title: Environmental tobacco smoke exposure and health disparities: 8-year longitudinal findings from a large cohort of Thai adults.
abstract: BACKGROUND
  In rich countries, smokers, active or passive, often belong to disadvantaged groups. Less is known of tobacco patterns in the developing world. Hence, we seek out to investigate mental and physical health consequences of smoke exposure as well as tobacco-related inequality in transitional middle-income Thailand.
  
  
  METHODS
  We studied a nationwide cohort of 87,151 middle-aged and older adults that we have been following for eight years (2005-2013) for emerging chronic diseases. Logistic regression was used to identify attributes associated with passive smoke exposure. Longitudinal associations between smoke exposure and wellbeing (SF-8) or psychological distress (Kessler 6) were investigated with multiple linear regression or multivariate logistic regression analysis.
  
  
  RESULTS
  A high proportion of cohort members, especially females, were passive smokers at home and at public transport stations; males were more exposed at workplace and recreational places. We observed a social gradient with more passive smoking in poorer people. We also observed a dose response relationship linking graded smoke exposures (current, former, passive, non-exposed) to less wellbeing and more psychological distress (p-trend < 0.001). Female smokers in general had less wellbeing and more distress.
  
  
  CONCLUSIONS
  Our findings add to current knowledge on the impact of active and passive smoking on health in a transitional economy. Promotion of smoking cessation programs both in public and at home could also potentially reduce adverse disparities in health and wellbeing in middle and lower income settings such as Thailand.
authors.affiliation: Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Building 62, Mills Rd, Acton 2601, Canberra, Australia. tam.tran@anu.edu.au.
authors.forename: Thanh Tam
authors.initials: TT
authors.lastname: Tran
authors.affiliation: Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Building 62, Mills Rd, Acton 2601, Canberra, Australia. Vasoontara.yieng@anu.edu.au.
authors.forename: Vasoontara
authors.initials: V
authors.lastname: Yiengprugsawan
authors.affiliation: Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand. pinkybeautiful2006@hotmail.com.
authors.forename: Dujrudee
authors.initials: D
authors.lastname: Chinwong
authors.affiliation: School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, Thailand. sam-ang.seubsman@anu.edu.au.
authors.forename: Sam-Ang
authors.initials: SA
authors.lastname: Seubsman
authors.affiliation: Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Building 62, Mills Rd, Acton 2601, Canberra, Australia. Adrian.sleigh@anu.edu.au.
authors.forename: Adrian
authors.initials: A
authors.lastname: Sleigh
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003906:Developing Countries; D004781:Environmental Exposure; D005260:Female; D006262:Health; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012737:Sex Factors; D012907:Smoking; D016540:Smoking Cessation; D013315:Stress, Psychological; D013785:Thailand / Q000453:epidemiology; D014028:Tobacco Smoke Pollution; D014026:Nicotiana
chemical_list: D014028:Tobacco Smoke Pollution