{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:33:36Z","timestamp":1790649216668,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T00:00:00Z","timestamp":1582243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Key R &amp; D Program of China","award":["2017YFC0907000"],"award-info":[{"award-number":["2017YFC0907000"]}]},{"name":"Zhejiang Provincial Public Welfare Technology Application Research Project of China","award":["LGF19H260003"],"award-info":[{"award-number":["LGF19H260003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>There is currently no consensus regarding the effects of passive smoking exposure on cognitive function in older adults. We evaluated 7000 permanent residents from six regions within Zhejiang Province, China, aged \u226560 years, without cognitive impairment at baseline and during follow-up examinations for two years. The Chinese version of the Mini-Mental State Examination was used to assess the participants\u2019 cognitive function. Multivariate regression analyses were carried out to calculate the adjusted relative risks (RRs) as measures of the association between passive smoking exposure and cognitive impairment after adjusting for potential confounders. The results showed an association between passive smoking exposure in the living environment and increased risk of cognitive impairment (RR: 1.16; 95% confidence interval (CI): 1.01\u20131.35). No dose\u2013response relationship between the cumulative dose of passive smoking exposure (days) and cognitive impairment was observed. The results of stratified analyses suggested a harmful effect of passive smoking exposure on cognitive function in non-smokers (RR: 1.24; 95% CI: 1.06\u20131.46), but not in smokers (RR: 1.11; 95% CI: 0.71\u20131.92). Therefore, passive smoking exposure increased the risk of cognitive impairment in older adults, especially non-smokers. More effective measures to restrict smoking in the living environment should be developed and implemented.<\/jats:p>","DOI":"10.3390\/ijerph17041402","type":"journal-article","created":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T08:59:47Z","timestamp":1582275587000},"page":"1402","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Passive Smoking Exposure in Living Environments Reduces Cognitive Function: A Prospective Cohort Study in Older Adults"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6027-7157","authenticated-orcid":false,"given":"Fan","family":"He","sequence":"first","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"},{"name":"Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"Li","sequence":"additional","affiliation":[{"name":"Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junfen","family":"Lin","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fudong","family":"Li","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujia","family":"Zhai","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Gu","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genming","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,2,21]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2019, September 14). A Report of the Surgeon General, How Tobacco Smoke Causes Disease: What it Means to You, Available online: https:\/\/www.cdc.gov\/tobacco\/data_statistics\/sgr\/2010\/consumer_booklet\/pdfs\/consumer.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1093\/ntr\/ntq216","article-title":"Research opportunities related to establishing standards for tobacco products under the Family Smoking Prevention and Tobacco Control Act","volume":"14","author":"Hecht","year":"2012","journal-title":"Nicotine Tob. Res."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kim, A.S., Ko, H.J., Kwon, J.H., and Lee, J.M. (2018). Exposure to Secondhand Smoke and Risk of Cancer in Never Smokers: A Meta-Analysis of Epidemiologic Studies. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15091981"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e2017026","DOI":"10.4178\/epih.e2017026","article-title":"The association between smoking or passive smoking and cardiovascular diseases using a Bayesian hierarchical model: Based on the 2008\u20132013 Korea Community Health Survey","volume":"39","author":"Lee","year":"2017","journal-title":"Epidemiol. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3096","DOI":"10.3390\/ijerph110303096","article-title":"Modeling the effects of indoor passive smoking at home, work, or other households on adult cardiovascular and mental health: The Scottish Health Survey, 2008\u20132011","volume":"11","author":"Shiue","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1017\/S1041610217002824","article-title":"Passive smoking as a risk factor for dementia and cognitive impairment: Systematic review of observational studies","volume":"30","author":"Stirland","year":"2018","journal-title":"Int. Psychogeriatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1080\/00221309.2018.1535485","article-title":"Passive smoking is associated with cognitive and emotional impairment in adolescent girls","volume":"146","author":"Khorasanchi","year":"2019","journal-title":"J. Gen. Psychol"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1212\/WNL.0b013e31823efcbb","article-title":"Nicotine treatment of mild cognitive impairment: A 6-month double-blind pilot clinical trial","volume":"78","author":"Newhouse","year":"2012","journal-title":"Neurology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1007\/s002130050931","article-title":"Four-week nicotine skin patch treatment effects on cognitive performance in Alzheimer\u2019s disease","volume":"143","author":"White","year":"1999","journal-title":"Psychopharmacology (Berl)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"587","DOI":"10.2188\/jea.JE20150223","article-title":"Tea and risk of age-related cataracts: A cross-sectional study in Zhejiang Province, China","volume":"26","author":"Sheng","year":"2016","journal-title":"J. Epidemiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"139","DOI":"10.3233\/JAD-150444","article-title":"Reproductive history and risk of cognitive impairment in elderly women: A cross-sectional study in Eastern China","volume":"49","author":"Li","year":"2016","journal-title":"J. Alzheimers Dis."},{"key":"ref_12","first-page":"108","article-title":"Application of the Chinese version of the Mini-Mental State Examination","volume":"7","author":"Wang","year":"1989","journal-title":"Shanghai Arch. Psychiatr."},{"key":"ref_13","unstructured":"Zhang, Z.J. (2005). Handbook of Behavioral Medical Scales, Chinese Medical Multimedia Press."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1136\/oemed-2012-100785","article-title":"Association between environmental tobacco smoke exposure and dementia syndromes","volume":"70","author":"Chen","year":"2013","journal-title":"Occup. Environ. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"726948","DOI":"10.1100\/2012\/726948","article-title":"Relation of secondhand smoking to mild cognitive impairment in older inpatients","volume":"2012","author":"Orsitto","year":"2012","journal-title":"Sci. World J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1093\/aje\/kwp376","article-title":"Secondhand smoke, vascular disease, and dementia incidence: Findings from the cardiovascular health cognition study","volume":"171","author":"Barnes","year":"2010","journal-title":"Am. J. Epidemiol."},{"key":"ref_17","unstructured":"Centers for Disease Control and Prevention (2019, September 15). A Report of the Surgeon General, The Health Consequences of Involuntary Exposure to Tobacco Smoke, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK44324\/pdf\/Bookshelf_NBK44324.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.tins.2005.02.001","article-title":"Neurovascular mechanisms of Alzheimer\u2019s neurodegeneration","volume":"28","author":"Zlokovic","year":"2005","journal-title":"Trends Neurosci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2684","DOI":"10.1161\/CIRCULATIONAHA.104.492215","article-title":"Cardiovascular effects of secondhand smoke: Nearly as large as smoking","volume":"111","author":"Barnoya","year":"2005","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ho, Y.S., Yang, X., Yeung, S.C., Chiu, K., Lau, C.F., Tsang, A.W., Mak, J.C., and Chang, R.C. (2012). Cigarette smoking accelerated brain aging and induced pre-Alzheimer-like neuropathology in rats. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0036752"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1111\/j.1471-4159.2009.06203.x","article-title":"Tobacco carcinogen induces microglial activation and subsequent neuronal damage","volume":"110","author":"Ghosh","year":"2009","journal-title":"J. Neurochem."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"b462","DOI":"10.1136\/bmj.b462","article-title":"Exposure to secondhand smoke and cognitive impairment in non-smokers: National cross-sectional study with cotinine measurement","volume":"338","author":"Llewellyn","year":"2009","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1001\/archinternmed.2011.762","article-title":"Passive smoking and risk of cognitive impairment in women who never smoke","volume":"172","author":"Chen","year":"2012","journal-title":"Arch. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1177\/0891988713496165","article-title":"Association of passive smoking with cognitive impairment in nonsmoking older adults: A systematic literature review and a new study of Chinese cohort","volume":"26","author":"Chen","year":"2013","journal-title":"J. Geriatr. Psychiatry Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.coph.2003.11.001","article-title":"Effects of nicotinic stimulation on cognitive performance","volume":"4","author":"Newhouse","year":"2004","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1289\/ehp.7210","article-title":"Exposure to environmental tobacco smoke and cognitive abilities among U.S. children and adolescents","volume":"113","author":"Yolton","year":"2005","journal-title":"Environ. Health Perspect."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1080\/13607860220126808","article-title":"Nicotine\u2019s effect on neural and cognitive functioning in an aging population","volume":"6","author":"Murray","year":"2002","journal-title":"Aging Ment. Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1046\/j.0305-1846.2003.00528.x","article-title":"Selective changes in nicotinic acetylcholine receptor subtypes related to tobacco smoking: An immunohistochemical study","volume":"30","author":"Teaktong","year":"2004","journal-title":"Neuropathol. Appl. Neurobiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1136\/jnnp.68.5.622","article-title":"Smoking, drinking, and incident cognitive impairment: A cohort community based study included in the Gospel Oak project","volume":"68","author":"Cervilla","year":"2000","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1093\/ageing\/afg067","article-title":"Cigarette smoking and cognitive performance in healthy Swedish adults","volume":"32","author":"Hill","year":"2003","journal-title":"Age Ageing"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1006\/enrs.2001.4380","article-title":"Exposure to environmental tobacco smoke in pregnant women: The association between self-report and serum cotinine","volume":"90","author":"DeLorenze","year":"2002","journal-title":"Environ. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"46","DOI":"10.3389\/fpsyt.2016.00046","article-title":"The cognitive deficits associated with second-hand smoking","volume":"7","author":"Ling","year":"2016","journal-title":"Front. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1093\/oxfordjournals.epirev.a017925","article-title":"Cotinine as a biomarker of environmental tobacco smoke exposure","volume":"18","author":"Benowitz","year":"1996","journal-title":"Epidemiol. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Bono, R., Bellisario, V., Tassinari, R., Squillacioti, G., Manetta, T., Bugiani, M., Migliore, E., and Piccioni, P. (2019). Bisphenol a, tobacco smoke, and age as predictors of oxidative stress in children and adolescents. Int J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16112025"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0140-6736(10)61388-8","article-title":"Worldwide burden of disease from exposure to second-hand smoke: A retrospective analysis of data from 192 countries","volume":"377","author":"Oberg","year":"2011","journal-title":"Lancet"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/4\/1402\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:59:47Z","timestamp":1760173187000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/4\/1402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,21]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,2]]}},"alternative-id":["ijerph17041402"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17041402","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,21]]}}}