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US adult attitudes and practices regarding smoking restrictions and child exposure to environmental tobacco smoke: changes in the social climate from 2000-2001.

OBJECTIVE: A substantial proportion of homes and automobiles serve as settings for environmental tobacco smoke (ETS) exposure, and many public settings that children frequent are still not smoke-free. Tobacco control efforts are attempting to increase smoking bans. The objective of this study was to describe the knowledge, attitudes, and practices of smokers and nonsmokers regarding smoking bans and child ETS exposure in multiple public and private settings and to report changes from 2000-2001. METHODS: Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed for changes in knowledge, attitudes, and practices regarding tobacco. These data were collected via automated, random-digit-dialing telephone surveys that were conducted in the summers of 2000 and 2001. The samples were weighted by race and gender to be representative of the US population. RESULTS: Response rates for eligible adults actually contacted were 1501 (75%) of 1876 in 2000 and 3002 (84%) of 3566 in 2001. The majority of adults, both smokers and nonsmokers, support smoking bans in a wide variety of places. The percentage of all respondents reporting the presence of smoking bans in several public and private places increased from 2000-2001: the household (69%-74%), in the presence of children (84%-88%), convenience stores (68%-74%), fast-food restaurants (52%-58%), and non-fast-food restaurants (25%-28%). Support for smoking bans also increased in shopping malls (71%-75%), fast-food restaurants (77%-80%), and indoor sporting events (78%-80%). There were no significant changes in support for smoking bans in convenience stores, restaurants, or outdoor parks. Adults' knowledge of the harm caused by tobacco was unchanged, with the vast majority of adults recognizing the dangers of exposure to ETS from parental smoking (95%) and exposure to ETS in cars (77%). CONCLUSIONS: Small improvements in adult attitudes and practices regarding children's ETS exposure occurred from 2000-2001. However, a significant number of adults in the United States still report ignorance of the harmful effects of child ETS exposure, and there was no improvement in reported knowledge in this 1-year period. In contrast, a growing majority of smokers and nonsmokers favor restrictions on smoking in public settings, suggesting that states and communities have public support for broad public smoking restriction policies. There are significant roles that pediatricians can play in preventing children's ETS exposure, through both patient and family education and by moving smoking restriction policies forward on their community's agenda.

Adult↗

Field trial on the control effect of fipronil bait against German cockroaches.

A field trial on the control effect of fipronil poison bait against German cockroaches (Blatella germanica) was carried out at different restaurant types in Sinchon, Seoul, Republic of Korea. Monitoring was performed applying food baited traps for 2 days per week. Reduction rates of German cockroaches by applying fipronil baits were 90.9% at Korean restaurants, 96.4% at Chinese restaurants, and 89.4% in beer hall kitchens after 4 weeks of the treatment. Overall average of the reduction rate was 93.9%. As the natural reduction rate at untreated restaurants was 11.5% after 4 weeks, a correction of the average reduction rate by applying the Abbot formula was 93.1%.

Animals↗

A comprehensive evaluation of the 1993 city of Toronto smoking by-laws.

Effective January 1, 1993, the City of Toronto's two smoking by-laws--one regarding workplaces and another regarding public places--were replaced and amended respectively. Smoking is now prohibited in all workplaces (unless in a designated smoking area), and in at least 50% of eating areas in restaurants. Through a workplace telephone survey and restaurant inspection records, the implementation and enforcement of the by-laws were evaluated. Eighty-three per cent of the workplaces were completely smoke-free and 7% had restricted smoking to a designated area. A majority (76%) of the managers and owners were in favour of regulatory controls on smoking in workplaces. Eighty-six per cent of restaurants complied with requirements for a minimum 50% smoke-free area and signage, and nearly 4% of the sampled restaurants banned smoking throughout the entire premises even though this is not currently required.

Constitution and Bylaws↗

Outbreak of acute fluoride poisoning caused by a fluoride overfeed, Mississippi, 1993.

OBJECTIVE: To determine the extent and confirm the cause of an August 1993 outbreak of acute fluoride poisoning in a small Mississippi community, thought to result from excess fluoride in the public water supply. METHODS: State health department investigators interviewed patrons of a restaurant where the outbreak first became manifest and obtained blood and urine samples for measurement of fluoride levels. State health department staff conducted a random sample telephone survey of community households. Public health environmentalists obtained water and ice samples from the restaurant and tap water samples from a household close to one of the town's water treatment plant for analysis. Health department investigators and town water department officials inspected the fluoridation system at the town's main water treatment plant. RESULTS: Thirty-four of 62 restaurant patrons reported acute gastrointestinal illness over a 24-hour period. Twenty of 61 households that used the community water supply reported one or more residents with acute gastrointestinal illness over a four-day period, compared with 3 of 13 households that did not use the community water supply. Restaurant water and ice samples contained more than 40 milligrams of fluoride per liter (mg/L), more than 20 times the recommended limit, and a tap water sample from a house located near the main treatment plant contained 200 mg/l of fluoride. An investigation determined that a faulty feed pump at one of the town's two treatment plants had allowed saturated fluoride solution to siphon from the saturator tank into the ground reservoir and that a large bolus of this overfluoridated water had been pumped accidentally into the town system. CONCLUSIONS: Correct installation and regular inspection and maintenance of fluoridation systems are needed to prevent such incidents.

Adolescent↗

Cancer incidence among waitresses in Norway.

Previous studies have found high risk of cancers of the upper aerogastric tract, liver, and lung among waiters. Since approximately 75 percent of those working in the restaurant business in Norway are women, we have analyzed cancer incidence in a cohort of waitresses, to determine whether they have the same high cancer-risk as their male colleagues. The cohort consisted of 5,314 waitresses organized in the Restaurant Workers' Union between 1932 and 1978. The follow-up period was from 1959 to 1991. The standardized incidence ratio (SIR) for all causes of cancer was 1.0 (95 percent confidence interval [CI] = 0.9-1.1), based on 430 observed cases. Cancers of the tongue, mouth, pharynx, larynx, esophagus, and liver were grouped together as alcohol-associated cancers. SIR for these cancers combined was 1.1 (CI = 0.5-2.2). For lung cancer, SIR was 2.3 (CI = 1.6-3.1). Cervical cancer was also more frequent than expected, and breast cancer less frequent than expected. The larger excess of lung cancer and cervical cancer appeared in the sub-cohort working in restaurants with a license to serve alcohol. No excess risk of alcohol-associated cancers could be detected in this cohort of Norwegian waitresses. A longer follow-up period will be necessary to evaluate possible consequences of an increased alcohol consumption among younger waitresses. Waitresses in Norway are, like their male colleagues, at high risk for lung cancer.

Adult↗

Potential exposure of cooks to airborne mutagens and carcinogens.

Recent case-control and proportionate mortality studies in Canada, the United States, Britain, and Denmark have shown that cooks and other food-service workers may have elevated risks of cancers of the nasopharynx, buccal cavity, esophagus, lung, and bladder. The purpose of this pilot study was to determine if there might be airborne products of cooking which may be risk factors for these cancers in cooks. Eight air samples were taken in four restaurants and subsequently analyzed for mutagenicity using the Ames assay, and for carcinogens using gas chromatography/mass spectrometry. All four samples taken in the restaurant cooking areas were mutagenic to TA98 without metabolic activation, and two were mutagenic to TA100 also without metabolic activation. Of the four dining area samples, one was mutagenic to TA100 and one to TA98, both without metabolic activation. Compounds tentatively identified by mass spectrometry did not include known carcinogens. The ventilation systems in all four restaurants allow the exposure of cooks to both the air from dining room smoking areas and the volatile products of cooking.

Air Pollutants, Occupational↗

Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis.

BACKGROUND: Fast-food consumption has increased greatly in the USA during the past three decades. However, the effect of fast food on risk of obesity and type 2 diabetes has received little attention. We aimed to investigate the association between reported fast-food habits and changes in bodyweight and insulin resistance over a 15-year period in the USA. METHODS: Participants for the CARDIA study included 3031 young (age 18-30 years in 1985-86) black and white adults who were followed up with repeated dietary assessment. We used multiple linear regression models to investigate the association of frequency of fast-food restaurant visits (fast-food frequency) at baseline and follow-up with 15-year changes in bodyweight and the homoeostasis model (HOMA) for insulin resistance. FINDINGS: Fast-food frequency was lowest for white women (about 1.3 times per week) compared with the other ethnic-sex groups (about twice a week). After adjustment for lifestyle factors, baseline fast-food frequency was directly associated with changes in bodyweight in both black (p=0.0050) and white people (p=0.0013). Change in fast-food frequency over 15 years was directly associated with changes in bodyweight in white individuals (p<0.0001), with a weaker association recorded in black people (p=0.1004). Changes were also directly associated with insulin resistance in both ethnic groups (p=0.0015 in black people, p<0.0001 in white people). By comparison with the average 15-year weight gain in participants with infrequent (less than once a week) fast-food restaurant use at baseline and follow-up (n=203), those with frequent (more than twice a week) visits to fast-food restaurants at baseline and follow-up (n=87) gained an extra 4.5 kg of bodyweight (p=0.0054) and had a two-fold greater increase in insulin resistance (p=0.0083). INTERPRETATION: Fast-food consumption has strong positive associations with weight gain and insulin resistance, suggesting that fast food increases the risk of obesity and type 2 diabetes.

Adolescent↗

A multi-state outbreak of Salmonella serotype Thompson infection from commercially distributed bread contaminated by an ill food handler.

Foodborne transmission is estimated to account for 95% of non-typhoidal Salmonella infections reported in the United States; however, outbreaks of salmonellosis are rarely traced to food handlers. In August 2000, an increase in Salmonella serotype Thompson infection was noted in Southern California; most of the cases reported eating at a restaurant chain (Chain A) before illness onset. A case-control study implicated the consumption of burgers at Chain A restaurants. The earliest onset of illness was in a burger bun packer at Bakery B who had not eaten at Chain A but had worked while ill. Bakery B supplied burger buns to some Chain A restaurants in Southern California and Arizona. This outbreak is notable for implicating a food handler as the source of food contamination and for involving bread, a very unusual outbreak vehicle for Salmonella . Inadequate food-handler training as well as delayed reporting to the health department contributed to this outbreak.

Adolescent↗

Outbreaks of food borne diseases in the Lazio region, Italy: the results of epidemiological field investigations.

BACKGROUND: More thorough information about risks, exposures and vehicles of food borne diseases can be obtained from epidemiological field investigations than from infectious disease reports or laboratory data. METHODS: We analysed the results of 410 field investigations of food borne disease outbreaks reported from 1996 to 2000 and conducted as cohort studies. RESULTS: The incidence of food borne outbreaks increased from 0.8/100,000 in 1996 to 2.0 in 1999, as did the incidence of salmonellosis (from 16/100,000 to 21 in the same period) and diarrhoea episodes reported by laboratories (from 12/100,000 in 1997 to 29 in 1999). Of the food borne disease outbreaks, 264 (64.4%) occurred in private homes; 5 (1.2%) in hospitals; 31 (7.6%) in canteens and refectories, 84 (20.5%) in restaurants, 41 of which occurred during special functions. The home outbreaks exposed few people (average of 7), had high attack rates (61.7% average) and a high proportion of known aetiology (66%), while food borne disease outbreaks in canteens and restaurants (during special functions) exposed many people (300 and 81, respectively), had medium attack rates (19.7 and 34.5%, respectively) and a higher proportion of confirmed vehicles (50 and 49%, respectively), compared to those occurring at home (21%). Salmonella spp. was the most frequent agent detected in each setting (67% of confirmed cases). The most frequent vehicles at home were mushrooms and sweets containing eggs and cream; in canteens, meat and vegetables and in restaurants, shellfish. CONCLUSIONS: Outbreak characteristics varied according to the setting. This implies the need for a different approach of field investigations, and different preventive measures.

Agaricales↗

A dynamic multilevel model of demographic diversity and misfit effects.

In this study, the authors proposed and evaluated the linkages of a dynamic multilevel model of demographic diversity and misfit effects in a large sample of quick-service restaurants. Using a cross-level approach, the authors studied an employee's demographic misfit in relation to coworkers' demographics as a predictor of turnover risk over time. At the business-unit level, they studied changes in restaurant demographic diversity in relation to changes in profitability over time and unit turnover rates in relation to profitability. The authors also studied the impact of the match between the racial compositions of the restaurants and their communities on profitability. The results supported linkages between demographic misfit and turnover and partially supported a negative association between racial diversity and changes in profitability.

Adolescent↗

Food-purchasing patterns for home: a grocery store-intercept survey.

OBJECTIVES: To identify the most common frequency of food-purchasing patterns and relate this pattern to characteristics of individuals and families. DESIGN: A customer-intercept survey was conducted in the greater Houston area, Texas, USA, in 2002. The frequency of food shopping at supermarkets, convenience stores and restaurants to buy food for eating at home was assessed. SUBJECTS: A total of 823 adults (78.5% female; mean age 37.4 years) who went to any of several grocery or convenience stores, including European, Hispanic and African Americans, and Asian/Pacific Islanders. RESULTS: Major food-shopping patterns were a weekly big trip with a few small trips (34.9%), biweekly big trips with a few small trips (21.9%), no big shopping trips (15.4%), a weekly big trip without small trips (13.9%), a monthly big trip (8.3%), and biweekly big trips without small trips (6.4%). While 61.1% of participants never went to convenience stores to buy fruit and vegetables (F&V) for eating at home, 67% went to restaurants for F&V. African American families shopped for food least frequently, while Asian American families shopped for food most frequently. Educational level was negatively associated with the use of convenience stores and positively associated with take-away from restaurants. CONCLUSIONS: There is substantial variability in the frequency of food shopping. Future research on food shopping should incorporate this variable.

Adult↗

Relative influence of diet and physical activity on body composition in urban Chinese adults.

BACKGROUND: The relative influence of diet and physical activity on body fatness remains uncertain. OBJECTIVE: The objective of the study was to investigate associations of dietary variables and physical activity with body fatness in urban Chinese adults. DESIGN: We conducted a cross-sectional study in 130 weight-stable men and women aged 35-49 y. Subjects were selected from upper and lower tertiles of dietary fat and physical activity on the basis of screening questionnaires. Dietary intake was assessed by weighed food intake, physical activity level (PAL) was calculated as the ratio of predicted total energy expenditure (TEE) to predicted resting energy expenditure, and body composition was measured with the use of (2)H(2)O. Reported energy intake and predicted TEE were validated against TEE determined with the use of (2)H(2)(18)O (n = 73). RESULTS: Body fatness was positively associated with dietary variety (ie, variety of ingredients) (partial r = 0.186, P = 0.039) and frequency of consuming restaurant foods (partial r = 0.237, P = 0.001) and negatively associated with PAL (partial r = -0.307, P = 0.001) in a multiple regression analysis that controlled for sex and confounders. The combined variance accounted for by dietary variety and restaurant food consumption (9.1%) was equivalent to that for PAL (9.4%). Neither dietary fat nor energy density predicted body fatness, but dietary energy density predicted within-subject day-to-day variation in reported energy intake (P < 0.001). CONCLUSIONS: Dietary variety, frequency of restaurant food consumption, and PAL significantly predicted body fatness in urban Chinese adults, but dietary fat did not. These findings support previous studies in US adults and suggest that dietary variables other than fat have an important influence on adult body composition.

Adipose Tissue↗

Alcohol use in the service industry.

It is frequently alleged that hotel and restaurant personnel drink more than other groups in the service industry, although only indirect evidence has been presented to substantiate this allegation. This paper reports data from two surveys concerning alcohol use in different segments of the service industry. In the first study 84 students at three different colleges in the Stavanger region were interviewed concerning their alcohol habits using the screening instrument AUDIT (Alcohol Use Disorders Identification Test). The second survey concentrated on service employees in the Rogaland area. One hundred and five respondents answered the AUDIT questionnaire in this study. The results showed that hotel and restaurant affiliated individuals scored significantly higher on the AUDIT than the other respondents. The first survey indicated that students at the Norwegian College of Hotel Management obtained significantly higher AUDIT scores than other groups of students, whereas the second survey indicated that restaurant workers scored significantly higher than employees in other branches of the service industry. Implications of these results, as well as future research demands were indicated.

Alcohol Drinking↗

Reconsidering the effects of monosodium glutamate: a literature review.

PURPOSE: This article reviews the literature from the past 40 years of research related to monosodium glutamate (MSG) and its ability to trigger a migraine headache, induce an asthma exacerbation, or evoke a constellation of symptoms described as the "Chinese restaurant syndrome." DATA SOURCES: Literature retrieved by a search using PubMed, Medline, Lexis-Nexus, and Infotrac to review articles from the past 40 years. CONCLUSIONS: MSG has a widespread reputation for eliciting a variety of symptoms, ranging from headache to dry mouth to flushing. Since the first report of the so-called Chinese restaurant syndrome 40 years ago, clinical trials have failed to identify a consistent relationship between the consumption of MSG and the constellation of symptoms that comprise the syndrome. Furthermore, MSG has been described as a trigger for asthma and migraine headache exacerbations, but there are no consistent data to support this relationship. Although there have been reports of an MSG-sensitive subset of the population, this has not been demonstrated in placebo-controlled trials. IMPLICATIONS FOR PRACTICE: Despite a widespread belief that MSG can elicit a headache, among other symptoms, there are no consistent clinical data to support this claim. Findings from the literature indicate that there is no consistent evidence to suggest that individuals may be uniquely sensitive to MSG. Nurse practitioners should therefore concentrate their efforts on advising patients of the nutritional pitfalls of some Chinese restaurant meals and to seek more consistently documented etiologies for symptoms such as headache, xerostomia, or flushing.

Asthma↗

Preference and requests for smoke-free dining.

This study looked at whether people prefer to sit in smoking or smoke-free areas when they go to cafés and restaurants. It also considered whether those who said they would prefer smoke-free dining made this known when booking or going to a restaurant. The sample was 2387 Victorians, randomly selected and interviewed in their own homes. Overall, 68 per cent of respondents said they would prefer a nonsmoking area, and only 11 per cent preferred a smoking area. Even among smokers, less than half (42 per cent) wanted to sit in a smoking area. Of those people who wanted smoke-free dining, only 45 per cent said they always made this known. The results demonstrate strong community desire for smoke-free dining, but also point to the need for restaurant managers or the dining public to take the initiative, or for legislative action to ensure the provision of smoke-free areas.

Adult↗

Changes in hospitality workers' exposure to secondhand smoke following the implementation of New York's smoke-free law.

OBJECTIVE: To assess the impact on hospitality workers' exposure to secondhand smoke of New York's smoke-free law that prohibits smoking in all places of employment, including restaurants, bars, and bowling facilities. DESIGN: Pre-post longitudinal follow up design. SETTINGS: Restaurants, bars, and bowling facilities in New York State. SUBJECTS: At baseline, 104 non-smoking workers in restaurants, bars, and bowling facilities were recruited with newspaper ads, flyers, and radio announcements. Of these, 68 completed a telephone survey and provided at least one saliva cotinine specimen at baseline. At three, six, and 12 month follow up studies, 47, 38, and 32 workers from the baseline sample of 68 completed a telephone survey and provided at least one saliva cotinine specimen. INTERVENTION: The smoke-free law went into effect 24 July 2003. MAIN OUTCOME MEASURES: Self reported sensory and respiratory symptoms and exposure to secondhand smoke; self administered saliva cotinine specimens. Analyses were limited to subjects in all four study periods who completed a telephone survey and provided at least one saliva cotinine specimen. RESULTS: All analyses were limited to participants who completed both an interview and a saliva specimen for all waves of data collection (n = 30) and who had cotinine concentrations < or = 15 ng/ml (n = 24). Hours of exposure to secondhand smoke in hospitality jobs decreased from 12.1 hours (95% confidence interval (CI) 8.0 to 16.3 hours) to 0.2 hours (95% CI -0.1 to 0.5 hours) (p < 0.01) and saliva cotinine concentration decreased from 3.6 ng/ml (95% CI 2.6 to 4.7 ng/ml) to 0.8 ng/ml (95% CI 0.4 to 1.2 ng/ml) (p < 0.01) from baseline to the 12 month follow up. The prevalence of workers reporting sensory symptoms declined from 88% (95% CI 66% to 96%) to 38% (95% CI 20% to 59%) (p < 0.01); there was no change in the overall prevalence of upper respiratory symptoms (p < 0.16). CONCLUSION: New York's smoke-free law had its intended effect of protecting hospitality workers from exposure to secondhand smoke within three months of implementation. One year after implementation, the results suggest continued compliance with the law.

Adolescent↗

Urinary metabolites of a tobacco-specific lung carcinogen in nonsmoking hospitality workers.

Exposure of nonsmokers to environmental tobacco smoke results in increased risk for cancer and other diseases. In spite of this finding, some restaurants and bars continue to permit smoking. This study examined the uptake of nicotine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), a potent lung carcinogen, in nonsmokers who work in restaurants and bars that permitted smoking. Urine samples were collected for 24 hours on working and nonworking days and were analysed for total NNAL [the sum of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronides (NNAL-Glucs)], metabolites of NNK. In addition, urine samples were analysed for total nicotine (nicotine plus nicotine glucuronide), and total cotinine (cotinine plus cotinine-N-glucuronide). The results showed significant increases in urinary levels of total NNAL, total nicotine, and total cotinine on working days compared with nonworking days. The results of this study show that smoke exposure in bars and restaurants may have important health effects on nonsmoking employees, elicited by the increase in carcinogen levels.

Adolescent↗

Environmental tobacco smoke exposure among non-smoking waiters: measurement of expired carbon monoxide levels.

CONTEXT: Exposure to environmental tobacco smoke is a health risk that is of concern to patrons and of particular concern to employees of restaurants and bars. OBJECTIVE: To assess environmental tobacco smoke exposure (using expired carbon monoxide levels) in non-smoking waiters before and after a normal day's shift and to compare pre-exposure levels with non-smoking medical students. DESIGN: An observational study. SETTING: Restaurants with more than 50 tables or 100 places in São Paulo. SUBJECTS: 100 non-smoking restaurant waiters and 100 non-smoking medical students in São Paulo, Brazil. MAIN MEASUREMENTS: Levels of expired carbon monoxide, measured with a Smokerlyser (Bedfont EC 50 Scientific), before and after a normal day's work. RESULTS: Waiters' pre-exposure expired carbon monoxide levels were similar to those of medical students, but after a mean of 9 hours exposure in the workplace, median levels more than doubled (2.0 ppm vs. 5.0 ppm, P <0.001). Post-exposure carbon monoxide levels were correlated with the number of tables available for smokers (Kendall's tau = 0.2, P <0.0001). CONCLUSIONS: Exposure to environmental tobacco smoke is the most likely explanation for the increase in carbon monoxide levels among these non-smoking waiters. These findings can be used to inform the ongoing public health debate on passive smoking.

Adolescent↗