Exposure to secondhand tobacco smoke and the frailty syndrome in US older adults

Exposure to secondhand tobacco smoke (SHS) is a well-established risk factor for cardiovascular disease and lung cancer in non-smoking adults. However, few studies have focused on the health consequences of exposure to SHS in older adults. This is the first study to assess the association between SHS and the frailty syndrome in the non-smoking older adult population. Methods. Cross-sectional study among 2059 non-smoking adults aged ≥60 years who participated in the third U.S. National Health and Nutrition Examination Survey and had completed a physical examination. Exposure to SHS was assessed by serum cotinine concentrations and by self-reported data from the home questionnaire. Frailty was ascertained with a slight modification of the Fried criteria. Analyses were performed with logistic regression and adjusted for the main confounders. Results. The median (interquartile range) concentration of serum cotinine was 0.095 (IQR: 0.035-0.211) ng/mL. The prevalence of frailty was 6.0%. The odds ratios (95% CI) of frailty comparing the second, third and fourth to the lowest quartile of serum cotinine were, respectively, 1.44 (0.67-3.06), 1.46 (0.75-2.85) and 2.51 (1.06-5.95); p value for trend 0.04. An increased frequency of frailty was also observed in participants reporting to live with ≥2 smokers at home (odds ratio: 5.37; 95% CI: 1.13-25.5). Conclusions. In the US non-smoking older adult population, exposure to SHS was associated with an increased frequency of frailty. More efforts are needed to protect older adults from SHS, especially at home and in other areas not covered by smoke-free regulations.This work was supported by grants from the Instituto de Salud Carlos III, Ministry of Health of Spain (PI12/1166) and from the European Commission (FRAILOMIC Initiative FP7-HEALTH-2012-Proposal No: 305483-2). Dr. Navas-Acien was supported by the Flight Attendant Medical Research Institut

Association of lead and cadmium exposure with frailty in US older adults

This is the prepint version of a work that was accepted for publication in Enviromental Research A definitive version was subsequently published in Enviromental Research 137(2015) DOI: 10.1016/j.envres.2015.01.013BACKGROUND: Environmental lead and cadmium exposure is associated with higher risk of several age-related chronic diseases, including cardiovascular disease, chronic kidney disease and osteoporosis. These diseases may lead to frailty, a geriatric syndrome characterized by diminished physiologic reserve in multiple systems with decreased ability to cope with acute stressors. However, no previous study has evaluated the association between lead or cadmium exposure and frailty. METHODS: Cross-sectional study among individuals aged ≥ 60 years who participated in the third U.S. National Health and Nutrition Examination Survey and had either blood lead (N=5272) or urine cadmium (N=4887) determinations. Frailty was ascertained with a slight modification of the Fried criteria, so that individuals meeting ≥ 3 of 5 pre-defined criteria (exhaustion, low body weight, low physical activity, weakness and slow walking speed), were considered as frail. The association between lead and cadmium with frailty was evaluated using logistic regression with adjustment for relevant confounders. RESULTS: Median (intertertile range) concentrations of blood lead and urine cadmium were 3.9 µg/dl (2.9-4.9) and 0.62 µg/l (0.41-0.91), respectively. The prevalence of frailty was 7.1%. The adjusted odds ratios (95% confidence interval) of frailty comparing the second and third to the lowest tertile of blood lead were, respectively, 1.40 (0.96-2.04) and 1.75 (1.33-2.31). Lead concentrations were also associated with the frequency of exhaustion, weakness and slowness. The corresponding odds ratios (95% confidence interval) for cadmium were, respectively, 0.97 (0.68-1.39) and 1.55 (1.03-2.32), but this association did not hold after excluding participants with reduced glomerular filtration rate: 0.70 (0.43-1.14) and 1.09 (0.56-2.11), respectively. CONCLUSIONS: In the US older adult population, blood lead but not urine cadmium concentrations showed a direct dose-response relationship with frailty. These findings support that lead exposure increases frailty in older adultsThis work has been supported by grants from the Instituto de Salud Carlos III, Ministry of Health of Spain (PI12/1166) and from the European Commission (FRAILOMIC Initiative FP7-HEALTH-2012-Proposal No: 305483-2)

Excessive Exposure to Secondhand Tobacco Smoke among Hospitality Workers in Kyrgyzstan

The aim of this study was to assess the levels of secondhand smoke (SHS) exposure of men and women in public places in Kyrgyzstan. This cross-sectional study involved 10 bars and restaurants in Bishkek the capital city of Kyrgyzstan. Smoking was allowed in all establishments. Median (interquartile range) air nicotine concentrations were 6.82 (2.89, 8.86) μg/m3. Employees were asked about their smoking history and exposure to SHS at work. Employees were exposed to SHS for mean (SD) 13.5 (3.6) hours a day and 5.8 (1.4) days a week. Women were exposed to more hours of SHS at work compared to men. Hospitality workers are exposed to excessive amounts of SHS from customers. Legislation to ban smoking in public places including bars and restaurants is urgently needed to protect workers and patrons from the harmful effects of SHS

Metal/Metalloid Levels in Electronic Cigarette Liquids, Aerosols, and Human Biosamples: A Systematic Review

Background: Electronic cigarettes (e-cigarettes) have become popular, in part because they are perceived as a safer alternative to tobacco cigarettes. An increasing number of studies, however, have found toxic metals/metalloids in e-cigarette emissions. Results: We identified 24 studies on metals/metalloids in e-liquid, e-cigarette aerosols, and human biosamples of e-cigarette users. Metal/metalloid levels, including aluminum, antimony, arsenic, cadmium, cobalt, chromium, copper, iron, lead, manganese, nickel, selenium, tin, and zinc, were present in e-cigarette samples in the studies reviewed. Twelve studies reported metal/metalloid levels in e-liquids (bottles, cartridges, open wick, and tank), 12 studies reported metal/metalloid levels in e-cigarette aerosols (from cig-a-like and tank devices), and 4 studies reported metal/metalloid levels in human biosamples (urine, saliva, serum, and blood) of e-cigarette users. Metal/metalloid levels showed substantial heterogeneity depending on sample type, source of e-liquid, and device type. Metal/metalloid levels in e-liquid from cartridges or tank/open wicks were higher than those from bottles, possibly due to coil contact. Most metal/metalloid levels found in biosamples of e-cigarette users were similar or higher than levels found in biosamples of conventional cigarette users, and even higher than those found in biosamples of cigar users. Conclusion: E-cigarettes are a potential source of exposure to metals/metalloids. Differences in collection methods and puffing regimes likely contribute to the variability in metal/metalloid levels across studies, making comparison across studies difficult. Standardized protocols for the quantification of metal/metalloid levels from e-cigarette samples are needed.This study was supported by NIEHS/FDA grants R21ES029777 and R01ES030025, NIEHS grant P30ES009089, and a Johns Hopkins University Technology Transfer Seed Award. D. Z. was supported by the China Scholarship Council (201706190116). A. A. was supported by a grant from the MD Cigarette Restitution Fund (grantPHPA-G2034)

Comparison of methods for analyzing environmental mixtures effects on survival outcomes and application to a population-based cohort study

The estimation of the effect of environmental exposures and overall mixtures on a survival time outcome is common in environmental epidemiological studies. While advanced statistical methods are increasingly being used for mixture analyses, their applicability and performance for survival outcomes has yet to be explored. We identified readily available methods for analyzing an environmental mixture's effect on a survival outcome and assessed their performance via simulations replicating various real-life scenarios. Using prespecified criteria, we selected Bayesian Additive Regression Trees (BART), Cox Elastic Net, Cox Proportional Hazards (PH) with and without penalized splines, Gaussian Process Regression (GPR) and Multivariate Adaptive Regression Splines (MARS) to compare the bias and efficiency produced when estimating individual exposure, overall mixture, and interaction effects on a survival outcome. We illustrate the selected methods in a real-world data application. We estimated the effects of arsenic, cadmium, molybdenum, selenium, tungsten, and zinc on incidence of cardiovascular disease in American Indians using data from the Strong Heart Study (SHS). In the simulation study, there was a consistent bias-variance trade off. The more flexible models (BART, GPR and MARS) were found to be most advantageous in the presence of nonproportional hazards, where the Cox models often did not capture the true effects due to their higher bias and lower variance. In the SHS, estimates of the effect of selenium and the overall mixture indicated negative effects, but the magnitudes of the estimated effects varied across methods. In practice, we recommend evaluating if findings are consistent across methods

Secondhand tobacco smoke in bars and restaurants in Santiago, Chile: evaluation of partial smoking ban legislation in public places

To compare air nicotine concentrations according to the smoking policy selected by bars/restaurants in Santiago, Chile before and after the enactment of partial smoking ban legislation in 2007 (establishments could be smoke free, have segregated (mixed) smoking and non-smoking areas, or allow smoking in all areas). The study measured air nicotine concentrations over 7 days to characterise secondhand smoke exposure in 30 bars/restaurants in 2008. Owner/manager interviews and physical inspections were conducted. Median IQR air nicotine concentrations measured in all venues were 4.38 (0.61-13.62) μg/m(3). Air nicotine concentrations were higher in bars (median 7.22, IQR 2.48-15.64 μg/m(3)) compared to restaurants (1.12, 0.15-9.22 μg/m(3)). By smoking status, nicotine concentrations were higher in smoking venues (13.46, 5.31-16.87 μg/m(3)), followed by smoking areas in mixed venues (9.22, 5.09-14.90 μg/m(3)) and non-smoking areas in mixed venues (0.99, 0.19-1.27 μg/m(3)). Air nicotine con

A Cross-Sectional Study of Tobacco Advertising, Promotion, and Sponsorship in Airports across Europe and the United States

Altres ajuts: The work was supported by grant number 108594 from the Flight Attendant Medical Research Institute (FAMRI) to the Johns Hopkins FAMRI Center of Excellence. The funder had no role in the Int. J. Environ. Res. Public Health 2016, 13, 959 8 of 9 study design, collection, analysis or interpretation of data, writing of the report, nor in the decision to submit the paper for publication.Tobacco advertising, promotion, and sponsorship (TAPS) bans are effective and are increasingly being implemented in a number of venues and countries, yet the state of TAPS in airports and their effect on airport smoking behavior is unknown. The objective of this study was to evaluate the presence of TAPS in airports across Europe and the US, and to begin to examine the relationship between TAPS and smoking behaviors in airports. We used a cross-sectional study design to observe 21 airports in Europe (11) and the US (10). Data collectors observed points of sale for tobacco products, types of products sold, advertisements and promotions, and branding or logos that appeared in the airport. Tobacco products were sold in 95% of all airports, with significantly more sales in Europe than the US. Advertisements appeared mostly in post-security areas; however, airports with advertisements in pre-security areas had significantly more smokers observed outdoors than airports without advertisements in pre-security areas. Tobacco branding appeared in designated smoking rooms as well as on non-tobacco products in duty free shops. TAPS are widespread in airports in Europe and the US and might be associated with outdoor smoking, though further research is needed to better understand any relationship between the two. This study adds to a growing body of research on tobacco control in air transit and related issues. As smoke-free policies advance, they should include comprehensive TAPS bans that extend to airport facilities

Tampon use, environmental chemicals and oxidative stress in the BioCycle study

Background Tampons are used by up to 86% of US women and are a rarely considered potential source of pesticide and metal exposure. Tampons may be of particular concern given the likely higher absorption that occurs in the vagina. Our objective was to examine the potential associations between tampon use and metal concentrations, and biomarkers of inflammation and oxidative stress among healthy women. Methods We used information from a prospective cohort of 259 regularly menstruating women, aged 18–44, followed for two menstrual cycles. Tampon use was assessed using information provided in participant study diaries. Metal concentrations were measured from a blood sample collected at enrollment. Oxidative stress and inflammation biomarker concentrations were determined from blood samples collected at up to 8 clinic visits for each cycle. Linear regression models were used to estimate associations of tampon use with metal exposure, and linear mixed models to estimate associations of tampon use with inflammation and oxidative stress biomarkers at different times during the menstrual cycle. Results We observed non-significantly higher mean levels of mercury for tampon users compared to non-tampon users (exp(β) = 1.25, 95% CI = 0.93, 1.68). We found no evidence of an association between tampon use and inflammation biomarkers. We observed consistently higher isoprostane levels, an oxidative stress biomarker, among tampon users compared to non-tampon users (e.g. exp.(β) = 1.05, 95%CI = 0.96, 1.16, for the average isoprostane during the menstruating week); however, these results were not statistically significant. Conclusions While our results are not statistically significant, we observed suggestive associations between tampon use and elevated levels of mercury and oxidative stress biomarkers. Although our finding should be interpreted in light of our limitations, they indicate that tampons may be a source of exposure to metals and chemicals that have been largely ignored, and any related health effects are an important public health concern

Arsenic Exposure and Hypertension: A Systematic Review

Background: Environmental exposure to arsenic has been linked to hypertension in persons living in arsenic-endemic areas