| Measurement of Environmental Tobacco Smoke Exposure among Adults with Asthma Mark D. Eisner,1 Patricia P. Katz,2 Edward H. Yelin,2 S. Katharine Hammond,3 and Paul D. Blanc1 1Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, and 2Institute for Health Policy Studies and Department of Medicine, University of California, San Francisco, San Francisco, California, USA; 3Center for Occupational and Environmental Health and School of Public Health, University of California, Berkeley, California, USA 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 µg/m3 (25th-75th interquartile range 0-3.69 µg/m3) . Measured nicotine concentrations were highest among persons who reported home exposure (median 0.61 µg/m3) , followed by work exposure (0.03 µg/m3) , other (outdoor) exposure (0.025 µg/m3) , and no exposure (0 µg/m3 ; 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. Key words: asthma, biological markers, environmental monitoring, nicotine, smoking, tobacco smoke pollution. Environ Health Perspect 109:809-814 (2001) . [Online 13 August 2001] http://ehpnet1.niehs.nih.gov/docs/2001/109p809-814eisner/ abstract.html Address correspondence to M.D. Eisner, Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, 350 Parnassus Avenue, Suite 609, San Francisco, CA 94117 USA. Telephone: (415) 476-7351. Fax: (415) 476-6426. E-mail: eisner@itsa.ucsf.edu This study was supported by National Research Service award F32 HL0054 and NIH K23 HL04201 (to M.D. Eisner) and NIH RO1 HL56438 (to P.D. Blanc) . Received 18 December 2000 ; accepted 16 February 2001.
The full version of this article is available for free in HTML or PDF formats. |
