Health effects of passive smoking. 3. Parental smoking and prevalence of respiratory symptoms and asthma in school age children

BACKGROUND: A systematic quantitative review of the evidence relating parental smoking to the prevalence of asthma and respiratory symptoms was conducted amongst school age children. METHODS: Sixty relevant studies were identified after consideration of 1593 articles selected by electronic search of the Embase and Medline databases using keywords relevant to passive smoking in children. The search was completed in April 1997 and identified 25 studies of asthma, 41 of wheeze, 34 of chronic cough, seven of chronic phlegm and six of breathlessness which were included in a quantitative overview. RESULTS: The pooled odds ratios for either parent smoking were 1.21 (95% CI 1.10 to 1.34) for asthma, 1.24 (95% CI 1.17 to 1.31) for wheeze, 1.40 (95% CI 1.27 to 1.53) for cough, 1.35 (95% CI 1.13 to 1.62) for phlegm, and 1.31 (95% CI 1.08 to 1.59) for breathlessness. Adjustment for confounding had little effect. Evidence of heterogeneity between studies appeared largely explicable by publication bias with a superfluity of small studies with large odds ratios. However, excluding these had little effect on the pooled odds ratios. The prevalence of all symptoms increased with the number of parents who smoked. While maternal smoking had a greater effect than paternal smoking, the effect of father only was clearly significant. CONCLUSIONS: The relationship between parental smoking and respiratory symptoms seems very likely to be causal given statistical significance, robustness to adjustment for confounding factors, consistency of the findings in different countries, and evidence of dose response. The raised risk in households where the father, but not the mother, smoked argues for a postnatal effect.     

Baseline immunity of the population and impact of insecticide-treated curtains on malaria infection

The aim of this study was to investigate the relationship between dietary fish consumption and self-reported respiratory symptoms among young adults. A random sample of 4,300 subjects, aged 20-44 yrs, living in Bergen, Norway, received a postal questionnaire on respiratory symptoms, of whom 80% responded. Mean fish consumption was assessed in a food-frequency questionnaire by asking how often the subject consumed units of fish (150 g) during the last year. Average fish consumption was 1.8 units x week(-1). Fish intake of <1 unit x week(-1) was reported by 24%, 41% reported consumption of 1 unit x week(-1) and 35% intake of >1 unit x week(-1). A high fish intake was significantly associated with increasing age after adjusting for smoking. Adjusted for smoking habits, the prevalence of "cough at night" and "chest tightness" showed a decreasing trend with increasing fish consumption (p<0.05), while such a trend for "wheeze" was demonstrated only in smokers (p=0.008 for interaction). In logistic regression models (adjusting for age, sex, body mass, smoking habits and occupational exposure) fish consumption (three categories) was not significantly associated with "wheeze", "chest tightness", "breathless at night" or "asthma attack", although the odds ratios (OR) were consistently less than 1 (except for "asthma attack"). Fish consumption was of borderline significance as a protective factor of "cough at night", OR = 0.86 (95% confidence interval: 0.76-0.97) but in stratified analyses only in smokers. Subjects reporting very high levels of fish consumption (>14 units x week(-1)) did not have lower prevalences of respiratory symptoms. In conclusion, among young Norwegian adults, with a relatively low prevalence of asthma and an overall high fish intake, fish consumption was not a significant predictor of four out of five respiratory symptoms.     

Birth characteristics and asthma symptoms in young adults: results from a population-based cohort study in Norway

There is evidence that the origin of obstructive lung disease may be traced back to foetal life. The associations between birth characteristics and asthma symptoms were studied in a random population sample of young Norwegian adults. Respiratory symptoms were recorded in a population-based questionnaire survey. The records of all subjects aged 20-24 yrs were linked with the Medical Birth Registry of Norway. Of 868 subjects born in Norway, there were 690 (79%) responders. The associations between asthma symptoms and birth characteristics were analysed by logistic regression, adjusted for possible confounding factors. Asthma symptoms in young adults were inversely associated with birth weight (odds ratio (OR)wheeze=0.82; 95% confidence interval (CI)=0.69-0.96x500 g increase in birth weight(-1))), and after adjustment for gestational age, birth length, parity and maternal age (ORwheeze=0.69; 95% CI=0.50-0.95x500 g increase in birth weight(-1)). The association did not vary according to adult smoking habits or atopic status and remained when premature and low weight births were excluded (ORwheeze=0.73; 95% CI=0.60-0.90x500 g increase in birth weight(-1)). The association was consistent for all asthma symptoms. Adjusted for birth weight, asthma symptoms were further associated with low gestational age, high birth length and low maternal age. In a random sample of young adults, asthma symptoms were strongly associated with low birth weight, an association driven by the full-term births within the normal birth weight range. The findings show that the risk for adult asthma is partly established early in life and suggest that poor intrauterine growth is involved in the aetiology of asthma.     

The home environment and asthma symptoms in childhood: two population based case-control studies 13 years apart

BACKGROUND: Prevalence surveys of asthma and/or wheezing among all children aged between 7 1/2 and 8 1/2 attending state and private schools in the London Borough of Croydon were conducted in February 1978 and February 1991. Two population based case-control studies drawn from the survey responders were used to investigate the association between childhood wheeze and characteristics of the home environment and to assess whether changes in these characteristics between 1978 and 1991 may have contributed to an increase in the population prevalence of wheeze among school children. METHODS: Information on exposure to potential indoor environmental risk factors was obtained from parents by home interview and compared between cases-that is, children with frequent (> or = 5) or in-frequent (1-4) attacks of asthma or wheezing in the past 12 months- and controls, with adjustment for study. Changes in exposure over time were assessed by comparing control groups. RESULTS: Between 1978 and 1991 the population prevalence odds of wheeze increased by 20% (OR 1.20; 95% CI 1.04 to 1.39). Change in parental smoking, gas cooking, pet ownership, and central heating did not appear to explain the rise. Use of non-feather pillows was positively associated with childhood wheeze even after adjusting for other risk factors and after re-coding from non-feather to feather cases thought to have changed pillow in response to symptoms (OR 1.54; 95% CI 1.13 to 2.10). The proportion of control children reportedly using non-feather pillows was 44% in 1978 and 67% in 1991. CONCLUSIONS: Increased use of non-feather pillows was the only domestic indoor exposure studied which appeared to explain a modest rise in prevalence of wheeze from 1978 to 1991. Our analysis attempts to address behavioural change in response to the child's symptoms but an artifact arising from lifelong avoidance of feather bedding in atopic families cannot be entirely discounted.     

Primary intrasellar mixed germ-cell tumor with precocious puberty and diabetes insipidus

A case-control study using data from the Baltimore-Washington Infant Study (BWIS) examined possible paternal risk factors in the etiology of isolated membranous ventricular septal defects (VSD). There were 641 total VSD case infants and 3,549 randomly selected control infants ascertained between 1981 and 1989. Isolated membranous VSDs were identified in 499 cases. Socio-demographic factors (such as parental age and race), social habits, and medical conditions were analyzed by multiple logistic regression in order to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Paternal age was not found to be a risk factor per se, but small positive associations were found for some social habits and maternal factors. Significant associations were found for paternal marijuana use (OR 1.36, 95% CI 1.05-1.76), African-American race of the infant (OR 1.34, 95% CI 1.09-1.65), and for cocaine use among older fathers (OR 3.92, 95% CI 1.30-11.86). These associations support a multifactorial etiologic hypothesis for isolated membranous VSDs and point to some interesting parental behavioral and medical considerations which may contribute to risk for this common birth defect.     

Motivating Latino caregivers of children with asthma to quit smoking: A randomized trial.

Objective: Secondhand smoke exposure is associated with asthma onset and exacerbation. Latino children have higher rates of asthma morbidity than other groups. The current study compared the effectiveness of a newly developed smoking cessation treatment with existing clinical guidelines for smoking cessation. Method: Latino caregivers who smoked (N = 133; 72.9% female; mean age = 36.8 years) and had a child with asthma were randomly assigned to receive 1 of 2 smoking cessation counseling interventions during a home-based asthma program: (a) behavioral action model (BAM; modeled on clinical guidelines for smoking cessation) or (b) precaution adoption model (PAM; feedback on the caregiver’s carbon monoxide level and child’s secondhand smoke exposure using Motivational Interviewing). Counseling was delivered by a bilingual Latina health educator, and the content was tailored to Latino values and culture. It was not necessary for smokers to want to quit smoking to participate. Smoking cessation was biochemically verified and secondhand smoke exposure was objectively measured through passive nicotine monitors. Results: Intent-to-treat analyses showed that 20.5% of participants in the PAM condition and 9.1% of those in the BAM condition were continuously abstinent at 2 months posttreatment (OR = 2.54; 95% CI = 0.91–7.10), whereas 19.1% of participants in the PAM condition and 12.3% of those in BAM condition were continuously abstinent at 3 months posttreatment (OR = 1.68; 95% CI = 0.64–4.37). Secondhand smoke exposure decreased only in the BAM condition (p p     

The N-terminus of Nef from HIV-1/SIV associates with a protein complex containing Lck and a serine kinase

A multi-center case-referent study was conducted on the relation between paternal occupational exposure and spina bifida in offspring. Cases were born between 1980 and 1992 in The Netherlands. Referents were recruited from hospitals and from the general population. Postal questionnaires were used to gather information on occupation and potential confounders. Through job-specific telephone interviews with 122 case fathers and 411 referent fathers, detailed exposure information was collected on specific tasks, the use of chemical or physical agents, frequency of exposure, and use of protective equipment. The study yielded statistically significant associations between spina bifida and low exposure to welding fumes (OR = 1.6, 95% CI: 1.0-2.6) and low exposure to UV radiation during welding (OR = 2.6, 95% CI: 1.2-5.6), and suggestive findings of an association between spina bifida and moderate or high exposure to cleaning agents, moderate or high pesticide exposure (OR = 1.7, 95% CI: 0.7-4.0), and stainless steel dust (OR = 2.0, 95% CI: 0.8-5.2). No associations were identified for other paternal occupational exposures, such as organic solvents.     

Asthma and other atopic diseases in Australian children. Australian arm of the International Study of Asthma and Allergy in Childhood

OBJECTIVE: To determine the prevalence of asthma, eczema and allergic rhinitis in Australian schoolchildren using the protocol of the International Study of Asthma and Allergy in Childhood (ISAAC). DESIGN: Questionnaire-based survey. SETTING: Melbourne, Sydney, Adelaide (in winter-spring, 1993) and Perth (in winter-spring, 1994). SUBJECTS: All children in school years 1 and 2 (ages 6-7 years) or in year 8 (ages 13-14 years), attending a random sample of 272 schools, stratified by age and city. MAIN OUTCOME MEASURES: Parent-reported (for 6-7 year olds) or self-reported (for 13-14 year olds) symptoms of atopic disease in the previous 12 months, or ever; treatment of asthma; and country of birth. RESULTS: 10,914 questionnaires were completed for 6-7 year olds and 12,280 for 13-14 year olds (84% and 94% response rates, respectively). Prevalence of wheeze in the past 12 months was 24.6% for the 6-7 year olds and 29.4% for the 13-14 year olds, and, among 6-7 year olds, was significantly higher in boys (27.4%) than girls (21.7%). Children born in Australia were more likely to report current wheeze than those born elsewhere (6-7 year olds: odds ratio [OR], 1.82; 95% confidence interval [CI] 1.55-2.15; and 13-14 year olds: OR, 1.88; 95% CI, 1.68-2.11). Prevalences of current eczema and allergic rhinitis were 10.9% and 12.0%, respectively, for the 6-7 year olds, and 9.7% and 19.6%, respectively, for the 13-14 year olds. Asthma, eczema and rhinitis coexisted in 1.8% of 6-7 year olds and 2.8% of 13-14 year olds. CONCLUSION: This study provides evidence that asthma prevalence in Australian schoolchildren is continuing to increase and is higher among Australian-born children than among those born elsewhere. Asthma, eczema and allergic rhinitis coexist to a lesser extent than expected. These results form the basis for future Australian and international comparisons.     

Passive cigarette smoking and reduced HDL cholesterol levels in children with high-risk lipid profiles

BACKGROUND: HDL cholesterol levels are known to be lower in smokers than in nonsmokers. Previous studies have demonstrated an association of decreased HDL cholesterol with passive smoking in children but have not adjusted for potential confounding factors. METHODS AND RESULTS: In a cross-sectional, pilot-scale study, we examined the relationship of HDL cholesterol levels to passive smoking in children and adolescents referred to a tertiary hyperlipidemia clinic. Eligibility criteria included (1) first visit to a lipid clinic, (2) LDL cholesterol >95th percentile for age or HDL cholesterol <5th percentile, (3) age between 2 and 18 years, and (4) absence of secondary causes of hyperlipidemia. Sociodemographic information, diet record, medical history, and fasting lipid profiles were obtained. Of 109 eligible patients, 103 (94%) were studied. Twenty-seven percent came from households with cigarette smokers. HDL cholesterol levels were 38.7+/-1.2 mg/dL (mean+/-SEM) in passive smokers versus 43.6+/-1.2 mg/dL in children without smoke exposure (P=.005). Smoking exposure was not significantly associated with other lipid values. The effect of smoking on HDL cholesterol was minimally affected by potential confounders. In multivariate regression adjusting for body mass index, age, sex, exercise, and dietary fat intake, passive smoking remained a significant risk factor for decreased HDL cholesterol (P=.012). CONCLUSIONS: Mean HDL cholesterol levels are lower in dyslipidemic children from households with smokers than in those without household smoke exposure. Passive smoking may worsen the risk profile for later atherosclerosis among high-risk young persons.     

Passive smoking in children up to 5 years of age

Passive smoking is a major health risk in young children. We investigated the percentage of children with mothers and/or fathers who reported regular smoking. Data are the national and regional health surveys of the German Cardiovascular Prevention Study (GCP) conducted from 1984 to 1992 in West Germany. 2538 mothers aged 25-40 years were included. The prevalence of passive smoking in children due to smoking mothers was 33.6% 55.4% of the children up to 5 years lived in households with at least one smoking parent member. In 23.4% of these households both parents were smokers. If only one member of the parents smoked this was in two out of three cases the father. 28.2% of mothers with a child younger than one year were current smokers. This prevalence rate increased with the age of the youngest child up to 35.6% for mothers, whose youngest child was 5 years old. Multiple logistic regression analysis was performed to investigate the association between smoking behaviour and the following variables: mother's age, social class, family status, community size and year of the survey. It was found that lower social class members, unmarried or divorced mothers and inhabitants of large cities reported significantly more often regular current smoking. These results underscore the importance of special intervention programs to reduce smoking in parents with young children.     

Race, asthma, and persistent wheeze in Philadelphia schoolchildren

OBJECTIVES: Many studies show asthma to be more common in Black than in White children. This study assessed how much of this difference remains after adjustment for other potentially race-associated predictors of asthma. METHODS: We assessed the predictors of active diagnosed asthma and persistent wheeze in 1416 Black and White Philadelphia children aged 9 to 11 years, as reported by parents. RESULTS: Black race remained a significant predictor of active diagnosed asthma (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.3, 4.1) but not of persistent wheeze (OR = 1.0; 95% CI = 0.6, 1.8). The excess risk of asthma in Black children was not appreciably altered by adjustment for other demographic and environmental factors. CONCLUSIONS: Black race is an important risk factor for active diagnosed asthma in these urban children, a relationship not explained by social factors. This finding and the lack of an association of race with persistent wheeze after adjustment for social factors suggest that race may be more important to the acquisition of an asthma diagnosis than to the prevalence of the symptoms.     

The unreamed AO femoral intramedullary nail, advantages and disadvantages of a new modular interlocking system. A prospective study of 67 cases

The aim of this study was to investigate associations between sudden infant death syndrome (SIDS) and social factors in the Nordic countries. A case-control study was conducted in Denmark, Norway and Sweden: The Nordic Epidemiological SIDS Study. Parents of 244 SIDS infants and 869 control infants matched on gender, age at death and place of birth filled in questionnaires. The dataset was analysed by conditional logistic regression. In univariate analysis, the following sociodemographic factors were associated with an increased risk of SIDS: low maternal age [odds ratio (OR) 7.8; 2.8-21.5], high birth order (OR 4.4; 2.5-7.5), single motherhood (OR 2.9; 1.7-5.0), low maternal education (OR 4.5; 2.8-7.1), low paternal education (OR 3.0; 1.9-4.7), maternal unemployment (OR 2.4; 1.8-3.4) and paternal unemployment (OR 4.0; 2.7-5.9). In a multivariate analysis where maternal smoking was also included, only paternal unemployment, young maternal age and high birth order remained significantly associated with SIDS. Housing conditions were not associated with SIDS. However, the risk of SIDS was high if the family had lived in their present home for only a few years (OR 2.3; 1.3-4.1). Sociodemographic differences remain a major concern in SIDS in a low-incidence situation and even in an affluent population with adequate health services.     

Has the prevalence of asthma symptoms increased in Australian children?

This paper estimates whether an increase has occurred in the prevalence of asthma symptoms and diagnosed asthma in Australian children over the past two decades. Seventeen population-based studies undertaken in Australia since 1969 were reviewed. Inclusion criteria were studies using population samples of children aged 5-12 years, with standardized questionnaire measurements. Data from serial National Health Surveys were also examined for trends in recent and chronic asthma. The prevalence of recent (12 month) and cumulative wheeze increased, showing a significant correlation with year of study (r = 0.78 and r = 0.79, respectively). Diagnosed asthma showed a smaller but still significant increase (r = 0.65). The trends observed indicated that diagnosed asthma and reported wheeze have increased by almost 1% per year over the past two decades. Data since 1980 have provided estimates of bronchial hyperreactivity (BHR), but no trend was observed. Substantial increases were noted in the National Health Surveys, with recent asthma prevalence in children aged 5-14 increasing from 3.3% in 1983 to 8.3% in 1989, and chronic asthma prevalence increasing from 4.5% in 1977 to 15.2% in 1989. The findings of this review suggest an increase in the prevalence of asthma symptoms in children, but these observations could also be explained by changes in diagnostic fashion and an increased awareness of asthma symptoms.     

Alcohol, smoking, and cataracts: the Blue Mountains Eye Study

OBJECTIVE: To investigate the associations between alcohol consumption, tobacco smoking, and cataract. DESIGN: A population-based, cross-sectional study. SETTING: An urban community in the Blue Mountains, close to Sydney, Australia. PARTICIPANTS: Three thousand six hundred fifty-four people aged 49 to 97 years. The participation rate was 82%. MAIN OUTCOME MEASURES: Smoking history and details of current alcohol consumption were assessed by questionnaire. Lens photographs were taken and graded for presence and severity of cortical, nuclear, and posterior subcapsular cataracts. RESULTS: After adjusting for multiple potential confounders, people who had ever smoked cigarettes had a higher prevalence than nonsmokers of more severe nuclear (adjusted odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) and posterior subcapsular (adjusted OR, 1.5; 95% CI, 1.1-2.1) cataracts. The association between pipe smoking and nuclear cataract (adjusted OR, 3.1; 95% CI, 1.5-8.2) was stronger than the association with cigarette smoking. Alcohol consumption was associated with a reduced prevalence of cortical cataract: compared with people who did not drink, the adjusted OR for cortical cataract among people who drank at least 1 drink a day was 0.7 (95% CI, 0.6-0.9). Heavy alcohol consumption (> or =4 drinks a day) was associated with nuclear cataract in current smokers (adjusted OR compared with nondrinkers, 3.9; 95% CI, 0.9-16.6) but not in never smokers. CONCLUSIONS: Consistent with other studies, smoking was associated with a higher prevalence of nuclear and posterior subcapsular cataracts. The only adverse effect of alcohol was among smokers: people who smoked and drank heavily had an increased prevalence of nuclear cataract.     

Tobacco consumption among the student population. Related factors

OBJECTIVE: To know smoking prevalence among schoolchildren and factors related with this habit. METHODS: A cross-sectional study. 548 school-children in their 6th and 8th years of primary studies at schools from an area of Córdoba (Spain) were interviewed. INTERVENTIONS: Autoadministered questionnaire. RESULTS: Tobacco was tried in 22% (CI 95%: 18.7-25.8) school-children. The average age for starting with this habit was 11.6 (SD)(CI 95%: 11.4-11.8). 12.1% smoked regularly and 1.3% smokers every day. The tobacco consumption in children was related with age (OR = 2.96; CI 95%: 1.12-7.82), cough medicines consumption (OR = 3.15; CI 95%: 1.32-7.48), to have a smokers sister (OR = 2.53; CI 95%: 1.06-6.00) and best friend (OR = 4.42; CI 95%: 1.85-10.60) and drinking beer (OR = 3.68; CI 95%: 1.15-11.7). CONCLUSIONS: The prevalence of smoking in our school-children is very close to that reported by others. Among the factors accounted with the tobacco consumption in schoolchildren, highlight the presence of this habit in the eldest sister and the best friend.     

Degradation of weathered oil by mixed marine bacteria and the toxicity of accumulated water-soluble material to two marine crustacea

From 1982 to 1984, the authors conducted a population-based case-control study of lung cancer in men and women nonsmokers in New York State. In-person interviews were completed for 437 lung cancer cases (197 never smokers, 240 former smokers) and 437 matched population controls. Cases and controls were asked to report any history of physician-diagnosed nonmalignant lung disease; cases were more likely than controls to report such a history. Statistically significant associations were found for emphysema (odds ratio (OR) = 1.94, 95% confidence interval (CI) 1.10-3.43), chronic bronchitis (OR = 1.73, 95% CI 1.10-2.72), and the combined endpoint of emphysema, chronic bronchitis, or asthma (OR = 1.82, 95% CI 1.26-2.63). After adjustment for active and passive tobacco smoke exposure, emphysema, chronic bronchitis, and asthma (each condition and the combined endpoint) were significantly associated with lung cancer risk. The risk was more marked for squamous cell carcinomas and for subjects who were diagnosed at older ages, and it remained significant when surrogate interviews were excluded. These results are consistent with the hypothesis that certain prior lung conditions increase the risk of lung cancer in men and women nonsmokers.     

Trends in the prevalence of asthma in Scottish and English primary school children 1982-92

BACKGROUND: Some doubts exist as to whether the increase in the prevalence of asthma is real or an artefact. The 10 year trend of asthma up to 1993 in England and Scotland was therefore assessed. METHODS: Information on asthma and bronchitis attacks, occasional wheeze, and persistent wheeze in the last 12 months, was obtained using a self administered questionnaire completed by the parents. Exactly the same questions were asked in 14 study areas in Scotland and 22 study areas in England in 1982 or 1983 and in 1992 or 1993 in 5-11 year old children. RESULTS: The numbers of children with data for all respiratory illness were 5556 (85.2%) and 5801 (87.1%) in England and 3748 (90.4%) and 3738 (90.4%) in Scotland in 1982 and 1992, respectively. There was a significant increase in asthma attacks (approximately three times more in 1992 than in 1982) and occasional wheeze (30-60% more in 1992 than in 1982) in both sexes in England and Scotland. Persistent wheeze also increased in both countries, but the increase was significant only in England (30-40% more in 1992 than in 1982). CONCLUSIONS: The study coincides with others that suggest that the increased prevalence of asthma may be due, in part, to changes in diagnostic behaviour. However, the continuing increase of persistent wheeze in the total sample suggests that part of the increase is real. There was no difference in the increase of persistent wheeze between Scotland and England, but the trend was only significant in England.     

Dose-dependent induction of both pepsinogen-altered pyloric glands and adenocarcinomas in the glandular stomach of C3H mice treated with N-methyl-N-nitrosourea

BACKGROUND: Cigarette smoking has been shown to increase oxidative DNA damage in human sperm cells. Assessment of the role of cigarette smoking in the etiology of childhood cancer has focused primarily on the effect of maternal smoking. Similar studies in relation to paternal smoking, however, have been inconclusive. Few studies have evaluated the effect of paternal smoking in the preconception period, and most of these could not disentangle the effects of paternal from maternal smoking. PURPOSE: We investigated the relationship of paternal smoking, particularly in the preconception period, with childhood cancer among offspring of the nonsmoking mothers. METHODS: We conducted a population-based, case-control study in Shanghai, People's Republic of China, where the prevalence of smoking is high among men but extremely low among women. The study included 642 childhood cancer case patients (<15 years of age) and their individually matched control subjects. Information concerning parental smoking, alcohol drinking, and other exposures of the index child was obtained by direct interview of both parents of the study subjects. Odds ratios (ORs), derived from conditional logistic regression models, were used to measure the association between paternal smoking and risk of childhood cancers. RESULTS AND CONCLUSIONS: Paternal preconception smoking was related to a significantly elevated risk of childhood cancers, particularly acute leukemia and lymphoma. The risks rose with increasing pack-years of paternal preconception smoking for acute lymphocytic leukemia (ALL) (P for trend = .01), lymphoma (P for trend = .07), and total cancer (P for trend = .006). Compared with children whose fathers had never smoked cigarettes, children whose fathers smoked more than five pack-years prior to their conception had adjusted ORs of 3.8 (95% confidence interval [CI] = 1.3-12.3) for ALL, 4.5 (95% CI = 1.2-16.8) for lymphoma, 2.7 (95% CI = 0.8-9.9) for brain tumors, and 1.7 (95% CI = 1.2-2.5) for all cancers combined. Statistically significant increased risks of cancer were restricted to children under the age of 5 years at diagnosis or those whose fathers had smoked during all of the 5 years prior to conception. IMPLICATIONS: Further studies are needed to confirm the association of paternal smoking with increased risk of cancer in offspring, to clarify the pattern of risks in relation to the timing of cigarette smoking, and to elucidate the biologic mechanism involved in predisposing the offspring to cancer. For example, it may be that paternal smoking induces prezygotic genetic damage that, in turn, acts as the predisposing factor.     

Respiratory disease in workers exposed to colophony solder flux fumes: continuing health concerns

The objectives of this study were to establish the prevalence of respiratory, eye, nose and throat symptoms of likely work-relation in workers exposed to colophony solder flux fumes and to assess their lung function. A cross-sectional study was conducted in four medium-sized electronics firms in which control measures to capture solder flux fume were absent or visibly ineffective. All female solders and women working adjacent to soldering stations completed an administered questionnaire concerning symptoms, work history and current soldering frequency. Measurements were made of their forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) during the course of a working shift, using a Vitallograph-Compact portable spirometer. Using weekly hours of soldering as a crude index of current exposure, workers were classified into high (> or = 37 h/wk) and low (< or = 20 h/wk) exposure groups, and their health responses were compared in the analysis. Individuals with symptoms suggestive of work-related asthma were also asked to provide serial peak flow measurements over a further 2-week period, and adequate returns were charted and read by two physicians experienced in the diagnosis of occupational asthma. Data were collected on 152 female workers (overall participation rate = 97%). Symptoms of recurrent, persistent wheeze and/or chest tightness were reported by 75 (49%) of interviewees; 36 (24%) gave a history typical of occupational asthma and six more (4%) a history of pre-existing asthma worsened at work. Twenty-one (14%) of the workforce complained of recurrent breathlessness on moderate exertion; 41 workers (27%) had work-related symptoms of the nose or throat and 25 (16%) had work-related eye symptoms. The odds ratios for 'all wheeze', shortness of breath, and work-related eye, nose and chest symptoms were all significantly greater (raised about 4-5 fold) in women who soldered > or = 37 h/wk when compared with those soldering < or = 20 h/wk. After adjustment by logistic regression for atopy, age and smoking status even higher risk estimates were generally obtained. The odds ratios (OR) and 95% confidence intervals (CI) for high vs. low were: for 'all wheeze', OR = 7.2, CI = 2.5-20.7; for work-related eye symptoms, OR = 5.2, CI = 1.4-19.8; for work-related nasal symptoms, OR = 4.0, CI = 1.4-11.1 and for occupational asthma symptoms, OR = 5.2, CI = 1.4-14.2. Mean FEV1 and FVC percentage difference from expected were slightly lower in full-time solderers than in part-time solderers, but the differences were not significant. Thirty-seven of the 51 workers (73%) who were asked to carry out serial peak flow measurements completed an adequate return: 27 of these records confirmed the presence of asthma, and in all of the cases the history suggested onset post-dating employment in soldering. Eleven peak flow records were indicative of occupational asthma. The health problems associated with colophony solder flux were documented over 18 years ago, but are still clearly apparent in situations where adequate control has not been achieved.     

Smoking patterns and cancer of the oral cavity and pharynx: a case-control study in Uruguay

A case-control study of cancer of the oral cavity and pharynx was conducted in Uruguay, between 1992 and 1996. 425 patients microscopically diagnosed with squamous cell carcinoma of the oral cavity and pharynx were frequently matched on age, residence, and urban/rural status with 427 hospitalised controls. The study was restricted to males. Smokers of black tobacco cigarettes were associated with an increased risk of 12.1 (95% confidence interval (CI) 7.6-19.4), when compared with non-smokers after fitting a model which included the matching variables, birthplace, education, and total alcohol consumption. Lifelong smokers of hand-rolled cigarettes displayed an odds ratio (OR) of 8.7 (95% CI 5.6-13.4), compared with non-smokers. When smokers were excluded from the calculations, the OR for smokers of black tobacco cigarettes was 3.0 (95% CI 2.0-4.6), compared with smokers of blond tobacco cigarettes, after controlling for the same variables mentioned above, plus pack-years, years since stopping, and filter use. Hand-rolling appears to be less important than smoking black tobacco in this study (OR 1.6, 95% CI 0.9-2.5). Thus, smoking black tobacco cigarettes appears to be an important habit in oral and pharyngeal carcinogenesis.