Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
PLoS One. 2019 Apr 18;14(4):e0215445. doi: 10.1371/journal.pone.0215445. eCollection 2019.
Secondhand tobacco smoke (SHTS) is a tremendous public health hazard, leading to morbidity and premature mortality worldwide, with racial and ethnic minorities and those of lower socioeconomic status disproportionately affected. Flight attendants were historically exposed to high levels of SHTS in the aircraft cabin. The health effects of active smoking are known to persist for up to a lifetime, but the legacy effects of SHTS exposure have not been well characterized.
We aimed to evaluate the legacy health effects of occupational SHTS exposure among never smoking workers using the resources of the Harvard Flight Attendant Health Study, a large study of cabin crew health. We evaluated associations between SHTS exposure and a range of diagnoses using multivariate logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), employing a case-control sampling method and applying the bootstrap method to increase accuracy and precision of results.
We found no evidence of positive associations between SHTS and any cancer, but observed associations between SHTS and cardiac outcomes, including myocardial infarction (OR = 140, 95% CI: 1·04, 3·27) and peripheral artery disease (OR = 1·27, 95% CI: 1·00, 1·97). We also found associations between SHTS exposure and repeated pneumonia (OR = 1·06, 95% CI: 1·02, 1·10).
Our study reports associations between legacy SHTS exposure going back decades and severe cardiac and respiratory health outcomes. Given the high prevalence of ongoing and historical SHTS exposure, our findings, if confirmed, have important implications for smoking cessation efforts, health education, and clinical guidelines.
二手烟草烟雾（SHSTS）是一种巨大的公共卫生危害，导致全球发病率和早逝率上升，其中少数族裔和社会经济地位较低的人群受影响更为严重。历史上，空乘人员在飞机客舱内暴露于高水平的 SHSTS 中。众所周知，主动吸烟的健康影响可持续一生，但 SHSTS 暴露的遗留影响尚未得到很好的描述。
我们旨在利用哈佛空乘人员健康研究（一项针对客舱机组人员健康的大型研究）的资源，评估从不吸烟的工作人员职业性 SHSTS 暴露的遗留健康影响。我们使用多变量逻辑回归评估 SHSTS 暴露与一系列诊断之间的关联，以计算比值比（OR）和 95%置信区间（CI），采用病例对照抽样方法，并应用自举法提高结果的准确性和精密度。
我们没有发现 SHSTS 与任何癌症之间存在正相关的证据，但观察到 SHSTS 与心脏结局之间存在关联，包括心肌梗死（OR=140，95%CI：1.04，3.27）和外周动脉疾病（OR=1.27，95%CI：1.00，1.97）。我们还发现 SHSTS 暴露与复发性肺炎之间存在关联（OR=1.06，95%CI：1.02，1.10）。
我们的研究报告了数十年前遗留的 SHSTS 暴露与严重心脏和呼吸健康结局之间的关联。鉴于持续存在和历史上存在的 SHSTS 暴露的高患病率，如果得到证实，我们的发现对戒烟努力、健康教育和临床指南具有重要意义。
