Eisner M D, Katz P P, Yelin E H, Hammond S K, Blanc P D
Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, California 94117, USA.
Environ Health Perspect. 2001 Aug;109(8):809-14. doi: 10.1289/ehp.01109809.
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.
由于成人哮喘的发病率和死亡率一直在上升，确定可改变的加剧哮喘的环境暴露因素已成为当务之急。有限的证据表明，接触环境烟草烟雾（ETS）可能会对成年哮喘患者产生不利影响。为了更好地研究ETS的影响，我们开发了一种调查工具，用于测量居住在加利福尼亚州北部的成年哮喘患者队列中的ETS暴露情况，该地区室内公共场合吸烟受到限制。为了验证该调查工具，我们使用了一种被动徽章监测器，它可以测量实际接触环境尼古丁的情况，这是ETS的一种直接且特定的测量方法。在这项验证研究中，我们从一项正在进行的纵向哮喘队列研究中招募了50名受试者，他们对ETS暴露或潜在暴露的筛查问题呈阳性。每位受试者佩戴一个被动尼古丁徽章监测器7天。在个人监测期结束后，我们再次使用ETS暴露调查问卷。根据调查，在前7天内自我报告的总ETS暴露时长范围为0至70小时。根据上限边界，酒吧或夜总会（55小时）和家庭（50小时）是与自我报告的最大暴露相关的场所。通过个人尼古丁徽章监测器测量，7天尼古丁浓度的总体中位数为0.03微克/立方米（第25至75百分位数的四分位间距为0至3.69微克/立方米）。报告在家中暴露的人群中测量到的尼古丁浓度最高（中位数为0.61微克/立方米），其次是工作场所暴露（0.03微克/立方米）、其他（室外）暴露（0.025微克/立方米）和无暴露（0微克/立方米；p = 0.03）。在同一7天内，自我报告的ETS暴露时长与直接测量的个人尼古丁浓度之间的Spearman等级相关系数为0.47，支持了该调查的有效性（p = 0.0006）。与未检测到暴露的人相比，较低水平[比值比（OR）1.9；95%置信区间（CI），0.4 - 8.8]和较高水平的ETS暴露（OR 6.8；95% CI，1.4 - 32.3）与呼吸道症状风险增加相关。一种经过验证的简短调查工具可用于评估成年哮喘患者中的ETS暴露情况，即使暴露水平较低。该工具可能是研究ETS暴露对成年哮喘健康结局影响的有价值工具。
