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      Riesgos para la salud derivados del consumo voluntario e involuntario de tabaco Translated title: Health Risks from Active and Passive Smoking

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          Abstract

          Este trabajo examina y actualiza los aspectos sanitarios del consumo de tabaco basándose especialmente en estudios llevados a cabo en países europeos, con énfasis en el tabaquismo en el lugar de trabajo. Se revisan los riesgos del consumo de tabaco para la salud en ambos sexos, el impacto en la esperanza de vida, las ventajas del abandono del consumo de tabaco, el patrón social del tabaquismo en las sociedades occidentales y las diferencias sociales en las enfermedades que causa. Se describen también los efectos inmediatos y a largo plazo del consumo involuntario de tabaco, sus consecuencias en el lugar de trabajo, y las técnicas de medida del Aire Contaminado por Humo de Tabaco (ACHT).

          Translated abstract

          This study reviews and updates the health risks of cigarette smoking, based on the studies conducted in European countries, stressing cigarette smoking at the workplace. A review is made of the risks for both sexes, the impact on life expectancy, the advantages of quitting smoking, the social pattern of cigarette smoking in Western societies and the social differences in the diseases caused thereby. A description is also provided of the immediate and long-range effects of passive smoking, the consequences of passive smoking at the workplace and the methods for measuring Environmental Tobacco Smoke.

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          Most cited references 301

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          Passive smoking and the risk of coronary heart disease--a meta-analysis of epidemiologic studies.

          The effect of passive smoking on the risk of coronary heart disease is controversial. We conducted a meta-analysis of the risk of coronary heart disease associated with passive smoking among nonsmokers. We searched the Medline and Dissertation Abstracts Online data bases and reviewed citations in relevant articles to identify 18 epidemiologic (10 cohort and 8 case-control) studies that met prestated inclusion criteria. Information on the designs of the studies, the characteristics of the study subjects, exposure and outcome measures, control for potential confounding factors, and risk estimates was abstracted independently by three investigators using a standardized protocol. Overall, nonsmokers exposed to environmental smoke had a relative risk of coronary heart disease of 1.25 (95 percent confidence interval, 1.17 to 1.32) as compared with nonsmokers not exposed to smoke. Passive smoking was consistently associated with an increased relative risk of coronary heart disease in cohort studies (relative risk, 1.21; 95 percent confidence interval, 1.14 to 1.30), in case-control studies (relative risk, 1.51; 95 percent confidence interval, 1.26 to 1.81), in men (relative risk, 1.22; 95 percent confidence interval, 1.10 to 1.35), in women (relative risk, 1.24; 95 percent confidence interval, 1.15 to 1.34), and in those exposed to smoking at home (relative risk, 1.17; 95 percent confidence interval, 1.11 to 1.24) or in the workplace (relative risk, 1.11; 95 percent confidence interval, 1.00 to 1.23). A significant dose-response relation was identified, with respective relative risks of 1.23 and 1.31 for nonsmokers who were exposed to the smoke of 1 to 19 cigarettes per day and those who were exposed to the smoke of 20 or more cigarettes per day, as compared with nonsmokers not exposed to smoke (P=0.006 for linear trend). Passive smoking is associated with a small increase in the risk of coronary heart disease. Given the high prevalence of cigarette smoking, the public health consequences of passive smoking with regard to coronary heart disease may be important.
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            Association between exposure to environmental tobacco smoke and exacerbations of asthma in children.

            Exposure to environmental tobacco smoke, as reported by parents, has been linked to diminished pulmonary function and more frequent exacerbations of asthma in children with the disease. Further insight into this association might be gained by using urine cotinine levels to measure actual exposure. We measured urine cotinine levels in 199 children with asthma; 145 also underwent pulmonary-function studies. A parent answered questions about each child's exposure to environmental tobacco smoke. Acute exacerbations of asthma during the preceding year were documented through blinded review of medical records. Possible confounding factors were accounted for by the use of multivariate analysis and by comparisons of serum theophylline levels in exposed and unexposed children. The median urine cotinine levels were 5.6 ng per milliliter in the 116 children reported not to have been exposed to tobacco smoke, 13.1 ng per milliliter in the 53 children exposed to cigarette smoking by the mother or other persons, and 55.8 ng per milliliter in the 30 children exposed to cigarette smoking by the mother and other persons. Acute exacerbations of asthma increased with exposure, whether such exposure was reported by a parent or identified on the basis of the cotinine level; the relative risks for the highest as compared with the lowest exposure category were 1.8 (95 percent confidence interval, 1.4 to 2.2) for reported exposure and 1.7 (95 percent confidence interval, 1.4 to 2.1) for exposure indicated by cotinine levels. The forced expiratory volume in one second (FEV1), the forced expiratory flow between 25 and 75 percent of vital capacity, and the ratio of FEV1 to forced vital capacity also decreased with increases in both measures of exposure. Measurement of urine cotinine levels provides further evidence of an association between exposure to environmental tobacco smoke and pulmonary morbidity in children with asthma. These data emphasize the need for systematic, persistent efforts to stop the exposure of children with asthma to environmental tobacco smoke.
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              Biomarkers of environmental tobacco smoke exposure.

               N L Benowitz (1999)
              Biomarkers are desirable for quantitating human exposure to environmental tobacco smoke (ETS) and for predicting potential health risks for exposed individuals. A number of biomarkers of ETS have been proposed. At present cotinine, measured in blood, saliva, or urine, appears to be the most specific and the most sensitive biomarker. In nonsmokers with significant exposure to ETS, cotinine levels in the body are derived primarily from tobacco smoke, can be measured with extremely high sensitivity, and reflect exposure to a variety of types of cigarettes independent of machine-determined yield. Under conditions of sustained exposure to ETS (i.e., over hours or days), cotinine levels reflect exposure to other components of ETS. Supporting the validity of cotinine as a biomarker, cotinine levels have been positively correlated to the risks of some ETS-related health complications in children who are not cigarette smokers. Images Figure 1
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                Author and article information

                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                February 2003
                : 77
                : 1
                : 11-36
                Affiliations
                Ringkoebing orgnameUnidad de Investigación Médica Dinamarca
                orgnameDefacto Países Bajos
                Article
                S1135-57272003000100004 S1135-5727(03)07700100004
                10.1590/S1135-57272003000100004

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 140, Pages: 26
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