Exposure to second-hand smoke and risk of lung cancer among Iranian population: A multicenter case-control study

by Fereshte Lotfi, Hamideh Rashidian, Maryam Hadji, Elham Mohebbi, Maryam Marzban, Ahmad Naghibzadeh-Tahami, Eero Pukkala, Paolo Boffetta, Arash Etemadi, Kazem Zendehdel

Despite the implementation of the WHO Framework Convention on Tobacco Control (FCTC) program in Iran, the regulation of second-hand smoke (SHS) exposure—an often-overlooked hazard—, still requires improvement. We employed a multi-center case-control study to investigate the association between exposure to secondhand smoke (SHS) from various tobacco products (cigarettes, water-pipes, pipes, and chopogh), opium use, and the risk of lung cancer.

We included 627 lung cancer cases and 3477 controls. Exposure to SHS tobacco and SHS opium was collected through a questionnaire. We used mixed-model logistic regressions to estimate odds ratios (ORs) and 95% confidence intervals (CI).

Among the overall population exposed to second-hand tobacco smoke (SHTS), the odds ratio (OR) compared to those never exposed was 1.35 (95% CI: 1.08–1.71). Never smokers who were ever exposed to second-hand tobacco smoke (SHTS) had 1.69-fold risk of lung cancer compared to those who were never exposed (95% CI: 1.13–2.52). Exposure to SHTS between 2–3 per day (OR = 2.27, 95% CI: 1.13–4.53) and more than three hours per day (OR = 2.29, 95% CI: 1.20–4.37) can increase the risk of lung cancer compared with the no exposure group (P-trend <0.01). We did not observe any association between exposure to second-hand opium smoke (SHOS) and the risk of lung cancer, either in the overall population or among never-smokers.

Our study estimates the impact of second-hand tobacco smoke (SHTS) on lung cancer risk in both the overall population and never-smokers. Additional studies are required to evaluate the association between exposure to second-hand smoke from opium and other type of tobacco, including water-pipe and the risk of lung cancer.