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Francesco Forastiere,¹ Sandra Mallone,¹ Elena Lo Presti,¹ Sandra Baldacci,² Francesco Pistelli,² Marzia Simoni,³ Annarita Scalera,² Marzia Pedreschi,² Riccardo Pistelli,⁴ Giuseppe Corbo,⁴ Elisabetta Rapiti,¹ Nera Agabiti,¹ Sara Farchi,¹ Salvatore Basso,⁴ Luigi Chiaffi,² Gabriella Matteelli,² Francesco Di Pede,² Laura Carrozzi,² and Giovanni Viegi²

¹Agenzia di Sanità Pubblica, Regione Lazio, Rome, Italy
²Istituto di Fisiologia Clinica CNR, Pisa, Italy
³Dipartimento di Medicina Sperimentale e Diagnostica, Università di Ferrara, Ferrara, Italy
⁴Fisiopatologia Respiratoria, Università Cattolica, Rome, Italy

Abstract

The aim of this study was to evaluate whether risk factors associated with cardiovascular or respiratory diseases and lung cancer occur differently among nonsmoking women in Italy with and without exposure to environmental tobacco smoke (ETS) from husbands that smoke. We performed a cross-sectional study of 1,938 nonsmoking women in four areas of Italy. Data on respiratory and cardiovascular risk factors and on diet were collected using self-administered questionnaires. Medical examinations and blood tests were administered ; urine cotinine levels were measured. Nonsmoking women ever exposed to husbands' smoking were compared with unexposed women for several factors: education, husband's education, household crowding, number of children, current or past occupation, exposure to toxic substances at work, parental diseases, self-perceived health status, physician-diagnosed hypertension, hypercholesterol, diabetes, osteoporosis, chronic respiratory diseases, blood pressure medications, lifestyle and preventive behaviors, dietary variables, systolic and diastolic blood pressure, body mass index, waist-hip ratio, triceps skin folds, plasma antioxidant (pro-) vitamins (- and ß-carotene, retinol, l-ascorbic acid, -tocopherol, lycopene) , serum total and HDL cholesterol, and triglycerides. Women married to smokers were more likely to be less educated, to be married to a less educated husband, and to live in more crowded dwellings than women married to nonsmokers. Women married to smokers were significantly less likely to eat cooked [odds ratio (OR) = 0.72 ; 95% confidence interval (CI) , 0.55-0.93] or fresh vegetables (OR = 0.63 ; CI, 0.49-0.82) more than once a day than women not exposed to ETS. Exposed women had significantly higher urinary cotinine than unexposed subjects (difference: 2.94 ng/mg creatinine) . All the other variables were not more prevalent among exposed compared to unexposed subjects. The results regarding demographic factors are easily explained by the social class distribution of smoking in Italy. A lower intake of vegetables among exposed women in our study is consistent with the available literature. Overall, our results do not support previous claims of more frequent risk factors for cardiovascular and pulmonary diseases among ETS-exposed subjects. In Italy, as elsewhere in Europe and North America, women who have never smoked but are married to smokers are likely to be of lower social class than those married to never-smokers. However, once socioeconomic differences are considered, the possibility of confounding in studies on the health effects of ETS is minimal. Key words: confounding, environmental tobacco smoke, epidemiology, ischemic heart diseases, lung cancer, passive smoking, respiratory diseases. Environ Health Perspect 108:1171-1177 (2000) . [Online 13 November 2000]

http://ehpnet1.niehs.nih.gov/docs/2000/108p1171-1177forastiere/ abstract.html

Address correspondence to F. Forastiere, Agenzia di Sanità Pubblica, Regione Lazio, Via Santa Costanza 53, 00198 Rome, Italy. Telephone: 0039-06-51686484. Fax: 0039-06-51686463. E-mail: EPIAMB1@ASPLAZIO.IT

We thank T. Sapigni (University of Ferrara) , C.A. Perucci (Agenzia Sanità Pubblica, Lazio, Rome) , and R. Saracci (CNR Institute of Clinical Physiology, Pisa) for their scientific and technical suggestions ; and D. Kriebel for his comments to an earlier draft of the paper. We also thank the women who participated in the study. For their collaboration in data collection, we thank R. Puntoni (Pisa) , A. Bigazzi (Pisa) , T. Sampietro (Pisa) , R. Licitra (Pisa) , F. Bigazzi (Pisa) , A. Patricelli (Pisa) , A. Rosellini (Pisa) , A. Angino (Pisa) , B. Attisani (Pisa) , F. Martini (Pisa) , B. Piegaia (Pisa) , G. Lazzeri (Pisa) , P. Silvi (Pisa) , L. Zen (Ferrara) , E. Baraldi (Ferrara) , M.T. Prosdocimi (Ferrara) , and A. Quercia (Viterbo) .

This work was funded in part by the Center for Indoor Air Research, Linthicum, MD, USA (contracts 96-18 and 96-18A) .

Received 9 June 2000 ; accepted 29 August 2000.