Evaluating and preventing illness associated with indoor air pollution.
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Air Pollution, Indoor↗
Biomedical subjects
D B Coultas
Publications and source records attributed to D B Coultas.
Use of chest radiographs in epidemiological investigations of pneumoconioses.
The International Labour Organisation (ILO) classification of radiographs of pneumoconioses was developed to limit variation in classification of parenchymal abnormalities. In this study the manner in which chest radiographs were interpreted in 134 investigations reported in four peer reviewed journals during the five year period 1985-90 was examined. The approach for applying the ILO system was poorly described in most studies. For example, of 86 investigations using more than one reader, 66.3% described the method of reconciliation, but methods were not consistent among investigations. Our results indicate a number of potential problems in application of the ILO system, and gaps in existing recommendations that should be considered.
Decision Making↗
Prediction of lung function in Hispanics using local ethnic-specific and external non-ethnic-specific prediction equations.
We compared locally derived prediction equations for the FVC and FEV1 in Hispanics with external prediction equations derived from non-Hispanic whites. Algebraic subtraction of the external non-Hispanic equations from the New Mexico Hispanic equations showed that the differences would vary with age and height. The study population included 442 patients with Hispanic surnames between the ages of 25 and 80 yr evaluated at the University of New Mexico Hospital pulmonary function laboratory. We calculated percent predicted values for FVC and FEV1 using spirometric prediction equations from a New Mexico Hispanic population and from non-Hispanic white populations in Salt Lake City, Tucson, and six other U.S. cities. We employed either 80% of predicted or the lower fifth percentile as the criterion for separating normal from abnormal values. We found that the concordance of the classifications by the external and internal equations varied among the external equations and with the criterion used for abnormality. The classification of the FVC and FEV1 as normal or abnormal was influenced by the regression equation in about 5 to 10% of the subjects. Subjects with discordant classifications were not clearly predicted by age or height, although they tended to be at the extremes of the age and height distributions. This study shows that classification of lung function by locally derived ethnic-group-specific prediction equations may lead to a differing clinical categorization for some persons in comparison with external non-ethnic-group-specific equations.
Adult↗
Cigarette yields of tar and nicotine and markers of exposure to tobacco smoke.
Although cigarette yields of tar and nicotine have been declining since the early 1970s, little information is available for the general population on the consequences of their use on exposure to tobacco combustion products. In a population-based sample of 298 smokers, the majority of whom were Hispanic, we examined the relationships between yields of cigarettes currently smoked and levels of salivary cotinine and end-expired carbon monoxide. Spearman correlation coefficients between the current number of cigarettes smoked and cotinine (r = 0.52) or carbon monoxide (r = 0.51) were higher than correlations between the Federal Trade Commission (FTC) nicotine data and these same markers, 0.12 and 0.05, respectively. Correlations between FTC tar and carbon monoxide yields and the biologic markers were similarly weak. In multiple linear regression models, the current number of cigarettes smoked was the most important predictor of cotinine and carbon monoxide levels (p < 0.0001). The addition of FTC tar, nicotine, or carbon monoxide to the models explained little of the variability in cotinine or carbon monoxide levels. Because FTC yields of tar and nicotine are poor predictors of exposure to tobacco combustion products, subjects' reports of cigarette brand should not be used as a primary marker of exposure in epidemiologic investigations. Furthermore, smokers need to be advised about the limitations of cigarette yield information for predicting the potential for adverse health effects of smoking.
Adult↗
Reduced forced vital capacity in California grape workers. What does it mean?
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Adult↗
Occupational lung cancer.
The Contribution of Occupational Exposures to Lung Cancer. The overall importance of occupational agents as a cause of lung cancer has been a controversial subject since the 1970s. A federal report, released in the late 1970s, projected a surprisingly high burden of occupational lung cancer; for asbestos and four other agents, from 61,000 to 98,000 cases annually were attributed to these agents alone. Many estimates followed, some much more conservative. For example, Doll and Peto estimated that 15% of lung cancer in men and 5% in women could be attributed to occupational exposures. A number of population-based case-control studies also provide relevant estimates. In a recent literature review, Vineis and Simonato cited attributable risk estimates for occupation and lung cancer that ranged from 4% to 40%; for asbestos alone, the estimates ranged from 1% to 5%. These estimates would be expected to vary across locations and over time. Nevertheless, these recent estimates indicate that occupation remains an important cause of lung cancer. Approaches to Prevention. Prevention of lung cancer mortality among workers exposed to agents or industrial processes that cause lung cancer may involve several strategies, including eliminating or reducing exposures, smoking cessation, screening, and chemo-prevention. For example, changes in industrial processes that have eliminated or reduced exposures to chloromethyl ethers and nickel compounds have provided evidence of reduced risk of lung cancer following these changes. Although occupational exposures are important causes of lung cancer, cigarette smoking is the most important preventable cause of lung cancer. For adults, the work site offers an important location to target smoking cessation efforts. In fact, the work site may be the only place to reach many smokers. As many as 70% of smokers participating in a work site program reported that they would not seek out other programs for smoking cessation. Furthermore, these programs may be as effective as other smoking cessation programs, with abstinence approaching 30%. By creating a supportive social environment, policies restricting smoking in the workplace may also assist smokers trying to quit. Screening of workers at high risk of lung cancer, with periodic chest radiography and sputum cytology, offers potential methods for early detection that may improve prognosis. However, the failure of those procedures to improve outcome from lung cancer among high-risk smokers makes screening of workers of doubtful value. Both epidemiologic and experimental evidence suggest that dietary factors may modify the risk of lung cancer. To date, attention has been focused on vitamin A and carotenoids.(ABSTRACT TRUNCATED AT 400 WORDS)
Carcinogens↗
Heritability of ventilatory function in smoking and nonsmoking New Mexico Hispanics.
Familial aggregation of ventilatory function has been described in several populations, but the effects of age and cigarette smoking on the extent of aggregation have not been well characterized. We used data from a survey of a Hispanic population in New Mexico to obtain estimates of heritability for FVC and FEV1 as percentages of predicted value. Product-moment correlations for FVC of spouse pairs were 0.18 (n = 90 pairs) if neither smoked, 0.013 (n = 45 pairs) if only the wife smoked, 0.18 (n = 118 pairs) if only the husband smoked, and -0.04 (n = 83 pairs) if both smoked. Correlations for FEV1 of spouse pairs were similar. Because parent-child correlations did not vary with sex, we calculated product-moment correlations from the pooled data. The parent-child correlations for nonsmoking parents with nonsmoking children 6 to 17 yr of age and living in the same house were 0.16 (n = 335 pairs) and 0.17 for FVC and FEV1, respectively. For parents whose children were 25 yr of age or older, the parent-child correlations for those living in different houses were 0.37 (n = 63 pairs) for FVC and 0.40 for FEV1 if neither smoked, and 0.24 (n = 27 pairs) for FVC and 0.14 for FEV1 if both smoked. Heritability estimates, estimated by path analysis, were 0.43 for FVC and 0.42 for FEV1 if neither family member smoked and 0.65 for FVC and 0.44 for FEV1 if both family members smoked. We conclude that there is a moderate degree of heritability of FVC and FEV1 with no substantial change based on age or smoking status.
Age Factors↗
The physician's role in smoking cessation.
Physicians have many opportunities to facilitate smoking cessation among individual patients, and this could be complemented by efforts to curb smoking at the community level. If every physician advised all smokers to quit, there would be considerable public health benefit from the additional 5% to 10% of smokers who followed the advice. The benefits would be substantially greater if the interventions were targeted to the smoker's stage of change and with ongoing participation by the physician in the smoking cessation process. Possibly as important as the physician's active role with individual smokers are community-wide efforts to curb tobacco smoking. These efforts are essential to the prevention of the initiation of cigarette smoking among children and adolescents. Changing societal norms regarding cigarette smoking will not only decrease the numbers of future smokers but will also assist current smokers in cessation efforts.
Humans↗
Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity.
Snoring was investigated in a survey of respiratory disease in Hispanic-Americans of a New Mexico community. A population-based sample of 1222 adults was studied with questionnaires and measurements of height, weight, and blood pressure. The age-adjusted prevalence of regular loud snoring was 27.8% in men and 15.3% in women. Snoring prevalence increased with age and obesity in both men and women. Cigarette smoking was also associated with snoring, but chronic obstructive lung disease and alcohol consumption were not. Snorers more frequently had hypertension, ischemic heart disease, and excessive daytime sleepiness. In contrast to other studies, after adjustment for confounding factors, there was no effect of snoring on hypertension (odds ratio, 1.0; 95% confidence interval, 0.7 to 1.5), but an effect on myocardial infarction was still demonstrable (odds ratio, 1.8; 95% confidence interval, 0.9 to 3.6). The association of snoring with sleepiness suggests that respiratory disturbance of sleep related to upper airway obstruction, such as sleep apnea, occurs more frequently in snorers in this population.
Adult↗
Comparison of self- and spouse reports of snoring and other symptoms associated with sleep apnea syndrome.
We compared self- and spouse reports of snoring and other symptoms of sleep apnea syndrome ascertained from married couples in a community-based survey. Agreement between the two types of report varied between 70-98%, but was modest (kappa = -0.01-0.52) when adjusted for chance. For men, spouse reports yielded higher prevalence rates for snoring and for four other symptoms. For women, estimates of symptom prevalence were consistently lower by spouse report than by self-report. In multivariate analyses, the effect on snoring of gender and obesity increased and of age decreased when spouse reports were compared to self-reports. Snoring, according to spouse reports, was a significant risk factor for ischemic heart disease, but snoring according to self-reports showed a smaller effect and was not statistically significant. Snoring was not associated with hypertension when defined by either self- or spouse report. These observations suggest that questionnaire data of snoring and other symptoms of sleep apnea syndrome may be misclassified in part, and that such misclassification can affect estimates of prevalence and effects.
Adult↗
Variability of measures of exposure to environmental tobacco smoke in the home.
We assessed the variability of four markers of environmental tobacco smoke exposure in 10 homes with 20 nonsmoking and 11 smoking household members. We obtained exposure questionnaires, saliva and urine for cotinine, and air particle samples for respirable particles and nicotine on 10 sampling days: every other day over 10 days, and then 1 day every other week over 10 wk. The mean concentrations of respirable particles in the 10 homes ranged from 32.4 to 76.9 micrograms/m3, and concentrations of nicotine ranged from 0.6 to 6.9 micrograms/m3. Linear regression models that included indicator variables for self-reported exposure explained 9 and 6% of the variability of the respirable particle and the nicotine concentrations, respectively. The individual mean urinary cotinine levels standardized to creatinine concentration ranged from 3.9 to 55.8 ng/mg Cr, and for salivary cotinine the mean levels ranged from 0.9 to 4.3 ng/ml. Indicator variables for self-reported exposure explained 8 and 23% of the variability of the urinary and salivary cotinine levels, respectively. We conclude that because of the marked variability of these measures, multiple measurements are needed to establish a stable profile of exposure to environmental tobacco smoke in the home.
Adolescent↗
A personal monitoring study to assess workplace exposure to environmental tobacco smoke.
We enrolled 15 nonsmoking volunteers to evaluate the feasibility of measuring personal exposure to environmental tobacco smoke (ETS) at work and to characterize workplace exposures. During one workshift, we obtained questionnaires on exposure, saliva and urine for cotinine, and personal air samples for respirable particles and nicotine. The levels of cotinine, respirable particles, and nicotine varied widely with self-reports of exposure to ETS, but on average increased with increasing exposure.
Adult↗
Questionnaire assessment of lifetime and recent exposure to environmental tobacco smoke.
In a sample of 149 adult nonsmokers recruited in New Mexico in 1986, the authors assessed the reliability of questionnaire responses on lifetime exposure to tobacco smoke in the home. They also compared urinary cotinine levels with questionnaire reports of environmental tobacco smoke exposure during the previous 24 hours. The agreement of responses obtained on two occasions within six months was high for parental smoking during childhood: 94% for the mother and 93% for the father. For the amounts smoked by the mother and the father during the subject's childhood, the agreement between the two interviews was moderate: 52% and 39%, respectively. For the number of hours per day that each parent smoked in the home during the subject's childhood, the Spearman correlation coefficients also indicated only moderate reliability (r = 0.18 for maternal smoking and r = 0.54 for paternal smoking). For each set of interviews, responses concerning recent tobacco smoke exposure and urinary cotinine levels were correlated to only a modest degree. The authors conclude that adults can reliably report whether household members smoked during their childhood, but information on quantitative aspects of smoking is reported less reliably.
Adult↗
Diabetes, gallbladder disease, obesity, and hypertension among Hispanics in New Mexico.
Because Hispanics in the Southwest are genetically admixed with American Indians, the hypothesis has been advanced that the excess occurrence of diabetes mellitus, obesity, and gallbladder disease in this ethnic group may be genetic in origin and results from genes derived from American Indians. This report describes the prevalence of these diseases in 1,175 adult Hispanic participants in a survey of a New Mexico community conducted in 1984-1985. At nearly all ages, the majority of subjects had a body mass index of 25 kg/m2 or greater, and a substantial proportion exceeded 30 kg/m2. The prevalence of obesity was much greater in these Hispanics than is shown in nationwide data for US whites. Diabetes mellitus was also reported more often by Hispanic subjects in this survey than by US whites nationwide. A report of gallbladder trouble or of gallbladder removal was common in both males and females; the prevalence of gallbladder removal was as high in this population as in Mexican Americans previously studied in Starr County, Texas. In spite of the high prevalence of obesity, hypertension was less frequent among the New Mexico Hispanics than is shown in nationwide data for US whites. These findings complement those of previous surveys in Texas, which have shown a notably high proportion of adults to be obese, to have non-insulin-dependent diabetes mellitus, and to have gallbladder disease. The similar epidemiology of these diseases in the Hispanics of New Mexico and the Mexican Americans of Texas supports the hypothesis that American Indian admixture underlies the development of these conditions in Hispanics throughout the Southwest.
Adolescent↗
Discrepancies between self-reported and validated cigarette smoking in a community survey of New Mexico Hispanics.
In a population-based survey of respiratory disease in New Mexico Hispanics, we validated self-reports of cigarette use by 1,317 subjects against salivary cotinine level and end-tidal carbon monoxide concentration. For identifying likely deceivers about cigarette smoking among self-reported never smokers and former smokers, we used cutoff values of 20 ng/ml and 8 parts per million (ppm) for salivary cotinine and carbon monoxide, respectively. Among males and females, age-standardized prevalences of current smokers based upon questionnaire reports were 30.9 and 27.1%, respectively. After adjustment for cotinine alone, these percentages were 36.2 for males and 31.1 for females, and after adjustment for cotinine and carbon monoxide level, the corresponding percentages were 39.1 for males and 33.2 for females. We conclude that self-reports about smoking habits may lead to underestimation of the prevalence of current smokers and that questionnaire responses should be validated with biologic markers of tobacco smoke exposure.
Adolescent↗
Respiratory diseases and cigarette smoking in a Hispanic population in New Mexico.
We have conducted a cross-sectional study of Hispanic residents of a community in New Mexico. A total of 2,111 subjects were recruited from 733 households; the overall participation rates were 68.1% for males and 78.9% for females. For all subjects, a standardized respiratory symptoms questionnaire was completed, spirometric testing was performed, and saliva and end-tidal breath samples were obtained. As in other populations, chronic respiratory symptoms were uncommon in children, and asthma was more prevalent in boys than in girls. In adults, physician-diagnosed chronic bronchitis and emphysema were less prevalent in this population than in a previously studied sample of non-Hispanic whites in New Mexico. Spirometric testing was confirmatory; less than 1% of the Hispanic males and females had chronic air-flow obstruction. The prevalence of cigarette usage in the Hispanics was comparable to data from non-Hispanic whites in New Mexico and from nationwide surveys. However, daily cigarette consumption by the Hispanics in this sample tended to be low, as found in previous studies in New Mexico and elsewhere.
Adolescent↗
Spirometric prediction equations for Hispanic children and adults in New Mexico.
We conducted a population-based survey of respiratory diseases and lung function in a New Mexico Hispanic community, and developed spirometric prediction equations based on data from 576 children and adults. Spirometric test procedures were followed as recommended by the American Thoracic Society. For children 6 through 18 yr of age, we used a logarithmic model to predict spirometric parameters. We used simple linear regression for adults 25 through 80 yr of age. On the basis of exploratory analyses, we excluded adult subjects who were obese, defined as a body mass index of 30 kg/m2 or greater. This report describes these regressions. We did not perform regression analysis for those subjects between 19 and 24 yr of age because of small numbers and the inappropriateness of grouping these subjects with older adults for regression analysis. As an alternative to a regression equation for this age group specifically, we propose linear interpolation between values obtained using prediction equations developed for children and for adults. Finally, we compared the percent predicted values obtained from our internal prediction equations with equations from other populations of white children and adults. In general, the comparison equations underestimated the percent predicted values in our population.
Adolescent↗
Salivary cotinine levels and involuntary tobacco smoke exposure in children and adults in New Mexico.
We conducted a population-based household survey of respiratory disease in 2,029 children and adults and measured salivary cotinine levels by radioimmunoassay in 1,360 nonsmokers and ex-smokers. At all ages median and mean cotinine levels among nonsmokers and ex-smokers increased with the number of smokers in the home. The prevalence of a detectable level of cotinine was about 35% for those not living with a cigarette smoker and was greater with the number of cigarettes smoked by household members. In a multiple logistic regression model, the major determinants of a detectable level of cotinine in children were mother's smoking (odds ratio (OR) = 3.2), father's smoking (OR = 2.1), and smoking of other household members (OR = 4.0). Among adults, the effects of spouse's smoking were smaller with OR = 1.3 and 1.4 for husband's and wife's smoking, respectively. We conclude that in the general population cotinine can be frequently detected in the saliva of nonsmokers, even among those not living with a smoker.
Adolescent↗