ETS in the Workplace and at Home

RSPM:฀in฀this฀case,฀exposure฀was฀found฀to฀be฀heavier฀to฀other฀staff฀than฀to฀other฀areas฀ [31] .฀ Hair฀ nicotine฀ levels฀ were฀ also฀ higher฀ in฀ ETS-exposed฀ staff.฀ Nicotine฀ levels฀ were฀ only฀ lower฀where฀there฀was฀an฀absolute฀ban฀on฀smoking฀ [32] .฀A฀high฀proportion฀of฀ETS-exposed฀ bar฀and฀restaurant฀staff฀77฀reported฀respiratory฀tract฀irritation฀and฀75฀of฀interviewees฀ would฀have฀liked฀some฀smoking฀restriction฀in฀bars฀ [33] . Despite฀a฀high฀air฀exchange฀rate฀in฀intercontinental฀aircraft,฀considerable฀differences฀in฀ cabin฀air฀quality฀have฀been฀reported฀between฀smoking฀allowed฀lights฀respirable฀particles:฀ 200 400 600 800 1000 1200 1400 RSP FPM Solan RSP Solan RPr-RAR RPr-NRAR NRPr-RAR NRPr-NRAR Nic 3-BP 0.5 1 1.5 2 2.5 3 3.5 a b Mean Exposition [ m gm 3 24 h] Mean Exposition [ m gm 3 24 h] Fig. 9.2 ฀฀฀a,฀b฀Comparison฀of฀ ETS฀exposure฀of฀individuals฀ in฀and฀away฀from฀the฀ workplace฀ [26] .฀Mean฀values฀ in฀µgm 3 ฀in฀24฀h.฀RPr-RAR฀ n฀=฀119:฀passive฀smokers฀ both฀privately฀and฀in฀ workplace;฀RPr-NRAR฀฀ n฀=฀109:฀passive฀smokers฀ privately฀but฀not฀in฀ workplace;฀NRPr-RAR฀฀ n฀=฀163:฀passive฀smokers฀in฀ workplace฀but฀not฀privately;฀ NRPr-NRAR฀n฀=฀497:฀no฀ ETS฀exposure฀either฀ privately฀or฀in฀workplace.฀ 3-EP฀3-ethenyl฀pyridine;฀ Nic฀nicotine;฀RSP฀respirable฀ suspended฀particles;฀FPM฀ luorescing฀particulate฀ matter;฀Solan฀solanesol฀ particulate฀matter 66฀±฀56฀µgm 3 ฀and฀smoking-not-allowed฀lights฀3฀±฀0.8฀µgm 3 .฀ETS฀exposure฀on฀smoking฀ allowed฀lights฀is฀associated฀with฀ocular฀symptoms,฀decreased฀tear-ilm฀stability,฀headache฀and฀ fatigue฀among฀cabin฀attendants฀and฀passengers฀ [34] .฀Despite฀the฀spatial฀separation฀between฀ smokers฀and฀non-smokers฀on฀intercontinental฀lights,฀non-smoking฀cabin฀attendants฀had฀higher฀ ETS฀exposure฀in฀the฀rear฀cabin฀section฀than฀in฀the฀front฀cabin฀section฀ [35] .฀Median฀urinary฀ cotinine฀levels฀in฀cabin฀attendants฀increased฀from฀3.71฀2.08–8.67฀µgg฀creatinine฀before฀take- off฀to฀6.37฀3.98–19฀µgg฀creatinine฀after฀landing;฀however,฀attendants฀working฀in฀the฀front฀ cabin฀section฀had฀no฀appreciable฀increase฀in฀urinary฀cotinine฀levels฀during฀the฀light฀ [35] . A฀study฀performed฀in฀Norway฀tested฀the฀hypothesis฀that฀nurses’฀aides฀who฀were฀exposed฀ to฀ETS฀at฀home฀during฀childhood฀have฀an฀increased฀risk฀of฀long-term฀sick฀leave฀ [36] .฀The฀ study฀sample฀comprised฀5,563฀Norwegian฀nurses’฀aides,฀who฀were฀not฀on฀sick฀leave฀when฀ they฀completed฀a฀mailed฀questionnaire฀in฀1999.฀Of฀these,฀4,744฀85.3฀completed฀a฀second฀ questionnaire฀15฀months฀later.฀The฀outcome฀measure฀was฀the฀incidence฀proportion฀of฀long- term฀sick฀leave฀during฀the฀12฀months฀prior฀to฀the฀follow-up.฀It฀was฀found฀that฀respondents฀ who฀reported฀at฀baseline฀that฀they฀had฀been฀exposed฀to฀ETS฀at฀home฀during฀childhood฀had฀ increased฀risk฀of฀sick฀leave฀exceeding฀14฀days฀attributed฀to฀neck฀pain฀odds฀ratio฀OR,฀1.34;฀ 95฀conidence฀interval฀CI,฀1.04–1.73,฀high฀back฀pain฀OR,฀1.49;฀CI,฀1.07–2.06,฀low฀ back฀pain฀OR,฀1.21;฀CI,฀0.97–1.50,฀and฀any฀illness฀OR,฀1.23;฀CI,฀1.07–1.42,฀after฀adjust- ments฀for฀demographic฀and฀familial฀characteristics,฀former฀smoking,฀current฀smoking,฀physi- cal฀leisure-time฀activities,฀work฀factors,฀prior฀neck฀injury,฀and฀affective฀symptoms.฀They฀also฀ had฀increased฀risk฀of฀sick฀leave฀exceeding฀8฀weeks฀OR,฀1.29;฀CI,฀1.08–1.55.฀The฀authors฀ concluded฀that฀the฀study฀supported฀the฀hypothesis฀that฀nurses’฀aides฀who฀were฀exposed฀to฀ ETS฀at฀home฀during฀childhood฀have฀an฀increased฀risk฀of฀long-term฀sickness฀absence฀ [36] .

9.2 Changes at the Molecular and Cellular Level

Smokers฀display฀increased฀activity฀of฀coagulation฀variables,฀including฀elevations฀of฀plasma฀ ibrinogen฀and฀platelet฀reactivity.฀The฀rise฀in฀ibrinogen฀levels฀also฀causes฀an฀increase฀in฀ viscosity,฀leading฀to฀a฀deterioration฀in฀the฀low฀properties฀of฀the฀blood฀ [37,฀38] .฀In฀addition,฀ endothelial฀cells฀become฀damaged฀in฀response฀to฀an฀increase฀in฀total฀cholesterol฀TC฀and฀ a฀reduction฀in฀HDL฀cholesterol฀for฀review,฀see฀ [37] . RSP UVPM Sol-PM Nic 20 40 60 80 100 120 140 160 Non-bar areas Bar areas Wait staff Bartender Concentration of ETS [gm 3 ] Fig. 9.3 ฀฀฀Particle฀ concentrations฀in฀bar฀area฀ and฀other฀areas,฀and฀exposure฀ of฀barkeepers฀and฀other฀staff.฀ Mean฀concentrations฀of฀ETS฀ components฀in฀gm 3 ฀ [31] .฀ RSP฀respirable฀suspended฀ particles;฀UVPM฀฀ ultraviolet-absorbing฀ particulate฀matter;฀Sol-PM฀ solanesol฀particulate฀matter;฀ Nic฀nicotine

9.2.1 Fibrinogen

Plasma฀ibrinogen฀levels฀in฀1,140฀Japanese฀women฀aged฀between฀45฀and฀74฀years฀and฀ exposed฀passively฀to฀smoking฀were฀compared฀with฀those฀in฀524฀non-smokers,฀controlling฀ for฀age,฀cholesterol,฀body฀mass฀index,฀ethanol฀intake฀and฀menopausal฀status฀ [39] .฀Plasma฀ ibrinogen฀concentrations฀were฀8.6฀1.6–15.6฀mgdl฀higher฀in฀women฀exposed฀to฀ETS฀ outside฀the฀home,฀and฀11.2฀3.0–19.3฀mgdl฀higher฀in฀women฀exposed฀to฀ETS฀both฀in฀and฀ outside฀the฀home.฀Compared฀with฀non-smokers,฀plasma฀ibrinogen฀levels฀in฀a฀subgroup฀ aged฀45–59฀years฀were฀increased฀by฀15.3฀mgdl฀in฀women฀who฀were฀exposed฀to฀ETS฀in฀ both฀locations.฀Women฀exposed฀to฀ETS฀only฀in฀their฀own฀homes฀showed฀hardly฀any฀eleva- tion฀of฀ibrinogen,฀a฀inding฀that฀is฀attributable฀to฀sociocultural฀practices฀in฀Japan฀men฀ tend฀to฀spend฀the฀evenings฀with฀friends฀away฀from฀the฀home.฀Compared฀with฀cigarette฀ smoke-derived฀ SO 2 ,฀ NO 2 ฀ or฀ ozone,฀ smoke฀ particlulate฀ matter฀ with฀ a฀ diameter฀ 10฀ µm฀ PM 10 ฀correlate฀more฀closely฀with฀the฀increase฀in฀ibrinogen฀ [40] .฀These฀particles฀have฀ been฀assigned฀causal฀signiicance฀in฀the฀development฀of฀harmful฀cardiovascular฀effects.

9.2.2 Cholesterol

Raised฀cholesterol฀levels,฀represented฀by฀the฀total฀cholesterolHDL฀cholesterol฀TCHDL-C฀ ratio,฀are฀regarded฀as฀a฀marker฀for฀atherogenic฀potential฀and฀hence฀for฀the฀development฀of฀ coronary฀heart฀disease฀ [41–43] .฀Cholesterol฀levels฀may฀already฀be฀altered฀in฀childhood฀and฀ adolescence฀ [44,฀45] .฀After฀controlling฀for฀dietary฀factors,฀the฀TCHDL-C฀ratio฀was฀inves- tigated฀in฀444฀adolescent฀schoolchildren฀age฀14.8฀±฀1.6฀years,฀together฀with฀cotinine฀ determinations฀as฀a฀marker฀of฀passive฀smoking฀ [46] .฀Smokers฀and฀subjects฀with฀very฀ele- vated฀plasma฀cotinine฀levels฀25฀ngml฀were฀excluded฀from฀the฀study.฀The฀TCHDL-C฀ ratio฀was฀found฀to฀be฀greater฀where฀plasma฀cotinine฀levels฀were฀³2.5฀ngml฀Fig.฀ 9.4 .฀The฀ raised฀ratios฀were฀attributable฀in฀particular฀to฀lowered฀HDL฀cholesterol฀values,฀with฀ETS฀ exposure฀being฀associated฀with฀an฀8.9฀greater฀TCHDL-C฀ratio฀฀p฀=฀0.003฀and฀a฀6.8฀ lower฀HDL-C฀฀p฀=฀0.03.฀The฀disadvantage฀of฀the฀study฀was฀that฀insuficient฀account฀was฀ taken฀of฀the฀socioeconomic฀status฀of฀the฀schoolchildren฀and฀their฀parents,฀including฀their฀ dietary฀ habits.฀ Nevertheless,฀ the฀ raised฀ TCHDL-C฀ ratio฀ measured฀ in฀ passive฀ smokers฀ must฀be฀viewed฀as฀a฀risk฀factor฀for฀the฀development฀of฀CHD฀ [47] .฀Reduced฀HDL-C฀levels฀ had฀already฀been฀reported฀in฀an฀earlier฀study฀in฀ETS-exposed฀children฀ [48] .

9.2.3 Endothelium and Platelets

Passive฀smoking฀may฀be฀expected฀to฀cause฀endothelial฀damage฀and฀activation฀of฀platelet฀ function฀–฀additional฀risk฀factors฀for฀the฀development฀of฀arteriosclerosis฀ [49,฀50] .฀Debris฀ from฀endothelial฀cells฀is฀encountered฀increasingly฀in฀the฀bloodstream฀in฀response฀to฀pas- sive฀smoking฀ [51–53] .฀Similarly,฀increased฀platelet฀aggregate฀formation฀has฀been฀detected฀ both฀in฀active฀ [54] ฀and฀in฀passive฀smokers฀ [55] .