Associations between smoke-free vehicle legislation and childhood admissions to hospital for asthma in Scotland: an interrupted time-series analysis of whole-population data.

BACKGROUND: In Scotland, childhood admissions to hospital for asthma fell from March, 2006, after legislation was introduced to prohibit smoking in public places. In December, 2016, new Scottish legislation banned smoking in vehicles containing a child. We aimed to determine whether the introduction of this new legislation produced additional benefits. METHODS: We obtained data on all asthma emergency admissions to hospitals in Scotland between 2000 and 2018 for individuals younger than 16 years. We used interrupted time-series analyses to study changes in monthly incidence of asthma emergency admissions to hospital per 100 000 children after the introduction of smoke-free vehicle legislation, taking into account previous smoke-free interventions. We did subgroup analyses according to age and area deprivation, using the Scottish Index of Multiple Deprivation, and repeated the analyses for a control condition, gastroenteritis, and other respiratory conditions. FINDINGS: Of the 32 342 emergency admissions to hospital for asthma among children younger than 16 years over the 19-year study period (Jan 1, 2000, to Dec 31, 2018), 13 954 (43%) were among children younger than 5 years and 18 388 (57%) were among children aged 5-15 years. After the introduction of smoke-free vehicle legislation, there was a non-significant decline in the slope for monthly emergency admissions to hospital for asthma among children younger than 16 years (-1·21%, 95% CI -2·64 to 0·23) relative to the underlying trend in hospital admissions for childhood asthma. However, children younger than 5 years had a significant decline in the slope for monthly asthma admissions (-1·49%, -2·69 to -0·27) over and above the underlying trend among children in this age group (equivalent to six fewer hospitalisations per year), but no such decline was seen in children aged 5-15 years. Monthly admissions to hospital for asthma fell significantly among children living in the most affluent areas (-2·27%, -4·41 to -0·07) but not among those living in the most deprived areas. We found no change in admissions to hospital for gastroenteritis or other respiratory conditions after the introduction of the smoke-free vehicle legislation. INTERPRETATION: Although legislation banning smoking in vehicles did not affect hospital admissions for severe asthma among children overall or in the older age group, this legislation was associated with a reduction in severe asthma exacerbations requiring hospital admission among preschool children, over and above the underlying trend and previous interventions designed to reduce exposure to second-hand smoke. Similar legislation prohibiting smoking in vehicles that contain children should be adopted in other countries. FUNDING: None.

Creating smoke-free homes for children.

This article describes a tool that was designed to help nurses deliver health education on the subject of passive smoking. The tool is based on a Scottish study, which encouraged mothers to identify their own strategies for reducing smoking in the home in order to protect their children from being exposed to second-hand smoke. It is designed to give nurses and other health professionals who work with families and children the knowledge, skills and confidence they need to raise the issue of second-hand smoke with parents and help them to find their own solutions to reducing smoking in the home. This article also takes into consideration the implications for nursing practice that relate to raising the issue of exposing children to second-hand smoke with parents and carers.

'I'm not doing this for me': mothers' accounts of creating smoke-free homes.

This article explores mothers' narratives of changing home smoking behaviours after participating in an intervention (Reducing Families' Exposure to Smoking in the Home [REFRESH]) aimed at reducing families' exposure to secondhand smoke (SHS) in homes in Scotland. An analysis of qualitative findings illuminates quantitative changes in levels of SHS exposure. Prospective quantitative and qualitative data were drawn from 21 smoking mothers with at least one child under 6 years. Quantitative change was measured by home air quality, i.e. fine particulate matter <2.5µg (PM(2.5)). These measurements guided the organization of mothers into categories of change (smoke-free home at baseline [SFB], smoke-free home at final, some change and no change [NC]). Qualitative data from 17 mothers with non-SFB were analysed thematically within and across these categories. Three comparative case studies illustrate the varying changes made, barriers to change and how mothers valued such changes. The outcomes varied post-intervention, with homes smoke-free, partially smoke-free or making NC. The changes in home smoking behaviour were incremental, yet beneficial to reducing SHS exposure, and related to the nature of the restrictions and personal circumstances in the home pre-intervention. Across all change categories, mothers valued the changes they had made and expressed an intention to increase the changes.

Factors influencing exposure to secondhand smoke in preschool children living with smoking mothers.

INTRODUCTION: The health effects on young children of exposure to secondhand smoke (SHS) are well described. Recent work suggests that over one quarter of school-aged children in Scotland are regularly exposed to SHS in the home. The study was designed to describe SHS exposure in preschool children whose mothers smoked and identify factors that influence exposure. METHODS: Smoking mothers with at least one child aged 1-5 years were recruited to the Reducing Families' Exposure to Secondhand Smoke in the Home study. Concentrations of airborne particulate matter less than 2.5 µm in size (PM(2.5)) in the home were measured together with child's salivary cotinine. Demographics including age, accommodation type, socioeconomic status, and number of cigarettes smoked at home were recorded. RESULTS: Data were collected from 54 homes. In 89% of the homes, concentrations of PM(2.5) exceeded health-based guidance values at some point of the day. Household PM(2.5) concentrations were highest during the evening hours of 6 p.m. to midnight. Younger children had higher salivary cotinine concentrations than older children, and the geometric mean of salivary cotinine was 2.36 ng/ml. Household smoking restrictions and maternal confidence in enforcing smoking restrictions in their own home were strongly associated with child's SHS exposure. CONCLUSIONS: Preschool children's exposure to SHS in homes where the mother smokes is considerable. Interventions and policy development to increase parental awareness of the health effects of SHS and provide parents with the confidence to implement smoke-free households are required to reduce the SHS exposure of preschool age children.

Solvent exposure and cognitive ability at age 67: a follow-up study of the 1947 Scottish Mental Survey.

OBJECTIVES: Organic solvent exposure may be associated with cognitive impairment in later life although the evidence for this association is inconsistent. This study sought to examine the association between organic solvent exposure and cognitive function in later life. METHODS: A prospective longitudinal study set in Aberdeen, Scotland examined 336 men and women born in 1936 who participated in the 1947 Scottish Mental Survey. Cognitive function at age 67 years was measured using the Trail Making Test B (TMT B), the Digit Symbol (DS) test, and the Auditory Verbal Learning Test (AVLT). Occupational hygienists reviewed occupational histories, blind to cognitive function, and estimated lifetime solvent exposures. Multiple regression analyses were employed to explore the association between solvent exposure and cognitive performance after adjustment for confounders. RESULTS: After adjusting for childhood IQ, smoking, alcohol and sex, the solvent exposed group took on average almost 10 s longer than the unexposed group to complete the TMT B, a highly significant difference. For the DS test, after adjusting for childhood IQ, smoking and gender, the exposed group scored on average two points lower than the unexposed group, which was again highly significant. There was no evidence of an effect for cumulative solvent exposure on the TMT B or DS test. For the AVLT there were no significant differences associated with exposure. CONCLUSIONS: This study of subjects with generally low exposures, found no clear evidence of an association between solvent exposure and cognitive function.

Exposure assessment for a population-based case-control study combining a job-exposure matrix with interview data.

OBJECTIVES: A system that combines the ease of use of a job-exposure matrix while taking into account job-specific data is needed. This study aimed to produce a detailed method for combining interview data with expert assessments for a large population-based case-control study of Parkinson's disease. METHOD: An interview-administered core questionnaire with a series of questions that triggers substance-specific questionnaires to gather information on key parameters is administered. Using a job-exposure matrix to generate base estimates, assessors can modify this estimate of exposure intensity using worker-specific data such as the use of control measures, reports of substance-specific acute symptoms, and the quantity of material being processed. Detailed guidance for making adjustments to exposure estimates for these modifiers is presented. RESULTS: The method has been partially validated through the use of a comparison of estimates for a separate cohort with previously validated exposure reconstructions. Agreement was high, with a Spearman's rho of 0.89 (P < 0.01). The results from a quality assurance system employed as part of the methodology show a high degree of repeatability in generated exposure values both over time (Spearman's rho 0.98, P < 0.01) and between different assessors (Spearman's rho 0.88, P < 0.01). CONCLUSIONS: The method provides detailed quantitative exposure indices for occupational epidemiology. It has particular strengths both in terms of ease and speed of use. It is hoped that it will provide a useful structure for future epidemiologic work.

Use of Monte Carlo simulation to investigate uncertainty in exposure modeling.

OBJECTIVES: This study used Monte Carlo (MC) simulation to examine the influence of uncertainty on an exposure model and to determine whether a difference exists between two worker groups in a ceramic fiber manufacturing plant. METHODS: Data on work practices and conditions were gathered in interviews with long-serving employees. With the use of previously developed deterministic modeling techniques and likely distributions for model parameters, MC simulations generated exposure profiles for the two job titles. RESULTS: The exposure profiles overlapped considerably, although the average estimated exposure for one job was approximately double that of the other. However, when the correlation between the model parameters in the two jobs was considered, it was concluded that there was a significant difference in the two estimates. CONCLUSIONS: Models are increasingly being used to estimate exposure. Different work situations inevitably result in different exposure estimates. However, it is difficult to determine whether such differences in estimated exposure between worker groups are simply the result of uncertainty with respect to the model parameters or whether they reflect real differences between occupational groups. This study demonstrates the value of MC simulation in helping define the uncertainty in deterministic model estimates.