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In 1880, coal was the primary energy source for everything from home heating to industry. Regions where coal was readily available, such as the Ruhr Valley in Germany and western Pennsylvania in the United States, witnessed exponential growth-yet also suffered the greatest damage from coal pollution.These conditions prompted civic activism in the form of \"anti-smoke\" campaigns to attack the unsightly physical manifestations of coal burning. This early period witnessed significant cooperation between industrialists, government, and citizens to combat the smoke problem. It was not until the 1960s, when attention shifted from dust and grime to hazardous invisible gases, that cooperation dissipated, and protests took an antagonistic turn.The Age of Smokepresents an original, comparative history of environmental policy and protest in the United States and Germany. Dividing this history into distinct eras (1880 to World War I, interwar, post-World War II to 1970), Frank Uekoetter compares and contrasts the influence of political, class, and social structures, scientific communities, engineers, industrial lobbies, and environmental groups in each nation. He concludes with a discussion of the environmental revolution, arguing that there were indeed two environmental revolutions in both countries: one societal, where changing values gave urgency to air pollution control, the other institutional, where changes in policies tried to catch up with shifting sentiments.Focusing on a critical period in environmental history,The Age of Smokeprovides a valuable study of policy development in two modern industrial nations, and the rise of civic activism to combat air pollution. As Uekoetter's work reveals, the cooperative approaches developed in an earlier era offer valuable lessons and perhaps the best hope for future progress.

Active smoking is a risk factor for type 2 diabetes (T2DM), but it is unclear whether exposure to environmental tobacco smoke (ETS) is also associated with T2DM. The effect of passive and active smoking on the 7-year T2DM incidence was investigated in a populationbased cohort in Southern Germany (KORA S4/F4; 1,223 subjects aged 55-74 years at baseline in 1999-2001, 887 subjects at follow-up). Incident diabetes was identified by oral glucose tolerance tests or by validated physician diagnoses. Among never smokers, subjects exposed to ETS had an increased diabetes risk in the total sample (odds ratio (OR) = 2.5; 95% confidence interval (CI): 1.1, 5.6) and in a subgroup of subjects having prediabetes at baseline (OR = 4.4; 95% CI: 1.5, 13.4) after adjusting for age, sex, parental diabetes, socioeconomic status, and lifestyle factors. Active smoking also had a statistically significant effect on diabetes incidence in the total sample (OR = 2.8; 95% CI: 1.3, 6.1) and in prediabetic subjects (OR = 7.8; 95% CI: 2.4, 25.7). Additional adjustment for components of the metabolic syndrome including waist circumference did not attenuate any of these associations. This study provides evidence that both passive and active smoking is associated with T2DM.

Background: Cross-sectional and ecological studies indicate that air pollution may be a risk factor for type 2 diabetes, but prospective data are lacking. Objective: We examined the association between traffic-related air pollution and incident type 2 diabetes. Design: Between 1985 and 1994, cross-sectional surveys were performed in the highly industrialized Ruhr district (West Germany); a follow-up investigation was conducted in 2006 using data from the Study on the Influence of Air Pollution on Lung, Inflammation and Aging (SALIA) cohort. Participants: 1,775 nondiabetic women who were 54-55 years old at baseline participated in both baseline and follow-up investigations and had complete information available. Materials and Methods: Using questionnaires, we assessed 16-year incidence (1990-2006) of type 2 diabetes and information about covariates. Complement factor C3c as marker for subclinical inflammation was measured at baseline. Individual exposure to traffic-related particulate matter (PM) and nitrogen dioxide was determined at different spatial scales. Results: Between 1990 and 2006, 87 (10.5%) new cases of diabetes were reported among the SALIA cohort members. The hazards for diabetes were increased by 15-42% per interquartile range of PM or traffic-related exposure. The associations persisted when different spatial scales were used to assess exposure and remained robust after adjusting for age, body mass index, socioeconomic status, and exposure to several non—traffic-related sources of air pollution. C3c was associated with PM pollution at baseline and was a strong independent predictor of incident diabetes. Exploratory analyses indicated that women with high C3c blood levels were more susceptible for PM-related excess risk of diabetes than were women with low C3c levels. Conclusions: Traffic-related air pollution is associated with incident type 2 diabetes among elderly women. Subclinical inflammation may be a mechanism linking air pollution with type 2 diabetes. Relevance to clinical practice: Our study identifies traffic-related air pollution as a novel and potentially modifiable risk factor of type 2 diabetes.

Background Children who are exposed to secondhand smoke (SHS) have an increased risk of a wide range of health problems and illnesses. Smoke-free legislation aims to improve indoor air quality and in this way protect the health of people who do not smoke. This paper examines trends in SHS exposure at home among children in Germany since the introduction of smoking bans in public places. Special focus is placed on the importance of the family of origin’s socioeconomic status (SES) and on parental smoking behaviour. Methods The analyses are based on two waves of the “German Health Interview and Examination Survey for Children and Adolescents” (KiGGS)—one of which was conducted immediately before the introduction of central smoke-free legislation in the 2003-2006 period, the other approximately 6 years later from 2009 to 2012. A comparison is made between the answers given by the parents of children aged between 0 to 6 (KiGGS baseline study, n  = 6680; KiGGS Wave 1, n  = 4455). Domestic SHS exposure is covered in the parent interviews by asking whether anyone is allowed to smoke at home in the presence of their child. Parental smoking behaviour is determined separately for mothers and fathers. SES is determined on the basis of the parents’ education, occupational status and income. Results The percentage of 0- to 6-year-old children exposed to SHS in the parental home fell from 23.9 to 6.6 % in the period from 2003-2006 to 2009-2012. At the same time, the percentage of children with at least one parent who smokes decreased from 49.8 to 41.8 %. While relative social inequalities in parental smoking behaviour have tended to increase over time, inequalities in domestic SHS exposure have persisted. Children whose parents smoke and children from low-SES families are still most likely to be exposed to tobacco smoke. In both study periods and after statistical adjustment for parental smoking behaviour, children with a low SES had a 6.6-fold higher risk for SHS exposure in the parental home than children from high-SES households. Conclusions The results of the KiGGS study show that the proportion of children in Germany who are exposed to SHS at home has declined significantly over the last few years. There is much to suggest that the smoke-free legislation that has been introduced in Germany has led to a heightened awareness of the health risks of SHS both in public and in the private sphere, as well as to a denormalization of smoking. Children whose parents smoke, and among them particularly children from socially disadvantaged families, should be recognised as key target groups when implementing future tobacco-control measures.

Background: Living close to major roads or highways has been suggested to almost double the risk of dying from cardiopulmonary causes. We assessed whether long-term exposure to air pollution originating from motorized traffic and industrial sources is associated with total and cause-specific mortality in a cohort of women living in North Rhine-Westphalia, Germany. Methods: The study was a follow-up of a series of cross-sectional studies carried out during the 1980s and 1990s on the health of women (age 50-59 years). Approximately 4800 women were followed up for vital status and migration. Exposure to air pollution was defined by distance to major roads calculated from Geographic Information System data and by 1- and 5-year average nitrogen dioxide (NO₂) and particle (PM₁₀) concentrations calculated from air monitoring station data. We analyzed associations between exposure and mortality using Cox's proportional hazards models adjusting for confounders. Relative risks (RRs) refer to an interquartile range increase in exposure (16 μg/m³ for NO₂; 7 μg/m³ for PM₁₀). Results: During the follow-up period, 8% of the women died, 3% from cardiopulmonary causes. Cardiopulmonary mortality was associated with living within a 50-meter radius of a major road (adjusted RR = 1.70; 95% confidence interval = 1.02-2.81), with NO₂ (1.57; 1.23-2.00 for 1-year average), and with PM₁₀ (1.34; 1.06-1.71 for 1-year average). Exposure to NO₂ was also associated with all-cause mortality (1.17; 1.02-1.34). No association was seen with noncardiopulmonary nonlung cancer mortality. Conclusions: Living close to major roads and chronic exposure to NO₂ and PM₁₀ may be associated with an increased mortality due to cardiopulmonary causes.

Background Findings on the association between exposure to secondhand smoke (SHS) and depression are contradictory. Comparability of existing research is limited due to varied methods and measures. This study examines the potential association between exposure to SHS and depression and a potential moderation by sex using representative data from Germany. Methods For our study, we used data from the German Health Update (GEDA) 2014/2015 on n  = 10,274 never-smokers. We calculated a logistic regression model with an interaction term for potential sex-exposure interactions. We used the self-reported duration of exposure to predict current depression of any type as defined by the Patient Health Questionnaire PHQ-8 (score ≥ 10), accounting for a large number of confounders. Results In our sample, prevalence of depression was 8.8% in women and 5.3% in men. 90.4% were never or almost never exposed to SHS, while 7.1% were exposed < 1 h per day and around 2.5% reported being exposed for ≥1 h per day. While SHS exposure for < 1 h per day was not associated with current depression (OR = 1.54; 95%-CI: 0.93–1.61), SHS exposure for at least 1 h per day was associated with increased odds for current depression (OR = 1.59; 95%-CI: 1.08–2.35). No sex-specific differences were found. Conclusions Higher levels of SHS exposure are associated with current depression, although the nature and direction of the association are still unclear. We identified no differences in the association between men and women. More studies, particularly using longitudinal data, are needed to determine the nature of the association.

In contrast to other countries, there is an on-going debate but still no smoke-free legislation in Germany. Exposure to environmental tobacco smoke (ETS) in hospitality venues is assumed to be high, but air quality data are lacking. Therefore, the aim of our study was to perform a comprehensive exposure assessment by analysing the indoor air concentration of toxic or carcinogenic ETS compounds in restaurants, pubs, and discotheques. Active sampling of indoor air was conducted for 4 h during the main visiting hours in 28 hospitality venues. Polycyclic aromatic hydrocarbons (PAH), volatile organic compounds (VOC), aldehydes/ketones, and cadmium were analysed. In addition, particle mass concentration was assessed with two different methods and particle number concentration (PNC) was determined. Median nicotine levels were 15  μ g/m 3 in restaurants, 31  μ g/m 3 in pubs, and 193  μ g/m 3 in discotheques. Across these three sampling site categories median levels of 3-ethenylpyridine ranged from 3 to 24  μ g/m 3 , median levels of benzene from 8 to 20  μ g/m 3 , median levels of cadmium from 3 to 10 ng/m 3 , and median levels of the sum of 16 PAH according to US-EPA from 215 to 375 ng/m 3 , respectively. Median PM 2.5 mass concentration assessed gravimetrically varied between 178 and 808  μ g/m 3 and PNC between 120,000 and 210,000 particles per cm 3 in restaurants, pubs, and discotheques. The majority of the particles had a size of 0.01–0.5  μ m. Concentrations of ETS compounds were always highest in discotheques. The strong correlation between ETS-specific markers (nicotine, 3-ethenylpyridine) and PM 2.5 , PAH, VOC, aldehydes/ketones, and cadmium indicated ETS as main source of these toxic or carcinogenic substances. In conclusion, indoor air concentrations of ETS constituents were high in German hospitality venues and represented a substantial health threat. Effective measures to protect patrons and staff from ETS exposure are necessary from a public health point of view.

Background: Prenatal and postnatal tobacco exposure have been reported to be associated with behavioral problems. However, the magnitude of the association with tobacco exposure at specific periods of exposure is unclear. Objective: We assessed the relative risk of behavioral problems in children who had been exposed to tobacco smoke in utero and postnatally. Methods: We analyzed data from a prospective birth cohort study in two cities in Germany: the German Infant Nutrition Intervention. Our sample included 5,991 children born between 1995 and 1998 as well as their parents. We measured behavioral problems using the Strength and Difficulties Questionnaire (SDQ) at follow-up 10 years after birth. According to prespecified SDQ cutoff values, children were classified as \"normal,\" \"borderline,\" or \"abnormal\" according to the subscales \"emotional symptoms,\" \"conduct problems,\" \"hyperactivity/inattention,\" \"peer-relationship problems,\" and a total difficulties score. Smoke exposure and further covariates were assessed using parent questionnaires. Results: Compared with children not exposed to tobacco smoke, children exposed both pre- and postnatally to tobacco smoke had twice the estimated risk [95% confidence interval (CI), 1.4-3.1] of being classified as abnormal according to the total difficulties score of the SDQ at 10 years of age. Children who were only prenatally exposed had a 90% higher relative risk (95% CI, 0.9-4.0), whereas children who were only postnatally exposed had a 30% higher relative risk (95% CI, 0.9-1.9). These results could not be explained by confounding by parental education, father's employment, child's time spent in front of computer or television screen, being a single father or mother, or mother's age. Conclusions: Prenatal exposure to tobacco smoke is associated with behavioral problems in school-age children. Although our findings do not preclude the influence of postnatal exposure, prenatal exposure seems to be more important.