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      Exposure to secondhand smoke and cognitive impairment in non-smokers: national cross sectional study with cotinine measurement

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          Abstract

          Objective To examine the association between a biomarker of exposure to secondhand smoke (salivary cotinine concentration) and cognitive impairment.

          Design Cross sectional analysis of a national population based study.

          Setting Stratified random sample of households throughout England.

          Participants 4809 non-smoking adults aged 50 years or more from the 1998, 1999, and 2001 waves of the Health Survey for England who also participated in the 2002 wave of the English Longitudinal Study of Ageing and provided saliva samples for cotinine assay and a detailed smoking history.

          Main outcome measure Cognitive impairment as defined by the lowest 10% of scores on a battery of neuropsychological tests.

          Results Participants who did not smoke, use nicotine products, or have salivary cotinine concentrations of 14.1 ng/ml or more were divided into four equal size groups on the basis of cotinine concentrations. Compared with the lowest fourth of cotinine concentration (0.0-0.1 ng/ml) the odds ratios (95% confidence intervals) for cognitive impairment in the second (0.2-0.3 ng/ml), third (0.4-0.7 ng/ml), and highest fourths (0.8-13.5 ng/ml) were 1.08 (0.78 to 1.48), 1.13 (0.81 to 1.56), and 1.44 (1.07 to 1.94; P for trend 0.02), after adjustment for a wide range of established risk factors for cognitive impairment. A similar pattern of associations was observed for never smokers and former smokers.

          Conclusions Exposure to secondhand smoke may be associated with increased odds of cognitive impairment. Prospective nationally representative studies relating biomarkers of exposure to cognitive decline and risk of dementia are needed.

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          Most cited references33

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          Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study.

          Tobacco use is one of the major avoidable causes of cardiovascular diseases. We aimed to assess the risks associated with tobacco use (both smoking and non-smoking) and second hand tobacco smoke (SHS) worldwide. We did a standardised case-control study of acute myocardial infarction (AMI) with 27,089 participants in 52 countries (12,461 cases, 14,637 controls). We assessed relation between risk of AMI and current or former smoking, type of tobacco, amount smoked, effect of smokeless tobacco, and exposure to SHS. We controlled for confounders such as differences in lifestyles between smokers and non-smokers. Current smoking was associated with a greater risk of non-fatal AMI (odds ratio [OR] 2.95, 95% CI 2.77-3.14, p 21 h per week). Young male current smokers had the highest population attributable risk (58.3%; 95% CI 55.0-61.6) and older women the lowest (6.2%, 4.1-9.2). Population attributable risk for exposure to SHS for more than 1 h per week in never smokers was 15.4% (12.1-19.3). Tobacco use is one of the most important causes of AMI globally, especially in men. All forms of tobacco use, including different types of smoking and chewing tobacco and inhalation of SHS, should be discouraged to prevent cardiovascular diseases.
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            CIRCULATION

            K Nielsen (1972)
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              Cotinine as a biomarker of environmental tobacco smoke exposure.

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                Author and article information

                Contributors
                Role: research associate
                Role: research fellow
                Role: associate professor of internal medicine
                Role: doctoral researcher
                Role: senior research scientist
                Journal
                BMJ
                bmj
                BMJ : British Medical Journal
                BMJ Publishing Group Ltd.
                0959-8138
                1468-5833
                2009
                2009
                12 February 2009
                : 338
                : b462
                Affiliations
                [1 ]Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 2SR
                [2 ]Public Health and Epidemiology Group, Peninsula Medical School, Exeter
                [3 ]Department of Internal Medicine, University of Michigan, USA
                [4 ]Veterans Affairs Center for Practice Management and Outcomes Research, Michigan
                [5 ]Institute for Social Research, University of Michigan
                [6 ]MRC Biostatistics Unit, Institute of Public Health, Cambridge
                Author notes
                Correspondence to: D J Llewellyn dl355@ 123456medschl.cam.ac.uk
                Article
                lled563940
                10.1136/bmj.b462
                2643443
                19213767
                a9359e1c-fd76-431b-b8d9-812486a4794a
                © Llewellyn et al 2009

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 November 2008
                Categories
                Research

                Medicine
                Medicine

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