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Healthcare Assignment: Breast Cancer Among Female Non-Smokers Due To Exposure To Second Hand Smoke


Task: You are tasked to prepare a healthcare assignmenton annotated bibliography on the topic “Are female non-smokers with exposure to second-hand smoke more likely to develop breast cancer when compared with female non-smokers without exposure to second-hand smoke?”.


The current healthcare assignmentdiscusses how smoking has several detrimental effects on the body. The impact of first hand or direct smoking is known to all. However, many are unaware of the effects of second-hand smoking. The exposure to second-hand or passive smoke is not risk free. There are various negative effects of second-hand smoking on health, which include respiratory infections, asthma attacks, sudden infant death syndrome (SIDS), ear infections, etc. Second-hand smoking can cause lung cancer among adults. The adults might have never smoked themselves, however, are subject to such diseases due to passive inhalation of smoke. This passive smoking leads to 7,300 deaths due to lung cancer each year among the non-smokers of the United States. Among the females the chances of getting breast cancer are increased by 20-30 per cent when they are exposed to second-hand smoking. However, to be assured of the connection between second-hand smoking and breast cancer, few reliable and relevant sources will be referred to.

The research question that will be dealt in this paper is that:
Are female non-smokers with exposure to second-hand smoke more likely to develop breast cancer when compared with female non-smokers without exposure to second-hand smoke?

This research question will be investigated with reference to four articles. The paper will include annotated bibliography of each of these articles, its thorough analysis and finally a literature review.

Annotated Bibliography
Article 1:

Ngobese, S. P., Egbe, C. O., Londani, M., & Ayo-Yusuf, O. A. (2020). Non-Smoker’s Exposure to Second-Hand Smoke in South Africa during 2017. International Journal of Environmental Research and Public Health, 17(21), 8112.

• Type of analysis: In this paper, a quantitative data analysis has been conducted. The various factors which are related to the exposure level of second-hand smoke have been analysed and explored.
• Aim: Ngobese et al (2020) in this study has tried to investigate how the non-smokers are exposed to second-hand or passive smoke. In this paper, it has been stated that the presently prevailing South African laws on tobacco control permits 25 per cent designed areas for smoking in specific public, indoor places. This passive inhalation of second-hand smoke is experienced as the paper suggests in the cafes, restaurants, workplaces, shebeens and homes. The data for the research has been collected from the survey of South African Social Attitude.
• Conducting the study: The research implements a regression analysis that is multiple-variable adjusted. The sample size of this study is 3063 participants. All the participants are above 16 years of age. There were about 78.5 per cent Black Africans and 51.7 per cent females included in the research.
• Results: The research shows that there is a prevalence of smoking by 21.5 per cent. The results of the study also show that there were 47 per cent non-smokers who have been exposed to second-hand smoke. The females however, were less probable to be exposed to second hand smoke. They were mainly exposed to it at homes. The males were more exposed to second-hand smoke. However, the results do not answer the research question. It is only effective in explaining how people, especially non-smokers are exposed to second-hand smoke.
• Strength and Limitation: The adjusted logistic regression analysis which has been carried out in this research paper infer that the female adults in the age group of 45 to 54 years, in the age range of 55 to 64 years and those who were 65 above, had comparatively lower chances of being exposed to second-hand smoke. The study therefore concludes that almost 50 per cent of the non-smokers are subject to second-hand smoke, which can have detrimental health impact. The research design and its implementation are the strength of the paper, which makes it relevant. However, the only drawback is that the paper does not show the direct impact of second-hand smoking on among women causing breast cancer.
• Applicability: The research has good scope for application in future. The research also suggests that a smoke free policy with 100 per cent consistency with the framework of the World Health Organisation (WHO) convention of Tobacco Control will help in protecting the people of South Africa from being exposed to second-hand smoke.

Article 2:
Carreras, G., Lachi, A., Cortini, B., Gallus, S., López, M. J., Nicolás, Á. L., ... & Castillo, E. G. (2020). Burden of disease from second-hand tobacco smoke exposure at home among adults from European Union countries in 2017: an analysis using a review of recent meta-analyses. Preventive Medicine, 106412.

• Type of analysis: The research has adopted a risk analysis method of assessment. The paper is useful as it helps in understanding how the impact of second-hand smoke across genders vary. The research involves the investigation of relative risks of disease or death by gender among the adults who are exposed to second-hand smoke at their houses compared to those who are not exposed to second-hand smoke. The investigation is based on a meta-analysis. The study suggests that the smoke legislations have reduced the impact and chances of exposure to second-hand smoke at the public places. Thus, it opened areas for smoke free set ups. However, there is a huge portion of adult population who are exposed to second-hand smoke every day, even though they are non-smokers.

• Aim: The aim of this paper is to investigate the burden of illness caused by exposure to second-hand smoke at home. The paper takes into account the adult population among whom exposure is expected to be common. The research is based on the adults of the 28 countries under the European Union during the year 2017.
• Conducting the study: In this paper, the prevalence of the second-hand smoke at home by gender has been estimated with the help of Eurobarometer surveys implementing the imputation procedure. The data has been derived from the study of Injuries and Risk Factors and Global Burden of Disease. The data on disability and mortality which is adjusted to life years has been obtained.
• Results: The exposure to second-hand smoke has varying impacts on different genders. In the males and females, the exposure to second-hand smoke causes lung cancers, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), stroke, diabetes, asthma, etc. In the females the main impact of second-hand smoke is breast cancer.
• Strength and Limitation: In the year 2017, there were 526,000 disability adjusted life years and almost 24,000 deaths, which were caused due to exposure tosecond-hand smoke at home. This accounts for 0.36 per cent and 0.46 per cent cases respectively. Among the 28 nations of the EU, the IHD and COPD had been common. Among the south eastern EU nations the exposure to second-hand smoke was higher than that recorded by the northern EU nations. The research design is the strength of the paper. The limitation of the paper is that it deals with the effect of second-hand smoke across genders. However, it does not throw light on breast cancer and its risk among women due to second-hand smoke.
• Applicability: The prevalence of the second-hand smoke at home is still quite common. In the EU nations, this is an increasing problem for the health status of the people. The main solution to this problem of second-hand smoke at home is creating awareness. Once the people are made to realise the health hazards caused by second-hand smoke, the frequency of smoking at home would reduce, leading to lesser disease or death caused by second-hand smoke.

Article 3:
Carreras, G., Lugo, A., Gallus, S., Cortini, B., Fernández, E., López, M. J., ... & Perez, P. (2019). Burden of disease attributable to second-hand smoke exposure: a systematic review. Preventive medicine, 129, 105833.
• Type of analysis: The paper includes a literature review in which the diseases’ burden caused by second-hand smoke is analysed. The data has been gathered from the scholarly articles on SCOPUS and PubMed. The papers reviewed in this study have been published in English between 2007 and 2018. The literature review follows the recommendations of PRISMA. Out of 588 papers, total 94 were selected as they seemed eligible.
• Aim: The aim of the paper is to provide a review of the studies on second-hand smoke in a systematic manner. The burden of the various ailments caused by exposure to second-hand smoke have been analysed in this paper. The paper makes an exposure assessment, reviews various methods and studies the diseases which are caused by the second-hand smoke. The health outcomes have been reviewed, making an estimate based on the data till date.
• Conducting the study: In this literature review, total 72 articles have been reviewed in a systematic manner. The studies are mainly based on the approach of risk assessment. They try to assess the impact of the exposure to second-hand smoke by the non-smokers. The exposure level at workplace and home have been analysed here.
• Results: The study infers that the diseases that are commonly caused by second-hand smoke include ischemic heart disease, lung cancer, chronic obstructive pulmonary disease, stroke, asthma, infection in lower respiratory tract, breast cancer, otitis media, sudden infant death syndrome, etc. The assessment of the exposure to the second-hand smoke was heterogeneous to the population attributable fractions (PAF). The relative risks of the exposure to second-hand smoke vary across population.

The impact differs as per age and gender of the people.
• Strength and Limitation: The research is an effective study in the field of second-hand smoke and its impact. However, the paper has certain research gaps. The research investigates the effects of second hand smoke. But it neglects the impact of second hand smoke, specifically on the females. Moreover, how the impact varies across smokers and non-smokers is also not addressed in this study. There are many nations for whom the required and relevant data is not available. The methodology that has been applied reveals very poor quality data. Therefore, these are the limitations of the paper.
• Applicability: The paper has scope for further research and application in clinical field. The research outcome, PAF and disease burden investigated by this paper can be used in future to understand the ways in which the impact of second hand smoke can be controlled.

Article 4:
Vu, G. V., Ngo, C. Q., Phan, P. T., Doan, L. P. T., Nguyen, T. T., Nguyen, M. H., ... & Ho, C. S. (2020). Inadequate knowledge, attitude and practices about second-hand smoke among non-smoking pregnant women in urban Vietnam: The need for health literacy reinforcement. International journal of environmental research and public health, 17(10), 3744.
• Type of analysis: The research involves a cross-sectional study, including total 432 pregnant females. At the Bach Mai Hospital, these women have come to the Obstetrics Department of, Hanoi.They had come for their antenatal care. This study was conducted in the year 2016. The data has been collected about these females KAP which is linked to the second hand smoke.
• Aim: In this paper, the authors have investigated that the rate at which the people are exposed to second hand smoke is higher among certain nations like Vietnam. The health problems that are caused by second hand smoke have aggravated over the recent years. The females and infants are greatly affected. The health condition of the pregnant women in Vietnam can be enhanced through increase in practical interventions.
• Conducting the study: The study implemented the composite mean scores derived from the survey questions. The KAP have been assessed and calculated. The calculation was on a ten point scale. The high KAP scores indicate better knowledge, better attitude and better practice. The second hand smoke related KAP are impacted by occupation, age, source of information and living place.
• Results: The research outcome states that the government and the health ministry of every nation should implement the programs which have the potential to reduce the second hand smoke related diseases. There is a need for reinforcing the health literacy among the people, especially the mothers. The smokers should consider the health of the mothers, pregnant women and the infants while smoking in their presence.
• Strength and Limitation: The area of study of this research paper is its main strength. It deals with the diseases caused by second hand smoke and the impact of the same. The effect of the second hand smoke on males and females have been investigated. However, the paper has a limitation. It does not address or answer the research question directly. Though it deals with the impact of second hand smoke on pregnant women, it does not specifically investigate the impact of it on females, leading to breast cancer.

• Applicability: The research suggests that the increase in knowledge, the attitude and the practice known as KAP scores of Vietnam’s pregnant women could be enhanced through the increased intervention of the health care workers and the government. The diseases caused by the second hand smoke can be reduced or controlled by significant measures by the Vietnam government. This study has great applicability in future.

Literature Review
As per Vu et al (2020), second-hand smoking is closely related to breast cancers. The female non-smokers who are exposed to second-hand smoking are more prone to exhibiting the symptoms of breast cancer. The female non-smokers who are not exposed to second-hand smoking are in a much better state and are less likely to get affected by breast cancer.
As stated by Ngobese et al (2020), the research has shown that the exposure of the non-smoker females to second-hand smoke can increase the chances of getting breast cancer. The chances of being affected by breast cancer are 90 per cent, for the female non-smokers who are constantly being exposed to second-hand smoking.
According to Carreras et al (2019), the women who are not into smoking are also exposed to smoke in a passive form. The passive smoking which they encounter at home, at work places or at public places increases their risk of breast cancer. 53.1 per cent cases and 45.8 per cent controls are found among the women who are exposed to passive smoking at some time. They are at a higher risk of being affected by breast cancer compared to the females who have never been exposed to second-hand or passive smoking, accounting for an adjusted OR of 1.30.
As per Carreras et al (2020), the legislations making places smoke-free has been effective in controlling the exposure to second hand smoke at the public places. Today, there is a huge population of adults who are being exposed to second hand smoke, even though they are non-smokers. Due to exposure to second hand smoke at home, in the year 2017 in European Union, a total number of 526,000 lives, (disability adjusted life years) were lost. Besides, ischemic heart diseases and chronic obstructive pulmonary, breast cancer is an increasing concern. There is need for awareness among the global population to reduce the exposure to second hand smoke and the risks associated with it. At least, the second hand smoke exposures at home could be reduced or prevented.

The burden of the ailments caused by the second hand smoke has not been studied in the chosen papers across the entire global landscape. The other literature gap of the papers identified in the healthcare assignment was that all the causation which had strong evidence have not been assessed. The second hand smoke without any doubt has an impact on the health of the people, irrespective of male or female. However, the risk of the exposure of the females which could cause breast cancer in them has not been mentioned in these papers clearly. There are traces of risk which the papers have highlighted. However, the papers do not specifically deal with the breast cancer among female non-smokers due to exposure to second hand smoke. The population for the studies is different and so a common, generalised inference cannot be drawn


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