MISSION

consumer acceptance through Web-based surveys. The findings of this research will provide data to inform
strategies to communicate public health risks of PREPs, and develop important guidelines for sidestream
smoke emissions.
SMOKE-FREE AIR LAWS, EXPOSURE AND HEALTH IN ADOLESCENTS
Gregory N. Connolly, DMD, MPH; Harvard School of Public Health; CIA 2008
Every day, more than 15 million children are exposed to SHS at home, with millions also exposed in day
care centers, schools, restaurants, and other places. Scientific evidence shows causal relationships between
exposure to SHS and a range of developmental and respiratory effects in neonates, infants, children, and
adolescents. Children exposed to SHS are at an increased risk for sudden infant death syndrome, acute
respiratory infections, ear problems, and more severe asthma. SHS exposure among children has decreased
substantially since 1992-1993 when the national prevalence of households with smoke-free home rules was
43% and less than one percent of the US population was protected by 100% smoke-free workplace
standards. Eliminating smoking in indoor spaces fully protects non-smokers from SHS, yet no evidence has
been reported to demonstrate reductions in pediatric diseases resulting from these declines in SHS
exposure of children. Dr. Connolly hypothesizes that reductions in SHS exposure of children are associated
with fewer SHS-caused pediatric illnesses and reduced utilization of health services. To investigate this
hypothesis he will examine the association between SHS exposure of children in the home and SHS-related
pediatric diagnoses and symptoms in all US health care settings and the association between SHS exposure
of children in the home and health services utilization for treatment of SHS-related pediatric diagnoses and
symptoms in all US health care settings. He will use a cross-sectional observational design involving
secondary data analysis of existing national and state-level data sets. The outcome measures will be SHSrelated
pediatric diagnoses and symptoms and health services utilization for treatment of SHS-related
pediatric diagnoses and symptoms. The exposure measures will be percentage of households with an adult
smoker and any children, percentage of households with smoking restrictions, percentage of households
with an adult smoker, with smoking allowed and any children, percentage of children exposed to SHS in
the home, percentage of population coverage with comprehensive smoke-free workplace rules, and
percentage of coverage with smoke-free day care centers standards. The outcome measurements will be
obtained from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical
Care Survey, and the Healthcare Cost and Utilization Project Kids’ Inpatient Database. The exposure
measurements will be determined from the Behavioral Risk Factor Surveillance System and Current
Population Survey-Tobacco Use Supplements, and wll be analyzed by analysis of variance and multivariable
regression modeling.
Dr. Connolly used data from the 1999-2006 National Health and Nutrition Examination Survey, a
cross-sectional survey designed to monitor the health and nutritional status of the US population, to
investigate the association between smoke-free standards coverage and SHS exposure among non-smoking
youths (3-19 years) in the US. Serum cotinine levels were available for 11,486 non-smoking youths from
117 survey locations. Each location was categorized into one of three groups indicating extensive, partial,
and no coverage by a smoke-free law. SHS exposure was defined as having serum cotinine levels greater
than or = 0.05 ng/ml. In addition, cotinine was analyzed as a continuous outcome for years 2003-2006.
Among non-smoking youths living in counties with extensive smoke-free law coverage, 32.7% were
exposed to SHS, compared with 49.5% with partial coverage, and 64.7% with no standards. Adjusting for
covariates, youths residing in counties with extensive coverage had 0.31 times the odds of SHS exposure
and youths with partial coverage had 0.58 times the odds of SHS exposure compared to those residing in
counties without smoke-free standards. These results suggest that smoke-free standards are an effective
strategy for reducing SHS exposure not only in adults, but in youth as well.
TOBACCO SMOKE ENDOTOXIN
Lennart P. Larsson, PhD; Lund University; CIA 2007
Recent research has shown that tobacco smoke contains large amounts of bacterial lipopolysaccharides
(LPS, endotoxin), a family of inflammatory toxins from Gram-negative bacteria known to cause severe
respiratory disease upon inhalation. By using gas chromatography-mass spectrometry technology Dr.
Larsson measured LPS-specific 3-hydroxy fatty acids, peptidoglycan-specific muramic acid, and fungalspecific
ergosterol in cigarettes of 37 brands purchased in six different countries in Europe and Asia and in
10 brands of American cigarettes purchased in the US. The PI found that: 1) “light” and “full flavor”
cigarettes do not differ with respect to the microbial components mentioned; 2) the levels of some of these
components, mainly ergosterol, were comparatively low in certain local Asian brands of cigarettes; 3) the
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