Consequences of Incomplete Smoke-Free Legislation in the Republic of Korea: Results from Environmental and Biochemical Monitoring: Community Based Study

Environmental tobacco smoke at home and in public places prior to smoking ban enforcement: Assessment by hair analysis in a population of young adult students

Despite inititatives to reduce tobacco consumption, smoking remains a primary cause of death for both smokers and nonsmokers exposed to environmental tobacco smoke (ETS). The characteristics of some specific groups can make them more exposed to ETS or limit the benefit of prevention measures. This study investigated determinants of ETS in a population of young adult students, considered at higher risk of exposure due to their specific lifestyle. This cross-sectional study involved 90 students aged 20 ± 1.7 years, from the University of Luxembourg, prior to the smoking ban enforcement in public places in the country. Participants reported their tobacco consumption and exposure to ETS at home and/or in public places, and provided a hair sample analyzed for nicotine and cotinine. Nicotine and cotinine were significantly higher in smokers than in nonsmokers' hair in general (median: 2.6 vs. 0.9 ng/mg and 87.1 vs. 22.5 pg/mg respectively). However, nonsmokers exposed to ETS at home and in public places had comparable concentrations to smokers (nic = 2.2 ng/mg; cot = 56.2 pg/mg), whereas unexposed nonsmokers presented significantly lower values (nic = 0.4 ng/mg, cot = 8.5 pg/mg). Nonsmokers exposed to ETS only at home presented higher values than nonsmokers only exposed in public places (nic: 1.3 vs. 0.8 ng/mg, cot: 70.4 vs. 15.0 pg/mg). The study shows the widespread exposure to ETS in this population, the importance of exposure assessment, and the relevance of hair analysis for this purpose. Results suggest that ETS can lead to equivalent exposure to active smoking and that exposure at home can highly contribute to ETS, which is not solved by smoking ban in public places.

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.

Exposure to Secondhand Smoke: Inconsistency between Self-Response and Urine Cotinine Biomarker Based on Korean National Data during 2009-2018

This study aimed to estimate the secondhand smoke (SHS) exposure using urinary cotinine (UCo) to prove that the SHS exposure could not be properly assessed by self-reporting (SR). In total, 28,574 nonsmokers aged >19 years were selected from the Korean National Health and Nutrition Examination Survey data (2009-2018). First, changes in the annual concentration of UCo were analyzed, and the annual SHS exposure rates were measured based on SR and UCo from 2009 to 2018. Then, the average UCo concentration and UCo-measured SHS exposure rate were confirmed according to the subjects' characteristics. Finally, factors associated with the UCo-measured SHS exposure rate were identified based on multiple regression analysis. The findings showed that the annual UCo concentrations and self-reported SHS exposure rates dropped significantly over the past decade. In contrast, the UCo-measured SHS exposure rate indicated that >80% of nonsmokers are still exposed to SHS. Moreover, we found vulnerable groups using UCo-measured SHS exposure rate. In particular, the self-reported SHS exposure at home and in workplaces and house type was highly associated with SHS exposure. Thus, these findings indicate that the actual SHS exposure could not be properly assessed by SR and should be verified using a biomarker, such as UCo. Considering that even a short-term exposure can be harmful to health, the goal of the policy should be to keep cotinine concentration as low as possible.

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.

Towards smoke-free cars in the Republic of Korea: Evidence from environmental and biochemical monitoring of third-hand smoke exposure in taxis

INTRODUCTION

To evaluate the level of tobacco smoke exposure in taxis in Korea using tobacco specific environmental markers.

METHODS

From June to September 2012, cross-sectional measurements of air nicotine levels and dust nicotine-derived nitrosamine ketone (NNK) concentrations were conducted in 17 taxis in Goyang, Korea. Field investigators completed an observational questionnaire on building characteristics, smoking policies and evidence of smoking. Descriptive statistics including geometric means (GMs) ± standard deviations were produced for air nicotine levels and dust NNK concentrations.

RESULTS

There was no evidence of active smoking in the 17 taxis monitored, despite the fact that 10 drivers were current smokers. The overall GMs of air nicotine and dust NNK concentration were 0.42 μg/m3 and 6.78 pg/mg, respectively. These levels were 3.4-fold and 2.6-fold higher in taxis whose drivers were current smokers compared to the taxis of nonsmokers (GM of air nicotine: 0.65 μg/m3 vs 0.19 μg/m3; GM of dust NNK: 10.07 pg/mg vs 3.85 pg/mg).

CONCLUSIONS

The present study shows that air nicotine and dust NNK were detected in all taxis regardless of whether the taxi driver was smoking or not, which indicates the potential for exposure to SHS or THS. It suggests that an appreciable level of SHS and TSH exposure might occur if the environment is not completely smoke-free and enforcement is lacking.

ABBREVIATIONS

THS: third-hand smoke, SHS: second-hand smoke, FCTC: Framework Convention Alliance for Tobacco Control, NNK: 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, LOD: limit of detection, GM: geometric mean, GSD: geometric standard deviation.