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Moon KA, Rule AM, Magid HS, Ferguson JM, Susan J, Sun Z, Torrey C, Abubaker S, Levshin V, Çarkoglu A, Radwan GN, El-Rabbat M, Cohen JE, Strickland P, Breysse PN, Navas-Acien A. Biomarkers of Secondhand Smoke Exposure in Waterpipe Tobacco Venue Employees in Istanbul, Moscow, and Cairo. Nicotine Tob Res 2019; 20:482-491. [PMID: 28582531 DOI: 10.1093/ntr/ntx125] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 05/30/2017] [Indexed: 11/12/2022]
Abstract
Background Most smoke-free legislation to reduce secondhand smoke (SHS) exposure exempts waterpipe (hookah) smoking venues. Few studies have examined SHS exposure in waterpipe venues and their employees. Methods We surveyed 276 employees of 46 waterpipe tobacco venues in Istanbul, Moscow, and Cairo. We interviewed venue managers and employees and collected biological samples from employees to measure exhaled carbon monoxide (CO), hair nicotine, saliva cotinine, urine cotinine, urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and urine 1-hydroxypyrene glucuronide (1-OHPG). We estimated adjusted geometric mean ratios (GMR) of each SHS biomarker by employee characteristics and indoor air SHS measures. Results There were 73 nonsmoking employees and 203 current smokers of cigarettes or waterpipe. In nonsmokers, the median (interquartile) range concentrations of SHS biomarkers were 1.1 (0.2, 40.9) µg/g creatinine urine cotinine, 5.5 (2, 15) ng/mL saliva cotinine, 0.95 (0.36, 5.02) ng/mg hair nicotine, 1.48 (0.98, 3.97) pg/mg creatinine urine NNAL, 0.54 (0.25, 0.97) pmol/mg creatinine urine 1-OHPG, and 1.67 (1.33, 2.33) ppm exhaled CO. An 8-hour increase in work hours was associated with higher urine cotinine (GMR: 1.68, 95% CI: 1.20, 2.37) and hair nicotine (GMR: 1.22, 95% CI: 1.05, 1.43). Lighting waterpipes was associated with higher saliva cotinine (GMR: 2.83, 95% CI: 1.05, 7.62). Conclusions Nonsmoking employees of waterpipe tobacco venues were exposed to high levels of SHS, including measurable levels of carcinogenic biomarkers (tobacco-specific nitrosamines and PAHs). Implications Smoke-free regulation should be extended to waterpipe venues to protect nonsmoking employees and patrons from the adverse health effects of SHS.
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Affiliation(s)
- Katherine A Moon
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Hoda S Magid
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jacqueline M Ferguson
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jolie Susan
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Zhuolu Sun
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Christine Torrey
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Salahaddin Abubaker
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Asli Çarkoglu
- Department of Psychology, Kadir Has University, Istanbul, Turkey
| | - Ghada Nasr Radwan
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha El-Rabbat
- Department of Psychology, Kadir Has University, Istanbul, Turkey
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Paul Strickland
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Patrick N Breysse
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
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Kaplan B, Sussan T, Rule A, Moon K, Grau-Perez M, Olmedo P, Chen R, Carkoglu A, Levshin V, Wang L, Watson C, Blount B, Calafat AM, Jarrett J, Caldwell K, Wang Y, Breysse P, Strickland P, Cohen J, Biswal S, Navas-Acien A. Waterpipe tobacco smoke: Characterization of toxicants and exposure biomarkers in a cross-sectional study of waterpipe employees. Environ Int 2019; 127:495-502. [PMID: 30981020 PMCID: PMC6513716 DOI: 10.1016/j.envint.2019.03.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Few studies have comprehensively characterized toxic chemicals related to waterpipe use and secondhand waterpipe exposure. This cross-sectional study investigated biomarkers of toxicants associated with waterpipe use and passive waterpipe exposure among employees at waterpipe venues. METHOD We collected urine specimens from employees in waterpipe venues from Istanbul, Turkey and Moscow, Russia, and identified waterpipe and cigarette smoking status based on self-report. The final sample included 110 employees. Biomarkers of exposure to sixty chemicals (metals, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), nicotine, and heterocyclic aromatic amines (HCAAs)) were quantified in the participants' urine. RESULTS Participants who reported using waterpipe had higher urinary manganese (geometric mean ratio (GMR): 2.42, 95% confidence interval (CI): 1.16, 5.07) than never/former waterpipe or cigarette smokers. Being exposed to more hours of secondhand smoke from waterpipes was associated with higher concentrations of cobalt (GMR: 1.38, 95% CI: 1.10, 1.75). Participants involved in lighting waterpipes had higher urinary cobalt (GMR: 1.43, 95% CI: 1.10, 1.86), cesium (GMR: 1.21, 95% CI: 1.00, 1.48), molybdenum (GMR: 1.45, 95% CI: 1.08, 1.93), 1-hydroxypyrene (GMR: 1.36, 95% CI: 1.03, 1.80), and several VOC metabolites. CONCLUSION Waterpipe tobacco users and nonsmoking employees of waterpipe venues had higher urinary concentrations of several toxic metals including manganese and cobalt as well as of VOCs, in a distinct signature compared to cigarette smoke. Employees involved in lighting waterpipes may have higher exposure to multiple toxic chemicals compared to other employees.
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Affiliation(s)
- Bekir Kaplan
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, United States of America.
| | - Thomas Sussan
- U.S. Army Public Health Center, Toxicology Directorate, United States of America
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Katherine Moon
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Maria Grau-Perez
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, United States of America
| | - Pablo Olmedo
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, United States of America; Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, Granada, Spain
| | - Rui Chen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Asli Carkoglu
- Department of Psychology, Kadir Has University, Istanbul, Turkey
| | | | - Lanqing Wang
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Clifford Watson
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Benjamin Blount
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Jeffery Jarrett
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Kathleen Caldwell
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Yuesong Wang
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Pattrick Breysse
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Paul Strickland
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Joanna Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Shyam Biswal
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, United States of America
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Levshin V, Slepchenko N. Determinants of smoking cessation and abstinence in a Russian smoking-cessation center. Tob Prev Cessat 2017; 3:124. [PMID: 32432198 PMCID: PMC7232794 DOI: 10.18332/tpc/76623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/07/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoking prevalence in Russia is one of the highest in the world. It leads to significant damage to the National Health Service. The purpose of the present research was to assess the effectiveness of a qualified smoking-cessation (SC) center in Moscow, and to identify the main determinants of smoking cessation. METHODS The subjects of this study were a cohort of smokers (n=524) who had attended the SC service in Moscow between 2012-2015. They were followed, for at least 6 months after receiving the professional counselling in smoking cessation, to assess the results of the assistance and to identify determinants of successful smoking cessation. RESULTS Of the smokers, 19% succeeded in reducing by more than half the number of smoked cigarettes, more than 46% of patients completely stopped smoking for different terms: 38% for more than a month and 24% for more than half a year. Odds ratios (ORs) indicated that the probability of successful smoking cessation significantly increased if there was a previous success in smoking cessation: OR 3.71 (95% CI 1.70-8.12); and if there was a high level of motivation to stop smoking OR 4.3 (95% CI 1.92-5.61). The probability of successful smoking cessation decreased with intensity of smoking > 10 cigarettes a day: OR 0.57 (95% CI 0.31-1.02); and an elevated (>7 points) Fagerström-test score OR 0.64 (95% CI 0.37-1.07). CONCLUSIONS Degree of motivation and willingness to quit smoking were the principal determinants of the effectiveness in the attempt to quit smoking within our study cohort.
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Moon KA, Magid H, Torrey C, Rule AM, Ferguson J, Susan J, Sun Z, Abubaker S, Levshin V, Çarkoğlu A, Radwan GN, El-Rabbat M, Cohen J, Strickland P, Navas-Acien A, Breysse PN. Secondhand smoke in waterpipe tobacco venues in Istanbul, Moscow, and Cairo. Environ Res 2015; 142:568-74. [PMID: 26298558 PMCID: PMC4609287 DOI: 10.1016/j.envres.2015.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The prevalence of waterpipe tobacco smoking has risen in recent decades. Controlled studies suggest that waterpipe secondhand smoke (SHS) contains similar or greater quantities of toxicants than cigarette SHS, which causes significant morbidity and mortality. Few studies have examined SHS from waterpipe tobacco in real-world settings. The purpose of this study was to quantify SHS exposure levels and describe the characteristics of waterpipe tobacco venues. METHODS In 2012-2014, we conducted cross-sectional surveys of 46 waterpipe tobacco venues (9 in Istanbul, 17 in Moscow, and 20 in Cairo). We administered venue questionnaires, conducted venue observations, and sampled indoor air particulate matter (PM2.5) (N=35), carbon monoxide (CO) (N=23), particle-bound polycyclic aromatic hydrocarbons (p-PAHs) (N=31), 4-methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (N=43), and air nicotine (N=46). RESULTS Venue characteristics and SHS concentrations were highly variable within and between cities. Overall, we observed a mean (standard deviation (SD)) of 5 (5) waterpipe smokers and 5 (3) cigarette smokers per venue. The overall median (25th percentile, 75th percentile) of venue mean air concentrations was 136 (82, 213) µg/m(3) for PM2.5, 3.9 (1.7, 22) ppm for CO, 68 (33, 121) ng/m(3) for p-PAHs, 1.0 (0.5, 1.9) ng/m(3) for NNK, and 5.3 (0.7, 14) µg/m(3) for nicotine. PM2.5, CO, and p-PAHs concentrations were generally higher in venues with more waterpipe smokers and cigarette smokers, although associations were not statistically significant. CONCLUSION High concentrations of SHS constituents known to cause health effects indicate that indoor air quality in waterpipe tobacco venues may adversely affect the health of employees and customers.
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Affiliation(s)
- Katherine A Moon
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Hoda Magid
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Torrey
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana M Rule
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacqueline Ferguson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jolie Susan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zhuolu Sun
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Salahaddin Abubaker
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Joanna Cohen
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul Strickland
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Navas-Acien
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patrick N Breysse
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
The retroprospective study of breast cancer in relation to benign breast lesions (BBL) involved an analysis of the breast cancer incidence in a cohort of women with a history of BBL. This cohort was formed on the basis of histological and cytological investigations performed during 1982-1991. A total of 10,776 cases with BBI were recorded, followed-up and analyzed. The total person-years of follow-up was 60,872. A total of 35 women with breast cancer were detected during the study. Cohort members with a BBL history were stratified into six subcohorts with respect to morphological and cytological patterns. Comparison of the observed breast cancer incidence with the expected breast cancer incidence calculated on the basis of the age-adjusted breast cancer incidence in the general population showed no significant rise in breast cancer incidence in the whole BBL cohort. The ratio of observed to expected incidence rates was 1.16. The analysis of subcohorts with diverse BBL patterns demonstrated a marked increase in breast cancer incidence only in the intraductal papilloma and cyst subcohorts. The ratios of observed and expected rates were 5.4 and 1.6, respectively. There was no significant difference from population levies of breast cancer risk in subcohorts with history of fibroadenoma, fibrocystic disease, breast nipple discharge and other lesions. Similar results were obtained in the prospective part of the study.
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Affiliation(s)
- V Levshin
- Moldova Institute of Oncology, Kishinev
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Levshin V. 667 The prevalence of known breast cancer risk factors among population. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)95916-t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Levshin V. New approaches to cancer prevention. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)92103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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