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It remains a paradox that Nigeria, rich in energy resources, suffers from severe energy poverty. It ranks second in the world with the number of people without electricity, meaning that most of its citizens rely on dirty traditional energy sources. Also, the vast majority of households connected to the grid experience incessant blackouts and voltage fluctuations. To tackle this problem and following the World Bank's recommendations, the government has made some policies that encourage private-sector-driven renewable energy projects. However, rural and urban households are heterogeneous in socio-economic composition and energy demand. Thus, an effective policy should consider these discrepancies, which can be investigated through stated preference techniques. The first chapter contributes directly to the World Bank's private sector-driven "Lighting Africa" program, which aims to provide clean, modern, and affordable electricity to 6 million Nigerians living in rural and peri-urban areas and to reduce greenhouse gas emissions by 120,000 metric tons. Households want to transition to clean energy but cannot afford the upfront costs. They have long waited for the government to solve their energy problems, to no avail. Rural households' energy status can be improved if companies offer them an installment plan to acquire clean energy technologies. Thus, we provide evidence about how much money households can afford every month, how long it will take them to complete the payment, and whether such a payment plan is viable. We employ the contingent valuation method (CVM) to elicit willingness to pay (WTP) for pico-photovoltaics and improved cookstoves. We find that 92% and 80% of households are willing to pay $2.86 and $2.15 for pico-PV and improved cookstove per month, respectively. It will take only eighteen and nineteen months to complete the payments of those technologies. Moreover, adopting these technologies would save each household $60 annually, on average. Furthermore, our cost-benefit analysis shows that it is viable to invest in the technologies even at a higher discount rate of 16%. To bolster investors' confidence, we provide a model that would ensure accountability. We also show that the models that account for inter-dependent demand based on language clusters produce more robust estimates. In chapter two, we focus on urban households. We show that as the world clamors for reducing the global carbon footprint to tackle climate change, Nigeria, as a country, is well placed to make a significant impact. Since the country has abundant sunshine year-round, off-grid solar PV would produce the cheapest and most sustainable power. As the number of companies that deal with off-grid solar PV systems grows in Africa, it is vital to investigate households' preferences and financing options. Although the government has declared its support for a market-driven off-grid solar power transition, little has been done regarding financial policy incentives. An effective way to help households would be to provide them with a solar PV subsidy and installment system. Thus, like the first chapter, we utilize the CV method to analyze households' willingness to pay for a solar PV system under four scenarios - (i) WTP when a solar PV is complemented with a generator (ii) WTP when a solar PV completely displaces a generator (iii) WTP when a solar PV is complemented with a generator, plus a subsidy and (iv) WTP when a solar PV completely displaces a generator, given a subsidy. We find that overwhelming 64% and 70% indicated a positive WTP for solar PV in the first two scenarios. Although the figure declines by one percent (63%) in the third scenario compared to the first, it increases significantly when a 20% subsidy option is given in scenario four (76%). The monthly mean WTP values in the four scenarios are $9.53, $11.04, $8.76, and $14.58. Our cost-benefit analysis shows that solar PV investment under the installment option is a win-win venture between households and investors. It would save families $72.81 annually. However, we also find that Nigerians have high discounts for the future, which may give further insight into why there is a slow energy transition in Nigeria. Chapter three uses choice experiments and contingent valuation techniques to quantify the attributes of environmental tobacco smoke (ETS) health risks, focusing on generating cross-country comparisons due to heterogeneous healthcare systems. We hypothesize that agents in different healthcare systems (private and public) would differ in health risk valuation. We find that U.K. respondents are indifferent (neutral) to a potential policy that would give a monetary payoff to nonsmokers as compensation for ETS exposure. However, the opposite is the case among U.S. respondents. We further find that U.S. respondents are more "health risk-averse" than their U.K. counterparts. Furthermore, there is a consistent gender difference in the valuation of health risks regardless of the healthcare system. Thus, this study uncovers a new dimension of health risk-related behaviors lacking in the literature.

Following the implementation of the smokefree law in 2006, which formed part of the Smoking, Health and Social Care (Scotland) Act 2005, smoking in enclosed public spaces has been prohibited in Scotland. The law has led to a number of improvements in public health but does not cover homes and cars where children are primarily exposed. Secondhand smoke (SHS) exposure is associated with particularly significant risks to child health, yet few studies have explored children’s perspectives on SHS and smoking in the home and car. Comprising a qualitative exploration of the views and experiences of 38, 10- to 15-year-olds of SHS in the home and car, this thesis begins to address this gap. It addresses the nature and extent of children’s involvement in negotiating smoking restrictions, compares the understandings, experiences and involvement among participants living in communities of contrasting socioeconomic profiles and considers the implications for health promotion interventions aimed at reducing children’s exposure to SHS in the home and car. Informed by a Childhood Studies perspective, the study focuses, both in methods and content, on the voices and agency of the participants. Recruited from two Edinburgh communities with contrasting socioeconomic profiles, the participants were interviewed either individually, in pairs or in small focus groups about their understandings of SHS, smoking restrictions in their homes and cars and their role in negotiating them. Home floor plans constructed by the participants were used to prompt discussion and also served to identify spatial and temporal home smoking restrictions. Both discursive and thematic techniques were used in analysis. The thesis details the participants’ overt and covert strategies to resist family members’ smoking, demonstrating the active roles that participants describe in their accounts. While acknowledging SHS as a health risk and using an embodied language of disgust to describe it, the participants’ main concern was for their smoking family members’ health, rather than their own. Many participants also challenged the stigma surrounding smoking parents by detailing the ways in which their parents restricted where, how much and with whom they smoked. Parents were described as especially careful in protecting small children from SHS. While most participants described such protective practices, those from the disadvantaged area reported less stringent smoking restrictions that were more challenging to negotiate. Participants’ resistant (to smoking) and defensive (of parents who smoke) accounts may stem from the growing stigma associated with smoking, particularly smoking in the presence of children. Such findings highlight the importance of a sensitive and asset based public health response that acknowledges parents’ attempts to protect their children from SHS and recognises the potential of the active role of children in family negotiations around smoking in the home and car.

Study One AbstractBackground: Home tobacco smoke exposure (TSE) and negative neighborhood characteristics adversely affect children’s health. The study objective was to examine the associations of child TSE status and neighborhood characteristics among U.S. school-aged children. Methods: We conducted a secondary analysis of the 2018-2019 National Survey of Children’s Health data including 17,300 U.S. children ages 6-11 years old. We categorized children’s home TSE status into: (1) no TSE: child did not live with a smoker; (2) THS exposure alone: child lived with a smoker who did not smoke inside the home; and (3) SHS and THS exposure: child lived with a smoker who smoked inside the home. We conducted a series of weighted linear, logistic, and ordinal regression analyses to assess the associations between child TSE status and neighborhood characteristics, adjusting for covariates. Results: Overall, 13.2% and 1.7% of children were exposed to home THS alone and home SHS and THS, respectively. Compared to children with no TSE, children with home THS exposure alone (ß=-0.27, 95%CI=-0.38, 0.15, p

While the incidences of cardiovascular diseases declined by 27% over the past few decades, the number of deaths related to cardiovascular diseases increased by 42%, owing to the population growth and increased life expectancy. Consequently, cardiovascular diseases are the leading cause of death worldwide. Cardiovascular diseases are complex, multifactorial diseases that cannot be ascribed to a single risk factor. Secondhand smoke (SHS) and high-fat diet (HFD) are two preventable risk factors for the development and progression of cardiovascular diseases. Interestingly, epidemiological studies have correlated SHS exposure with poor dietary habits including higher total fat intakes, suggesting an underestimated incidences of co-exposure of SHS and HFD worldwide. In this study, we sought to characterize the effects of SHS, at an environmentally relevant concentration, on cardiovascular regulation, and the time-course of SHS-induced cardiovascular changes using a mouse model (chapter 2). We also assessed the effects of long-term consumption of HFD on heart rate (HR) and blood pressure (BP) regulation in mice (chapter 3). Moreover, this work aimed to investigate the effects of SHS and HFD co-exposure on cardiovascular function (chapter 3). To test these aims, mice implanted with BP/ electrocardiogram (ECG) telemetry devices were fed with either standard rodent chow (13.6 kcal% fat) or HFD (60 kcal% fat) and exposed to either filtered air (FA) or SHS (3 mg/m3, 6 hours/day, 5 days/week). BP, HR, HR variability (HRV), BP variability, and baroreflex sensitivity (BRS) were obtained to evaluate the cardiovascular function. We found that long-term exposure of SHS decreased measures of autonomic regulation of HR (HRV) and BP (BRS), as well as decreased pulse pressure (PP) in a time-dependent manner. The effects of SHS on PP and HRV had a faster onset that observed after four weeks of exposure, while the effects of SHS on BRS had a slower onset and accumulated with longer exposure time. However, all SHS-induced cardiovascular dysfunctions recovered after removal from SHS exposure for four weeks. Long-term exposure of HFD alone increased weight gain, increased BP, and reduced BRS and HRV. Strikingly, we found that co-exposure of SHS and HFD significantly increased BP variability that was not observed with SHS or HFD alone, suggesting a co-exposure-induced BP dysregulation. Overall, this study demonstrated that chronic exposure to SHS and HFD both reduces the autonomic regulation of the cardiovascular function. Co-exposure of SHS and HFD can interactively induce BP dysregulation, which may put individuals under even higher risks of cardiovascular morbidity and mortality. This study provides insights into the importance of understanding the interplay between multiple risk factors in inducing cardiovascular dysfunctions when studying the multifactorial cardiovascular diseases.

In China, cervical cancer is recognized as a major public health problem. Human papillomavirus (HPV) infections cause almost all cases of cervical cancer. Tobacco smoking and co-infection with human immunodeficiency virus (HIV) are two independent risk factors for cervical cancer. Women living with HIV (WLWH) have been shown to have higher risks of HPV infection, precancerous lesions, and cervical cancer. Similarly, smoking negatively impacts the immune system and increases the risk of cervical cancer. Routine cervical cancer screening followed by early treatment is effective in reducing the burden of cervical cancer. In 2009, the Chinese government launched a population-based cervical cancer screening program in rural China as the first step towards implementing national population-based cervical cancer screening. Cervical cancer incidence among Chinese WLWH is estimated to be 47.6 per 100,000, compared to 15.5 per 100,000 in the general population. Considering their excess risk of developing cervical cancer, current screening coverage remains low. Moreover, the current cervical cancer screening guidelines for China do not provide separate screening recommendations for WLWH to account for their increased risk. The aims of this dissertation are to provide evidence to support tailored cervical cancer screening programs for WLWH in Guangxi, a region with a high prevalence of HIV in China. Since smoking control is a challenge in China, and more than 70% of adults are exposed to secondhand smoke in a typical week, we specifically consider the additional risk of cervical cancer associated with smoking exposure. In particular, we (1) surveyed WLWH in Guangxi regarding their knowledge about cervical cancer screening and risk factors for cervical cancer, (2) systematically summarized the literature on the effect of smoking exposure on cervical abnormalities among WLWH, and (3) evaluated the benefits and the harms associated with cytology-based cervical cancer screening tailored to WLWH in Guangxi using decision modeling.

Cigarette smoke contains thousands of harmful substances and is one of the leading preventable causes of mortality and morbidity in the United States. Past studies examining tobacco smoke exposures on fecundability and pregnancy outcomes are inconsistent. NAT2 is an important enzyme in the metabolism of xenobiotic substances found within tobacco smoke. This preconception cohort study examines associations between active smoking and secondhand smoke exposure (SHSe) on fecundability and spontaneous abortion (SA), and explores a possible interaction with NAT2 acetylator status. A total of 223 women seeking fertility care were followed for up to 2.3 years. Preconception tobacco smoke exposures were collected by questionnaires and verified by urinary cotinine. SHSe at home and work was measured using the questionnaire (never, rarely (once/week), often (1-6 times/week), daily for each location) and then combined and categorized as low or high SHSe. NAT2 was genotyped to determine acetylator status (rapid vs slow). Pregnancy outcomes (SA vs live birth) were collected on 72 women. Cox proportional hazards regression was used to estimate fecundability ratios (FR) and 95% confidence intervals (CI), and logistic regression to estimate odds ratios (OR) and 95% CIs for the association of active smoking and SHSe on fecundability and SA, respectively. Full models were adjusted for age, BMI, assisted conception, gravidity, marital status, alcohol use and race. Overall, no significant effect of tobacco smoke exposure on fecundability was established. Though statistically insignificant, the effect of smoking on fecundability was stronger among slow NAT2 acetylators. Smokers (OR: 6.28; 95% CI 1.31, 37.9) and nonsmokers with high SHSe (OR: 3.20; 95% CI 0.87, 12.7) had increased odds of SA (ptrend= 0.02), compared to nonsmokers with low SHSe. Among nonsmokers, women with high SHSe had higher odds of SA (OR: 4.30; 95% CI 1.14, 19.1) than women to low SHSe. No significant interaction with NAT2 was reported. Despite wide CIs, results suggest that active smoking and high levels of SHSe may increase in the risk of SA among women seeking fertility care. This dissertation has clinical implications for patient care, and points to biological mechanisms by which tobacco smoke may affect fertility and pregnancy outcomes.

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) may lower cardiovascular disease risk by reducing blood pressure (BP). We hypothesized that fat-1 transgenic mice, which convert n-6 PUFAs to n-3 PUFAs, would have improved vascular function in BP regulation and following secondhand smoke (SHS) exposure, compared to wild type (WT) mice. BP was recorded in mice fed an n-6 PUFA, or standard chow diet. On the n-6 PUFA diet fat-1 mice had a lower mean arterial pressure and a greater decrease in diastolic BP when treated with an ACE inhibitor, compared to WT mice. No differences were observed on the chow diet. Next, fat-1 mice on the n-6 PUFA or chow diet were exposed to SHS. SHS enhanced vasoconstriction on the n-6 PUFA diet, but not on chow, but did not affect vasorelaxation. These data suggest n-3 PUFAs have a protective role in basal BP regulation and SHS-induced vascular dysfunction.

The dangers of secondhand smoke (SHS) exposure on the human body were initially reported in 1972, just eight years after the negative effects of smoking on smokers was reported. The Surgeon General of the United States systematically expanded (and continues to expand) the warnings over time, as new scientific evidence becomes available. Warnings, which began to incorporate youths in 1975, emphasized the need to pay particular attention to fetuses, newborns, infants, children, adolescents, and young adults since they rely on parents, guardians, and other adults to keep them safe. Although fewer in number than adults, the diseases that are causally linked to smoking and exposure to SHS in youths are also complex and can result in death (i.e., sudden infant death syndrome). The introduction of new tobacco products, such as low nicotine cigarettes and electronic cigarettes, prompted the Surgeon General to release additional warnings. In 2016, the Surgeon General advised the nation that more information will become available as the electronic cigarette manufacturers comply with new Tobacco Control Act requirements to report harmful vapor constituents. Physicians need to keep abreast of the vast and growing body of knowledge related to the biological and chemical components of SHS and vapor, as well as the dangers that SHS and vapor cause. To ease the burden on physicians, the federal government and medical professional societies created clinical practice guidelines which summarize the literature related to the dangers of SHS and make recommendations for medical management. Guidelines recommend that physicians and other clinicians should offer smoking cessation advice and intervene to limit youth exposure to SHS. Although the approach recommended for use with patients in a physician’s office is clear and attempts to streamline the processes have been made, the identification and counseling process for smoking cessation and eliminating SHS exposure remains time consuming. Barriers to payment make it difficult for physicians to be adequately reimbursed for their efforts to keep their patients safe from the dangers of SHS and vapor exposure. More work is needed to be able to continue to reduce the percentage of youths exposed to SHS in their environments. Additional attention is needed to address the racial and ethnic disparities that are evident in the scientific literature.

More than eight percent of United States’ children have asthma, with more than half having an asthma exacerbation annually. Minority children and those living in low income households are more likely to experience adverse asthma events and to be exposed to secondhand smoke (SHS), a potent trigger of exacerbations. State smoking bans are associated with reductions in SHS exposure and rates of cardiovascular and respiratory events. This study assesses the impact of Michigan's Dr. Ron Davis Smoke Ban on asthma exacerbations among low-income children and identifies potential effect modification by individual and area level exposures on that association. A cohort of 98,277 children with full coverage in Michigan Medicaid programs and health care utilization consistent with a diagnosis of persistent asthma contributed 4,335,439 months to the cohort between 2007 and 2012. The 48,500 adverse asthma events (representing exacerbations) identified from administrative claims data were compared to area level estimates of neighborhood disadvantage and indicators of exposure to smoking bans. Rates of adverse asthma events were associated with non-white race, younger age, poor asthma control in identification year and increasing neighborhood deprivation. The ban was associated with a 17 percent reduction in asthma events (95% CI: 12-21 percent), adjusting for age group, sex, race/ethnicity, calendar month, prior poor control, prior local smoking ban, and neighborhood disadvantage. The 17 percent reduction is equivalent to 9,400 asthma events during the follow up period, which would have resulted more than $11,000,000 in emergency department charges alone. Children in prior poor control had a larger reduction in adverse asthma events after ban enactment than those with no prior evidence of poor control. Use of asthma medications exhibited similar reductions in the post-Ban period. The injury visit rate showed a smaller reduction, suggesting the reduction in asthma events was not solely due to a secular trend. These findings support the continued enforcement of Michigan’s Ban and provide evidence for the importance of environmental policy for improving asthma management in Michigan. This cohort provides a data model for other jurisdictions needing to assess or predict the impact of a smoking ban.

BackgroundAlthough exposure to environmental tobacco smoke (ETS) is a well-established risk factor for lung cancer in never smokers, studies to date have not been able to precisely estimate the magnitudes of association between ETS and lung cancer by histological subtypes, especially for small cell lung cancer, large cell lung cancer, and adenocarcinoma in situ/minimally invasive carcinoma (AIS/MIA). In addition, few studies have investigated the roles of candidate susceptibility genes in lung cancer development and explored their potential interactions in relation to ETS exposure among never smokers. Objectives and Specific Aims The overall objective of this doctoral dissertation is to examine the associations of ETS exposure and variants of candidate genes with lung cancer susceptibility and to assess potential gene-environmental interactions among never smokers. The specific aims were: 1) To estimate the magnitudes of association between exposure to ETS and risk of lung cancer by major histological type (adenocarcinoma, squamous cell carcinoma, large cell lung cancer, and small cell lung cancer) and for AIS/MIA; 2) To estimate the associations between polymorphisms of DNA repair, carcinogen metabolism, and cell cycle control genes and lung cancer in never smokers and to test for gene-environmental interactions with ETS exposure; and 3) To evaluate the associations of genetic polymorphisms related to miRNAs and stem cell regulation with lung cancer susceptibility in never smokers and to assess potential gene-environmental interactions with ETS exposure. Study Design and Population We conducted case-control studies using pooled data from 18 studies participating in the International Lung Cancer Consortium (ILCCO) for Specific Aims 1 and 2 and pooled data from the Jiangsu Four Cancers Study and the Taiyuan Air Pollution and Lung Cancer Study for Specific Aim 3. The study populations in the ILCCO studies were racially diverse while all participants in the Jiangsu and Taiyuan Studies were Chinese. All studies provided epidemiologic data collected through interviews using structured questionnaires. There was a total of 12,667 cases (2,503 never smokers) and 14,410 controls (7,276 never smokers) in the pooled ILCCO data and 382 non-smoking cases and 1,271 non-smoking controls in the pooled data of Jiangsu and Taiyuan Studies. Statistical MethodsWe imputed the missing data for pack-years of smoking, education, and income using the median values among controls. Observations with missing data for other variables were excluded from the analyses. Potential confounders were adjusted for in data analyses, including age, sex, study or area of residence, race/ethnicity (ILCCO studies only), education (Chinese studies only), and income (Chinese studies only). We also adjusted for tobacco smoking status and pack-years of smoking in analyses including both ever and never smokers. We used multivariate unconditional logistic regression analyses to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations and ratio of odds ratios (ROR) and 95% CI for gene-environmental interactions of interest. In order to mitigate sparse data bias, we employed the semi-Bayesian shrinkage method with informative priors based on the literature (when available) or a null-effect prior of OR=1.00 and 95% CI 0.25–4.00. Multiplicative interactions were assessed using the product-term method to estimate the ratio of odds ratios (ROR). Additive interactions were assessed by estimating the relative excess risk due to interaction (RERI).Results ETS and Lung Cancer among Never Smokers. In the pooled ILCCO data, the adjusted ORs of ETS exposure on lung cancer among never smokers was 1.31 (95% CI 1.17–1.47) for all histological types combined. When stratified by histological type, the adjusted ORs among never smokers were 1.26 (95% CI 1.10–1.45) for adenocarcinoma overall, 1.52 for (95% CI 1.03–2.24) AIS/MIA, 1.38 (95% CI 0.98–1.95) for squamous cell carcinoma, 1.50 (95% CI 0.90–2.48) for large cell lung cancer, 1.28 (95% CI 1.13–1.45) for non-small cell lung cancer overall, and 2.89 (95% CI: 1.53–5.45) for small cell lung cancer. After applying the semi-Bayes shrinkage approach with informative priors from the literature, the ORs were 1.24 (95% CI 1.16–1.31) for all histological types combined, 1.27 (95% CI 1.15–1.41) for adenocarcinoma overall, 1.47 (95% CI 1.02–2.14) for AIS/MIA, 1.38 (95% CI 1.05–1.82) for squamous cell carcinoma, 1.30 (95% CI 0.87–1.95) for large cell lung cancer, 1.23 (95% CI 1.15–1.30) for non-small cell lung cancer overall, and 1.97 (95% CI 1.30–3.00) for small cell lung cancer. The estimated magnitude of association with ETS exposure was greater for small cell lung cancer than for non-small cell lung cancer (ROR=2.08, 95% CI 1.10–3.94, P=0.024). In the combined analysis of the two Chinese studies, the pooled adjusted OR for ETS exposure on lung cancer risk was 1.46 (95% CI, 1.12–1.89). Genetic Susceptibility Markers and Lung Cancer among Never Smokers. In the ILCCO pooled analysis, a positive association was observed between lung cancer susceptibility and the G allele in the DNA repair gene polymorphism OGG1 S326C among those exposed to ETS (CG+GG vs. CC, Bayesian posterior OR=1.55, 95% CI 1.04–2.32). In addition, ERCC2/XPD D312N was also associated with an increased risk of lung cancer among those exposed to ETS (AA vs. GG, Bayesian posterior OR=1.48, 95% CI 1.01–2.16). In the combined analysis of the Jiangsu Four Cancers Study and the Taiyuan Air Pollution and Lung Cancer Study, associations with lung cancer were observed for CTTNB1 rs2953, RAN rs14035, TP53INP1 rs7760, TP53INP1 rs896849, EPCAM rs1126497, HEY1 rs1046472, HEY2 rs3734637, OCT4 rs13409, and WNT2 rs3729629. Interactions between ETS and Genetic Susceptibility Factors. For the ILCCO pooled analysis, additive interactions were observed between TP53 R72P and ETS on lung cancer. For the pooled Chinese case-control studies, there were statistical interactions between ETS exposure and GEMIN4 rs7813 (multiplicative and additive), WNT2B rs2273368 (multiplicative and additive), pre-miR-a46 rs2910164 (multiplicative), AXIN rs1981492 (multiplicative), and WNT8A rs4835761 (multiplicative).Discussion and Conclusions Our results confirm the role of ETS exposure in the development of lung cancer. Furthermore, the strengths of the associations vary by histological type and the association is stronger for small cell lung cancer than other histological types. This is the first large-scale collaborative study on the gene-environmental interactions between polymorphisms of DNA repair, carcinogen metabolism, cell cycle control, miRNA, and stem cell regulation genes and lung cancer susceptibility in never smokers. Our results add to the body of evidence demonstrating that polymorphisms of these genes affect lung cancer development in never smokers, and also suggest that some of these SNPs interact with ETS either multiplicatively or additively. Public Health Implications Identification of lung cancer susceptibility genes may aid in personalized risk prediction. A better understanding of the genetic, environmental, and behavioral risk factors for lung cancer in never smokers would help to identify those who need to be targeted for preventive interventions against lung cancer.

Exposure to secondhand smoke (SHS) among women and children indoors is a problem both in urban and rural environments. This study aimed to describe SHS exposure by women and children in Thai households. It is the first study of its kind in Thailand to characterize levels of nicotine in the air of homes with smokers and the extent of personal exposure to nicotine among women and children living in homes with smokers in urban and rural environments. A cross-sectional survey of nicotine exposure of 40 pairs of adult nonsmoking women and children in households with and without smokers was conducted using a questionnaire, passive air monitors, and hair samples of women and children in Bangkok and rural Mukdaharn. Questionnaire data were represented descriptively, while environmental (passive samplers) and metabolic samples (hair nicotine) used established laboratory analysis and statistical measures of association with smoke exposure. Data were analyzed and reported as percentages, means, medians, interquartile ranges, and from skew and log-10 transformed data for Pearson correlation coefficient analysis. Attention was given to results for insight to how exposure results differed between household locations (urban versus rural) and persons exposed (non-smoking adults versus children). Most smokers (81.8%) smoked inside the house and near their children. Hair nicotine level in women and children showed exposure to SHS. Hair nicotine levels among children were significantly higher than the women (p=0.038). Exposure to SHS was present with high levels of hair nicotine among women and children in both rural and urban environments when smoking was present. SHS exposure warrants increased attention due to the potential harm to non-smoking women and children reflected in these findings.

Current methods for the risk assessment of environmental exposures commonly involve questionnaires, stationary monitoring, and personal air sampling. However, as these approaches do not capture the body's internal response, they lend minimal understanding to the biologic consequence of exposure. In order to address the unmet need of connecting external exposure measurements with signatures of internal exposure, this thesis examines the overarching hypothesis that transcriptomic changes in the human airway epithelium can serve as indicators of physiologic responses to inhaled pollutants. This is an extension of previous work that has demonstrated an airway ''field of injury'' effect where cigarette smoke exposure alters gene-expression in epithelial cells lining the respiratory tract. Specifically, I examine transcriptomic changes and the biologic responses associated with exposure to the following pollutants: environmental tobacco smoke (Aim 1), household air pollution from smoky coal combustion (Aim 2), and electronic cigarette vapor (Aim 3). First, I performed whole-genome transcriptional profiling of the nasal epithelium in children and adults and detected gene-expression changes associated with exposure to environmental tobacco smoke. Next, I employed similar approaches to detect a signature of coal smoke exposure in the buccal epithelium of healthy, non-smoking females exposed to household air pollution Xuanwei, China. The findings from these studies suggest that upper airway gene-expression can reflect the host response to prolific sources of environmental exposures that are major risk factors for chronic lung disease. Lastly, I examine the cellular and physiologic consequences of electronic cigarette (ECIG) aerosol exposure by analyzing transcriptomic profiles of human bronchial epithelial cells that have either been (1) differentiated and exposed in vitro or (2) acquired via bronchoscopy from the airway epithelium of ECIG users. The studies detailed in this dissertation offer valuable insight that will accelerate the efforts to evaluate the health effects of both well-established and emerging types of inhaled exposures in large-scale population studies. Furthermore, the transcriptomic strategies woven throughout the following chapters push for a novel assessment paradigm that may enable the public health community to rapidly characterize the physiologic host response to inhalation exposures of different sources, and to evaluate the biologic consequences of exposure-reduction initiatives.

Secondhand cigarette smoke exposure (SSE) has been linked to carcinogenic, oxidative, and inflammatory reactions. Herein, we investigated whether premature skin aging could be induced by SSE in a rat model, and assessed the cytoplasmic translocation of high mobility group box 1 (HMGB1) protein and collagen loss in skin tissues. Animals were divided into two groups: SSE and controls. Whole body SSE was carried out for 12 weeks. Dorsal skin tissue specimens were harvested for HMGB1 and Mallory’s azan staining. Correlations between serum HMGB1 and collagen levels were determined. Rat skin exposed to secondhand smoke lost collagen bundles in the papillary dermis and collagen decreased significantly (p < 0.05) compared with control rats. In epidermal keratinocytes, cytoplasmic HMGB1 staining was more diffuse and there were more HMGB1-positive cells after four weeks in SSE compared to control rats. A negative correlation between HMGB1 serum and collagen levels (r = −0.631, p = 0.28) was also observed. Therefore, cytoplasmic HMGB1 expression in skin tissues might be associated with skin collagen loss upon the initiation of SSE. Additionally, long-term SSE might affect the appearance of the skin, or could accelerate the skin aging process.

Background: The impact of secondhand smoke (SHS) on Southeast Asian children’s health has been assessed by a limited number of studies. The purpose of this study was to determine whether in Thailand, pre- and postnatal exposure to SHS is associated with acute lower respiratory conditions in young children. Methods: We conducted a case control study of 462 children under age five admitted with acute lower respiratory illnesses, including asthma and pneumonia, at a major hospital in Bangkok. We selected 462 comparison controls from the well-child clinic at the hospital and matched them by sex and age. We used a structured questionnaire to collect information about exposure to SHS and other factors. We conducted bivariate and multivariate analyses to identify risk factors for acute lower respiratory conditions. Results: The number of cigarettes smoked at home per day by household members was significantly greater among cases. A greater number of household caregivers of cases held and carried children while smoking as compared to controls (26% versus 7%, p

Background: Secondhand smoke (SHS) exposure remains an important public health concern, especially in children and Appalachian communities, despite widespread smoke-free laws and tobacco control policies. Previous studies on neurotoxic effects of SHS primarily focused on health neurobehavioral outcomes, despite the fact that neuromotor functions play an important role in child's normal developmental course, cognition, and social interactions. Objectives: To estimate the prevalence of SHS exposure in 7-9 year old Appalachian children and associated neuromotor deficits using standardized neuromotor tests.Methods: Exposure to SHS was determined by self-reported and serum cotinine measures. A comprehensive neuromotor assessment using Halstead-Reitan Finger Tapping Test, Purdue Grooved Pegboard Test, and brief version of Bruininks Osteretsky Test of Motor Proficiency - 2 was administered to 7-9 year old children residing in Washington and Guernsey Counties, Ohio. Results: Approximately 50% of Appalachian children were exposed to SHS based on serum cotinine measures. Parental education and parental IQ were significantly and inversely associated with serum cotinine levels in children. After adjustment for parental education, parental IQ, blood lead, blood and hair manganese, there was a significant inverse association between serum cotinine and child's performance on visuo-motor coordination, fine motor precision, fine motor integration, balance, upper-limb coordination, and strength.Conclusions: Exposure to SHS is associated with deficits in fine and gross motor skills and visuo-motor coordination in Appalachian children. Our findings support the efforts to encourage smoke-free households, where children are primarily exposed to SHS. Future research should confirm the causality of these findings, and whether these neuromotor deficits in childhood continue to persist into adolescence affecting their postural stability or risk for falls and injuries.

The purpose of this study was to determine whether the location of hospitality venues considering; rurality, presence of local ordinances, and socioeconomic status, influenced the quantity of tobacco smoke pollution in a predominantly rural state. The study built on current scientific literature in four aspects. First, it was the first U.S. statewide study on tobacco smoke pollution levels in hospitality venues. Second, it quantified indoor tobacco smoke pollution specifically in rural areas. Third, it used random sampling, a method rarely used in studying indoor tobacco smoke pollution. Fourth, it analyzed tobacco smoke exposure as a function of socioeconomic status. A stratified random sample of 136 restaurant and bars were assessed, using a modification Roswell Cancer Park Institutes method, for the indoor air quality indicator of particulate matter that was 2.5 μm aerodynamic diameter or smaller (PM2.5). A unique partial mediation model found 69.1% of smoke-free policy's impact on tobacco smoke pollution was mediated by observed smoking and 30.9% was the direct impact of policy on tobacco smoke pollution levels. A significant association (Welch's F(2, 43.63) = 9.55, p < .001) between rurality and tobacco smoke pollution in bars was also observed. A significant association (R2 =0.51, F(3,131)=70.47, p < .001) between local smoke-free laws and tobacco smoke pollution depended upon the venue type. Compliance was significantly lower in venues in communities without local ordinances (Fisher's Exact Test, p< .01, 2-tailed) and in co-located venues (Fisher's Exact Test, p< .01, 2-tailed). In conclusion, smoke-free laws had an indirect and direct impact on tobacco smoke pollution. As rurality increased tobacco smoke pollution in bars significantly increased. The impact of local ordinances on tobacco smoke pollution levels depended on the venue type. Compliance with laws increased significantly in communities with a local ordinance and decreased significantly in co-located venues. Continued recognition of the disparities in exposure to tobacco smoke pollution in rural areas is needed. Future studies should determine if the mediation model can be replicated. Additional studies of tobacco smoke exposure and policy impact in rural areas are needed. Further research of poverty influences on tobacco smoke pollution levels in hospitality venues is recommended.

Introduction: The purpose of this study is to examine the change in smoking policy status among bars and restaurants since the Georgia Smokefree Air Act of 2005 was implemented and identify restaurant and bar characteristics that are associated with allowing smoking. Methods: Data was obtained from similar Georgia indoor air surveys conducted in 2006 and 2012. Both surveys were designed to gather information about restaurant and bar smoking policies and examine owner and manager perceptions of the Georgia Smokefree Air Act. Descriptive analysis and paired sample t-tests were performed to identify changes in smoking policy status and other variables over time. Chi-square and logistic regression analysis were used to test for significant associations between establishment smoking policy status and other characteristics. Results: The percent of restaurants and bars in Georgia allowing smoking nearly doubled from 9.2% in 2006 to 18.2% in 2012. The analysis showed a statistically significant increase in the percentage of establishments allowing smoking when minors are present. After adjusting for the effects of other variables, three variables were significant predictors of allowing smoking: having seats for drinking outdoors, having a liquor license, and generating greater than or equal to 25% of gross sales from alcohol. Conclusions: The Smokefree Air Act was enacted to protect the health and welfare of Georgia citizens, but the percentage of establishments allowing smoking has risen since it was implemented. These results suggest that policy makers should reevaluate the law and consider strengthening it to make restaurants and bars 100% smokefree without exemptions.

Introduction: Despite the known consequences of cigarette smoking, almost 20% of adults in the United States smoke. Smoking has been shown to harm nearly every organ of the body. Its detrimental effects have been seen not only in smokers themselves but also in those exposed to secondhand smoke (SHS) at work and in other public places. Methodology: The purpose of this thesis was to examine compliance with the signage requirement of the Georgia Smokefree Air Act (GSAA) of 2005 among 99 hospitality venues located in Atlanta. Photographs of bars and restaurant entrances were taken and raters then classified each venue as compliant or non-compliant with smoking status signage requirements of the GSAA. Additionally, air samples were collected using Sidepak equipment from 59 venues in order to estimate the PM2.5 levels, which is a recognized measure of air quality. With Spearman’s rho correlation coefficient (r), analyses were run to determine correlations between signage compliance, number of cigarettes being smoked, and smoking permitted with air quality (PM2.5). Analyses were conducted using the Statistical Package for Social Sciences (SPSS) version 19. Results: Of the 99 venues assessed, only 21 (21.2 %) complied with the signage requirements of the GSAA. Venues that do adhere to signage requirements and indicate no smoking on their signs and at the same time via telephone stated that smoking is prohibited had the lowest PM2.5 levels =15.03. On the contrary, those venues that display signs permitting smoking and via telephone indicated smoking is allowed had the highest PM2.5 levels =230.31. It was determined that there is a strong positive correlation between PM2.5 and “number of cigarettes” (r=.611, n=59, p2.5 and “smoking permitted” as indicated from phone calls (r=.464, n=59, p2.5 and “signage compliance” in accordance with GSAA (r=.107, n=59, p>.001). Conclusions: Enforcement of GSAA must be enhanced in order to better protect workers and patrons of Atlanta’s bars and restaurants from harmful exposure to SHS. Findings from this study support that prohibiting smoking in bars and restaurants and having signs stating that smoking is prohibited would improve air quality and protect workers by eliminating their exposure to SHS while working.

Objective: This study aimed to estimate the annual healthcare utilization and expenditures associated with smoke exposure inside the home and childhood asthma.Methods: Healthcare utilization and expenditures data came from the 2001 and 2006 Medical Expenditure Panel Survey (MEPS). Child’s asthma diagnosis and demographic information were from MEPS as well. Secondhand smoke exposure data were determined by in-person interviews in the 2000 and 2005 National Health Interview Survey (NHIS), which used same nationally representatives as MEPS. A total of 7482 children aged 0-11 years were included in the present study. Multivariable regression models that controlling for potential confounders were used for the analysis.Results: The presence of smoking inside the home was associated with an 18% increased odds of having childhood asthma (p

Introduction. Mandatory smoke-free policies in subsidized, multi-unit housing (MUH) may decrease secondhand smoke (SHS) exposure in households with the highest rates of exposure. However, to be effective, policies must be based on a strong understanding of factors affecting smoking and in-home smoking behaviors in the target population. This study used a social ecological model to assess these factors. Methods. A face-to-face survey was conducted from August-October 2011 with lease holders in a probability sample of private, project-based subsidized housing units in Columbus, Ohio without an existing smoke-free policy (N = 301, 64% response rate). The survey included questions about smoking behaviors, voluntary home smoking restrictions (HSRs), and support for smoke-free policies as well as individual, social, and environmental factors hypothesized to be associated with HSRs and policy support. A surface wipe sample was collected from the living room to measure nicotine concentration to validate self-reported in-home smoking behaviors. Results: Almost half (47.5%) of respondents were current smokers and only 29.2% reported having complete HSRs. Slightly more than half (54.5%) supported a smoke-free policy in their unit but only one-third (36.3%) supported a ban on porches or steps outside. Complete HSRs and support for smoke-free policies inside and outside were more common among non-smokers than smokers. Several individual and social factors but no environmental variables were independently associated with HSRs and policy support. Geometric mean surface nicotine concentration was significantly different between non-smoking and smoking homes (11.4 vs. 89.3 μg/m2; P < .001), and between homes with complete, partial, and no HSRs (8.9 vs. 55.6 vs. 142.2 μg/m2; P < .001). Nicotine concentration was also significantly associated with the number of cigarettes smoked inside.More than half of smokers were either non-daily (20.3%) or light daily (≤ 5 cigarettes per day; 35.0%) smokers. More than half (61.3%) purchased single cigarettes in the past month. A majority of smokers intended to quit within six months or less (60.1%) and were interested in using nicotine replacement therapy (65.5%). Most respondents had Medicaid, but only 30.4% knew that Medicaid covered cessation medications.Discussion. Although the prevalence of complete HSRs was less than half of national estimates, support for smoke-free policies was similar to rates among non-subsidized MUH tenants. Several individual- and social-level factors must be addressed in parallel with smoke-free policies, such as knowledge of SHS health effects and social norms that currently support smoking in the home. Environmental factors should be assessed in future studies with more heterogeneous neighborhoods. Based on the validation study, tenants were willing and able to report in-home smoking behaviors, at least in the absence of a smoke-free policy. Surface nicotine should be considered as an objective measure to evaluate effectiveness of mandatory smoke-free policies in subsidized MUH. Among smokers, access to evidence-based cessation medications could be improved by increasing awareness of Medicaid coverage among tenants and healthcare providers. However, few studies have evaluated tobacco dependence treatments with very low-SES or light smokers. Strategies to address other factors such as availability of single cigarettes should be considered in parallel with smoke-free policies.

Introduction: In low- and middle-income countries (LMICs) over the past two decades locally relevant tobacco control research has been scant. Experience shows that tobacco control measures should be based on sound research findings to ensure that measures are appropriate for local conditions and that they are likely to have an impact. Research should also be integrated within tobacco control measures to ensure ongoing learning and the production of knowledge. Thailand, a middle-income country, has a public health community with a record of successful tobacco control and a longstanding commitment to research. Thailand’s comprehensive approach includes taxation; bans on tobacco advertising, sponsorship and promotion; smoke-free areas; graphic cigarette pack warnings; social marketing campaigns; cessation counseling; and an established tobacco control research program. The purpose of this study was to document and analyze the development of tobacco control research capacity in Thailand and the impact of research on Thai tobacco control measures.Method: We used mixed methods including review of historical documentation and policy reports, qualitative interviews with key members of Thailand’s tobacco control community, and an analysis of research productivity. Findings: In Thailand, tobacco control research has evolved through three phases: (1) discovery of the value of research in the policymaking arena, (2) development of a structure to support research capacity building through international collaborations supported by foreign funding agencies, and (3) delivery of locally relevant research made possible largely through substantial stable funding from a domestic health promotion foundation. Over two decades, Thai tobacco control advocates have constructed five steppingstones to success: (1) adapting foreign research to inform policymaking and lobbying for more support for domestic research; (2) attracting foreign funding agencies to support small-scale research and capacity building; (3) participating in multi-country research and capacity building programs; (4) using collaborative experiences to demonstrate the need for domestic support of locally relevant research; and (5) maintaining an unwavering commitment to research while being vigilant to ensure continued research support. Conclusion: The evolution of tobacco control research in Thailand provides examples of steppingstones that LMICs may be able to use to construct their own tobacco control research pathways.

Exposure to secondhand smoke (SHS) is harmful and hazardous to the health of the general public. A large body of research has been conducted in this topic, and great efforts have been made to prevent people from being exposed to SHS. Legislation on restricting smoking in workplaces and many public places has also been increasing. However, tobacco industries have been fighting against smoking bans in restaurants and bars with multiple strategies, which has led to the current situation that smoking bans in restaurants and bars usually lag behind other environments in many countries. As of January 2012, a total of 66 nations worldwide have enacted a 100% smoke-free law in workplaces and hospitality venues, while only 46 of the 66 include both restaurants and bars, and more than 90% of the world population can't enjoy smoke-free restaurants and bars. In addition, tobacco industries have made continuing efforts to remove existing smoking bans, and such efforts are sometimes successful. For example, as of October 2011, 15 U.S. municipalities that had adopted effective smoke-free laws subsequently repealed, weakened, or postponed them due to such efforts. This dissertation aims to quantify SHS exposure and the attendant health risks, morbidity and mortality, among restaurant and bar servers and patrons, to provide scientific evidence on whether SHS exposure in restaurants and bars can be ignored and whether restaurants and bars should be exempted from smoking bans. The dissertation consists of seven chapters. Chapter 1 presents the general background, Chapters 2 and 3 focus on quantifying SHS exposure in restaurants and bars by workers and patrons; Chapter 4 evaluates the efficacy of different smoking policies adopted to reduce SHS exposure in restaurants and bars in Beijing China; and Chapters 5 and 6 assess the excess heath risks, morbidity and mortality, due to SHS exposure in restaurants and bars, and the last chapter summarizes the findings and conclusions from the previous five chapters. The study in Chapter 2 applies multiple approaches to assess restaurant and bar servers' and patrons' exposure to SHS two years after the implementation of the governmental smoking restriction in Beijing, 2010. Of the 79 restaurants and bars monitored in the study, 37 (47%) nominally prohibited smoking, and 14 (18%) restricted smoking to designated sections. A total of 121 visits were made during peak-patronage times, and smoking was observed in 26 (51%) of these nominal nonsmoking venues or sections. Patrons were exposed to a median (interquartile range IQR) of 27 (4-93) µg/m3 of fine particulates derived from SHS (SHS PM) and a median (IQR) of 1.53 (0.69-3.10) µg/m3 of airborne nicotine during their visits. For servers, continuous real-time sampling of SHS PM and sequential area sampling of airborne nicotine, for more than 24 hours in two restaurants, showed obvious spikes of SHS concentrations during peak-patronage times, and SHS concentrations remained high during intervals between peak-patronage times or in evenings due to staff smoking. Servers were exposed to a median (IQR) of 2.62 (1.22-5.40) µg/m3 of airborne nicotine during their day-time working hours by one-day active personal sampling, and 1.83 (0.92-3.21) µg/m3 of airborne nicotine during a whole week by week-long passive sampling. Nonparametric Kruskal-Wallis rank tests of SHS concentrations by different nominal smoking policies showed statistically significant difference of peak-patronage-time SHS PM and airborne nicotine concentrations, while no statistically significant differences of one-day average nicotine concentration by active area or personal sampling, or of week-long average nicotine concentration by passive sampling. Comparison of results by different sampling approaches showed that both measured SHS PM and airborne nicotine concentrations were significantly related to observed active smoker activities. A slope of 17 µg/m3 of SHS PM per one µg/m3 of nicotine was observed. Time-weighted nicotine concentrations by one-hour peak-patronage time area sampling were higher than those by one-day area sampling and by week-long area sampling; and results of peak-patronage-time sampling could explain about half of the variance of the results by the latter two sampling approaches. One-hour peak-patronage-time area nicotine sampling results were very close to one-day personal nicotine sampling results. Thus, peak-time area sampling is a feasible and also a reasonably accurate way to access patrons' exposure to SHS during their short-term visits and servers' exposure during their full shifts. Chapter 3 develops and evaluates a mass balance model to predict SHS concentrations in restaurants and bars in China during peak-patronage times. The model is based on field data from an intensive study, with field monitoring of SHS concentrations in a representative sample of Minnesota restaurants and bars during representative peak-patronage times, and field data from existing studies of Chinese restaurants and bars. The model could predict SHS PM concentrations reasonably well, but not so well for airborne nicotine concentrations. Using the model and Monte Carlo simulation, the mean (SD) of simulated SHS PM concentrations was predicted to be 135 (182) μg/m3, 90 (129) μg/m3, and 49 (79) μg/m3 in restaurants with smoking allowed everywhere, designated smoking sections of restaurants, and designated nonsmoking restaurants, respectively. Predicted SHS concentrations in bars were about two times as in restaurants with the same smoking policy. These predicted concentrations were used to assess the health risks for both servers and patrons in Chapter 6. Chapter 4 uses field data collected in three previous studies from 2006 to 2008 and the study conducted in 2010, which is presented in Chapter 2, to evaluate the efficacy of different smoking policies adopted in Beijing restaurants and bars during this time period. There were significant overlaps of sampling venues included in each year. In 2006, all voluntary smoking bans in restaurants and bars were completely self-motivated by owners, and in 2007, they were encouraged by the government. Less than 20% of restaurants and bars prohibited or restricted smoking in 2006 or 2007. This indicates that both the self-motivated and governmental encouraged voluntary smoking bans are rarely adopted; thus, voluntary smoking bans cannot protect people from SHS exposure in restaurants and bars. When the Beijing government started to require smoking restrictions in restaurants and bars in 2008, more than 80% of venues did so as required; in these venues, the active smoking rate of patrons decreased, while no significant changes were observed in venues without any policy changes. However, some venues stopped prohibiting or restricting smoking two years later in 2010, resulting in less than 60% restaurants and bars nominally prohibited or restricted smoking, showing non-continuous enforcement by the government and decreasing compliance by venue owners. Though SHS PM concentrations in Beijing restaurants and bars decreased after the governmental smoking restriction in both 2008 and 2010, compared to those in 2006 and 2007, this happened in all the venues followed up with, regardless of the policy changes. In 2010, two years after the smoking restrictions, both SHS PM concentrations and active smoking rates in restaurants and bars were higher than in 2008, regardless of the changes in smoking policy. The similarity of SHS levels experienced by servers of restaurants and bars with different nominal smoking policies during their full shifts in 2010 also showed poor enforcement and compliance of the restrictions two years after the implementation.Chapters 5 and 6 estimate the health risks and excess morbidity and mortality caused by SHS exposure in restaurants and bars in Minnesota, in the U.S., and in China. Intensive field monitoring of SHS exposure in a representative sample of 65 Minnesota restaurants and bars, for multiple times in each venue, showed that more than 80% of patrons were exposed to SHS concentrations above the threshold of eye and nasal irritation during more than 80% of their visits. Patrons' and servers' lifetime excess risk (LER) of lung cancer death (LCD) due to SHS exposure in restaurants and bars in both Minnesota and in China was well above the acceptable level of 1×10-6. And this was true even for patrons who visited designated nonsmoking sections only for about 1.5 hours a week in their lifetime. The LER can be much higher for patrons who visit restaurants and bars more often, or for patrons who also visit smoking sections or venues allowing smoking everywhere. As for servers, their LER of LCD or asthma initiation (estimated for Minnesota and U.S. restaurant and bar servers only) could be higher than the significant risk of 1×10-3, considered an unsafe level by the U.S. Occupational Safety and Health Administration (OSHA). In the population level, SHS exposure in restaurants and bars was estimated to cause three LCDs and 32 ischaemic heart disease (IHD) deaths per year among the general nonsmoking population, and 53 new asthma cases per year among nonsmoking servers in Minnesota, 214 LCDs and 3001 IHD deaths per year among the general nonsmoking population, and 1420 new asthma cases per year among nonsmoking servers in the U.S. This death toll was predicted to be 1325 LCDs and 1525 IHD deaths a year in China.In all, restaurants and bars are major employers, and they are also important public places for the general population. This dissertation shows that both servers and patrons are exposed to high concentrations of SHS in restaurants and bars, and the attendant health risks, morbidity, and mortality are too significant to be ignored. Thus, to protect people from the health hazards of SHS exposure, restaurants and bars should not be exempted from any smoking bans. The only effective way is to create 100% smoke-free environments by comprehensive smoking bans, and just passing a smoking ban is not enough, while full enforcement and compliance is extremely important.

Infertility and early pregnancy loss are prevalent in the United States and worldwide, and a large proportion of non-tobacco users are exposed to secondhand tobacco smoke (STS). In one of the only previous studies of early pregnancy that utilized biomarkers of STS exposure, no relationship was observed between urinary cotinine and in vitro fertilization (IVF) outcomes. However, we hypothesize that urine may not be the most relevant sample media within which to measure biomarkers for a study of early pregnancy, and that the lack of an association may have been due to a large degree exposure measurement error. In the first chapter of this dissertation we report a weak rank-order relationship (Spearman r

The present study assessed students’ perceptions, attitudes, and knowledge of the effects of secondhand smoke and their willingness to patronize smoke free establishments at one public and one private university in the same Midwest city. A total of 1232 university students enrolled in courses at one public and one private university in the same Midwest city were surveyed regarding their support for smoking bans, preferences regarding smoking policy, and projected relative time and money spent in restaurants and bars/nightclubs if there was a smoking ban in effect (participation rate = 98.%). Results indicated that most university students believed that secondhand smoke is unhealthy and most supported a law banning smoke in restaurants and a law banning smoke in bars/nightclubs. Most students also reported preferring stricter smoking restrictions (M=3.59, SD=.599) compared to their impression of their friends’ preferences (M=3.16, SD=.880). The same was true for their preferences for smoking restrictions in bars/nightclubs (M=3.04, SD=1.018 and M=2.57, SD=1.126). On average, students predicted that their money and time expenditures in restaurants would not change if there were a law banning smoke in restaurants. On average, the same was also true for the university students’ money and time expenditures in bars/nightclubs. T-tests were conducted on twelve hypotheses. Results indicated that smoking status significantly affected support for restaurant smoking bans, bar smoking bans, projected change in money and time expenditures in bars, and projected change in money and time expenditures in restaurants. Restaurant patronage had no significant relationship with students’ support for laws banning smoking in restaurants and students’ projected changes in money and time expenditures in restaurants. However, bar patronage did have a significant relationship with students’ support for laws banning smoking in restaurants, and projected changes in time and money expenditures in bars/nightclubs if there was a law banning smoking in bars/nightclubs.

This study examines local tobacco-control legislation which was enacted or amended between January 1985 and August 2003 and affects restaurants in Ohio. This study follows the work of Paula Bistak who examined the same topic from 1985 through 1992 by extending the period covered from July 1992 – August 2003. Both studies examine the regulations of 19 cities and one county in Ohio and analyze the tobacco-control regulations for comprehensiveness and strength. A content analysis of the regulations and amendments has been conducted to determine the comprehensiveness and strength of the regulations as of August 2003. The scientific evidence confirming that environmental tobacco smoke (ETS) is harmful to nonsmokers has increased and in recent years has been driving the argument for a smokefree environment in the workplace, specifically restaurants and bars. The Office of the Surgeon General in 2000 concluded that the most effective method for reducing or eliminating environmental tobacco smoke (ETS) exposure is to establish smoke free environments (U.S. Public Health Service, 2000). A local tobacco control ordinance that restricts or eliminates smoking is a positive step towards a healthy, smoke-free environment (Bistak, 1995; U.S. Public Health Service, 1999). This study found that since the late 1990s there has been very little general progress in tobacco control in Ohio. The exceptions would be the cities of Bowling Green and Toledo.

การวิจัยนี้เป็นการประเมินเชิงสำรวจนี้มีวัตถุประสงค์ เพื่อประเมินการรับรู้ สังเกตการปฏิบัติและศึกษาอุปสรรคของผู้ประกอบการร้านอาหารเกี่ยวกับกฎหมายคุ้มครองสุขภาพผู้ไม่สูบบุหรี่ ในพื้นที่ภาคกลาง ด้วยแบบสอบถามมีโครงสร้างร่วมกับการสังเกต โดยคัดเลือกแบบเจาะจง 5 จังหวัดในภาคกลางที่ได้รับทุนสนับสนุน จากสำนักงานกองทุนสนับสนุนการสร้างเสริมสุขภาพ (สสส.) เพื่อดำเนินโครงการจังหวัดปลอดบุหรี่ในปี พ.ศ. 2556-2558 โดยสุ่มตัวอย่างร้านอาหารอย่างเป็นระบบ ซึ่งครั้งนี้เป็นการรายงานผลการสำรวจก่อนดำเนินกิจกรรมที่เกี่ยวข้องกับการขับเคลื่อนจังหวัดปลอดบุหรี่ ผลการศึกษาพบว่า ผู้ประกอบการร้านอาหารภาคกลาง มีการรับรู้ถูกต้องปานกลาง เกี่ยวกับสถานที่ห้าม สูบบุหรี่ตามกฎหมาย พ.ร.บ. คุ้มครองสุขภาพผู้ไม่สูบบุหรี่ คิดเป็นคะแนนเฉลี่ย 55 จาก 100 คะแนน โดยร้อยละ 70 ขึ้นไปของผู้ประกอบการร้านอาหารรับรู้ถูกต้อง ว่าร้านอาหารเป็นสถานที่ต้องจัดเขตปลอดบุหรี่ตามกฎหมาย แต่ผู้ประกอบการร้านอาหารส่วนใหญ่ไม่ทราบว่า ตลาดสด ตลาดนัด สวนสาธารณะ สนามแข่งขัน กีฬา สถานีขนส่งมวลชน ป้ายรถเมล์ สถานีรถไฟ เป็นสถานที่ต้องจัดเขตปลอดบุหรี่ตามกฎหมาย ร้านอาหารมีการปฏิบัติจัดเขตปลอดบุหรี่ที่ถูกต้องคิดเป็นเฉลี่ยร้อยละ 48 โดยสังเกตจากเครื่องหมายเขตปลอดบุหรี่ อุปสรรค มีดังนี้ ร้อยละ 14 ของเจ้าของร้านตอบว่าลูกค้าไม่ยอมรับต่อการเข็มงวดห้ามการสูบบุหรี่ในร้านอาหาร, ลูกค้าไม่พอใจต่อการเข้มงวดในการห้ามสูบบุหรี่ในร้านอาหารร้อยละ 18 และร้อยละ 11 มีความเห็นว่าจำนวนลูกค้าลดลงภายหลังจากการเข้มงวดในการห้ามการสูบบุหรี่ในร้านอาหาร และมีร้อยละ 8 ที่เจ้าของร้านเคยขัดแย้งกับลูกค้า นอกจากนี้ ร้อยละ 29 ของเจ้าของร้าน ไม่รู้จักควันบุหรี่มือสอง อย่างไรก็ตาม การสำรวจนี้พบว่าร้อยละ 68 ของร้านค้าที่เห็นด้วยว่า ลูกค้ายอมรับต่อการเข้มงวดห้ามการสูบบุหรี่ในร้านอาหาร ซึ่งถือว่ายังต่ำอยู่

การศึกษาวิจัยเชิงสำรวจครั้งนี้มีวัตถุประสงค์เพื่อ 1) ประเมินการเปลี่ยนแปลงอัตราการได้รับควันบุหรี่ในบ้านของประชากรไทยระหว่าง พ.ศ.2550 ถึง พ.ศ.2554 2) ศึกษาพฤติกรรมการสูบบุหรี่ของพ่อ และ 3) ศึกษาทัศนคติและความต้องการที่จะป้องกันและแก้ไขปัญหาและผลกระทบจากการสูบบุหรี่ของพ่อ ใช้ข้อมูลเชิงปริมาณที่ได้จากการสำรวจทั้งแหล่งข้อมูลทุติยภูมิจากโครงการสำรวจการบริโภคยาสูบในผู้ใหญ่ ระดับโลกปี พ.ศ. 2552 และ 2554 และการสำรวจพฤติกรรมการสูบบุหรี่และดื่มสุรา ปี พ.ศ.2550 และ 2554 และข้อมูลปฐมภูมิจากโครงการสำรวจพฤติกรรมการสูบบุหรี่ของพ่อที่สัมภาษณ์โดยใช้แบบสอบถามกับพ่อที่สูบบุหรี่และมีลูกอายุไม่เกิน 10 ปี และอาศัยอยู่ในเขตกรุงเทพมหานครรวมจำนวนทั้งสิ้น 403 ตัวอย่าง โดยใช้วิธีการสุ่มตัวอย่างแบบชั้นภูมิหลายขั้น ผลการศึกษาพบว่าร้อยละ 36-40 ของประชากรอายุ 15 ปีขึ้นไปที่ได้รับควันบุหรี่ในบ้านตนเองอย่างน้อยเดือนละครั้ง ร้อยละ 80 ของพ่อผู้สูบบุหรี่มีการสูบบุหรี่ ขณะอยู่ในบ้านส่วนพ่อที่สูบบุหรี่พบว่ามีถึงสองในสาม (ร้อยละ 68.2) ที่มีพฤติกรรมสูบบุหรี่ในบริเวณบ้านส่วนต่าง ๆ ได้แก่ บริเวณรั้วบ้าน บริเวณระเบียงบ้านและห้องน้ำ ความกังวลใจของพ่อที่สูบบุหรี่ พบว่า กังวลเกี่ยวกับสุขภาพของตนเองร้อยละ 55.4 และกังวลใจในเรื่องสุขภาพของลูกร้อยละ 45.8 และกังวลเรื่องการเลียนแบบในการสูบบุหรี่ร้อยละ 52.1 สำหรับการเลิกบุหรี่ ร้อยละ 54.6 มีความคิดที่จะเลิกสูบบุหรี่โดยระบุ เหตุผลสำคัญคือ เพื่อสุขภาพของตนเอง/มีปัญหาเรื่องสุขภาพ รองลงมาเพื่อสุขภาพของลูกและภรรยา และ ร้อยละ 56.0 เห็นด้วยกับการรณรงค์ให้บ้านปลอดบุหรี่ ดังนั้นควรเพิ่มการรณรงค์สร้างกระแสการไม่สูบบุหรี่ในทุกพื้นที่ของบ้านและให้สถานบริการ สาธารณสุข/คลินิกเด็กที่ทางานเกี่ยวกับการเจ็บป่วยของเด็กเล็กได้บูรณาการการช่วยเลิกบุหรี่ในผู้ปกครองเข้าไว้ในแผนการรักษาเด็กเล็ก