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. 2000 Dec;108(12):1171–1177. doi: 10.1289/ehp.001081171

Characteristics of nonsmoking women exposed to spouses who smoke: epidemiologic study on environment and health in women from four Italian areas.

F Forastiere 1, S Mallone 1, E Lo Presti 1, S Baldacci 1, F Pistelli 1, M Simoni 1, A Scalera 1, M Pedreschi 1, R Pistelli 1, G Corbo 1, E Rapiti 1, N Agabiti 1, S Farchi 1, S Basso 1, L Chiaffi 1, G Matteelli 1, F Di Pede 1, L Carrozzi 1, G Viegi 1
PMCID: PMC1240199  PMID: 11133398

Abstract

The aim of this study was to evaluate whether risk factors associated with cardiovascular or respiratory diseases and lung cancer occur differently among nonsmoking women in Italy with and without exposure to environmental tobacco smoke (ETS) from husbands that smoke. We performed a cross-sectional study of 1,938 nonsmoking women in four areas of Italy. Data on respiratory and cardiovascular risk factors and on diet were collected using self-administered questionnaires. Medical examinations and blood tests were administered; urine cotinine levels were measured. Nonsmoking women ever exposed to husbands' smoking were compared with unexposed women for several factors: education, husband's education, household crowding, number of children, current or past occupation, exposure to toxic substances at work, parental diseases, self-perceived health status, physician-diagnosed hypertension, hypercholesterol, diabetes, osteoporosis, chronic respiratory diseases, blood pressure medications, lifestyle and preventive behaviors, dietary variables, systolic and diastolic blood pressure, body mass index, waist-hip ratio, triceps skin folds, plasma antioxidant (pro-) vitamins (- and ss-carotene, retinol, l-ascorbic acid, -tocopherol, lycopene), serum total and HDL cholesterol, and triglycerides. Women married to smokers were more likely to be less educated, to be married to a less educated husband, and to live in more crowded dwellings than women married to nonsmokers. Women married to smokers were significantly less likely to eat cooked [odds ratio (OR) = 0.72; 95% confidence interval (CI), 0.55-0.93] or fresh vegetables (OR = 0.63; CI, 0.49-0.82) more than once a day than women not exposed to ETS. Exposed women had significantly higher urinary cotinine than unexposed subjects (difference: 2.94 ng/mg creatinine). All the other variables were not more prevalent among exposed compared to unexposed subjects. The results regarding demographic factors are easily explained by the social class distribution of smoking in Italy. A lower intake of vegetables among exposed women in our study is consistent with the available literature. Overall, our results do not support previous claims of more frequent risk factors for cardiovascular and pulmonary diseases among ETS-exposed subjects. In Italy, as elsewhere in Europe and North America, women who have never smoked but are married to smokers are likely to be of lower social class than those married to never-smokers. However, once socioeconomic differences are considered, the possibility of confounding in studies on the health effects of ETS is minimal.

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Selected References

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  1. Agabiti N., Mallone S., Forastiere F., Corbo G. M., Ferro S., Renzoni E., Sestini P., Rusconi F., Ciccone G., Viegi G. The impact of parental smoking on asthma and wheezing. SIDRIA Collaborative Group. Studi Italiani sui Disturbi Respiratori nell'Infanzia e l'Ambiente. Epidemiology. 1999 Nov;10(6):692–698. doi: 10.1097/00001648-199911000-00005. [DOI] [PubMed] [Google Scholar]
  2. Bailar J. C., 3rd Passive smoking, coronary heart disease, and meta-analysis. N Engl J Med. 1999 Mar 25;340(12):958–959. doi: 10.1056/NEJM199903253401211. [DOI] [PubMed] [Google Scholar]
  3. Baldacci S., Carrozzi L., Viegi G., Giuntini C. Assessment of respiratory effect of air pollution: study design on general population samples. J Environ Pathol Toxicol Oncol. 1997;16(2-3):77–83. [PubMed] [Google Scholar]
  4. Boffetta P., Agudo A., Ahrens W., Benhamou E., Benhamou S., Darby S. C., Ferro G., Fortes C., Gonzalez C. A., Jöckel K. H. Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe. J Natl Cancer Inst. 1998 Oct 7;90(19):1440–1450. doi: 10.1093/jnci/90.19.1440. [DOI] [PubMed] [Google Scholar]
  5. Brennan P., Butler J., Agudo A., Benhamou S., Darby S., Fortes C., Jöckel K. H., Kreuzer M., Nyberg F., Pohlabeln H. Joint effect of diet and environmental tobacco smoke on risk of lung cancer among nonsmokers. J Natl Cancer Inst. 2000 Mar 1;92(5):426–427. doi: 10.1093/jnci/92.5.426. [DOI] [PubMed] [Google Scholar]
  6. Ciccone G., Forastiere F., Agabiti N., Biggeri A., Bisanti L., Chellini E., Corbo G., Dell'Orco V., Dalmasso P., Volante T. F. Road traffic and adverse respiratory effects in children. SIDRIA Collaborative Group. Occup Environ Med. 1998 Nov;55(11):771–778. doi: 10.1136/oem.55.11.771. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Coultas D. B. Health effects of passive smoking. 8. Passive smoking and risk of adult asthma and COPD: an update. Thorax. 1998 May;53(5):381–387. doi: 10.1136/thx.53.5.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cress R. D., Holly E. A., Aston D. A., Ahn D. K., Kristiansen J. J. Characteristics of women nonsmokers exposed to passive smoke. Prev Med. 1994 Jan;23(1):40–47. doi: 10.1006/pmed.1994.1006. [DOI] [PubMed] [Google Scholar]
  9. Curtin F., Morabia A., Bernstein M. S. Relation of environmental tobacco smoke to diet and health habits: variations according to the site of exposure. J Clin Epidemiol. 1999 Nov;52(11):1055–1062. doi: 10.1016/s0895-4356(99)00089-x. [DOI] [PubMed] [Google Scholar]
  10. Fontham E. T., Correa P., Reynolds P., Wu-Williams A., Buffler P. A., Greenberg R. S., Chen V. W., Alterman T., Boyd P., Austin D. F. Environmental tobacco smoke and lung cancer in nonsmoking women. A multicenter study. JAMA. 1994 Jun 8;271(22):1752–1759. [PubMed] [Google Scholar]
  11. Forastiere F., Agabiti N., Corbo G. M., Pistelli R., Dell'Orco V., Ciappi G., Perucci C. A. Passive smoking as a determinant of bronchial responsiveness in children. Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):365–370. doi: 10.1164/ajrccm.149.2.8306031. [DOI] [PubMed] [Google Scholar]
  12. Hackshaw A. K., Law M. R., Wald N. J. The accumulated evidence on lung cancer and environmental tobacco smoke. BMJ. 1997 Oct 18;315(7114):980–988. doi: 10.1136/bmj.315.7114.980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kaaks R., Slimani N., Riboli E. Pilot phase studies on the accuracy of dietary intake measurements in the EPIC project: overall evaluation of results. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol. 1997;26 (Suppl 1):S26–S36. doi: 10.1093/ije/26.suppl_1.s26. [DOI] [PubMed] [Google Scholar]
  14. Kawachi I., Colditz G. A. Invited commentary: confounding, measurement error, and publication bias in studies of passive smoking. Am J Epidemiol. 1996 Nov 15;144(10):909–915. doi: 10.1093/oxfordjournals.aje.a008860. [DOI] [PubMed] [Google Scholar]
  15. Law M. R., Morris J. K., Wald N. J. Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. BMJ. 1997 Oct 18;315(7114):973–980. doi: 10.1136/bmj.315.7114.973. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Matanoski G., Kanchanaraksa S., Lantry D., Chang Y. Characteristics of nonsmoking women in NHANES I and NHANES I epidemiologic follow-up study with exposure to spouses who smoke. Am J Epidemiol. 1995 Jul 15;142(2):149–157. doi: 10.1093/oxfordjournals.aje.a117613. [DOI] [PubMed] [Google Scholar]
  17. Pagano R., La Vecchia C., Decarli A. Smoking in Italy, 1995. Tumori. 1998 Jul-Aug;84(4):456–459. doi: 10.1177/030089169808400404. [DOI] [PubMed] [Google Scholar]
  18. Renzoni E., Forastiere F., Biggeri A., Viegi G., Bisanti L., Chellini E., Ciccone G., Corbo G., Galassi C., Rusconi F. Differences in parental- and self-report of asthma, rhinitis and eczema among Italian adolescents. SIDRIA collaborative group. Studi Italiani sui Disordini Respiratori dell' Infanzia e l'Ambiente. Eur Respir J. 1999 Sep;14(3):597–604. doi: 10.1034/j.1399-3003.1999.14c19.x. [DOI] [PubMed] [Google Scholar]
  19. Riboli E., Haley N. J., Trédaniel J., Saracci R., Preston-Martin S., Trichopoulos D. Misclassification of smoking status among women in relation to exposure to environmental tobacco smoke. Eur Respir J. 1995 Feb;8(2):285–290. doi: 10.1183/09031936.95.08020285. [DOI] [PubMed] [Google Scholar]
  20. Sidney S., Caan B. J., Friedman G. D. Dietary intake of carotene in nonsmokers with and without passive smoking at home. Am J Epidemiol. 1989 Jun;129(6):1305–1309. doi: 10.1093/oxfordjournals.aje.a115250. [DOI] [PubMed] [Google Scholar]
  21. Sowell A. L., Huff D. L., Yeager P. R., Caudill S. P., Gunter E. W. Retinol, alpha-tocopherol, lutein/zeaxanthin, beta-cryptoxanthin, lycopene, alpha-carotene, trans-beta-carotene, and four retinyl esters in serum determined simultaneously by reversed-phase HPLC with multiwavelength detection. Clin Chem. 1994 Mar;40(3):411–416. [PubMed] [Google Scholar]
  22. Steenland K., Sieber K., Etzel R. A., Pechacek T., Maurer K. Exposure to environmental tobacco smoke and risk factors for heart disease among never smokers in the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 1998 May 15;147(10):932–939. doi: 10.1093/oxfordjournals.aje.a009383. [DOI] [PubMed] [Google Scholar]
  23. Steenland K., Thun M., Lally C., Heath C., Jr Environmental tobacco smoke and coronary heart disease in the American Cancer Society CPS-II cohort. Circulation. 1996 Aug 15;94(4):622–628. doi: 10.1161/01.cir.94.4.622. [DOI] [PubMed] [Google Scholar]
  24. Thompson M. L., Myers J. E., Kriebel D. Prevalence odds ratio or prevalence ratio in the analysis of cross sectional data: what is to be done? Occup Environ Med. 1998 Apr;55(4):272–277. doi: 10.1136/oem.55.4.272. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Thornton A., Lee P., Fry J. Differences between smokers, ex-smokers, passive smokers and non-smokers. J Clin Epidemiol. 1994 Oct;47(10):1143–1162. doi: 10.1016/0895-4356(94)90101-5. [DOI] [PubMed] [Google Scholar]
  26. Van Vunakis H., Gijka H. B., Langone J. J. Radioimmunoassay for nicotine and cotinine. IARC Sci Publ. 1993;(109):293–299. [PubMed] [Google Scholar]
  27. Viegi G., Pedreschi M., Baldacci S., Chiaffi L., Pistelli F., Modena P., Vellutini M., Di Pede F., Carrozzi L. Prevalence rates of respiratory symptoms and diseases in general population samples of North and Central Italy. Int J Tuberc Lung Dis. 1999 Nov;3(11):1034–1042. [PubMed] [Google Scholar]
  28. Volkov V. S., Tsikulin A. E., Khusid I. Kh, Sorokina T. G., Shepelok L. N., Razin'kova N. G., Kolbasnikov S. V. Novye podkhody k otsenke v usloviiakh polikliniki fizicheskoi rabotosposobnosti bol'nykh gipertonicheskoi bolezn'iu. Ter Arkh. 1993;65(12):24–26. [PubMed] [Google Scholar]

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