Discrimination of smoking status by thiocyanate and cotinine in serum, and carbon monoxide in expired air.

To develop a procedure for maximizing the discrimination of smoking status, the authors analysed parallel samples of thiocyanate and cotinine in serum, and carbon monoxide (CO) in expired air in a cohort of 145 male subjects aged 45-65 years. The sensitivity and specificity were 93% and 82%, 97% and 83%, and 98% and 100% for thiocyanate, cotinine, and CO respectively. The results were not significantly improved when combining two or three methods as compared with CO separately. Also, cotinine in urine was analysed in a subgroup of 21 subjects. The correlation coefficient between cotinine in serum and urine was 0.92. In a subgroup of 44 subjects with extensive information on smoking habits, CO was the only indicator significantly related to the quantity of tobacco smoked. We conclude that CO seems sufficient for validating smoking status, but as atypical smokers who are vulnerable to misclassification may be overrepresented in smoking cessation programmes, combining two methods could still be useful. Validating the amount of tobacco smoked is of limited use with the current methods.     

Personal exposure to environmental tobacco smoke: salivary cotinine, airborne nicotine, and nonsmoker misclassification.

A large study was conducted to assess exposure to environmental tobacco smoke (ETS) in a geographically dispersed study population using personal breathing zone air sampling and salivary cotinine levels. Approximately 100 self-reported nonsmoking subjects in each of 16 metropolitan areas were recruited for this investigation. Cumulative distributions of salivary cotinine levels for subjects in smoking and nonsmoking homes and workplaces exhibited a general trend of decreasing salivary cotinine levels with decreasing time spent in smoking environments. Median salivary cotinine levels for the four experimental cells in the study (product of smoking and nonsmoking home and workplaces) were comparable to those reported for a large national study of serum levels of cotinine (Third National Health and Nutrition Examination Survey, NHANES III), when the latter was corrected for expected differences between serum and saliva concentrations. However, the most highly exposed group in this study had a median salivary cotinine concentration approximately a factor of 2 greater than that of the comparable group in the NHANES III study. Misclassification rates, both simple (for self-reported nonsmokers) and complex (self-reported lifetime never smokers), were near the median of those reported for other studies. Estimated misclassification rates for self-reported lifetime never-smoking females are sufficiently high (2.95% using a discrimination level of 106 ng/ml) that, if used in the Environmental Protection Agency (EPA) risk assessment related to ETS and lung cancer, would place the lower 90% confidence interval (CI) for relative risk at nearly 1.00, i.e., no statistically significant increased risk. For the 263 most highly exposed subjects in the study whose self-reported nonsmoking status was accurate, the correlation between airborne exposure to nicotine and average salivary cotinine is so small, on an individual basis, that it makes the relationship useless for estimating exposure on a quantitative basis. When subjects are grouped according to likely categories of nicotine exposure, correlation between group median airborne nicotine exposure and salivary cotinine level increases dramatically. The comparison improves for the most highly exposed subjects, suggesting that such quantitative comparisons are useful for only those subjects who are exposed to the higher levels of ETS. However, airborne nicotine exposure for most of the subjects does not account for estimated systemic levels of nicotine, based on salivary cotinine levels.     

Serum cotinine as a marker of environmental tobacco smoke exposure in epidemiological studies: the experience of the MATISS project

To describe serum cotinine levels in a rural Italian population and to examine its usefulness as an epidemiologic biomarker of nicotine exposure, cross-sectional data collected in 1993 for the MATISS Project (2098 men and 1352 women, aged 20–79 years) were used. The study population consisted of 977 current smokers, 882 nonsmokers reporting exposure to environmental tobacco smoke (ETS) and 1520 nonsmokers reporting no ETS exposure. Mean values of serum cotinine measured by radioimmunoassay for never smokers, ex-smokers and current smokers (including four categories of cigarette consumption), and for categories of ETS exposure in all nonsmokers were calculated. In univariate analysis, there was a positive association between self-reported nicotine exposure and serum cotinine levels in all groups. Using self-reported status as truth, sensitivity and specificity for various cotinine cutoff points were estimated to distinguish nonsmokers from smokers. The value of 15 ng/mL represented the best combined levels of sensitivity (95%) and specificity (96%). Using this cutoff point, the overall misclassification rate for self-reported nonsmokers was 2.1% and about two times greater for the more vs. the less educated. In multivariate analysis, reported ETS exposure among nonsmokers was significantly associated with serum cotinine even after adjusting for age, socio-demographic and behavioural factors, though the strength of the association was not strong. In conclusion, serum cotinine represents a reliable epidemiological marker of nicotine intake and may be helpful when studying ETS exposure. Improved information collection is needed to reduce misclassification among nonsmokers and enhance our understanding of the relationship between ETS and cotinine measures.     

Cooking smoke and tobacco smoke as risk factors for stillbirth

Smoke from biomass combustion produces some of the same pollutants found in tobacco smoke and ambient air, yet only one study to date has linked cooking with biomass fuels to increased risk of stillbirth. The mechanisms by which biomass smoke may cause stillbirth are through exposure to CO and particulates in biomass smoke. Using information on 19,189 ever-married women aged 40-49 included in India's 1998-99 National Family Health Survey, we examined the association between household use of biomass fuels (wood, dung, and crop residues), tobacco smoke (both active and passive), and risk of stillbirth. Data were analyzed using binary and multinomial logistic regression after controlling for several potentially confounding factors. Results indicate that, with other factors controlled, women who cook with biomass fuels are significantly more likely to have experienced a stillbirth than those who cook with cleaner fuels (OR= 1.44; 95% CI: 1.04, 1.97). Women who cook with biofuels are twice as likely to have experienced two or more stillbirths as those who cook with cleaner fuels (RRR= 2.01; 95% CI: 1.11, 3.62). The adjusted effect of active tobacco smoking is also positive (OR = 1.23) but not statistically significant. No effect of passive smoking was found, nor was there evidence of any modifying effects of tobacco smoking.     

Passive smoking at work: biochemical and biological measures of exposure to environmental tobacco smoke

Summary Several biochemical and biological measures of tobacco smoke intake were used to evaluate exposure of restaurant personnel to environmental tobacco smoke as compared with active smokers and non-exposed non-smokers. All of the measured parameters — carboxyhaemoglobin (COHb), thiocyanate (SCN) and cotinine in plasma, cotinine and mutagenicity in urine, total white blood cell count (WBC), and sister chromatid exchange (SCE) frequency in cultured lymphocytes — were significantly elevated in the smoker group (n = 22) compared to the non-exposed group (n = 20). Work-related passive exposure (n = 27) was seen most clearly in the cotinine values, both from plasma (mean P-cot in passive smokers 10 ng/ml vs 5.2 ng/ml in non-exposed) and from urine (mean U-cot in passive smokers 56 ng/ml vs 8.3 ng/ml in non-exposed), but significant increases were also seen in the thiocyanate levels (mean P-SNC in passive smokers 58 mol/1 vs 46 mol/1 in non-exposed) and, as a preliminary finding, in total leucocyte count (in passive smokers 8.0 × 10⁹/1 vs 6.8 x 10⁹/1 in non-exposed). The results demonstrate that environmental tobacco smoke may be an occupational health hazard.     

Is exposure to secondhand smoke associated with cognitive parameters of children and adolescents?-a systematic literature review

PurposeDespite the known association of second hand smoke (SHS) with increased risk of ill health and mortality, the effects of SHS exposure on cognitive functioning in children and adolescents are unclear. Through a critical review of the literature we sought to determine whether a relationship exists between these variables.MethodsThe authors systematically reviewed articles (dated 1989-2012) that investigated the association between SHS exposure (including in utero due to SHS exposure by pregnant women) and performance on neurocognitive and academic tests. Eligible studies were identified from searches of Web of Knowledge, MEDLINE, Science Direct, Google Scholar, CINAHL, EMBASE, Zetoc, and Clinicaltrials.gov.ResultsFifteen articles were identified, of which 12 showed inverse relationships between SHS and cognitive parameters. Prenatal SHS exposure was inversely associated with neurodevelopmental outcomes in young children, whereas postnatal SHS exposure was associated with poor academic achievement and neurocognitive performance in older children and adolescents. Furthermore, SHS exposure was associated with an increased risk of neurodevelopmental delay.ConclusionsRecommendations should be made to the public to avoid sources of SHS and future research should investigate interactions between SHS exposure and other risk factors for delayed neurodevelopment and poor cognitive performance.     

Yields of tar, nicotine, and carbon monoxide in the sidestream smoke from 15 brands of Canadian cigarettes

Sidestream smoke yields for 15 brands of cigarettes were determined under conditions where mainstream yields were approximately equal to those used for determining the values which appear on packages of Canadian cigarettes. Sidestream yields of tar, nicotine, and carbon monoxide were much higher than mainstream yields for all brands tested. The average sidestream-to-mainstream ratios for the 15 brands were 3.5, 6.6, and 6.8 for tar, nicotine, and carbon monoxide, respectively. The highest yields of sidestream were obtained from the brands with the lowest mainstream yields.     

Association between tobacco smoke exposure and levels of C-reactive protein in the Oslo II Study

It is well known that tobacco smoke exposure is related to the risk of developing cardiovascular diseases and events. One mechanism could be that tobacco smoke acts on the cardiovascular system by altering the autonomic function and/or inducing inflammatory responses. We used data from 3 744 men aged 67–77 years from the city of Oslo that participated in the health screening for the Oslo II Health Study in 2000, to explore associations between C-reactive protein and environmental exposures including exposure to tobacco smoke products. Levels of C-reactive protein were higher in current smokers (2.05 mg/l, IQR, 1.11–4.17 mg/l), compared to former-smokers (1.58 mg/l, IQR, 0.83–3.03 mg/l) and non-smokers (1.26 mg/l, IQR, 0.65–2.40 mg/l). The risk of elevated C-reactive protein increased with both numbers of current cigarettes smoked per day and numbers of pack-years of smoking, when other factors were adjusted for (P < 0.001). We found a positive dose–response relationship between amount of current cigarette smoking and elevated C-reactive protein levels. These findings support the idea that the induction or exacerbation of inflammation could be a mechanism by which smoking promotes atherosclerotic cardiovascular diseases.     

Human blood concentrations of cotinine, a biomonitoring marker for tobacco smoke, extrapolated from nicotine metabolism in rats and humans and physiologically based pharmacokinetic modeling

The present study defined a simplified physiologically based pharmacokinetic (PBPK) model for nicotine and its primary metabolite cotinine in humans, based on metabolic parameters determined in vitro using relevant liver microsomes, coefficients derived in silico, physiological parameters derived from the literature, and an established rat PBPK model. The model consists of an absorption compartment, a metabolizing compartment, and a central compartment for nicotine and three equivalent compartments for cotinine. Evaluation of a rat model was performed by making comparisons with predicted concentrations in blood and in vivo experimental pharmacokinetic values obtained from rats after oral treatment with nicotine (1.0 mg/kg, a no-observed-adverseeffect level) for 14 days. Elimination rates of nicotine in vitro were established from data from rat liver microsomes and from human pooled liver microsomes. Human biomonitoring data (17 ng nicotine and 150 ng cotinine per mL plasma 1 h after smoking) from pooled five male Japanese smokers (daily intake of 43 mg nicotine by smoking) revealed that these blood concentrations could be calculated using a human PBPK model. These results indicate that a simplified PBPK model for nicotine/cotinine is useful for a forward dosimetry approach in humans and for estimating blood concentrations of other related compounds resulting from exposure to low chemical doses.     

Expired air carbon monoxide and serum thiocyanate as objective measures of cigarette exposure.

Expired air carbon monoxide (CO) and serum thiocyanate (SCN) were used to asses exposure to cigarettes in 139 middle-aged men. Subjects who reported smoking cigarettes generally had CO levels exceeding 8ppm and SCN levels exceeding 100umol/L; non-smokers had lower levels. For both tests the mean concentration among men smoking more than one pack daily was three times that of non-smokers. The is a high correlation between the two tests (r=.571 for smokers), an association that was largely independent of the smaller correlations between either test and reported smoking frequency (r=.476 for CO; r=.479 for SCN). The ability to distinguish between individuals who reported "typical" smoking habits and non-smokers was best when the CO and SCN analyses were used together to take advantage of their separate sources of variance; it was 99 per cent when the two tests were mutually concordant (91 per cent of cases). The CO and SCN measurements allowed 16 individuals who reported light smoking habits to be categorized into high and low presumptive tobacco exposure groups. The two tests are inexpensive and suitable for use in epidemiologic and health care delivery programs.     

结核病人吸烟状况调查研究

目的了解中国结核病人中吸烟的情况以及吸烟的态度和行为状况,对制定综合性控烟及结核病控制措施提供参考依据。方法随机抽取浙江、河南、吉林3个省的937例结核病人,采用横断面研究方法进行调查。结果结核病人中,男性吸烟率为79.00%,女性吸烟率为15.58%,在男性病人中,50岁组的既往吸烟率最高,为92.06%,其次是40岁年龄组,为88.81%;在女性病人中,70岁年龄组的既往吸烟率最高,为31.25%。男性病人中,下岗人员的既往吸烟率最高,为87.50%;在女性中,农民既往吸烟率最高,为26.21%。平均开始吸烟的年龄为21.33岁,最早开始吸烟的年龄为8岁,最晚开始吸烟的年龄为51岁。36.50%的吸烟者每天吸烟在10～20支之间,35.02%的吸烟者吸烟量少于10支,85.80%的结核病人认为吸烟可以提神,84.48%的人同意吸烟有害健康,45.25%的人没有戒过烟,39.41%的人曾经戒过1～2次烟,15.31%的人有过3次以上戒烟史。结论结核病人中人群既往吸烟率明显高于一般人群,应加强结核病人控烟宣传,制定结核病控制与控烟策略相结合的综合性措施,在结核病防治机构实施。     

Urinary nicotine and its metabolites as a biomarker of exposure to environmental tobacco smoke

The validity of urinary nicotine and its metabolites as a biomarker of exposure to environmental tobacco smoke (ETS) has been investigated. After exposure to ETS, urine samples were collected from 10 subjects for the analyses of nicotine, cotinine and 3'-hydroxycotinine. The former two chemicals were detected in the urine of all subjects, and 3'-hydroxycotinine was detected in the urine of 9 subjects out of 10, indicating these three chemicals can be used as a biomarker of ETS exposure. 3'-Hydroxycotinine was not detected in the urine of one subject, suggesting that this subject may be a poor metabolizer of nicotine. In 9 subjects with 3'-hydroxycotinine excreted, the amounts of nicotine and cotinine started to increase after exposure, reached the peak at the end of the second exposure and decreased gradually. 3'-Hydroxycotinine started to be excreted into urine from 3 hours after exposure and kept the same level until 72 hours after exposure. In the urine of 72 hours after exposure, the amount of 3'-hydroxycotinine was the highest among these three chemicals.     

Bladder cancer, tobacco smoking, coffee and alcohol drinking in Brescia, northern Italy

The association between tobacco smoking, the consumption of coffee and alcohol and bladder cancer was investigated in a hospital-based case-control study in Brescia, northern Italy. A total of 172 incident cases (135 men and 37 women) and 578 controls (398 men and 180 women) were enrolled. As expected, cigarette smoking was strongly associated with bladder cancer. The odds ratios (OR) for coffee drinking adjusted for age, education, residence and cigarette smoking in current drinkers were 2.6 (95% confidence interval, CI: 1.1–6.1) in men and 5.2 (95% CI: 1.0–30.4) in women. A dose-response relationship was found in men, with the highest risk in the highest category of exposure: drinkers of more than 5 cups per day had an OR of 4.5 (95% CI: 1.2–16.8). The ORs for current alcohol drinkers were 2.1 (95% CI: 1.0–4.8) in men and 3.4 (95% CI: 1.2–9.7) in women; according to grams of ethanol drunk per day (grams/day, g/d) the ORs were: 1.7 (1–20 g/d), 1.6 (21–40 g/d), 4.3 (41–60 g/d) and 4.6 (61+ g/d) in men and 3.1 (1–20 g/d) and 3.9 (21+ g/d) in women. These results suggest that regular consumption of both coffee and alcohol can be independently associated with an increased bladder cancer risk.     

控烟条例实施1年对北京市15岁及以上人群二手烟暴露情况的影响

目的 监测北京市≥ 15岁人群在公共场所、工作场所、公共交通工具和家庭的二手烟暴露情况,评价《北京市控制吸烟条例》实施效果。方法 数据源于2014年和2016年北京市成人烟草调查。两次调查均覆盖北京市16个区。每次调查均采用多阶段整群概率抽样法,采用面对面询问调查方式,应用电子化问卷收集相关数据。2014年和2016年分别获得100个监测点的有效个人问卷8 484份和9 372份。采用SPSS 20.0软件和R 3.4.4软件对样本进行复杂抽样加权后,估计≥ 15岁人群在各类场所中的二手烟暴露率,并进行χ²检验。结果 北京市≥ 15岁人群在医疗机构、政府大楼、大学、中小学校（室内外）和餐馆的二手烟暴露率分别由2014年的12.8%、19.7%、24.3%、32.8%和65.7%下降到2016年的6.2%、10.8%、12.5%、19.1%和32.5%;酒吧/夜总会的二手烟暴露率分别为89.5%和80.3%;室内工作场所的二手烟暴露率从35.7%下降到20.0%;公共交通工具的二手烟暴露率由3.9%下降到2.5%;家庭二手烟暴露率分别为39.8%和37.6%。结论 《北京市控制吸烟条例》规定的禁止吸烟场所中二手烟暴露率明显下降,实施的效果已经显现。     

Smoking cessation program: baseline carbon monoxide and serum thiocyanate levels as predictors of outcome

One hundred and sixty-two smokers who participated in an aggressive smoking cessation program underwent analysis of expired air carbon monoxide (CO) and serum thiocyanate (SCN) at entry and one year later. Persons who failed to quit smoking had higher baseline CO and SCN and smoked more cigarettes per day than did those who succeeded in quitting. The use of CO, SCN, number of cigarettes smoked, age, and blood pressure at baseline permitted accurate classification of over 70 per cent of the subjects into groups which would succeed and fail in their effort to quit smoking. Persons who failed to quit reduced the reported number of cigaretts smoked per day by one-third, but there was no corresponding reduction in CO and SCN, suggesting that self-reporting of a reduction in the number of cigarettes smoked may not lead to a corresponding decline in exposure.     

The global tobacco disease pandemic: Nature,causes, and cures

Abstract

Tobacco use kills 5 million citizens globaly every year. The World Health Organization (WHO) projects that the number of deaths will double just 15 years from now. Tobacco will then constitute the leading cause of death in the developing world, as it already is in developed countries today. This paper describes the nature and extent of the tobacco pandemic, characteristics of the global tobacco industry, and national and international efforts to diminish the toll of tobacco. The review includes examination of the economic and political strategies employed by the multinational tobacco industry to increase cigarette consumption, as well as the policies that governments have adopted to combat smoking. The most promising development is the new Framework Convention on Tobacco Control, WHO's first-ever international health treaty. While aggressive tobacco control policies can and will diminish the toll of tobacco, the prospects for the foreseeable future appear grim.     

Tar, nicotine, and carbon monoxide yields of some Nigerian cigarettes.

Fourteen cigarette brands manufactured in Nigeria in 1981 were analysed to determine the tar, nicotine, and carbon monoxide yields. Five of the brands belonged to the high and middle to high tar category (greater than 22 mg/cigarette) and nine to the middle tar (17-22 mg/cigarette) category. None of the cigarettes was in the low to middle and low tar (less than 17 mg/cigarette) category. The nicotine and carbon monoxide yields were similar to those of European cigarettes. Tobacco companies need to manufacture low tar cigarettes in the Third World as is the practice in the economically developed parts of the world.     

湖北省武汉市餐馆/酒吧顾客吸烟现状及对公共场所控烟知识态度调查

目的了解武汉市餐馆/酒吧顾客吸烟现状以及对吸烟的危害和控烟政策的态度。方法在武汉市城区选取2个餐馆/酒吧较为集中的区,每个区随机抽取40家餐馆/酒吧进行调查。采取拦截问卷调查的方式,对每个餐馆/酒吧的顾客进行调查,最终参加问卷调查的共计65个餐馆和15个酒吧的496名顾客。结果居民现在吸烟率为39.3%,男性吸烟率为61.1%,显著高于女性吸烟率为7.0%。支持在公共场所全部禁烟的比例由高到低分别为:学校(85.5%),医院(85.3%),公共交通工具(82.9%),办公室(55.6%),餐馆(28.6%),酒吧(21%)。结论武汉市公共场所禁烟现状不容乐观,加大吸烟和被动吸烟危害的宣传教育,营造全面无烟环境的氛围。     

《天津市控制吸烟条例》实施十周年控烟监测结果分析

目的评估《天津市控制吸烟条例》实施10周年后各类公共场所的实施效果, 调查人群的烟草暴露和危害认知情况, 为控烟政策和措施的落实提供依据。方法数据源于2012和2021年天津市控烟调查。调查采用现场观察法记录天津市各类公共场所内各项控烟措施的落实情况, 并采用拦截面对面调查方式收集天津市≥15岁常住居民二手烟暴露和烟草相关知识数据。结果 2012-2021年天津市医疗卫生机构禁烟标志张贴率处于较高水平(100.0%), 教育机构、政府办公机构上升至100.0%, 出租车下降幅度较大。医疗卫生机构、公共交通等候场所、互联网上网服务营业场所、公交车的控烟宣传资料摆放率下降, 其他场所均上升。除出租车外, 其他调查场所在观察期间发现有人吸烟的现象均下降。非吸烟人群公共场所和工作场所的二手烟暴露率从43.2%下降至26.6%。公众对吸烟导致中风的知晓率上升11.3%、导致心脏病、肺癌的知晓率分别下降7.7%和7.2%;二手烟导致成年人心脏病、儿童肺部疾病、成年人肺癌的知晓率分别下降21.8%、22.1%、9.1%。结论《天津市控制吸烟条例》实施以来, 二手烟暴露情况得到改善, 但禁烟场所的环境...