Table 7.3

Case-control studies by geographic area of exposure to secondhand smoke and the relative risks for lung cancer among lifetime nonsmokers

StudyPopulation/date of studyCases/histologic confirmation and cell type (%)*ControlsData collectionFindingsMeasure of secondhand smokeRelative risk (95% confidence interval)Comments (covariates considered, definition of lifetime nonsmokers)
Canada
Johnson et al. 2001 Women aged 20–74 years from 8 Canadian Tumor Registries
Frequency was matched for age and province of residence
Canada
1994–1997
161
100% histologic confirmation
No cell type information
1,271 selected from insurance/property assessment databases or by random-digit telephone dialing (RDD)Mailed questionnaire
Response rate
 Cases: 70%
 Controls: 70%
Approximately all self-respondents
  • Significant trend with smoker-years of workplace and residential/workplace (i.e., total) secondhand smoke exposures
Any secondhand smoke exposure (childhood and adulthood):Controlled for age (10-year age group), education, province, fruit and vegetable intake; these results were based on 71 cases and 761 controls who had a more complete secondhand smoke exposure history; lifetime nonsmokers had smoked <100 cigarettes per lifetime
 No1.0
 Yes1.63 (0.8–3.5)
Total (smoker-years):
 None1.0
 1–360.83 (0.3–2.1)
 37–771.54 (0.7–3.5)
 ≥781.82 (0.8–4.2)
Europe
Jöckel et al. 1998 Men and women well enough to be interviewed from all hospitals in the study area
Germany (Bremen, Frankfurt)
1988–1993
55 lifetime nonsmokers
100% histologic or cytologic confirmation
160 lifetime nonsmokers selected from population registries (general population)In-person interview
100% self-respondents
  • Risk increased with high secondhand smoke exposure during childhood and adulthood from spouse and other sources (all sources combined = total)
Secondhand smoke exposure from spouse:Controlled for gender, age, fruit and vegetable intake, and region; lifetime nonsmokers smoked regularly for <6 months (regular = 1 cigarette/day); intensity of the secondhand smoke exposure was based on hours and years of exposure and the degree of smokiness
 No1.0
 Yes1.12 (0.54–2.32)
Total secondhand smoke exposure by intensity:
 None1.0
 Medium0.87 (0.36–2.07)
 High3.24 (1.44–7.32)
Nyberg et al. 1998a Men and women aged >30 years from 3 main local hospitals
2 controls per case
Frequency matched for gender, age, and area of residence
Sweden (Stockholm county)
1989–1995
124 (35 men, 89 women)
96% histologic confirmation
Squamous cell carcinoma: 10%
Small cell carcinoma: 2%
Adenocarcinoma: 67%
235 (72 men, 163 women) selected from population registerIn-person interview or by telephone
Response rate
 Cases: 86%
 Controls: 83%
100% self-respondents
  • Significant trends of increasing risk with increasing years of workplace secondhand smoke exposure
  • Strongest association with recent secondhand smoke exposure
MenControlled for age, gender, catchment area, occasional smoking, vegetable intake, degree of urban residence, and occupation; lifetime nonsmokers smoked <1 cigarette/day or <10 cigarettes/week and other equivalences for cigars, pipes, and cigarillos
 Spousal secondhand smoke:
  No1.0
  Yes1.96 (0.72–5.36)
 Workplace secondhand smoke:
  No1.0
  Yes1.89 (0.53–6.67)
Women
 Spousal secondhand smoke:
  No1.0
  Yes1.05 (0.60–1.86)
 Workplace secondhand smoke:
  No1.0
  Yes1.57 (0.80–3.06)
Zaridze et al. 1998 2 main cancer treatment hospitals
Controls were from the same hospital as cases
Russia (Local Moscow residents only)
189 women
100% histologic confirmation
Squamous cell carcinoma: 22%
Small cell carcinoma: 5%
Adenocarcinoma: 56%
358 other cancer patientsIn-person interview within 3 days of hospital admission
Response rate was not reported
100% self-respondents
  • Increased risk with husband’s smoking was stronger when restricted to controls with nonsmoking-related cancers
  • Stronger association with squamous cell cancers
Husband smoked:Controlled for age and education; lifetime nonsmokers were not defined; age of participants and the study period were not reported
 No1.0
 Yes1.53 (1.06–2.21)
Workplace secondhand smoke:
 No1.0
 Yes0.88 (0.55–1.41)
Kreuzer et al. 2000 Men and women aged <76 years from 15 clinics/hospitals
Area residents for at least 25 years
Frequency matched for gender, age, region, and length of residence
East/West Germany
1990–1996
292 (234 women, 58 men)
100% histologic confirmation
Squamous cell carcinoma: 20%
Adenocarcinoma: 59% (n = 173)
1,338 (535 women, 803 men)
RDD and local residential registries
In-person interview within 3 months of diagnosis
Response rate:
 Cases: 76%
 Controls: 41%
100% self-respondents
  • No significant association with any secondhand smoke exposure from spouse, work, or childhood
  • Increased risk with weighted duration of secondhand smoke exposures from all sources
Men and womenControlled for gender, age, region, occupation, education, radon, family history, previous lung diseases, length of residence, and selected vegetable intake; lifetime nonsmokers had smoked <400 cigarettes/lifetime; secondhand smoke from all sources combined included exposures inside and outside the home (weighted duration = hours times smokiness)
 Spouse smoked:
  No1.0
  Yes0.99 (0.73–1.34)
 Secondhand smoke from all sources with weighted duration:
  None1.0
  Low1.29 (0.79–2.09)
  Medium1.78 (1.05–3.04)
Asia
Du et al. 1996; Lei et al. 1996Reviewed death certificates of local residents
Matched for gender, age, year of death, and block of residence
Guangzhou, China
1986
75 women
No histologic confirmation or cell type information
128 women
Excluded those with history of respiratory disease/tumors
In-person interview with next of kin
Response rate was not reported
No self-respondents
  • No significant increased risk was associated with husband’s smoking by amount or duration
Husband smoked:Crude risk estimate; definition of lifetime nonsmokers was not reported; there were many limitations in the study methods
 No1.0
 Yes1.19 (0.66–2.16)
Shen et al. 1996, 1998Hospital-based
Local residents ≥20 years
Matched for age, gender, neighborhood, and occupation
Nanjing, China
1986–1993
70 women
100% histologic confirmation
Included only adenocarcinoma
70 women
General population
In-person interview
Response rate was not reported
100% self-respondents
  • No significant trend with amount and duration of secondhand smoke exposure at home
Daily household secondhand smoke exposure:Controlled for neighborhood, gender, age, and occupation; possible overmatching
 No1.0
 Yes1.63 (0.68–3.89)
Wang et al. 1996; Zhou et al. 200018 hospitals
Aged 35–69 years
Matched for age and lifetime nonsmoking status
Shenyang, China
1991–1995
135 women, 72 with adenocarcinoma
Approximately 50% histologic confirmation
Squamous cell carcinoma: 16%
Small cell carcinoma: 20%
Adenocarcinoma: 55%
135 women, 72 designated specifically for adenocarcinoma patients
General population
In-person interview within 2 weeks of case diagnosis
Response rate was not reported
100% self-respondents
  • No significant trend with years/amount smoked by husband
  • Results in analyses restricted to adenocarcinoma were similar
Husband smoked:Crude risk estimates; histologic cell type classification is questionable
 No1.0
 Yes1.11 (0.65–1.88)
Workplace exposure:
 No1.0
 Yes0.89 (0.45–1.77)
Rapiti et al. 1999 1 hospital
Men and women
Excluded some diseases among hospital controls
No matching
Chandigarh, India
1991–1992
58 (17 men, 41 women)
100% histologic confirmation
Squamous cell carcinoma: 28%
Small cell carcinoma: 19%
Adenocarcinoma: 51%
123 (56 men, 67 women)
2 sources: other hospital patients and visitors
In-person interview
Response rate was not reported
100% self-respondents
  • No significant association with years of spousal smoking
  • Increased risk with secondhand smoke exposure during childhood
Husband smoked:Controlled for gender, age, religion, and residence; lifetime nonsmokers had smoked <400 cigarettes/lifetime
 No1.0
 Yes1.1 (0.5–2.6)
Zhong et al. 1999 Women aged 35–69 years
Permanent residents of the area
Frequency matched for age
Shanghai, China Cancer
Registry
1992–1994
504
Approximately 77% histologic confirmation
Squamous cell carcinoma: 12.4%
Small cell carcinoma: 2%
Adenocarcinoma: 76.5%
601
General population
In-person interview at home, hospital, or work
 Response rate:
  Cases: 92%
  Controls: 84%
 Self-respondents:
  Cases: 80%
  Controls: 98%
  • Significant association between secondhand smoke exposure at work and risk when stratified by various intensity measures
Secondhand smoke at home:Controlled for age, income, vitamin C intake, respondent status, smokiness of kitchen, family history of lung cancer, and high-risk occupations; lifetime nonsmokers had smoked <1 cigarette/day for 6 months
 No1.0
 Yes1.2 (0.8–1.7)
Workplace exposure:
 No1.0
 Yes1.9 (0.9–3.7)
Lee et al. 2000 1 hospital
Women only
Matched for age, lifetime nonsmoking status, date of admission
Kaohsiung (Taiwan)
1992–1998
268
100% histologic confirmation
Squamous cell carcinoma: 18%
Small cell carcinoma: 11%
Adenocarcinoma: 68%
445 hospital controls
Eye or orthopedic patients, or in for check-ups
In-person interview
 Response rate:
  Cases: 91%
  Controls: 90%
100% self-respondents
  • Significant associations between various sources of secondhand smoke exposure and risk (husband, work, and paternal smoking)
Husband smoked:Controlled for area of residence, education, occupation, tuberculosis, cooking fuels, and fume extractor; lifetime nonsmokers had smoked <1 cigarette/day for 1 year or <365 cigarettes/lifetime
 No1.0
 In wife’s absence1.2 (0.7–2.0)
 In wife’s presence2.2 (1.5–3.3)
Lifetime exposure:
 None1.0
 1–20 smoker-years1.3 (0.6–2.6)
 21–40 smoker-years1.6 (0.9–2.6)
 41–60 smoker-years2.0 (1.2–3.5)
 >60 smoker-years2.8 (1.6–4.8)
Wang et al. 2000 Local hospitals and clinics
Aged 30–75 years
Frequency matched for age, gender, and prefecture of residence
Gansu Province (China)
1994–1998
233 (33 men, 200 women)
30% histologic confirmation
Cell type distribution was not reported
521 (114 men, 407 women)
General population
In-person interview at home/hospital
 Response rate:
  Cases: 95%
  Controls: 90%
 Self-respondents:
  Cases: 46%
  Controls: 96%
  • No significant association with secondhand smoke exposure in adulthood
  • Significant association with secondhand smoke exposure in childhood
Secondhand smoke in adulthood:Controlled for age, social class, prefecture, and other potential confounders; lifetime nonsmokers smoked cigarettes or pipes regularly for ≤6 months
 No1.0
 Yes0.90 (0.6–1.4)
Secondhand smoke in childhood:
 No1.0
 Yes1.52 (1.1–2.2)
Lifetime secondhand smoke:
 No1.0
 Yes1.19 (0.7–2.0)
Seow et al. 2002 3 major hospitals
Aged <90 years (alert enough for interview)
Frequency matched for age, hospital, and date of admission
Singapore
1996–1998
176 women
100% histologic confirmation
Squamous cell carcinoma: 10%
Small cell carcinoma: 1.1%
Adenocarcinoma: 72%
663
No history of cancer, heart or chronic respiratory disease, or renal failure
In-person interview within 3 months of diagnosis
 Response rate:
  Cases: 95%
  Controls: 97%
 100% self-respondents
  • Increased risk with any household secondhand smoke exposure
Any secondhand smoke:Controlled for age, birthplace, family history of cancer, soy intake, length of menstrual cycle; lifetime nonsmokers had smoked <1 cigarette/day for 1 year; there was a single question on secondhand smoke exposure
 No1.0
 Yes1.3 (0.9–1.8)
*

Percentages do not add up to 100%.

Smoker-years = The number of years of exposure weighted by the number of smokers.

Smokiness = Subjective index: (1) not visible but smellable, (2) visible, and (3) very smoky.

Percentages do not add up to 100%.

Smoker-years = The number of years of exposure weighted by the number of smokers.

Smokiness = Subjective index: (1) not visible but smellable, (2) visible, and (3) very smoky.

From: 7, Cancer Among Adults from Exposure to Secondhand Smoke

Cover of The Health Consequences of Involuntary Exposure to Tobacco Smoke
The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General.
Office on Smoking and Health (US).

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