Association between second-hand smoking and acute coronary heart disease among Arab women with multiple risk factors.
BACKGROUND
Active smoking is a well-established risk factor for coronary heart disease (CHD). However, the role of second-hand smoking (SHS) needs further investigation. We aimed to study the association between SHS and CHD in Arab women in Israel.


METHODS
A matched case-control study among non-smoking Arab women. The case group included women discharged from hospital after having acute coronary event. The control group was women without CHD who were individually matched for age and type-2 diabetes. The women were interviewed with structured questionnaires on exposure to SHS and on attitudes towards such exposure, and underwent anthropometric measurements.


RESULTS
A total of 146 women were included, the majority had type-2 diabetes (68.5%) and were overweight or obese (89.4% of cases and 93.2% of controls, P = 0.727). The prevalence of exposure to domestic-SHS after marriage was higher among the cases than controls (91.8% vs. 53.4%, P < 0.001). After adjustment for hypertension, body mass index > 25 and family history, exposure to domestic-SHS after marriage was an independent risk factor for CHD (OR = 6.1, 95% CI 1.93-19.3). Compared with no exposure, the exposed for 2-6 h a day had an OR of 5.68 (1.48-21.73), and for >6 h a day the OR reached 26.12 (4.26-159.92). Women with CHD felt less comfortable voicing their concern about smoking near them and more highly agreed with prohibition of smoking.


CONCLUSIONS
Exposure to domestic-SHS is independently associated with CHD in Arab women, with a strong dose-response relationship, emphasizing the need for public health initiatives to reduce exposure to domestic-SHS.
1 School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
Khaled
K
Awawdi
2 Division of Cardiovascular Medicine, The Baruch Padeh Medical Center, Poriya, Tiberias, Israel.
Hillel
H
Steiner
1 School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
Manfred S
MS
Green
1 School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel zelbersagi@bezeqint.net.
Shira
S
Zelber-Sagi
D000368:Aged; D018912:Arabs; D001837:Body Weights and Measures; D016022:Case-Control Studies; D003327:Coronary Disease / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D004781:Environmental Exposure / Q000032:analysis*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000032:analysis*
D014028:Tobacco Smoke Pollution