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      Association between secondhand smoke exposure and hypertension in never smokers: a cross-sectional survey using data from Korean National Health and Nutritional Examination Survey V, 2010–2012

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          Abstract

          Objectives

          Secondhand smoke (SHS) exposure is associated with cardiovascular disease. This study aims to determine the association between SHS exposure estimated by questionnaire and hypertension in Korean never smokers.

          Setting

          Korean National Health and Nutrition Examination Survey (KNHANES) V was conducted from 2010 to 2012.

          Participants

          We selected the never smokers aged over 20 years who answered the question about the SHS exposure.

          Primary and secondary measures

          SHS exposure in both the home and work place was estimated using a self-reporting questionnaire. We investigated the association between SHS exposure and hypertension by using multivariate analysis. And we evaluated the mean systolic and diastolic blood pressure values according to SHS exposure after adjusting for possible confounding factors. All analyses were stratified by women and men.

          Results

          There were 10 532 (women 8987 and men 1545) never smokers. We divided the subjects into three groups according to the amount of SHS exposure: none—group I, <2 hour/day—group II and ≥2 hour/day—group III. Using multivariate analysis, hypertension was more commonly associated with group III than group I in women (adjusted OR 1.50, 95% CI 1.00 to 2.04, p=0.011). Adjusted mean systolic and diastolic blood pressure values in women who were not taking antihypertensive medication were significantly elevated in group III by 2.3 and 1.7 mm Hg, respectively.

          Conclusion

          SHS exposure is significantly associated with hypertension in women never smokers.

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          Most cited references20

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          Hidden female smokers in Asia: a comparison of self-reported with cotinine-verified smoking prevalence rates in representative national data from an Asian population.

          Young-Ho Khang, Su-Kyung Jung, HONG-SIK CHO (2012)
          The low smoking prevalence in Asian women may be due to under-reporting. We therefore investigated gender difference in self-reported and cotinine-verified smoking prevalence rates in Korea We analysed data from 5455 individuals (2387 men and 3068 women) in the 2008 Korean National Health and Nutrition Examination Survey. A urinary cotinine concentration of 50 ng/ml was the cut-off distinguishing smokers from non-smokers. Sensitivity analysis was done using different cut-offs of 25, 75 and 100 ng/ml. Cotinine-verified smoking rates were 50.0% for men and 13.9% for women, or 5.3% point and 8.0% point higher in absolute terms, respectively, than the self-reported rates for men and women. Ratios of cotinine-verified to self-reported smoking rates were 2.36 for women and 1.12 for men. Of the 1620 cotinine-verified smokers, 12.1% of men and 58.9% of women classified themselves as non-smokers. Women who live with a spouse or parents tend to under-report their smoking more than those who live alone or with others. Since the number of self-reported female smokers was less than half of cotinine-verified smokers, current anti-smoking policies based on self-reported smoking prevalence rates in Korea should be further directed towards hidden female smokers. Also, biochemical verification needs to be considered with national tobacco surveys in Asian countries.
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            Association between smoking and blood pressure: evidence from the health survey for England.

            N Poulter, Michael Marmot, S. Gupta … (2001)
            Cigarette smoking causes acute blood pressure (BP) elevation, although some studies have found similar or lower BPs in smokers compared with nonsmokers. Cross-sectional data from 3 years (1994 to 1996) of the annual Health Survey for England were used to investigate any difference in BP between smokers and nonsmokers in a nationally representative sample of adults (>/=16 years old). Randomly selected adults (33 860; 47% men) with valid body mass index (BMI) and BP measurements provided data on smoking status (never, past, or current) and were stratified into younger (16 to 44 years old) and older (>/=45 years old) age groups. Analyses provided between 89% and 94% power to detect a difference of 2 mm Hg systolic BP between smokers and nonsmokers in the 4 age/gender strata (alpha=0.05). Older male smokers had higher systolic BP adjusted for age, BMI, social class, and alcohol intake than did nonsmoking men. No such differences were seen among younger men or for diastolic blood pressure in either age group. Among women, light smokers (1 to 9 cigarettes/d) tended to have lower BPs than heavier smokers and never smokers, significantly so for diastolic BP. Among men, a significant interaction between BMI and the BP-smoking association was observed. In women, BP differences between nonsmokers and light smokers were most marked in those who did not drink alcohol. These data show that any independent chronic effect of smoking on BP is small. Differences between men and women in this association are likely to be due to complex interrelations among smoking, alcohol intake, and BMI.
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              Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: focus on developmental toxicology.

              Ana-Maria Florescu, Offie Soldin, Gideon Koren … (2009)
              Active and passive smoking have been associated with an array of adverse effects on health. The development of valid and accurate scales of measurement for exposures associated with health risks constitutes an active area of research. Tobacco smoke exposure still lacks an ideal method of measurement. A valid estimation of the risks associated with tobacco exposure depends on accurate measurement. However, some groups of people are more reluctant than others to disclose their smoking status and exposure to tobacco. This is particularly true for pregnant women and parents of young children, whose smoking is often regarded as socially unacceptable. For others, recall of tobacco exposure may also prove difficult. Because relying on self-report and the various biases it introduces may lead to inaccurate measures of nicotine exposure, more objective solutions have been suggested. Biomarkers constitute the most commonly used objective method of ascertaining nicotine exposure. Of those available, cotinine has gained supremacy as the biomarker of choice. Traditionally, cotinine has been measured in blood, saliva, and urine. Cotinine collection and analysis from these sources has posed some difficulties, which have motivated the search for a more consistent and reliable source of this biomarker. Hair analysis is a novel, noninvasive technique used to detect the presence of drugs and metabolites in the hair shaft. Because cotinine accumulates in hair during hair growth, it is a unique measure of long-term, cumulative exposure to tobacco smoke. Although hair analysis of cotinine holds great promise, a detailed evaluation of its potential as a biomarker of nicotine exposure, is needed. No studies have been published that address this issue. Because the levels of cotinine in the body are dependent on nicotine metabolism, which in turn is affected by factors such as age and pregnancy, the characterization of hair cotinine should be population specific. This review aims at defining the sensitivity, specificity, and clinical utilization of different methods used to estimate exposure to cigarette smoking and environmental tobacco smoke.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2018
                Publication date (Electronic): 14 May 2018
                Volume: 8
                Issue: 5
                Electronic Location Identifier: e021217
                Affiliations
                [1 ] departmentDepartment of Internal Medicine , Seoul National University Hospital , Seoul, Korea
                [2 ] departmentDepartment of Internal Medicine , Chonnam National University Hospital , Gwangju, Korea
                [3 ] departmentDepartment of Internal Medicine , Yonsei University College of Medicine , Seoul, Korea
                [4 ] departmentDepartment of Internal Medicine , Chungnam National University School of Medicine , Daejeon, Korea
                [5 ] departmentDepartment of Internal Medicine , Ajou University School of Medicine , Suwon, Korea
                [6 ] departmentDepartment of Internal Medicine , College of Medicine, The Catholic University of Korea , Seoul, Korea
                [7 ] departmentDepartment of Internal Medicine , Chung-Ang University College of Medicine , Seoul, Korea
                [8 ] departmentDepartment of Internal Medicine , Ewha Womans University School of Medicine , Seoul, Korea
                [9 ] departmentDepartment of Internal Medicine , Chilgok Kyungpook National University School of Medicine , Daegu, Korea
                [10 ] departmentDepartment of Internal Medicine , Konkuk University College of Medicine , Seoul, Korea
                Author notes
                [Correspondence to ] Professor Chang-Hoon Lee; kauri670@ 123456empal.com
                Article
                Publisher ID: bmjopen-2017-021217
                DOI: 10.1136/bmjopen-2017-021217
                PMC ID: 5961559
                PubMed ID: 29764884
                SO-VID: 378afbda-3b36-4470-b120-0f6ca271c25a
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 15 December 2017
                Date revision received : 31 March 2018
                Date accepted : 06 April 2018
                Categories
                Subject: Smoking and Tobacco
                Subject: Research
                Subject: 1506
                Subject: 1734
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: second-hand smoke,hypertension,blood pressure,knhanes
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: second-hand smoke, hypertension, blood pressure, knhanes

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