Abstract
BackgroundCotinine levels provide a valid measure of exposure to environmental tobacco smoke (ETS). The goal of this study was to examine exposure to tobacco smoke among smoking and nonsmoking Israeli adults and to identify differences in ETS exposure among nonsmokers by socio-demographic factors.MethodsWe analyzed urinary cotinine data from the first Israeli human biomonitoring study conducted in 2011. In-person questionnaires included data on socio-demographic and active smoking status. Cotinine levels were measured using a gas chromatography–mass spectrometry procedure. We calculated creatinine-adjusted urinary cotinine geometric means (GM) among smokers and nonsmokers, and by socio-demographic, smoking habits and dietary factors. We analyzed associations, in a univariable and multivariable analysis, between socio-demographic variables and proportions of urinary cotinine ≥1 μg/l (Limit of Quantification = LOQ) or ≥4 μg/l.ResultsCotinine levels were significantly higher among 91 smokers (GM = 89.7 μg/g creatinine; 95% confidence interval [CI]: 47.4-169.6) than among 148 nonsmokers (GM = 1.3; 1.1-1.7). Among exclusive waterpipe smokers, cotinine levels were relatively high (GM = 53.4; 95% CI 12.3-232.7). ETS exposure was widespread as 62.2% of nonsmokers had levels ≥ LOQ, and was higher in males (75.8%) than in females (52.3%). In a multivariable model, urinary cotinine ≥ LOQ was higher in males (Prevalence ratio [PR] = 1.30; 95% CI: 1.02-1.64, p = 0.032) and in those with lower educational status (PR = 1.58; 1.04-2.38, p = 0.031) and decreased with age (PR = 0.99; 0.98-1.00, p = 0.020, per one additional year). There were no significant differences by ethnicity, residence type or country of birth.ConclusionsOur findings indicate widespread ETS exposure in the nonsmoking Israeli adult population, especially among males, and younger and less educated participants. These findings demonstrate the importance of human biomonitoring, were instrumental in expanding smoke-free legislation implemented in Israel on July 2012 and will serve as a baseline to measure the impact of the new legislation.
Highlights
Cotinine levels provide a valid measure of exposure to environmental tobacco smoke (ETS)
The 248 study participants were divided into nonsmokers (n = 148) and smokers (n = 91) as 4 participants were excluded due to unverified smoking status and 5 additional participants were excluded due to discrepancy between self-reported smoking status as “nonsmokers” and creatinine-adjusted levels of cotinine >150 μg/g [20]
Nonsmokers included a lower proportion of males (41.9% vs. 63.7%), Jewish ethnicity (69.7% vs. 83.3%) and rural residence (7.4% vs. 17.6%) compared to smokers
Summary
Cotinine levels provide a valid measure of exposure to environmental tobacco smoke (ETS). The adverse effects of ETS among nonsmoking adults are well proven and mirror those associated with active smoking [2]. Nicotine is a specific biomarker of exposure to tobacco smoke, either active or ETS, but due to its short half life (1-3 hours) it has limited value as a marker of exposure. The primary proximate metabolite of nicotine, is used most frequently as a biomarker of tobacco smoke exposure, as its half-life is longer (approximately 16-18 hours) and levels remain fairly constant during the day. The cotinine level provides a valid and quantitative measure of average recent human ETS exposure and is the preferred biomarker of exposure to tobacco smoke in active smokers and in nonsmokers exposed to ETS [7]. Especially when corrected for creatinine concentration, is highly correlated with plasma cotinine [9]
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