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Environ Health Perspect. 2001 Aug; 109(8): 809–814.
PMCID: PMC1240408
Research Article

Measurement of environmental tobacco smoke exposure among adults with asthma.


Because the morbidity and mortality from adult asthma have been increasing, the identification of modifiable environmental exposures that exacerbate asthma has become a priority. Limited evidence suggests that exposure to environmental tobacco smoke (ETS) may adversely affect adults with asthma. To study the effects of ETS better, we developed a survey instrument to measure ETS exposure in a cohort of adults with asthma living in northern California, where public indoor smoking is limited. To validate this survey instrument, we used a passive badge monitor that measures actual exposure to ambient nicotine, a direct and specific measure of ETS. In this validation study, we recruited 50 subjects from an ongoing longitudinal asthma cohort study who had a positive screening question for ETS exposure or potential exposure. Each subject wore a passive nicotine badge monitor for 7 days. After the personal monitoring period, we readministered the ETS exposure survey instrument. Based on the survey, self-reported total ETS exposure duration ranged from 0 to 70 hr during the previous 7 days. Based on the upper-range boundary, bars or nightclubs (55 hr) and the home (50 hr) were the sites associated with greatest maximal self-reported exposure. As measured by the personal nicotine badge monitors, the overall median 7-day nicotine concentration was 0.03 microg/m(3) (25th-75th interquartile range 0-3.69 microg/m(3)). Measured nicotine concentrations were highest among persons who reported home exposure (median 0.61 microg/m(3)), followed by work exposure (0.03 microg/m(3)), other (outdoor) exposure (0.025 microg/m(3)), and no exposure (0 microg/m(3); p = 0.03). The Spearman rank correlation coefficient between self-reported ETS exposure duration and directly measured personal nicotine concentration during the same 7-day period was 0.47, supporting the survey's validity (p = 0.0006). Compared to persons with no measured exposure, lower-level [odds ratio (OR) 1.9; 95% confidence interval (CI), 0.4-8.8] and higher-level ETS exposures (OR 6.8; 95% CI, 1.4-32.3) were associated with increased risk of respiratory symptoms. A brief, validated survey instrument can be used to assess ETS exposure among adults with asthma, even with low levels of exposure. This instrument could be a valuable tool for studying the effect of ETS exposure on adult asthma health outcomes.

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Selected References

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  • Ostro BD, Lipsett MJ, Mann JK, Wiener MB, Selner J. Indoor air pollution and asthma. Results from a panel study. Am J Respir Crit Care Med. 1994 Jun;149(6):1400–1406. [PubMed]
  • Sippel JM, Pedula KL, Vollmer WM, Buist AS, Osborne ML. Associations of smoking with hospital-based care and quality of life in patients with obstructive airway disease. Chest. 1999 Mar;115(3):691–696. [PubMed]
  • Blanc PD, Ellbjär S, Janson C, Norbäck D, Norrman E, Plaschke P, Torén K. Asthma-related work disability in Sweden. The impact of workplace exposures. Am J Respir Crit Care Med. 1999 Dec;160(6):2028–2033. [PubMed]
  • Macdonald HR, Glantz SA. Political realities of statewide smoking legislation: the passage of California's Assembly Bill 13. Tob Control. 1997 Spring;6(1):41–54. [PMC free article] [PubMed]
  • Delfino RJ, Ernst P, Jaakkola MS, Solomon S, Becklake MR. Questionnaire assessments of recent exposure to environmental tobacco smoke in relation to salivary cotinine. Eur Respir J. 1993 Sep;6(8):1104–1108. [PubMed]
  • Kemmeren JM, van Poppel G, Verhoef P, Jarvis MJ. Plasma cotinine: stability in smokers and validation of self-reported smoke exposure in nonsmokers. Environ Res. 1994 Aug;66(2):235–243. [PubMed]
  • Pirkle JL, Flegal KM, Bernert JT, Brody DJ, Etzel RA, Maurer KR. Exposure of the US population to environmental tobacco smoke: the Third National Health and Nutrition Examination Survey, 1988 to 1991. JAMA. 1996 Apr 24;275(16):1233–1240. [PubMed]
  • Rebagliato M, Bolumar F, Florey C du V. Assessment of exposure to environmental tobacco smoke in nonsmoking pregnant women in different environments of daily living. Am J Epidemiol. 1995 Sep 1;142(5):525–530. [PubMed]
  • Emmons KM, Abrams DB, Marshall RJ, Etzel RA, Novotny TE, Marcus BH, Kane ME. Exposure to environmental tobacco smoke in naturalistic settings. Am J Public Health. 1992 Jan;82(1):24–28. [PMC free article] [PubMed]
  • Emmons KM, Abrams DB, Marshall R, Marcus BH, Kane M, Novotny TE, Etzel RA. An evaluation of the relationship between self-report and biochemical measures of environmental tobacco smoke exposure. Prev Med. 1994 Jan;23(1):35–39. [PubMed]
  • Riboli E, Preston-Martin S, Saracci R, Haley NJ, Trichopoulos D, Becher H, Burch JD, Fontham ET, Gao YT, Jindal SK, et al. Exposure of nonsmoking women to environmental tobacco smoke: a 10-country collaborative study. Cancer Causes Control. 1990 Nov;1(3):243–252. [PubMed]
  • Coultas DB, Peake GT, Samet JM. Questionnaire assessment of lifetime and recent exposure to environmental tobacco smoke. Am J Epidemiol. 1989 Aug;130(2):338–347. [PubMed]
  • Masi MA, Hanley JA, Ernst P, Becklake MR. Environmental exposure to tobacco smoke and lung function in young adults. Am Rev Respir Dis. 1988 Aug;138(2):296–299. [PubMed]
  • Jaakkola MS, Jaakkola JJ, Becklake MR, Ernst P. Passive smoking and evolution of lung function in young adults. An 8-year longitudinal study. J Clin Epidemiol. 1995 Mar;48(3):317–327. [PubMed]
  • Jaakkola MS, Jaakkola JJ. Assessment of exposure to environmental tobacco smoke. Eur Respir J. 1997 Oct;10(10):2384–2397. [PubMed]
  • Benowitz NL. Biomarkers of environmental tobacco smoke exposure. Environ Health Perspect. 1999 May;107 (Suppl 2):349–355. [PMC free article] [PubMed]
  • Hammond SK, Sorensen G, Youngstrom R, Ockene JK. Occupational exposure to environmental tobacco smoke. JAMA. 1995 Sep 27;274(12):956–960. [PubMed]
  • Blanc PD, Cisternas M, Smith S, Yelin EH. Asthma, employment status, and disability among adults treated by pulmonary and allergy specialists. Chest. 1996 Mar;109(3):688–696. [PubMed]
  • Blanc PD, Eisner MD, Israel L, Yelin EH. The association between occupation and asthma in general medical practice. Chest. 1999 May;115(5):1259–1264. [PubMed]
  • Blanc P. Correction to the scientific record. Chest. 2000 Aug;118(2):564–564. [PubMed]
  • Eisner MD, Katz PP, Yelin EH, Henke J, Smith S, Blanc PD. Assessment of asthma severity in adults with asthma treated by family practitioners, allergists, and pulmonologists. Med Care. 1998 Nov;36(11):1567–1577. [PubMed]
  • Marks GB, Dunn SM, Woolcock AJ. A scale for the measurement of quality of life in adults with asthma. J Clin Epidemiol. 1992 May;45(5):461–472. [PubMed]
  • Ware J, Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996 Mar;34(3):220–233. [PubMed]
  • O'Connor TZ, Holford TR, Leaderer BP, Hammond SK, Bracken MB. Measurement of exposure to environmental tobacco smoke in pregnant women. Am J Epidemiol. 1995 Dec 15;142(12):1315–1321. [PubMed]
  • Coghlin J, Hammond SK, Gann PH. Development of epidemiologic tools for measuring environmental tobacco smoke exposure. Am J Epidemiol. 1989 Oct;130(4):696–704. [PubMed]
  • Wells AJ. Passive smoking as a cause of heart disease. J Am Coll Cardiol. 1994 Aug;24(2):546–554. [PubMed]
  • Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung cancer and environmental tobacco smoke. BMJ. 1997 Oct 18;315(7114):980–988. [PMC free article] [PubMed]
  • Daisey JM. Tracers for assessing exposure to environmental tobacco smoke: what are they tracing? Environ Health Perspect. 1999 May;107 (Suppl 2):319–327. [PMC free article] [PubMed]
  • Jenkins RA, Palausky A, Counts RW, Bayne CK, Dindal AB, Guerin MR. Exposure to environmental tobacco smoke in sixteen cities in the United States as determined by personal breathing zone air sampling. J Expo Anal Environ Epidemiol. 1996 Oct-Dec;6(4):473–502. [PubMed]

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