Abstract
There is no direct evidence that workplace environmental tobacco smoke (ETS) increases lung cancer risk. Demands for regulation of workplace smoking are based on studies reporting increased risk in non-smoking women whose husbands smoke. Although denying smoking can artificially elevate risk estimates, and although many studies reporting an increase have been conducted in Asia, no previous study of smoking habit misclassification has been conducted there. In this study 400 married Japanese women answered questions on smoking and ETS exposure and supplied urine for cotinine analysis. Of 106 with a cotinine/creatinine ratio (CCR) indicating current smoking ( > 100 ng/mg), 22 reported never smoking. These misclassified smokers had a median CCR (1408 ng/mg) similar to the 78 self-reported current smokers (1483 ng/mg). Of current smokers, 89.7% had a currently smoking husband, while this was true of 51.0% of non-smokers. Among 264 confirmed nonsmokers (with CCR < 100 ng/mg), CCR was non-significantly lower if the husband smoked (11.51 vs 17.98 ng/mg) and was unrelated to various indices of smoking by the husband. Japanese epidemiological studies using “marriage to a smoker” to index ETS exposure may therefore have compared groups with similar ETS exposure, suggesting that associations reported between lung cancer and this index in some of these studies may result from bias. While other biases, including confounding, may also be important, bias resulting from smoking misclassification combined with husband/wife smoking concordance is shown to be of major concern. The high misclassification rates in Japan, much higher than in Western populations, undermine conclusions from epidemiological studies conducted there.
Similar content being viewed by others
References
Akiba S, Kato H, Blot WJ (1986) Passive smoking and lung cancer among Japanese women. Cancer Res 46:4804–4807
Albanes D, Blair A, Taylor PR (1989) Physical activity and risk of cancer in the NHANES I population. Am J Public Health 79:744–750
Bjercke RJ, Cook G, Rychlik N, et al. (1986) Sterospecific monoclonal antibodies to nicotine and cotinine and their use in enzyme-linked immunosorbent assays. J Immunol Methods 90:203–213
Chang K-M, Gentry G, Davis R, et al. (1992) Determination of plasma nicotine and cotinine in rats exposed to aged and diluted sidestream smoke, using an enzyme-linked immunosorbent assay (ELISA). The Toxicologist 17:263
Ecobichon DJ, Wu JM (1990) Environment tobacco smoke. Proceedings of the International Symposium at McGill University 1989. Lexington Books, Massachusetts
Fontham ETH (1990) Protective dietary factors and lung cancer. Int J Epidemiol 19:S32-S42
Friedman GD, Pettiti DB, Bawol RD (1983) Prevalence and correlates of passive smoking. Am J Public Health 73:401–405
Fry JS, Lee PN (1988) Stratified rank tests. Appl Stat 37:264–266
Garfinkel L (1981) Time trends in lung cancer mortality among non-smokers and a note on passive smoking. J Natl Cancer Inst 66:1061–1066
Hirayama T (1981) Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan. Br Med J 282:183–185
Hirayama T (1984) Cancer mortality in nonsmoking women with smoking husbands based on a large-scale cohort study in Japan. Prev Med 13:680–690
Hirayama T (1985) A cohort study on cancer in Japan. In: Blot WJ, Hirayama T, Hoel DG (eds) Statistical methods for cancer epidemiology. Radiation Effects Research Foundation, Hiroshima, pp 73–91
Inoue R, Hirayama T (1988) Passive smoking and lung cancer in women. In: Aoki M, Hisamichi S, Tominaga S (eds) Smoking and health, 1987. Elsevier, Amsterdam, pp 283–285
Katada H, Mikami R, Konishi M, et al. (1988) Effect of passive smoking in lung cancer development in women in the Nara Region. Gen No Rinsho 34:21–72
Koo LC, Ho JH-C, Rylander R (1988) Life-history correlates of environmental tobacco smoke: a study on nonsmoking Hong Kong Chinese wives with smoking versus nonsmoking husbands. Soc Sci Med 26:751–760
LeVois ME, Layard MW (1994) Inconsistency between workplace and spousal studies of environmental tobacco smoke and lung cancer. Regul Toxicol Pharmacol 19:309–316
Lee PN (1992) Environmental tobacco smoke and mortality. Karger, Basle
Lee PN (1993) An assessment of the epidemiologic evidence relating lung cancer risk in never smokers to environmental tobacco smoke exposure. In: Kasuga H (ed) Environmental tobacco smoke. Springer, New York Berlin Heidelberg, pp 28–70
Lee PN (1993) An estimate of adult mortality in the United States from passive smoking. Environ Int 19:91–100
LeMarchand L, Wilkens LR, Hankin NJ, et al. (1991) Dietary patterns of female nonsmokers with and without exposure to environmental tobacco smoke. Cancer Causes Control 2:11–16
Matsukura S, Taminato, Kitano N, et al. (1984) Effects of environmental tobacco smoke on urinary cotinine excretion in nonsmokers. N Engl J Med 311:828–832
National Research Council. Environmental tobacco smoke. Measuring exposures and assessing health effects. National Academy Press, Washington, DC, 1986
Oguni I, Chen SJ, Lin PZ, et al. (1992) Protection against cancer risk by Japanese green tea. Prev Med 21:332
Riboli E, Preston-Martin S, Saracci R, et al. (1990) Exposure of non-smoking women to environmental tobacco smoke: a 10country collaborative study. Cancer Causes Control 1:243–252
Saito R (1988) Smoking among young women in Japan. In: Aoki M, Hisamichi S, Tominaga S (eds) Smoking and health, 1987. Elsevier, Amsterdam, pp 517–519
Shimizu H, Morishita M, Mizuno K, et al. (1988) A case-control study of lung cancer in nonsmoking women. Tohoku J Exp Med 154:389–397
Sidney S, Caan BJ, Friedman GD (1989) Dietary intake of carotene in non-smokers with and without passive smoking at home. Am J Epidemiol 124:1305–1309
Sobue T (1990) Association of indoor air pollution and lifestyle with lung cancer in Osaka, Japan. Int J Epidemiol 19 (Suppl 1):562–566
Thompson SG, Barlow RD, Wald NJ, et al. (1990) How should urinary cotinine concentrations be adjusted for urinary creatinine concentration? Clin Chim Acta 187:289–296
Thornton AJ, Lee PN (1994) Differences between smokers, exsmokers, passive smokers and non-smokers. J Clin Epidemiol 47:1143–1162
US Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders. Washington DC 1992; EPA/600/6-90/006F
US Occupational and Health Administration (1994). Indoor air quality; proposed rule. Fed Regist 59:15968–16039
US Surgeon General. The health consequences of involuntary smoking, a report of the Surgeon General. US Department of Health and Human Services, Public Health Service, Rockville, Md., 1986; (CDC) 87-8398
Wald NJ, Nanchahal K, Thompson SG, et al. (1986) Does breathing other people's tobacco smoke cause lung cancer? Br Med J 293:1217–1222
Wells AJ (1988) An estimate of adult mortality in the United States from passive smoking. Environ Int 14:249–265
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lee, P.N. “Marriage to a smoker” may not be a valid marker of exposure in studies relating environmental tobacco smoke to risk of lung cancer in Japanese non-smoking women. Int. Arch Occup Environ Heath 67, 287–294 (1995). https://doi.org/10.1007/BF00385642
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00385642