Assessment of passive human exposure to tobacco smoke by environmental and biological monitoring in different public places in Wuhan, central China

Passive exposure to tobacco smoke is a global public health problem, while there are few data on public place monitoring and general population exposure assessment in central China. This study aimed to examine the levels of airborne nicotine (n = 256) in ten kinds of different public places in Wuhan, central China, and assess short-term and long-term smoke exposure in 340 non-smokers aged 18-67 who worked in these public places using tobacco biomarkers [i.e., cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), respectively]. The highest median concentration of airborne nicotine (17.0 μg/m³) was observed in internet cafes, approximately 304-fold of the lowest value found in nurseries (55.9 ng/m³). Among the other studied public places, restaurants had the highest median concentrations (ng/m³) of airborne nicotine (3,120), followed by subway stations (810), hotels (624), government officess (286), middle schools (269), health institutions (268), public institutions (190), and primary schools (140). Urinary cotinine and NNAL were found in almost all the participants, and the highest concentrations were found in non-smokers from the internet cafes [specific gravity (SG)-corrected urinary median concentrations: 23.1 ng/mL, geometric mean (GM): 24.1 ng/mL, range: 0.62-1679 ng/mL] for cotinine and 104 pg/mL (GM: 97.6 pg/mL, range: 32.3-236 pg/mL) for NNAL, respectively]. Urinary cotinine concentrations in male non-smokers (median: 2.02 ng/mL) were significantly higher than those in female non-smokers (1.44) (P < 0.01). Participants aged 18-27 were detected with the highest urinary cotinine and NNAL concentrations. Urinary cotinine and NNAL concentrations were significantly correlated with daily and monthly working hours, respectively. Besides, a positive correlation was observed between log-transformed urinary concentrations of cotinine and NNAL (r = 0.32, P < 0.001). This is the first time to report matched data on airborne nicotine and urinary cotinine/NNAL among employees in different public places. This study demonstrated ubiquitous exposure to environmental tobacco smoke in the studied public places.

Evaluation of Secondhand Smoke Using PM2.5 and Observations in a Random Stratified Sample in Hospitality Venues from 12 Cities

Background: Turkey passed a law banning smoking in all indoor public places in 2008. In response to the indoor smoking restriction, many smokers may have relocated to outdoor areas of venues. The aim of this study was to evaluate air pollution related to SHS exposure in indoor and outdoor areas of hospitality venues in 12 cities in Turkey. Method: In this cross-sectional study, we evaluated hospitality venues in 12 cities in Turkey. In each visited venue, we evaluated a pre-specified number of study locations such as the outdoor area of the main entrance, indoor areas, and patios or other outdoor dining areas, completely or partially covered with window walls. We measured particulate matter 2.5 (PM2.5) in those areas. Results: The fieldworkers visited 72 randomly selected hospitality venues and measured PM2.5 concentrations in 165 different locations (indoor, outdoor, and patios) of those venues. Overall, 2573 people were observed, 909 of them smoking. The median (IQR) PM2.5 concentrations were 95 (39–229) μg/m³ indoors, 25 (13–48) μg/m³ outdoors, and 31 μg/m³ (16–62) in the patios (p < 0.001). After adjustment, each additional smoker was associated with a 2% increase in PM2.5 concentrations in patio air (GMR (95% CI): 1.02 (1.00, 1.05), and a 4% increase in indoor air (GMR (95% CI): 1.04 (1.02, 1.05). Conclusions: There were unhealthy levels of smoking-caused PM2.5 concentrations, not only indoors, but also in the patios of hospitality venues. Legislative efforts to expand the smoke-free legislation to outdoor areas adjacent to indoor public places and an action plan to increase compliance with the smoke-free policy are urgently needed in Turkey.

Biomarkers of Exposure to Secondhand and Thirdhand Tobacco Smoke: Recent Advances and Future Perspectives

Smoking is the leading preventable disease worldwide and passive smoking is estimated to be the cause of about 1.0% of worldwide mortality. The determination of tobacco smoke biomarkers in human biological matrices is key to assess the health effects related to the exposure to environmental tobacco smoke. The biomonitoring of cotinine, the main nicotine metabolite, in human biofluids-including urine, serum or saliva-has been extensively used to assess this exposure. However, the simultaneous determination of cotinine together with other tobacco biomarkers and the selection of alternative biological matrices, such as hair, skin or exhaled breath, would enable a better characterization of the kind and extent of tobacco exposure. This review aims to perform a critical analysis of the up-to-date literature focused on the simultaneous determination of multiple tobacco smoke biomarkers studied in different biological matrices, due to the exposure to secondhand smoke (SHS) and thirdhand smoke (THS). Target biomarkers included both tobacco-specific biomarkers-nicotine and tobacco specific nitrosamine biomarkers-and tobacco-related biomarkers, such as those from polycyclic aromatic hydrocarbons, volatile organic compounds, metals and carbon monoxide. To conclude, we discuss the suitability of determining multiple biomarkers through several relevant examples of SHS and THS exposure.

Firm strategy and consumer behaviour under a complex tobacco tax system: implications for the effectiveness of taxation on tobacco control

BACKGROUND

The current tobacco taxation scheme in Turkey, a mix of high ad valorem tax and low specific tax, contains incentives for firms and consumers to change pricing and consumption patterns, respectively. The association between tax structure and price and tax revenue stability has not been studied in detail with micro data containing price segment information.

OBJECTIVES

In this study, we analyse whether incentives for firms and consumers undermine the effectiveness of tax policy in reducing consumption.

METHODS

We calculate alternative taxation scheme outcomes using differing ad valorem and specific tax rates through simulation analysis. We also estimate price elasticity of demand using detailed price and volume statistics between segments via regression analysis.

FINDINGS

A very high ad valorem rate provides strong incentives to firms to reduce prices. Therefore, this sort of tax strategy may induce even more consumption despite its initial aim of discouraging consumption. While higher prices dramatically reduce consumption of economy and medium price segment cigarettes, demand for premium segment cigarettes is found to be highly price-inelastic.

CONCLUSIONS

The current tax scheme, based on both ad valorem and specific components, introduces various incentives to firms as well as to consumers which reduce the effectiveness of the tax policy. Therefore, on the basis of our theoretical predictions, an appropriate tax scheme should involve a balanced combination of ad valorem and specific rates, away from extreme (ad valorem or specific dominant) cases to enhance the effectiveness of tax policy for curbing consumption.