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A cross-sectional study of secondhand smoke exposure and respiratory symptoms in non-current smokers in the U.S. trucking industry: SHS exposure and respiratory symptoms

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Laden, Francine, Yueh-Hsiu Chiu, Eric Garshick, S Katharine
Hammond, and Jaime E Hart. 2013. A cross-sectional study of secondhand smoke exposure and respiratory symptoms in noncurrent smokers in the U.S. trucking industry: SHS exposure and respiratory symptoms. BMC Public Health 13: 93.

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doi:10.1186/1471-2458-13-93

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November 9, 2015 11:01:06 AM EST

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http://nrs.harvard.edu/urn-3:HUL.InstRepos:11181195

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Laden et al. BMC Public Health 2013, 13:93 http://www.biomedcentral.com/1471-2458/13/93 RESEARCH ARTICLE

Open Access

A cross-sectional study of secondhand smoke exposure and respiratory symptoms in noncurrent smokers in the U.S. trucking industry: SHS exposure and respiratory symptoms
Francine Laden1,2,3*, Yueh-Hsiu Chiu1, Eric Garshick3,4, S Katharine Hammond5 and Jaime E Hart1,3

Abstract
Background: Previous studies have suggested associations of adult exposures to secondhand smoke (SHS) with respiratory symptoms, but no study has focused on blue-collar industrial environments. We assessed the association between SHS and respiratory symptoms in 1,562 non-current smoking U.S. trucking industry workers.
Methods: Information on SHS exposure and respiratory health was obtained by questionnaire. Multiple logistic regression analyses were used to assess the associations of recent and lifetime exposures to SHS with chronic phlegm, chronic cough, and any wheeze, defined by American Thoracic Society criteria.
Results: In analyses adjusted for age, gender, race, childhood SHS exposure, former smoking, pack-years of smoking and years since quitting, body mass index, job title, region of the country, and urban residence, recent exposures to
SHS were associated with all three respiratory symptoms (odds ratio (OR) = 1.46; 95% confidence interval (CI) = 1.002.13) for chronic cough, 1.55 (95% CI = 1.08-2.21) for chronic phlegm, and 1.76 (95% CI = 1.41-2.21) for any wheeze).
Workplace exposure was the most important recent exposure. Childhood exposure to SHS was also associated with all three symptoms, but only statistically significantly for chronic phlegm (OR = 1.84; 95% CI = 1.24-2.75). Additional years of living with a smoker were associated with an increased risk, but there was no evidence of a dose–response, except for chronic phlegm.
Conclusions: In this group of trucking industry workers, childhood and recent exposures to SHS were related to respiratory symptoms.
Keywords: Occupational health, Secondhand smoke, Respiratory symptoms

Background
Secondhand smoke (SHS) is a complex mixture of chemicals generated by the burning of tobacco and the smoke exhaled by smokers [1]. Previous studies have suggested that adult exposure to SHS may be associated with adverse respiratory effects including acute and chronic respiratory symptoms, chronic rhinosinusitis, and asthma [1-10]; furthermore, the burden of respiratory symptoms on health related quality of life may
* Correspondence: francine.laden@channing.harvard.edu
1
Department of Environmental Health, Harvard School of Public Health,
Boston, MA, USA
2
Department of Epidemiology, Harvard School of Public Health, Boston, MA,
USA
Full list of author information is available at the end of the article

be even stronger than that of lung function [11].
Epidemiologic studies of SHS exposure and respiratory symptoms have mainly considered office environments or service workers (in bars, restaurants, and casinos), but no study that we know of has focused on blue-collar industrial environments. Smoking prevalence in adults has been declining in the U.S. [12-14], but among the major blue-collar occupations it remains higher than that of many other occupational groups [15-20], suggesting that this is a population that still has high potential for SHS exposure [21]. Our previous work also found that despite state and local movements toward smoke-free laws, U.S. trucking industry workers were still exposed to workplace SHS as recently as 2005 [22].

© 2013 Laden et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Laden et al. BMC Public Health 2013, 13:93 http://www.biomedcentral.com/1471-2458/13/93 In this study, we examined the association between SHS exposure and self-reported chronic respiratory symptoms, including cough, phlegm and wheeze, in a population of non-smoking employees in the U.S. unionized trucking industry. Methods
Study subjects

In 2004 we mailed a health questionnaire to 3,689 members of the International Brotherhood of Teamsters, working or recently retired (within 7 years) from three large U.S. trucking companies. These individuals were all respondents to a previous questionnaire focused on active smoking habits [23]. We were unable to relocate
104 individuals and received responses from 2,294. The participants represented the major job categories in the trucking industry: long-haul driver (driving between cities), pick-up/delivery (P&D) driver (local driving within cities), dock worker (moving freight within the terminal), combination worker (workers who work both on the dock and drive P&D trucks), mechanic (repairing tractors and trailers), hostler (moving trucks in the terminal yard), and clerk (office worker). The study protocol was approved by the Brigham and Women’s
Hospital, the Harvard School of Public Health and VA
Boston Institutional Review Boards and consent was inferred from return of the completed questionnaires.
Respiratory symptoms and illness

Prevalence of chronic respiratory symptoms was identified based on self-reports using questions from the
American Thoracic Society DLD-78 questionnaire that includes questions on timing and severity of the symptoms [24]. “Chronic cough” was defined as cough on most days for 3 consecutive months or more during the year. “Chronic phlegm” was defined as phlegm on most days for 3 consecutive months or more during the year. “Any wheeze” was any report of wheezing with a cold or occasionally apart from colds or on most days or nights. Information on other respiratory illnesses, including hay fever, chronic bronchitis, emphysema, chronic rhinitis, chronic obstructive pulmonary disease
(COPD), and asthma, was also obtained. In sensitivity analyses, we excluded all participants with existing doctor diagnosed chronic respiratory disease.
Secondhand smoke exposure

We examined several metrics of SHS exposure. First, we used a previously validated question on exposure to SHS in the past 7 days from all sources. Workers were classified as “exposed” if they reported “yes” to “In the past 7 days, have you been exposed to someone else’s tobacco smoke?”. We also obtained information on recent home and recreational SHS exposures during an average week,

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as well as workplace exposure in the past 2 work days, and used this information to identify the likely sources of current SHS exposure. Recent home exposure was identified by the question “Has anyone (not including you) smoked tobacco in your home in the past 7 days?”
(yes/no). Recreational and workplace exposures were identified based on time spent at places where people were smoking (restaurants, bars, clubs, other people’s homes, sports arena, concerts, etc.) in an average week, and amount of time spent in areas at work where smoking was allowed in the past 2 work days. Individuals were considered non-exposed if they did not spend time at smoking allowed areas or if they spent time there but reported no one was smoking.
We also examined two measures of chronic SHS exposure. Childhood SHS exposure was defined by whether the individual had ever lived with at least one smoker during their childhood (yes/no). Long-term exposure to SHS at home was identified by lifetime total years of residency with at least one smoker, and was categorized into four groups (

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