Received date:
08/27/2014
Accepted date:
02/19/2015
Revised date:
02/03/2015
Category of manuscript: Original article Title:
Secondhand Smoke Screening for Schoolchildren in Japan Running head: Secondhand smoke screening for schoolchildren
Authors: Toshihiro Ino, MD. PhD. Kazuo Kurosawa, PmD. From Gunma Paz College, Faculty of Health Science Address: Gunma Paz College, Faculty of Health Science 1-7-1 Tonyamachi, Takasaki, Gunma, 370-0006、Japan
Reprint request Toshihiro Ino, MD. PhD. Ino Clinic 1-12-24 Hakoda, Kumagaya, Saitama, 360-0014 JAPAN TEL: 048-528-8300 FAX: 048-526-3900 E-mail: [email protected] Text pages: 15 pages Total text words number: 3,905 words References pages: 3 pages Figures: 8 figures
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/ped.12630 This article is protected by copyright. All rights reserved.
Abstract Background: There was no systematic screening for secondhand smoke exposure of children.
Methods: In 2002, we began a secondhand smoke screening (SSS) program for grade 4 elementary schoolchildren with the corporation of public administration. The SSS program consisted of urinary cotinine measurement in children and a questionnaire survey of their parents.
Results: More than 1,200 schoolchildren were enrolled in this program annually. The level of urinary cotinine in 30% of the children was more than 5 ng/mL, whereas in half of them it was undetectable. The major risk factor affecting the cotinine level was a mother’s smoking. The average cotinine levels were significantly high in children who had a history of ―short stature‖ ―decayed tooth and/or periodontal disease,‖ and ―frequent stridor‖. In addition, the highest level of cotinine was detected in children whose father and/or mother smoked in living room and the lowest level of cotinine was detected in children whose father and/or mother smoked on the veranda or outside the door. However, these levels were two to five times high, compared with those in children whose parents did not smoke. The follwup questionnaire survey four year after initial SSS revealed a significant elevated motivation for smoking cessation.
Conclusions: The SSS program is a very simple mass screening that can be done using only a urine test and is very effective for motivating parents to stop smoking in terms of its cost benefit. Key words: 1. Biomarker 2. Carcinogen 3. Cotinine 4. Screening 5. Secondhand smoke
This article is protected by copyright. All rights reserved.
Introduction In examining past smoking prevalence in Japan, the average smoking rates were 83.7% of males and 18.0% of females in 1966 [1]. Although exact data on the smoking rate before and during World War II could not be obtained, it is surmised that a higher smoking rate among males was estimated and the majority of males smoked. During World War II, the Japanese emperor granted a case of tobacco with the so-called ―Onshi-no-tobacco‖ painting depicting the imperial chrysanthemum crest to soldiers who had been to or had returned from the front [2]. At that time, Japanese people worshiped the emperor as a god and therefore, might have felt compelled by that gift to smoke. Since 1960s, the smoking rate has been gradually decreasing because the health problems of smoking have been demonstrated and there has been an ongoing anti-smoking campaign [1]. The national survey of health and nutrition by the Ministry of Health, Labor, and Welfare in 2012 revealed that the combined smoking rate of males and females in Japan was 20.7%, and it has been gradually decreasing [1]. Among males, the average smoking rate was 34.1 %, with the highest rate at 43.2 % among those 30 to 49 years old. This smoking rate among male has been gradually decreasing and dipped below 40% in 2005. Among females, on the other hand, the average smoking rate was 9.0 % in 2012, with a rate of 12.3% among 20- to 29-year-olds, and 11.9% among 30- to 39-year-olds. The Organization for Economic Cooperation and Development showed an international comparison of smoking rates for males and females in 2012 [3, 4]. According to these data, the daily smoking rate of Japanese adults was average level (19.5%) in the world compared to that of OECD (21.3%); whereas that of females was relatively low (12%), compared to that of advanced countries. However, these rates have recently approached those of Western countries, while decreasing for males and increasing for young females. Since October 2002, we have performed a secondhand smoke screening (SSS) program for elementary schoolchildren in Kumagaya city, Saitama prefecture with corporation of public administration, school and medical association [5-6]. This article reveals the results of the SSS program and the effectiveness of this screening program.
Methods Secondhand smoke screening program: The SSS program consisted of a questionnaire survey of parents’ smoking (Fig.1) and the measurement of urinary cotinine concentration in children. We initially attempted this screening in several schools of Kumagaya city, Saitama prefecture, which activity was supported by a research fund of the Kumagaya Medical Association.
This article is protected by copyright. All rights reserved.
On the basis of these results, the public administration of Kumagaya city undertook this screening at public expense beginning in 2007 [5, 6]. All grade 4 children, in 30 elementary schools (29 schools from 2010, because one school was being closed down) of the city, whose parents agreed to participate in this SSS program, were enrolled in this screening. We initially discussed at which age it would be appropriate to perform the screening, and eventually determined to perform it at grade 4. A lifestyle disease screening was also performed in children of grade 4 of elementary school; it might, therefore, be valuable to assess the relationship between lipid profiles and secondhand smoke. In addition, this age was thought the best for providing education against smoking, because this was reported as the earliest age at which habitual smoking began in this country. The studies regarding with SSS program and lifestyle disease screening were approved by both ethical committee of Kumagaya Medical Association and Board of education in Kumagaya city.
Protocol of SSS program in Kumagaya City: The merits of SSS include the following: (1) One can know which child was exposed and how much the child were exposed to secondhand smoke. (2) One can make use of the results of cotinine concentration in an anti-smoking education program. (3) This screening is useful for motivating parents to cease smoking. (4) One can assess the relationship between secondhand smoke and lifestyle diseases in children. This screening basically consisted of a questionnaire survey about parents’ smoking and the measurement of urinary cotinine concentration. The questionnaire survey included 20 items (if parents smoke, cigarette consumption, age of initiating smoking, the place of smoking, history of smoking cessation, past history of a child, and so on), shown in Fig.1. The items regarding past history were obtained from any choice of 10 diseases. The ―short stature‖ used in these items might include shorter length which had been pointed out by family doctors. Figure 2 revealed the flowchart of the SSS program in Kumagaya city. Urinary cotinine concentration in children was measured by high-sensitive enzyme
linked
immunosorbent assay (ELISA) method. This high-sensitive ELISA method was previously developed by our colleagues and was suitable for evaluating secondhand smoke exposure because of very low value of measurement limit [7]. After measuring urinary cotinine concentration, the parents were informed of the result in a letter. The children were classified into 4 groups of normal (
08/27/2014
Accepted date:
02/19/2015
Revised date:
02/03/2015
Category of manuscript: Original article Title:
Secondhand Smoke Screening for Schoolchildren in Japan Running head: Secondhand smoke screening for schoolchildren
Authors: Toshihiro Ino, MD. PhD. Kazuo Kurosawa, PmD. From Gunma Paz College, Faculty of Health Science Address: Gunma Paz College, Faculty of Health Science 1-7-1 Tonyamachi, Takasaki, Gunma, 370-0006、Japan
Reprint request Toshihiro Ino, MD. PhD. Ino Clinic 1-12-24 Hakoda, Kumagaya, Saitama, 360-0014 JAPAN TEL: 048-528-8300 FAX: 048-526-3900 E-mail: [email protected] Text pages: 15 pages Total text words number: 3,905 words References pages: 3 pages Figures: 8 figures
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/ped.12630 This article is protected by copyright. All rights reserved.
Abstract Background: There was no systematic screening for secondhand smoke exposure of children.
Methods: In 2002, we began a secondhand smoke screening (SSS) program for grade 4 elementary schoolchildren with the corporation of public administration. The SSS program consisted of urinary cotinine measurement in children and a questionnaire survey of their parents.
Results: More than 1,200 schoolchildren were enrolled in this program annually. The level of urinary cotinine in 30% of the children was more than 5 ng/mL, whereas in half of them it was undetectable. The major risk factor affecting the cotinine level was a mother’s smoking. The average cotinine levels were significantly high in children who had a history of ―short stature‖ ―decayed tooth and/or periodontal disease,‖ and ―frequent stridor‖. In addition, the highest level of cotinine was detected in children whose father and/or mother smoked in living room and the lowest level of cotinine was detected in children whose father and/or mother smoked on the veranda or outside the door. However, these levels were two to five times high, compared with those in children whose parents did not smoke. The follwup questionnaire survey four year after initial SSS revealed a significant elevated motivation for smoking cessation.
Conclusions: The SSS program is a very simple mass screening that can be done using only a urine test and is very effective for motivating parents to stop smoking in terms of its cost benefit. Key words: 1. Biomarker 2. Carcinogen 3. Cotinine 4. Screening 5. Secondhand smoke
This article is protected by copyright. All rights reserved.
Introduction In examining past smoking prevalence in Japan, the average smoking rates were 83.7% of males and 18.0% of females in 1966 [1]. Although exact data on the smoking rate before and during World War II could not be obtained, it is surmised that a higher smoking rate among males was estimated and the majority of males smoked. During World War II, the Japanese emperor granted a case of tobacco with the so-called ―Onshi-no-tobacco‖ painting depicting the imperial chrysanthemum crest to soldiers who had been to or had returned from the front [2]. At that time, Japanese people worshiped the emperor as a god and therefore, might have felt compelled by that gift to smoke. Since 1960s, the smoking rate has been gradually decreasing because the health problems of smoking have been demonstrated and there has been an ongoing anti-smoking campaign [1]. The national survey of health and nutrition by the Ministry of Health, Labor, and Welfare in 2012 revealed that the combined smoking rate of males and females in Japan was 20.7%, and it has been gradually decreasing [1]. Among males, the average smoking rate was 34.1 %, with the highest rate at 43.2 % among those 30 to 49 years old. This smoking rate among male has been gradually decreasing and dipped below 40% in 2005. Among females, on the other hand, the average smoking rate was 9.0 % in 2012, with a rate of 12.3% among 20- to 29-year-olds, and 11.9% among 30- to 39-year-olds. The Organization for Economic Cooperation and Development showed an international comparison of smoking rates for males and females in 2012 [3, 4]. According to these data, the daily smoking rate of Japanese adults was average level (19.5%) in the world compared to that of OECD (21.3%); whereas that of females was relatively low (12%), compared to that of advanced countries. However, these rates have recently approached those of Western countries, while decreasing for males and increasing for young females. Since October 2002, we have performed a secondhand smoke screening (SSS) program for elementary schoolchildren in Kumagaya city, Saitama prefecture with corporation of public administration, school and medical association [5-6]. This article reveals the results of the SSS program and the effectiveness of this screening program.
Methods Secondhand smoke screening program: The SSS program consisted of a questionnaire survey of parents’ smoking (Fig.1) and the measurement of urinary cotinine concentration in children. We initially attempted this screening in several schools of Kumagaya city, Saitama prefecture, which activity was supported by a research fund of the Kumagaya Medical Association.
This article is protected by copyright. All rights reserved.
On the basis of these results, the public administration of Kumagaya city undertook this screening at public expense beginning in 2007 [5, 6]. All grade 4 children, in 30 elementary schools (29 schools from 2010, because one school was being closed down) of the city, whose parents agreed to participate in this SSS program, were enrolled in this screening. We initially discussed at which age it would be appropriate to perform the screening, and eventually determined to perform it at grade 4. A lifestyle disease screening was also performed in children of grade 4 of elementary school; it might, therefore, be valuable to assess the relationship between lipid profiles and secondhand smoke. In addition, this age was thought the best for providing education against smoking, because this was reported as the earliest age at which habitual smoking began in this country. The studies regarding with SSS program and lifestyle disease screening were approved by both ethical committee of Kumagaya Medical Association and Board of education in Kumagaya city.
Protocol of SSS program in Kumagaya City: The merits of SSS include the following: (1) One can know which child was exposed and how much the child were exposed to secondhand smoke. (2) One can make use of the results of cotinine concentration in an anti-smoking education program. (3) This screening is useful for motivating parents to cease smoking. (4) One can assess the relationship between secondhand smoke and lifestyle diseases in children. This screening basically consisted of a questionnaire survey about parents’ smoking and the measurement of urinary cotinine concentration. The questionnaire survey included 20 items (if parents smoke, cigarette consumption, age of initiating smoking, the place of smoking, history of smoking cessation, past history of a child, and so on), shown in Fig.1. The items regarding past history were obtained from any choice of 10 diseases. The ―short stature‖ used in these items might include shorter length which had been pointed out by family doctors. Figure 2 revealed the flowchart of the SSS program in Kumagaya city. Urinary cotinine concentration in children was measured by high-sensitive enzyme
linked
immunosorbent assay (ELISA) method. This high-sensitive ELISA method was previously developed by our colleagues and was suitable for evaluating secondhand smoke exposure because of very low value of measurement limit [7]. After measuring urinary cotinine concentration, the parents were informed of the result in a letter. The children were classified into 4 groups of normal (
