Meningococcal Infections ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

stage,฀shortly฀before฀the฀development฀of฀breast฀tissue,฀in฀order฀to฀induce฀mitogenic฀changes฀ consistent฀with฀carcinogenesis฀ [246] .฀More฀extensive฀studies฀are฀certainly฀required฀in฀this฀ area฀before฀a฀deinitive฀verdict฀can฀be฀given. Johnson฀and฀Glantz฀compared฀the฀strength฀of฀evidence฀from฀epidemiologic฀studies฀of฀ second฀hand฀smoke฀of฀the฀US฀Surgeon฀General’s฀1986฀conclusion฀that฀secondhand฀smoke฀ caused฀ lung฀ cancer฀ with฀ the฀ California฀ Environmental฀ Protection฀ Agency’s฀ CalEPA฀ similar฀2005฀conclusion฀on฀breast฀cancer฀in฀younger,฀primarily฀premenopausal฀women฀ [247] .฀They฀reviewed฀each฀report฀for฀criteria฀used฀to฀assess฀causality:฀number฀of฀studies,฀ statistically฀signiicant฀increases฀in฀risk,฀and฀pooled฀summary฀risk฀estimates.฀The฀authors฀ showed฀that฀both฀the฀Surgeon฀General฀and฀CalEPA฀used฀updated฀Bradford฀Hill฀criteria฀for฀ assessing฀causality฀and฀found฀that฀the฀evidence฀met฀those฀criteria.฀Six฀of฀13฀lung฀cancer฀ studies฀46฀had฀statistically฀signiicant฀increases฀one฀of฀three฀cohort฀studies.฀Pooled฀ risk฀ estimates฀ for฀ lung฀ cancer฀ for฀ spousal฀ exposure฀ were฀ 1.53฀ for฀ ten฀ combined฀ case-฀ control฀studies฀and฀1.88฀for฀seven฀studies฀with฀dose–response฀results.฀The฀CalEPA฀reported฀ 10฀of฀14฀studies฀71฀had฀statistically฀signiicant฀increases฀in฀breast฀cancer฀risk฀two฀of฀ four฀cohort฀studies.฀Pooled฀relative฀risk฀estimates฀for฀younger,฀primarily฀premenopausal฀ women฀were฀1.68฀95฀CI:฀1.33,฀2.12฀for฀all฀exposed฀women฀and฀2.19฀95฀CI:฀1.68,฀ 2.84฀for฀ive฀studies฀with฀better฀exposure฀assessment.฀It฀was฀concluded฀that฀the฀evidence฀ from฀epidemiologic฀studies฀of฀passive฀smoke฀in฀2005฀for฀breast฀cancer฀in฀younger,฀primar- ily฀premenopausal฀women฀was฀stronger฀than฀for฀lung฀cancer฀in฀1986.

9.10 Psychosocial Changes

Children฀exposed฀to฀ETS฀display฀behavioural฀changes฀that฀can฀be฀linked฀with฀ETS.฀Within฀a฀ family฀ setting,฀ lifestyle฀ habits฀ evolve฀ e.g.฀ smoking,฀ fat฀ consumption,฀ sedentary฀ lifestyle฀ increased฀alcohol฀consumption฀which฀in฀turn฀may฀be฀regarded฀as฀risk฀factors฀for฀the฀children฀ because฀they฀adopt฀these฀lifestyle฀habits฀ [248,฀249] .฀Body฀measurements฀were฀performed฀in฀ a฀study฀of฀804฀children฀aged฀10–12฀years;฀additionally,฀smoking฀behaviour฀and฀dietary฀char- acteristics฀were฀identiied.฀Among฀the฀children฀from฀these฀families,฀19฀of฀boys฀and฀10฀of฀ girls฀were฀already฀smokers.฀Among฀the฀children฀who฀smoked,฀57฀boys฀and฀68฀girls฀ came฀from฀families฀in฀which฀at฀least฀one฀parent฀smoked฀OR,฀2.1;฀CI,฀1.2–3.8.฀In฀the฀longer฀ term,฀however,฀girls฀were฀less฀likely฀to฀adopt฀the฀smoking฀habits฀of฀their฀parents฀OR,฀0.4;฀ CI,฀0.2–0.6.฀Parental฀smoking฀behaviour฀was฀an฀additive฀predictor฀in฀children฀of฀lower฀ physical฀activity฀and฀more฀television฀watching,฀regardless฀of฀which฀parent฀smoked.฀Children’s฀ fat฀intake฀was฀signiicantly฀greater฀if฀either฀parent฀smoked,฀whereas฀children’s฀body฀mass฀ index฀and฀waist-to-hip฀ratio฀were฀signiicantly฀greater฀if฀mothers฀smoked฀ [250] . Overall,฀children฀who฀grow฀up฀in฀“smoker฀households”฀take฀health฀risks฀upon฀them- selves฀ regardless฀ of฀ the฀ risks฀ already฀ present฀ as฀ a฀ result฀ of฀ smoking฀ during฀ pregnancy฀ [251] .฀Parental฀smoking฀is฀formative฀in฀encouraging฀an฀unhealthy฀lifestyle฀in฀children,฀