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Joint effect of smoking and drinking on blood lead level

Jian Li

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Introduction and Significance

Smoking harms nearly every organ in the body, causing many diseases and reducing the health of smokers in general. Tobacco smoke is a source of exposure to thousands of toxic chemicals including lead.
Study found that more than 60% of people who smoke have a habit of drinking alcohol.
Excessive blood lead levels can lead to lead poisoning.
Gap: Most studies have focused on the direct relationship between smoking and blood lead levels, while ignoring the role of alcohol consumption.

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Research Question

RQ: Is there a Joint effect of smoking and drinking on blood lead level

Hypothesis: Smoking and drinking will have negative effect on blood lead level.

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Methods

Data Source and Study design: All data were obtained from the CDC’s National Health and Nutrition Examination Survey (NHANES) , NHANES is representative of civilian, noninstitutionalized residents of the United States aged 2 months or older.
Outcome: Blood lead level.
Exposure: Smoking habits , Alcohol consumption.
Covariates: age, gender, sex, race, marital status, poverty-to-income ratio (PIR), education.

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Total 5992 participants

Only data from respondents with lead measurements were included

Participants should be aged 12 or older since smoking questions are asked on people over 12

Total 917 participants

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Results

Result

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1. Univariate Analysis

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Results

Result

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2. Bivariate Analysis

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Results

Result

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3. Mutivariate Analysis

Variable	Coefficient	P Value
Now smoke cigarettes?	0.126	0.004
Drink 12 alcohol/1 yr?	0.101	0.035
Interaction of smoke and alcohol	0.203	0.059
Poverty	-0.179	0.020
Education	-0.013, -0.197, -0.275, -0.293	<0.001
Age	0.022	<0.001

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Conclusions

Interpretation of main finding:

1. Both alcohol and cigarette smoking are making significant independent contributions to blood lead concentrations

2. Higher blood lead level are more prevalent among those lower-income, lower-education people.

3. P value of interaction of alcohol and cigarette smoking is just above 0.05 may still be clinically or practically meaningful

Limitations:

1. Small sample size.

2. People can be exposed to lead from residential, occupational, dietary, and other environmental sources

3. Data are cross-sectional, making it impossible to determine whether tobacco smoke exposure preceded higher blood lead levels

Future Plan & Policy:

1. Need to control for exposure to heavy metals in some occupations.

2. People who have a drinking habit need to have their liver checked regularly to prevent alcoholic liver disease exhibit

3. Increase awareness of the dangers of smoking and alcohol consumption on blood lead levels, especially the need to avoid both smoking and alcohol consumption

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Reference

1. Brody DJ, Kramer RA, Flegal KM, et al. Blood Lead Levels in the US Population: Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991). JAMA: The Journal of the American Medical Association. 1994;272(4):277-283-283. doi:10.1001/jama.1994.03520040039038

2. The Health Consequences of Involuntary Exposure to Tobacco Smoke : A Report of the Surgeon General. Rockville, MD : U.S. Dept. of Health and Human Services, Public Health Service, Office of the Surgeon General, 2006; 2006. Accessed November 7, 2022. https://search-ebscohost-com.proxy.library.nyu.edu/login.aspx?direct=true&db=edsgpr&AN=edsgpr.000590131&site=eds-live.

3. Mannino DM, Homa DM, Matte T, Hernandez-Avila M. Active and passive smoking and blood lead levels in U.S. adults: Data from the Third National Health and Nutrition Examination Survey. Nicotine & Tobacco Research. 2005;7(4):557-564. Accessed September 27, 2022. https://search-ebscohost-com.proxy.library.nyu.edu/login.aspx?direct=true&db=edsjsr&AN=edsjsr.26760813&site=eds-live

4. Shaper AG, Pocock SJ, Walker M, et al. Effects Of Alcohol And Smoking On Blood Lead In Middle-Aged British Men. British Medical Journal (Clinical Research Edition). 1982;284(6312):299-302. Accessed September 27, 2022. https://search-ebscohost-com.proxy.library.nyu.edu/login.aspx?direct=true&db=edsjsr&AN=edsjsr.29505127&site=eds-live

5. Richter PA, Bishop EE, Wang J, Kaufmann R. Trends in tobacco smoke exposure and blood lead levels among youths and adults in the United States: The national health and nutrition examination survey, 1999-2008. Preventing Chronic Disease. 2013;10(12). doi:10.5888/pcd10.130056

6. Grandjean P, Olsen NB, Hollnagel H. Influence of smoking and alcohol consumption on blood lead levels. International Archives of Occupational and Environmental Health. 1981;48(4):391-397-397. doi:10.1007/BF00378687

7. Joo H, Lim M-H, Ha M, et al. Secondhand Smoke Exposure and Low Blood Lead Levels in Association With Attention-Deficit Hyperactivity Disorder and Its Symptom Domain in Children : A Community-Based Case–Control Study. Nicotine & Tobacco Research. 2017;19(1):94-101. Accessed November 7, 2022. https://search-ebscohost-com.proxy.library.nyu.edu/login.aspx?direct=true&db=edsjsr&AN=edsjsr.26770507&site=eds-live

8. Eskenazi B, Bradman A, Castorina R. Exposures of children to organophosphate pesticides and their potential adverse health effects. Environ

Health Perspect. 1999;107(Suppl 3):409–419. doi:sc271_5_1835.

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Acknowledgments

I would like to thank Professor Joshua and Jennifer for their invaluable assistance and support, which played a crucial role in the successful completion of my thesis.

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Thanks!