Characteristics of nonsmoking women exposed to spouses who smoke: Epidemiologic study on environment and health in women from four Italian areas

The aim of this study was to evaluate whether risk factors associated with cardiovascular or respiratory diseases and lung cancer occur differently am ong nonsmoking women in Italy with and without exposure to environmental to bacco 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-admi nistered questionnaires. Medical examinations and blood tests were administ ered; 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, cur rent or past occupation, exposure to toxic substances at work, parental dis eases, self-perceived health status, physician-diagnosed hypertension, hype rcholesterol, diabetes, osteoporosis, chronic respiratory diseases, blood p ressure medications, lifestyle and preventive behaviors, dietary variables, systolic and diastolic blood pressure, body mass index, waist-hip ratio, t riceps skin folds, plasma antioxidant (pro-) vitamins (alpha- and beta -car otene, retinol, L-ascorbic acid, alpha -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 t o live in more crowded dwellings than women married to nonsmokers. Women ma rried 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 (O R = 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 su bjects (difference: 2.94 ng/mg creatinine). All the other variables were no t more prevalent among exposed compared to unexposed subjects. The results regarding demographic factors are easily explained by the social class dist ribution of smoking in Italy. A lower intake of vegetables among exposed wo men in our study is consistent with the available literature. Overall, our results do not support previous claims of more frequent risk factors for ca rdiovascular and pulmonary diseases among ETS-exposed subjects. In Italy, a s elsewhere in Europe and North America, women who have never smoked but ar e married to smokers are likely to be of lower social class than those marr ied to never-smokers. However, once socioeconomic differences are considere d, the possibility of confounding in studies on the health effects of ETS i s minimal.