the need to explore policy options in the public and private realm for smoke-free housing.

Background and Objectives: Environmental tobacco smoke (ETS) is widely recognized as a serious health hazard. No safe level of exposure to ETS has been identified (USDHHS, 2006; WHO, 2007). The importance of smoke-free spaces in improving health outcomes for both smokers and non-smokers is clearly understood and as such, many individuals living in Ontario have made their homes smoke-free. Although those living in units within multi-unit dwellings (MUDs) have the option of making their own unit smoke-free, they may still be involuntarily exposed to ETS drifting from smoking units to their unit. The present study explores tenant’s perceptions of this drifting ETS and the potential market for smoke-free rental housing. Methods: Anonymous surveys were sent to 3724 households within rented MUDs (apartments and row housing) with five or more units in Kitchener, Ontario. In addition to demographic questions, the survey addressed respondents’ experiences with, perceptions of, and reactions to drifting ETS and their views on smoke-free rental housing. Three hundred and five surveys were returned, and 291 met the final inclusion criteria to be included in the analysis. Survey data were weighted by age and education level. Descriptive analyses and logistic regression models were run to answer the research questions. Results: Over half of the respondents who do not smoke in their unit on a daily basis indicated they were exposed to drifting ETS in their home at least ‘sometimes’. Of those who were exposed, 89.5% were bothered and nearly half were bothered ‘a lot’. This suggests drifting ETS is a concern for many tenants living in MUDs. The majority of tenants indicated they did not live in a smoke-free building however there was a strong interest in smoke-free rental housing. Nearly 90% of tenants showed at least some interest in smoke-free rental housing, and many tenants would prefer to live in a building with the strongest possible restrictions on smoking in place. Younger tenants, non-smokers, those who spent less time at home on weekends and those who perceived indoor smoking as a fire risk were more likely to be interested in smoke-free rental housing. Conclusions and Significance: This study provides insight into the magnitude of the problem of drifting ETS in MUDs and can be used to inform policy on smoke-free MUDs. Many respondents indicated they were exposed to drifting ETS and the majority of those who were exposed were bothered by this exposure. There also appears to be a strong market for smoke-free rental housing. The response rate for this study was low at 8.5% and as such the results must be interpreted with caution. Future research should be completed in other jurisdictions and with larger sample sizes. Landlord surveys and air quality monitoring studies are also needed. While additional research is needed, the current study suggests this is an important public health issue, and provides additional evidence supporting the need to explore policy options in the public and private realm for smoke-free housing.

This study prospectively examined the timing and predictors of returning to smoking after pregnancy in a group of women who quit smoking cigarettes during pregnancy. We interviewed women during the postpartum hospital stay and at their infants 2-week and 2-month health supervision visits. Urine cotinine levels were measured at each interview. Fifty-three women were interviewed during the postpartum stay, 37 women at the 2-week and 36 women at the 2 month visits. At the 2-week visit, 40.5% had returned to smoking, and at the 2-month visit, 47.2% had returned to smoking. Factors associated with a return to smoking at 2 weeks included a lower level of education (high school graduate/GED vs. some college education; 13/37 vs. 2/37, p=0.02), the presence of someone else in the household who smoked (14/37 vs. 1/37, p=0.001), formula-feeding their infant at the time of interview (14/37 vs. 1/37, p=0.003), having smoking discussed with a doctor or nurse during pregnancy (12/37 vs. 3/27, p=0.009), and being African-American vs. Caucasian or Hispanic (10/37 vs. 5/37, p=0.008). Predictors of a return to smoking at 2 months included the presence of someone else in the household who smoked (17/36 vs. 0/36, p<0.001) and smoking at least 1 cigarette during pregnancy after initially quitting (12/36 vs. 5/36, p=0.02). Women who quit smoking cigarettes during pregnancy are likely to resume in the days immediately after delivery. The presence of household smokers and formula feeding are the strongest predictors of resuming smoking within 2 weeks.

Thesis (MPH.) -- University of Limpopo, 2016. / Introduction: Annually, hundred thousands of people worldwide die as a result of second hand smoke (SHS) exposure. There is no safe exposure level to SHS yet in Bulawayo, smokers have been observed smoking without restraint thus exposing non-smokers to SHS. The purpose of this study was to establish the prevalence and contributing factors of SHS exposure among adults in Bulawayo, Zimbabwe. Methods: A cross sectional study was conducted and participants were randomly selected from residents who visited the 13 municipal revenue halls. A structured questionnaire was used to collect data from respondents. Descriptive and multivariate logistic regression analyses were performed. Results: Home SHS exposure prevalence was 22% and females were 2.11 times more likely than males to be exposed at home. Prevalence of SHS exposure in public transportation, health facilities, educational and food premises was 40.9%, 26.3%, 42,9% and 36.8% respectively. Conclusion: SHS exposure in Bulawayo was high and there is need to reduce SHS exposure to non-smoking adults. Keywords: Second hand smoke (SHS), Bulawayo, Prevalence, Exposure, Adult

Introduction Although studies have examined the association between childhood asthma and parental smoking and secondhand smoke, little research has explored the moderating role of birth weight and prematurity (BWP) status on this association. We examined the association between secondhand smoke exposure, asthma, and asthma severity in children aged six to 17 as well as the modifying effect of BWP on parental smoking and asthma. Methods We used data from 36,954 children from the National Survey of Children's Health 2017-2018. In addition to univariate analysis, adjusted and unadjusted logistic regression models were used to estimate the effect of secondhand smoke on asthma. The interaction term between parental smoking and BWP was tested. Multinomial regression was used to evaluate the association between secondhand smoke on asthma severity. Results About 15.1 % of children had asthma and 15.4% of parents reported smoking. Odds of asthma were higher in children living with an outdoor (AOR, 1.27; 95% CI, 1.06-1.52) and indoor (AOR, 1.46; 95% CI, 1.01-2.11) smoker in the adjusted model. The association of parental smoking with asthma differed by birth weight and premature status. Normal weight children who are premature had the highest odds ratio (AOR, 2.15; 95% CI, 1.2-3.86). In the multinomial model, low birth weight and premature children had higher odds of mild (AOR, 1.90; 95% CI, 1.40-2.56) and moderate/severe (AOR, 1.81; 95% CI, 1.16-2.84) asthma compared to the no asthma group. Conclusion The Association of parental smoking on asthma was modified by BWP. Focused asthma interventions in children should inquire about BWP status as well as parental smoking and household smoke exposure to reduce asthma morbidity and mortality.

Child Health Services (CHS) in Sweden are offered free of charge to all Swedish parents with children 0-5 years of age.  The regular service schedule includes home visits, health examinations, vaccinations and participation in parenting groups. The CHS should pay extra attention to disadvantaged families. The aim of this thesis was to investigate to what extent the CHS reaches groups of families with special needs, e.g. immigrant families, low income families, young and single mothers, with universal or selective measures, as well as to investigate the variation of two determinants of child health, second hand smoke and breastfeeding, in these groups of families. The thesis also aimed at investigating validity of data in the county CHS quality database (Basta). The thesis is based on data from Basta together with several national registers. The CHS equally reached all families with infants with the universal program except for participation in parenting group. Foreign born, young, single and low-income mothers had lower participation rates. Smoking rates were lower in foreign-born than in Swedish-born mothers and higher for foreign-born than in Swedish-born fathers. Smoking was more common among single and low income parents and young mothers. Young and single mothers had lower breastfeeding rates at 6 months. At 12 months the breastfeeding rates were higher among foreign-born mothers. The validity test of data in the Basta database showed sensitivity values for immunizations, breastfeeding and smoking at 90-100 % and for any home visit, participation in parenting group at any time, a minimum number of 6 visits at the Child Health Centre (CHC) and a minimum number of 11 visits at the CHC at 88 - 96 %. The sensitivity value for the exact match of number of CHC visits (+/- 3 visits) was 88 %. Conclusions: The universal programme was equally distributed in different immigrant and socio-demographic populations. However, the results did not indicate equality according to the assumption that some families need more input than others in order to achieve equity of outcome. Individual data routinely collected from CHS records to a quality database provides data of good quality that can be used for both quality surveillance and research.

Made available in DSpace on 2016-04-29T13:31:32Z (GMT). No. of bitstreams: 1 Andrea.pdf: 1279654 bytes, checksum: a0de2590f9818f5e6c9492531bfd610b (MD5) Previous issue date: 2007-06-04 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Tobacco use may be considered a global epidemic and has a great impact on health as well as social, economic and sanitarian consequences. Besides the damage to smoker s health, second hand smoke is very critical to collective health and environment. It is the third leading preventable cause of death in the world. Tobacco control is a public health issue and has been the target of an international framework convention. Among tobacco control policies in Brazil, the 9294/96 law that forbids smoking indoors was chosen to be the purpose of this study. This law is not widely accepted by entertainment establishments (restaurants, bars, fast-food places, cafes, disco houses). Implied is the need to better understand owners and managers rationale concerning to this political issue. In fact, it is important to identify the factors that may influence their decision to adopt this law. For this, an exploratory study was conducted in two phases: a qualitative phase with 11 face-to-face interviews in which the content analysis generated a questionnaire answered by 60 participants in the quantitative phase. To guarantee validity, a panel of 8 experts analyzed the instrument and it was retested by a sub sample of 30 participants. Statistical tests performed showed that 73,3% of participants do not favor the law mentioned above, and that there is no significant difference of opinion among all the segments investigated. Data showed that both political and social factors play a relevant role in this matter. Both variables can not be analyzed apart from each other, as SANDOVAL (2001) and AIRHIHENBUWA (1995) had defended in their theoretical models (political conscientiousness and PEN- 3, respectively). Based on these models, some arguments identified were the law is not enforced, government initiatives are culturally discredited, competition between establishments is great, and owners and managers fear that they would lose business. There is inter- and intra-group favoritism that leads establishments to accept smokers behavior. Data suggests that tobacco control policies for these places must be revisited / O tabagismo é uma epidemia global que provoca danos sérios à saúde, com conseqüências sociais, econômicas e sanitárias. Além dos malefícios que causa à saúde do próprio fumante, a fumaça exalada pelo consumo dos derivados do tabaco também é prejudicial à saúde coletiva e ao meio ambiente. A Poluição Tabágica Ambiental é a terceira maior causa de morte evitável no mundo. Trata-se de uma questão de saúde pública que ganhou notória ênfase nas últimas décadas, dando origem ao primeiro tratado mundial de saúde pública, que fixa padrões internacionais para o controle do tabaco. Entre as políticas no Brasil, destacou-se, para fins do presente estudo, a Lei n.º 9.294/96, que proíbe fumar em ambientes fechados. Essa lei não chega a ser amplamente adotada pelos estabelecimentos do ramo do entretenimento (restaurante, bar, lanchonete, danceteria, café, shopping center), o que pode ser considerado como um fenômeno político e reforça a necessidade de se entender que fatores compõem a lógica dos seus proprietários e gerentes. Para tanto, uma pesquisa exploratória foi conduzida em duas etapas: uma qualitativa, com 11 entrevistas face a face, cuja análise do seu conteúdo gerou um questionário, aplicado a 60 participantes na fase quantitativa. Para validação desse instrumento, foi feita uma avaliação por 8 profissionais de diferentes áreas de atuação e a sua reaplicação com uma subamostra de 30 participantes. Os testes estatísticos revelaram que 73,3% dos pesquisados não adotam a lei e que não existem divergências de opinião significativas entre os diversos segmentos investigados. Além disso, os dados apontam uma inter-relação de fatores políticos e sociais como pano de fundo da decisão de se adotar ou não a lei em questão. Ficou claro que essas variáveis não podem ser analisadas isoladamente, corroborando o pressuposto pelos modelos teóricos utilizados para explicar esse fenômeno, isto é, o modelo de consciência política (SANDOVAL, 2001) e o PEN-3 (AIRHIHENBUWA, 1995). Com base nesses modelos, alguns argumentos foram identificados: a lei não é regulamentada; as ações do governo estão ou são culturalmente desacreditadas; a concorrência com outros estabelecimentos do mesmo ramo é grande e seus administradores temem perder a clientela; existe um favorecimento inter e intragrupal que leva os estabelecimentos à conivência com o comportamento dos fumantes. Os resultados sugerem que as políticas de controle do tabaco para essas empresas carecem de adequação

More than half of all cases of breast cancer occur among women without any known risk factors. More research is needed on suspected risk factors in order to refine current breast cancer screening tools. The objectives of this thesis were: to determine the breast cancer risk associated with known risk factors (ethnicity, family history, breast biopsy, age at menarche, age at first birth, alcohol, HRT, and BMI), suspected risk factors (smoking, second-hand smoke exposure, smoked/grilled foods, and NSAID use), and to examine the above associations according to tumour receptor status, histologic grade, and menopausal status, with potential confounders also considered. This thesis project was conducted within the framework of the Molecular Epidemiology of Breast Cancer study, a case-control study of women in Vancouver, BC and Kingston, ON, with 1140 cases and 1169 controls recruited from 2005-2010. Information was collected from a detailed questionnaire. Cases and controls were similar in terms of age at menarche, age at first birth, smoking history, second-hand smoke exposure, lifetime smoked/grilled food consumption, HRT, and BMI. Among cases, there were significantly less Europeans and more Chinese, Japanese, and Filipino subjects compared to controls. Cases were more likely to have a first degree relative with breast cancer, as well as a previous benign breast biopsy. Alcohol consumption and past NSAID usage was higher among controls. The level of education completed was higher among controls. Cases were also more likely to be postmenopausal. Family history was associated with breast cancer risk (OR=1.59, CI=1.30-1.94), as was BMI (OR=1.28, CI=1.05-1.58 for overweight and OR=2.28, CI=1.35-3.86 for obese class II). Second-hand smoke was also found to be associated with breast cancer risk (OR=1.42, CI=1.02-1.97 for individuals with a less than 10 pack-year smoking history). Due to reduced sample size with stratification and marginally significant results, it is not possible to draw definitive conclusions regarding pathology sub-types. In summary, these results provide support for the association between several risk factors and breast cancer risk. More research is needed to ascertain how receptor status, histologic grade, and menopausal status affect these associations. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2011-08-15 19:43:06.689