Measurement of environmental tobacco smoke exposure among adults with asthma
M D Eisner, P P Katz, E H Yelin, S K Hammond, P D Blanc, M D Eisner, P P Katz, E H Yelin, S K Hammond, P D Blanc
Abstract
Because the morbidity and mortality from adult asthma have been increasing, the identification of modifiable environmental exposures that exacerbate asthma has become a priority. Limited evidence suggests that exposure to environmental tobacco smoke (ETS) may adversely affect adults with asthma. To study the effects of ETS better, we developed a survey instrument to measure ETS exposure in a cohort of adults with asthma living in northern California, where public indoor smoking is limited. To validate this survey instrument, we used a passive badge monitor that measures actual exposure to ambient nicotine, a direct and specific measure of ETS. In this validation study, we recruited 50 subjects from an ongoing longitudinal asthma cohort study who had a positive screening question for ETS exposure or potential exposure. Each subject wore a passive nicotine badge monitor for 7 days. After the personal monitoring period, we readministered the ETS exposure survey instrument. Based on the survey, self-reported total ETS exposure duration ranged from 0 to 70 hr during the previous 7 days. Based on the upper-range boundary, bars or nightclubs (55 hr) and the home (50 hr) were the sites associated with greatest maximal self-reported exposure. As measured by the personal nicotine badge monitors, the overall median 7-day nicotine concentration was 0.03 microg/m(3) (25th-75th interquartile range 0-3.69 microg/m(3)). Measured nicotine concentrations were highest among persons who reported home exposure (median 0.61 microg/m(3)), followed by work exposure (0.03 microg/m(3)), other (outdoor) exposure (0.025 microg/m(3)), and no exposure (0 microg/m(3); p = 0.03). The Spearman rank correlation coefficient between self-reported ETS exposure duration and directly measured personal nicotine concentration during the same 7-day period was 0.47, supporting the survey's validity (p = 0.0006). Compared to persons with no measured exposure, lower-level [odds ratio (OR) 1.9; 95% confidence interval (CI), 0.4-8.8] and higher-level ETS exposures (OR 6.8; 95% CI, 1.4-32.3) were associated with increased risk of respiratory symptoms. A brief, validated survey instrument can be used to assess ETS exposure among adults with asthma, even with low levels of exposure. This instrument could be a valuable tool for studying the effect of ETS exposure on adult asthma health outcomes.
References
- J Clin Epidemiol. 1992 May;45(5):461-72
- Environ Health Perspect. 1999 May;107 Suppl 2:349-55
- Am J Respir Crit Care Med. 1994 Jun;149(6):1400-6
- Prev Med. 1994 Jan;23(1):35-9
- Am J Respir Crit Care Med. 1999 Dec;160(6):2028-33
- Chest. 2000 Aug;118(2):564
- Am Rev Respir Dis. 1988 Aug;138(2):296-9
- Am J Epidemiol. 1989 Aug;130(2):338-47
- Am J Epidemiol. 1989 Oct;130(4):696-704
- Cancer Causes Control. 1990 Nov;1(3):243-52
- Am J Public Health. 1992 Jan;82(1):24-8
- J Am Coll Cardiol. 1994 Aug;24(2):546-54
- Environ Res. 1994 Aug;66(2):235-43
- J Clin Epidemiol. 1995 Mar;48(3):317-27
- JAMA. 1995 Sep 27;274(12):956-60
- Am J Epidemiol. 1995 Sep 1;142(5):525-30
- Am J Epidemiol. 1995 Dec 15;142(12):1315-21
- Chest. 1996 Mar;109(3):688-96
- JAMA. 1996 Apr 24;275(16):1233-40
- Med Care. 1996 Mar;34(3):220-33
- J Expo Anal Environ Epidemiol. 1996 Oct-Dec;6(4):473-502
- Tob Control. 1997 Spring;6(1):41-54
- BMJ. 1997 Oct 18;315(7114):980-8
- Eur Respir J. 1997 Oct;10(10):2384-97
- Med Care. 1998 Nov;36(11):1567-77
- Chest. 1999 Mar;115(3):691-6
- Chest. 1999 May;115(5):1259-64
- Environ Health Perspect. 1999 May;107 Suppl 2:319-27
- Eur Respir J. 1993 Sep;6(8):1104-8
Source: PubMed