Passive Smoking and Lung Cancer in Nonsmoking Women

Lung cancer is a deadly disease that causes inflammation and breathing difficulties, contributing to the global high mortality rate. Although lung cancer is associated with genetic and family history factors, previous studies reveal that smoking remains the leading risk factor for the infection. Besides, the prevalence of lung cancer in nonsmoking females is high in women who live with smoking spouses or family members with active smoking habits. However, very few studies have investigated the association between passive childhood smoking exposure and lung cancer. In the article, “Passive Smoking and Lung Cancer in Nonsmoking Women,” Brownson et al. evaluate the severity of lung cancer in nonsmoking adult women. Besides, the authors assessed the likelihood of developing lung cancer at an older age due to childhood passive smoking exposure in women. (1) While the authors established that most lung cancer cases in women are directly related to childhood smoking exposure, it is worth considering the data collection methods used and the possibility of recall bias before generalizing the findings.

Brownson et al. carried out an experiment to assess the relationship between lung cancer and passive smoking among women. The authors conducted a case-control study to shed some light on the possible etiology of lung cancer in nonsmokers. The subjects were retrieved from the Missouri Cancer Registry, including white women aged 30-34 years with lung cancer between 1986 and 1991. A total of 618 lung cancer patients were recruited in this survey. Out of the 618 patients, 432 were had never smoked, while 186 had a mild smoking history. On the other hand, the population-based control group for younger women was obtained through their states driver’s license and from the health care finance administration for older women. Data collection was done through telephone interviews during the enrolment period to assess the participant’s age, race and smoking status. Next, full interviews and questionnaires were administered to evaluate passive smoking exposure, family health background, dietary habits and occupation. Data analysis was performed using multiple logistic regression. The main findings were as follows; the mean age of the case and control subjects was 71.5 and 69.9 years, respectively. Besides, the odds ratio for lung cancer risk during childhood due to passive smoking was 1.7 (95% CI=1.1, 2.5) and increased to 2.4 (95% CI=1.3, 4.7) in heavy exposure. There was a 30% increase in risk at more than 40 packs per year for lifetime nonsmokers in adulthood. As such, lifetime non-smoking women who had moderate or heavy smoking exposure during childhood were at a higher risk of contracting lung cancer during adulthood. This study revealed an increased risk of lung cancer in passive smoking. The authors recommended that smoking should be prohibited in public areas.

Smoking is the primary cause of lung cancer, a deadly infection that affects the lungs, causing breathing difficulties. Sadly, lung cancer affects both active and passive smokers. According to Dubin and Griffin, nonsmoking women living with an active smoker or having historical exposure to smoking are likely to develop lung cancer at an older age. (2) In this article, Brownson et al. investigated the prevalence of lung cancer in nonsmoking and passive smoking women. The researchers found that significant lung cancer cases in women result from passive and nonsmoking. Although the authors evaluated the historical passive smoking exposure in women, the findings were limited by self-reported data and recall bias. Firstly, the researchers used interviews and questionnaires to collect data relating to passive smoking from the participants in both the experimental and healthy control groups. However, the data obtained was self-reported. For example, the researchers conducted telephone interviews to assess the subjects’ race, smoking habits and age for eligibility. After the first phase, the authors obtained the participants’ residential history, reproductive history, dietary behavior, and occupational exposure using self-reported questionnaires. According to Harling et al., self-reported questionnaires are highly associated with overrated or underrated reports, which undermine the truthfulness of results. (3) Therefore, the self-reported interviews and questionnaires during the data collection process undermined the accuracy of outcomes. Secondly, the information regarding smoking exposure and habits was based on historical events. As such, there was a high likelihood of recall bias. For instance, the participants in their 30’s could not remember in detail their passive smoking incidences during childhood. In addition, the subjects could not recall their intensity of smoking exposure during childhood hence bias information. According to Althubaiti, reports based on historic incidences and habits are prone to recall bias and incorrect assessments and findings. (4). As such, this study’s findings could not be generalized. In contrast, some researchers may have different views on the self-reported questionnaires and telephone interviews. For example, Rienties et al. argue that interviews and self-administered questionnaires are the most effective data collection methods to obtain subjective reports. (5) Nevertheless, Bakker et al., medical research analysts, claim that subjective reports are likely to produce unreliable results which cannot be generalized to the entire population. (6)Therefore, the fact that this study was subjective undermined the accuracy and reliability of findings. All in all, this study’s outcomes were undermined by self-report and recall bias.

To sum up, the authors revealed that women with a history of passive smoking risk contracting lung cancer. They also established that close family members’ moderate and heavy smoking exposure resulted in a high risk of lung cancer in nonsmoking women. Nevertheless, this study faced several limitations related to the data collection methods and recall bias. Although the interviews were well administered and a significantly large population responded to the questionnaires, the information was prone to an anonymous response that could alter the accuracy of findings. Again, it was difficult to assess childhood smoking exposure during adulthood since the subjects were likely to provide inaccurate information due to poor childhood memories. Therefore, there is a need for more research on this topic to fill in the gaps. Also, parents should ensure that children are not exposed to passive smoking. Generally, smoking should be discouraged since it results in severe long-term health challenges for active and passive smokers.

References

1. Brownson RC, Alavanja MC, Hock ET, Loy TS. Passive smoking and lung cancer in nonsmoking women. American Journal of Public Health. 1992 Nov;82(11):1525-30.
2. Dubin S, Griffin D. lung cancer in nonsmokers. Missouri medicine. 2020 Jul;117(4):375. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7431055/
3. Harling G, Gumede D, Mutevedzi T, McGrath N, Seeley J, Pillay D, Bärnighausen TW, Herbst AJ. The impact of self-interviews on response patterns for sensitive topics: a randomized trial of electronic delivery methods for a sexual behavior questionnaire in rural South Africa. BMC medical research methodology. 2017 Dec; 17(1):1-4. Available from: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-017-0403-8
4. Althubaiti A. Information bias in health research: definition, pitfalls, and adjustment methods. Journal of multidisciplinary healthcare. 2016;9:211. Available from: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4862344/
5. Rienties B, Tempelaar D, Nguyen Q. Subjective data, objective data and the role of bias in predictive modelling: Lessons from a dispositional learning analytics application. PloS one. 2020 Jun 12;15(6):e0233977. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233977
6. Bakker EA, Hartman YA, Hopman MT, Hopkins ND, Graves LE, Dunstan DW, Healy GN, Eijsvogels TM, Thijssen DH. Validity and reliability of subjective methods to assess sedentary behavior in adults: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity. 2020 Dec;17(1):1-31. Available from: https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-00972-1