Elsevier

Addictive Behaviors

Volume 47, August 2015, Pages 22-32
Addictive Behaviors

A systematic review of secondhand tobacco smoke exposure and smoking behaviors: Smoking status, susceptibility, initiation, dependence, and cessation

https://doi.org/10.1016/j.addbeh.2015.03.018Get rights and content

Highlights

  • Secondhand smoke exposure is associated with being a smoker.

  • Secondhand smoke exposure increases smoking susceptibility and initiation.

  • Secondhand smoke exposure may increase nicotine dependence in adults.

  • Secondhand smoke exposure hinders smoking cessation

Abstract

Objectives

To examine the association between secondhand tobacco smoke exposure (SHSe) and smoking behaviors (smoking status, susceptibility, initiation, dependence, and cessation).

Methods

Terms and keywords relevant to smoking behaviors and secondhand tobacco smoke exposure were used in a search of the PubMed database. Searches were limited to English language peer-reviewed studies up till December 2013. Included papers: a) had clearly defined measures of SHSe and b) had clearly defined measures of outcome variables of interest. A total of 119 studies were initially retrieved and reviewed. After further review of references from the retrieved studies, 35 studies were finally selected that met all eligibility criteria.

Results

The reviewed studies consisted of thirty-five (89.7%) studies with differing measures of SHSe (including questionnaire and biological measures) and varying definitions of main outcome variables of interest between studies. The majority of the studies (77%) were cross-sectional in nature. The majority of studies found that SHSe was associated with greater likelihood of being a smoker, increased susceptibility and initiation of smoking, greater nicotine dependence among nonsmokers, and poorer smoking cessation.

Conclusions

The review found positive associations between SHSe and smoking status, susceptibility, initiation and nicotine dependence and a negative association with smoking cessation. In light of design limitations, future prospective and clinical studies are needed to better understand the mechanisms whereby SHSe influences smoking behaviors.

Introduction

Secondhand tobacco smoke exposure (SHSe) remains a global health problem with 40% of children and 34% of non-smoking adults exposed and resulting in 603,000 attributable deaths from ischemic heart disease, respiratory infections, asthma, and lung cancer (Öberg et al., 2011). This global impact continues to spur the need for tobacco control measures that aim to limit and protect individuals from SHSe. Particularly, Article 8 of the WHO Framework Convention recommends effective measures to protect exposure from tobacco smoke in both indoor and public spaces (World Health Organization, 2009). These recommendations come from extensive studies suggesting that there is no risk free level of SHSe (U.S. Department of Health and Human Services, 2006). Indeed, even brief and transient SHSe confers health risks (Flouris et al., 2010, Raupach et al., 2006).

Although the adverse physical health consequences of SHSe is extensively recognized, (Barnoya and Glantz, 2005, Jones et al., 2011, U.S. Department of Health and Human Services, 2010, Zhong et al., 2000) a growing body of research has begun to assess its behavioral effects. Notably, studies have demonstrated the neurocognitive detriments (Herrmann et al., 2008, Llewellyn et al., 2009, Swan and Lessov-Schlaggar, 2007, Yolton et al., 2005) and mental health effects (Bandiera, 2011, Bandiera et al., 2010, Bandiera et al., 2011, Hamer et al., 2011, Hamer et al., 2010) associated with SHSe. Given its acknowledged psychological and neurocognitive effects, the risks conferred by SHSe may extend to behaviors which reinforce smoking. For instance, environments of tobacco smoke exposure are associated with increased smoking cues that may potentiate smoking behaviors among smokers (Field et al., 2007, McRobbie et al., 2008). Additionally, through the psychoactive effect of nicotine exposure from SHSe, novice smokers may be at increased susceptibility to initiate tobacco use (Anthonisen & Murray, 2005). Indeed, clinical studies have found that SHSe results in increased occupancy of nicotine-acetylcholine receptors in the brains of adult smokers and nonsmokers, (Brody et al., 2011) suggesting increased neural vulnerability to nicotine exposure from SHS.

Despite the putative mechanisms of action whereby SHSe may influence smoking behavior, it is important to first determine to what extent SHSe is associated with such behaviors. Therefore, our study aims to systematically examine the literature for studies assessing the associations between SHSe and smoking behaviors; particularly smoking status, susceptibility, initiation, dependence, and cessation. The finding of this review will be informative in strengthening policies to limit SHSe, prevent smoking uptake, and to promote strategies for cessation.

Section snippets

Methods

We performed a literature search for published articles in the English language that reported on the relationship between SHSe and smoking related behaviors (i.e., smoking status, smoking susceptibility, smoking initiation, nicotine dependence and smoking cessation) prior to December 2013, through PubMed electronic database. Key terms used for the search were as follows: Secondhand tobacco smoke OR Environmental tobacco smoke AND smoking initiation OR smoking susceptibility OR risk for smoking

Description of studies

The retrieved studies consisted of 27 (77%) cross-sectional analyses, seven (20%) longitudinal analyses, and one (3%) case–control study; representing findings from a population of 1,138,101 participants. The samples represent 14 countries with thirteen (37.1%) studies from the United States, six (17.1%) from Canada, four (11.4%) from China or Hong Kong, two (5.7%) from Turkey, one combined Global Health Survey data from Cambodia, Laos, and Vietnam, one combined Global Youth Tobacco Survey data

Discussion

The association between SHSe and smoking behaviors has been elucidated through several clinical and epidemiological studies. Relationships between SHSe and smoking behaviors include: a) an increased likelihood of being a smoker; b) increased susceptibility to smoking; c) increased likelihood of smoking initiation; d) greater nicotine dependence symptoms; and e) reduced attempts and success in smoking cessation. These findings provide important considerations for future research and directions

Limitations

Several limitations need to be considered in interpreting the findings of this review. First, the variability in SHSe measures and outcome measures reported in each study precluded the possibility of meta-analytic procedures in summarizing the studies. Second, the majority of studies were cross-sectional in nature which limits the causal inferences in explaining the relationship between SHSe and main outcomes of interest. Among the prospective studies, the majority relied on self-report

Conclusions

In summary, despite inherent limitations in the designs of studies, clinical and epidemiological studies have demonstrated a relationship between SHSe and smoking behaviors. Specifically, longitudinal studies from our review suggest that SHSe is predictive of current smoking status among children and adults, (Glover et al., 2011, Homish et al., 2011, Hopenhayn et al., 2013) smoking initiation among children, (Becklake et al., 2005, Glover et al., 2011, Wang et al., 2011) and poor success in

Role of funding sources

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors

Contributors

Chizimuzo Okoli conceived, planned, conducted, and drafted the report of the manuscript. Jonathan Kodet conducted the data retrieval and review of articles for the study. Jonathan Kodet also assisted in drafting sections of the report.

Conflict of interest

All authors declare that they have no conflicts of interest.

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