Assessment of Sources of Second-Hand Smoke Exposure in a Putatively Unexposed Population

The authors sought to determine levels of urinary cotinine and its association with collateral exposure to second-hand smoke in public health workers. Urinary cotinine was measured twice at 1-wk intervals in 28 public health workers or their spouses. Information on sources of second-hand smoke exposure and a dietary history were obtained from each participant. Geometric mean and median cotinine levels were 2.74 and 2.33 ng/mL, respectively. Only 6 instances of second-hand smoke exposure were reported from a combined 204 days of potential exposure, and these did not correspond to higher cotinine values. There was no association between consumption of foods containing nicotine and log-transformed urine cotinine levels (p = 80). The authors' analysis indicates dietary sources of nicotine are not important, even for persons with very low urinary cotinine levels. Further study is needed to determine sources of variation in urinary cotinine among largely unexposed populations.     

Air Nicotine Levels in Public Places in Ahmedabad,India: Before and After Implementation of the Smoking Ban

Aim:

To compare air nicotine levels in public places in Ahmedabad, India, before (June 2008) and after (January, 2010) the implementation of a comprehensive smoking ban which was introduced in October 2008.

Materials and Methods:

Air nicotine concentrations were measured by sampling of vapor-phase nicotine using passive monitors. In 2008 (baseline), monitors were placed for 5-7 working days in 5 hospitals, 10 restaurants, 5 schools, 5 government buildings, and 10 entertainment venues, of which 6 were hookah bars. In 2010 (follow-up), monitors were placed in 35 similar venues for the same duration.

Results:

Comparison of the overall median nicotine concentration at baseline (2008) (0.06 μg/m³ Interquartile range (IQR): 0.02-0.22) to that of follow-up (2010) (0.03 μg/m³ IQR: 0.00-0.13), reflects a significant decline (% decline = 39.7, P = 0.012) in exposure to second-hand smoke (SHS). The percent change in exposure varied by venue-type. The most significant decrease occurred in hospitals, from 0.04 μg/m³ at baseline to concentrations under the limit of detection at follow-up (%decline = 100, P < 0.001). In entertainment venues, government offices, and restaurants, decreases in SHS exposure also appeared evident. However, in hookah bars, air nicotine levels appeared to increase (P = 0.160).

Conclusion:

Overall, SHS exposure was significantly reduced in public places after the smoke-free legislation came into force. However, nicotine concentrations were still detected in most of the venues indicating imperfect compliance with the comprehensive ban.     

居民二手烟暴露与控烟权利执行意愿关联性分析

目的 了解广东省广州市居民二手烟暴露情况,探讨二手烟暴露程度与控烟权利执行意愿的关联性。方法 采用多阶段分层随机抽样方法,对广州市5 135名≥15岁居民进行问卷调查,比较不同人口学特征居民二手烟暴露率,并对有统计学关联的二手烟暴露程度和控烟权利执行意愿进行关联性分析。结果 不吸烟者4 239人,男性占48.98%;二手烟暴露率为46.99%,男性二手烟暴露率(48.95%)高于女性(45.98%),暴露率高中/中专学历者(55.72%)和企业职员(54.34%)较高,≥65岁组(28.51%)和离异/分居/丧偶者(23.60%)较低;二手烟暴露与控烟权利执行意愿有关联,与二手烟危害知识无关联;对应分析结果显示,知晓并会执行控烟权利与无二手烟暴露相关联;知晓但不会执行控烟权利与二手烟暴露1~3 d/周相关联;不知晓控烟权利与二手烟暴露4~7 d/周相关联。结论 居民有执行控烟权利意愿能减少二手烟暴露,在控烟工作中应加强控烟权利宣传。     

甘肃省20～80岁汉族男性吸烟和饮酒的交互作用对γ – 谷氨酰转肽酶的影响

  目的  了解浙江省杭州市居民在新版《杭州市公共场所控制吸烟条例》（简称“《条例》”）实施2年后的室内公共场所二手烟暴露情况及其对室内公共场所控烟的满意度,为新版《条例》的推进提供参考。  方法  于2021年1月采用分层随机抽样方法在杭州市下城区、余杭区和桐庐县抽取1320名15～75岁居民进行问卷调查。  结果  杭州市最终纳入分析的1315名居民中目前不吸烟者1101人,不吸烟者中有303人近1周内在公共场所吸入过二手烟,二手烟暴露率为27.52 %;杭州市居民对室内公共场所控烟的总体满意度为67.76 %,其中对控烟宣传的满意度为64.49 %,对控烟监督执法的满意度为59.54 %,对党政机关无烟示范的满意度为65.63 %;在控制了性别、年龄、文化程度、婚姻状况、职业、居住地、是否自报慢性病患病、目前吸烟情况、控烟条例核心知识知晓情况、烟草危害知晓情况和控烟参与意愿等混杂因素后,多因素非条件logistic回归分析结果显示,对控烟宣传满意度（OR = 2.293,95 % CI = 1.507～3.491）、控烟监督执法满意度（OR = 3.960,95 % CI = 2.793～5.615）和党政机关无烟示范满意度（OR = 3.911,95 % CI = 2.534～6.036）越高的杭州市居民,其对室内公共场所控烟的总体满意度越高。  结论  杭州市居民室内公共场所二手烟暴露率较低且对控烟的满意度较高,新版《条例》的实施取得了一定效果,相关部门应重点加强监督执法力度和巩固党政机关的无烟示范作用以提高居民对室内公共场所控烟的总体满意度。     

Prevalence and determinants of SHS exposure in public and private areas after the 2010 smoke-free legislation in Greece

The objective of the present survey was to assess the extent and socio-economic determinants of population exposure to secondhand smoke (SHS) in Greece in 2011. The national household survey Hellas Health IV was conducted in October 2011. SHS exposure was based on self-reported exposure within home, workplace and public places. Thirty-three per cent of the respondents reported living in a smoke-free home. Smokers (p?<?0.001) and single individuals (p?<?0.017) were less likely to prohibit smoking at home. SHS exposure at work, in restaurants and in bars/clubs/cafes was frequently mentioned by 41.6, 84.2 and 90.5%, respectively. SHS exposure in a bar/club/cafe was noted more among single individuals (p?=?0.004) and those aged 18–34?years (p?=?0.007). Inhabitants of rural areas were more likely to report someone smoking indoors in all the above venues. Public health education and effective enforcement of the nationwide smoke-free legislation are imperative.     

Smoke-free spaces over time: a policy diffusion study of bylaw development in Alberta and Ontario, Canada

Policy diffusion is a process whereby political bodies 'learn' policy solutions to public health problems by imitating policy from similar jurisdictions. This suggests that diffusion is a critical element in the policy development process, and that its role must be recognised in any examination of policy development. Yet, to date, no systematic work on the diffusion of smoke-free spaces bylaws has been reported. We examined the diffusion of municipal smoke-free bylaws over a 30-year period in the provinces of Alberta and Ontario, Canada, to begin to address this gap and to determine whether spatial patterns could be identified to help explain the nature of policy development. Bylaw adoption and change were analysed within local, regional, and provincial contexts. Geographical models of hierarchical and expansion diffusion in conjunction with the diffusion of innovations framework conceptually guided the analyses. Study findings contribute to a broader understanding of how and why health policies diffuse across time and place. Policy development can be a powerful mechanism for creating environments that support healthy decisions; hence, an understanding of policy diffusion is critical for those interested in policy interventions aimed at improving population health in any jurisdiction.     

Tobacco control and gender in south-east Asia. Part II: Singapore and Vietnam

In the World Health Organization's Western Pacific Region, being born male is the single greatest risk marker for tobacco use. While the literature demonstrates that risks associated with tobacco use may vary according to sex, gender refers to the socially determined roles and responsibilities of men and women, who initiate, continue and quit using tobacco for complex and often different reasons. Cigarette advertising frequently appeals to gender roles. Yet tobacco control policy tends to be gender-blind. Using a broad, gender-sensitivity framework, this contradiction is explored in four Western Pacific countries. Part I of the study presented the rationale, methodology and design of the study, discussed issues surrounding gender and tobacco, and analysed developments in Malaysia and the Philippines (see the previous issue of this journal). Part II deals with Singapore and Vietnam. In all four countries gender was salient for the initiation and maintenance of smoking. Yet, with a few exceptions, gender was largely unrecognized in control policy. Suggestions for overcoming this weakness in order to enhance tobacco control are made.     

Occupational exposure of non-smoking restaurant personnel to environmental tobacco smoke in Finland

BACKGROUND: Environmental tobacco smoke (ETS) exposure levels in different restaurant types in Finland were assessed before the National Tobacco Act restricting smoking in restaurants was activated. METHODS: Exposure to ETS was determined by measuring nicotine in the breathing zone of non-smoking restaurant workers and by quantification of the nicotine metabolites cotinine and 3-hydroxycotinine in the urine of these workers during one whole work week. Altogether 23 workers from 15 restaurants were included in the study. RESULTS: The geometric mean (GM) breathing-zone nicotine level was 3.9 microg/m(3) (3.7 microg/m(3) in pubs, 1.4 microg/m(3) in dining restaurants, and 10.2 microg/m(3) in nightclubs). The GM cotinine and trans-3'-hydroxycotinine level in urine were 3.3 ng/mg((creatinine)) and 15.3 ng/mg((creatinine)), respectively. The exposure to ETS of restaurant workers in dining restaurants was clearly lower than that of workers in pubs and nightclubs as indicated by all ETS-markers used in the present study. During the work week, the cotinine and 3'-hydroxycotinine levels in urine of the study subjects increased. The correlation between breathing zone nicotine and urine cotinine and hydroxycotinine was 0.66 for both compounds. Post-shift cotinine and hydroxycotinine levels were not significantly higher than the pre-shift levels. CONCLUSIONS: If 9 ng cotinine/mg((creatinine)) is considered as the level above which heavy exposure has occurred, then this level was exceeded by 14 (approximately 60%) subjects at least once during the work week. Nicotine metabolite concentrations in the urine increased during the work week in 80% of the subjects, and the increase was especially noticeable for subjects working in both pubs and nightclubs. The study indicates that measures to restrict ETS exposure in restaurants are needed.     

Comparison of parental reports of smoking and residential air nicotine concentrations in children

Background

Using questionnaires to assess children''s residential exposure to environmental tobacco smoke (ETS) may result in misclassification from recall and response bias. Questionnaire data have frequently been validated against urinary cotinine measurements, but rarely against actual measurements of residential air nicotine.

Objective

To compare questionnaire reported smoking with air nicotine concentrations in a large population of children and with urinary cotinine levels in a subpopulation; and to assess the potential impact of the symptom status of the children on the agreement between different measures of exposure.

Methods

The authors assessed residential exposure to ETS in 347 German, 335 Dutch, and 354 Swedish preschool and schoolchildren by questionnaire and air nicotine measurements, and in a subset of 307 German children by urinary cotinine measurements. They then compared the different measures of ETS exposure.

Results

In all countries, air nicotine concentrations increased with increasing questionnaire reported smoking in a dose‐response fashion. Specificity and negative predictive values of questionnaire reports for nicotine concentrations were excellent. Sensitivity and positive predictive values were moderate to good. Excluding occasional smokers, the overall percentage of homes misclassified was 6.9%, 6.7%, and 5.1% in Germany, the Netherlands, and Sweden, respectively. Similar results were found for the agreement of urinary cotinine concentrations with questionnaire reports and air nicotine levels. There was no indication of underreporting by parents of symptomatic children.

Conclusion

Despite some misclassification, questionnaire reports are an inexpensive and valid estimate of residential ETS exposure among preschool and school children.     

Thirdhand tobacco smoke: emerging evidence and arguments for a multidisciplinary research agenda

Background: There is broad consensus regarding the health impact of tobacco use and secondhand smoke exposure, yet considerable ambiguity exists about the nature and consequences of thirdhand smoke (THS).Objectives: We introduce definitions of THS and THS exposure and review recent findings about constituents, indoor sorption–desorption dynamics, and transformations of THS; distribution and persistence of THS in residential settings; implications for pathways of exposure; potential clinical significance and health effects; and behavioral and policy issues that affect and are affected by THS.Discussion: Physical and chemical transformations of tobacco smoke pollutants take place over time scales ranging from seconds to months and include the creation of secondary pollutants that in some cases are more toxic (e.g., tobacco-specific nitrosamines). THS persists in real-world residential settings in the air, dust, and surfaces and is associated with elevated levels of nicotine on hands and cotinine in urine of nonsmokers residing in homes previously occupied by smokers. Much still needs to be learned about the chemistry, exposure, toxicology, health risks, and policy implications of THS.Conclusion: The existing evidence on THS provides strong support for pursuing a programmatic research agenda to close gaps in our current understanding of the chemistry, exposure, toxicology, and health effects of THS, as well as its behavioral, economic, and sociocultural considerations and consequences. Such a research agenda is necessary to illuminate the role of THS in existing and future tobacco control efforts to decrease smoking initiation and smoking levels, to increase cessation attempts and sustained cessation, and to reduce the cumulative effects of tobacco use on morbidity and mortality.     

Banning smoking in cars carrying children: an analytical history of a public health advocacy campaign

OBJECTIVE: Framing public health policy reform in ways that attract public and political support is a core skill of advocacy. In this paper we summarise the 12-year Australian history of advocacy for banning smoking in cars carrying children, culminating in the governments of the Australian States of South Australia and Tasmania enacting legislation. METHOD: 'Smoking in cars' was searched on the factiva.com print news media database, with returns limited to Australian newspapers published before 1 June 2007. RESULTS: The issue of smoking in cars received extensive and emotive media coverage, primarily in support of legislating a ban. Invoking the protection of vulnerable children in the debate about smoking in cars was a powerful and persuasive theme. Unlike all other advocacy for smoke-free areas, this debate was not contested by the tobacco industry or other commercial interest groups. CONCLUSIONS: Even in the absence of a co-ordinated advocacy campaign, public opinion studies on support for such legislation have been consistently strong. Communities view the protection of children as paramount and non-negotiable. IMPLICATIONS: Smoke-free cars legislation can and should be fast tracked in order to capitalise on this community support.     

Air Nicotine Monitoring for Second Hand Smoke Exposure in Public Places in India

Background:

Air nicotine monitoring is an established method of measuring exposure to second hand smoke (SHS). Not much research has been done in India to measure air nicotine for the purpose of studying exposure to SHS. It is a risk factor and many diseases are known to occur among non smokers if they are exposed to second hand smoke.

Objective:

To conduct monitoring of air nicotine for second hand smoke exposure in public places across major cities in India.

Materials and Methods:

A cross sectional survey was conducted across four cities across the country, using passive air monitoring. The buildings included hospitals, secondary schools, Governmental offices, bars and restaurants. The buildings were selected through convenience sampling method keeping in view specific sentinel locations of interest.

Result:

The presence of air nicotine was recorded in most of the buildings under the study, which included government buildings, hospitals, schools, restaurants and entertainment venues (bars) in all four cities under the study. The highest median levels of air nicotine were found in entertainment venues and restaurants in cities.

Conclusion:

The presence of air nicotine in indoor public places indicates weak implementation of existing smoke free law in India. The findings of this study provide a baseline characterization of exposure to SHS in public places in India, which could be used to promote clean indoor air policies and programs and monitor and evaluate the progress and future smoke-free initiatives in India.     

Secondhand Tobacco Smoke Exposure in Open and Semi-Open Settings: A Systematic Review

Background: Some countries have recently extended smoke-free policies to particular outdoor settings; however, there is controversy regarding whether this is scientifically and ethically justifiable.Objectives: The objective of the present study was to review research on secondhand smoke (SHS) exposure in outdoor settings.Data sources: We conducted different searches in PubMed for the period prior to September 2012. We checked the references of the identified papers, and conducted a similar search in Google Scholar.Study selection: Our search terms included combinations of “secondhand smoke,” “environmental tobacco smoke,” “passive smoking” OR “tobacco smoke pollution” AND “outdoors” AND “PM” (particulate matter), “PM_2.5” (PM with diameter ≤ 2.5 µm), “respirable suspended particles,” “particulate matter,” “nicotine,” “CO” (carbon monoxide), “cotinine,” “marker,” “biomarker” OR “airborne marker.” In total, 18 articles and reports met the inclusion criteria.Results: Almost all studies used PM_2.5 concentration as an SHS marker. Mean PM_2.5 concentrations reported for outdoor smoking areas when smokers were present ranged from 8.32 to 124 µg/m³ at hospitality venues, and 4.60 to 17.80 µg/m³ at other locations. Mean PM_2.5 concentrations in smoke-free indoor settings near outdoor smoking areas ranged from 4 to 120.51 µg/m³. SHS levels increased when smokers were present, and outdoor and indoor SHS levels were related. Most studies reported a positive association between SHS measures and smoker density, enclosure of outdoor locations, wind conditions, and proximity to smokers.Conclusions: The available evidence indicates high SHS levels at some outdoor smoking areas and at adjacent smoke-free indoor areas. Further research and standardization of methodology is needed to determine whether smoke-free legislation should be extended to outdoor settings.     

深圳市公立医院戒烟门诊状况调查

目的 了解广东省深圳市各医疗卫生机构戒烟门诊设置及运作情况。方法 采用普查方法,利用统一自制调查问卷对深圳市全部59家公立医院进行调查,有效问卷56份。结果 深圳市公立医院戒烟门诊设有率为78.57%,未开设的原因主要是医护人员不足（45.45%）。戒烟门诊挂靠在呼吸内科居多（55.81%）;戒烟门诊开设时间主要是全天（58.93%）;仅有 1家三级医院对戒烟门诊医务人员进行补贴;戒烟门诊每周平均服务时间为22.3 h。戒烟门诊人员配置以医生为主,主要为兼职人员（89.29%）,有23家医院没有配备护理人员（45.10%）。一氧化碳检测仪（6.89%）和体重计（51.16%）保有率偏低;宣传教育材料保有率以宣传折页（76.74%）最高,器官模型和影像资料最低（11.63%）。过去1个月每个门诊平均接诊68人,其中二级医院最多,为97人;服务对象主要是门诊病人（81.82%）和医院工作人员（70.45%）;服务类型面谈辅导（100%）较高,而电话辅导（34.09%）较低;仅有9.09%的戒烟门诊能够提供药物治疗。共有12家医院（占27.27%）收费,其中只有1家医院可完全由医保支付。结论 戒烟门诊运行存在配置不全和政策支持不足等诸多困难,政府部门应出台相应的戒烟服务优惠政策,增加医务人员戒烟服务补贴,将戒烟药物纳入医保支付,开展综合性的戒烟干预方能有效提高戒烟门诊就诊率和戒烟成功率。     

泰安市实施结核病专科医院项目效果分析

目的分析评价泰安市实施山东省结核病专科医院项目效果,探索结核病专科医院在结核病防治规划中的地位和作用。方法资料来源于泰安市结核病防治院2009年7月1日²011年6月30日项目实施期间的结核病登记本、门诊及住院患者资料以及专科医院专报网络资料。所有资料录入并使用Excel2003软件进行汇总、统计分析。结果医院共登记肺结核患者771例,纳入项目管理的718例,纳入率93.13%。项目实施过程纳入项目管理的51例被排除在项目外,主要原因耐药(47.06%)和不良反应(39.22%)。实际接受治疗管理的共667例,管理率为92.90%,初治涂阳的232例,治愈率88.21%;复治涂阳的46例,治愈率86.96%;初治涂阴的358例。317例进行了培养与药敏试验,其中,耐1种及以上一线抗结核药物的69例,总体耐药率21.77%。结论实施结核病专科医院项目,规范了专科医院结核病的登记、报告、转诊,提高了肺结核患者发现和治疗依从性,发挥了结核病专科医院在结核病控制规划中的重要作用,值得在更大范围内推广。     

A study of environmental tobacco smoke in South Australian pubs, clubs and cafes

Exposure to Environmental Tobacco Smoke (ETS) in hotels and clubs is of community concern and may lead to a variety of adverse health outcomes for workers and patrons. This study sought to measure ETS in both smoking and non-smoking areas of hospitality venues in South Australia and to assess the effectiveness of ETS control measures. Seven hotels, clubs and cafes were investigated and the concentrations of airborne nicotine and particulate matter (PM(10)) were measured as markers of ETS exposure during normal to busy periods. Overall average concentrations were higher in smoking areas (nicotine = 15 microg/m(3) and PM(10) = 255microg/m(3)) compared with non-smoking dining areas (nicotine = 7 microg/m(3) and PM(10) = 192 microg/m(3)). The data demonstrate an approximate two-fold reduction of ETS within non-smoking areas and suggest that mechanical ventilation is only partially effective in preventing propagation of ETS throughout premises. Risk models suggest that ETS exposures in non-smoking areas may still represent an appreciable health risk. It is recommended that smoking be totally banned in enclosed publicly accessible areas.     

Efficacy of tobacco dependence treatment in the context of a "smoke-free grounds" worksite policy: a case study

BACKGROUND: Smoking restrictions provide opportunities to modify smoking behavior. A large insurance company implemented a smoke-free grounds policy at two of their office complexes in January, 2000. METHODS: This cohort study evaluated the impact of the smoke-free grounds policy on abstinence among 128 employees who participated in a tobacco dependence treatment program. RESULTS: The overall quit rate at 6 months was 44.5%. The larger complex showed a trend for higher quit rates compared to the smaller complex (46.5 vs. 28.6%). Post-ban participants had higher quit rates than pre-ban participants (52.4 vs. 43.0%). The probability of abstinence at 6 months follow-up was higher for post-ban compared to pre-ban participants (P = 0.03). Post-ban participants were 80% less likely to relapse than pre-ban participants. Non-quitters decreased their consumption by 6.6 cigarettes/day (39.1% decrease). CONCLUSIONS: A "smoke-free grounds" policy encourages abstinence and may play a significant role in harm reduction among continuing tobacco users.