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Evaluating the effectiveness of the US Navy and Marine Corps Tobacco Policy: an assessment of secondhand smoke exposure in US Navy submariners
  1. Nicholas J Yarnall1,
  2. Linda M Hughes2,
  3. Paul S Turnbull3,
  4. Mark Michaud4
  1. 1Fit for Work Ltd, Cromwell, Central Otago, New Zealand
  2. 2Submarine Medicine and Survival Systems, Naval Submarine Medical Research Laboratory, Groton, Connecticut, USA
  3. 3Submarine and Radiation Medicine, Institute of Naval Medicine, Hampshire, Alverstoke, UK
  4. 4Undersea Medicine and Radiation Health, Navy Bureau of Medicine and Surgery, Washington, DC, USA
  1. Correspondence to Linda M Hughes, Submarine Medicine and Survival Systems, Naval Submarine Medical Research Laboratory, Box 900, Groton, CT 06349-5900, USA;{at}


Objective To evaluate the effectiveness of the US Navy and Marine Corps tobacco policy in protecting submariners from secondhand smoke (SHS) by determining if non-tobacco users experienced a significant increase in urinary cotinine levels at sea when compared with in port levels.

Methods From February to August 2009, 634 volunteers recruited from nine US Navy submarines completed a survey to collect demographic data, information on tobacco use and pre-deployment exposure to SHS. Non-tobacco users (n=239) were requested to provide two urine samples (pre-deployment and while at sea) to quantify exposure to SHS using urinary cotinine as a biomarker. Matched samples were analysed using liquid chromatography–tandem mass spectrometry.

Results Overall, deployed cotinine levels were 2.1 times the in port levels in non-tobacco using submariners (95% CI 1.8 to 2.4, p<0.001, n=197). A significant increase in deployed urinary cotinine levels was found aboard six of nine submarines (p<0.05). A subgroup of submariners (n=91) who reported no SHS exposure within 10 days prior to in port cotinine sampling had deployed cotinine levels 2.7 times the in port levels (95% CI 2.2 to 3.3, p<0.001). Applying a 4.5:1 urine cotinine to serum cotinine correction factor, submariners' deployed geometric means are similar to recent US male population values at the 75th percentile.

Conclusions This study provides evidence that non-tobacco using submariners were exposed to SHS. Exposure was seen in all submarine classes and was not limited to personnel working in proximity to the smoking area. The existing policy was inadequate to protect non-smokers from exposure to SHS and required revision. As a result of a policy review, informed by this study, smoking below decks was banned aboard all US Navy submarines effective 31 December 2010.

  • Environment
  • secondhand smoke
  • cotinine
  • surveillance and monitoring
  • priority/special populations

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  • Funding Support for this study was provided by the Naval Sea Systems Command. The development of the method for measuring concentrations of cotinine and trans-3′-hydroxycotinine at the University of California, San Francisco, was supported in part by the Flight Attendant Medical Research Institute.

  • Disclaimer The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the US government.

  • Competing interests None.

  • Patient consent All research volunteers signed institutional review board approved consent forms prior to study enrolment. No BMJ consent form is needed as no personally identifiable information is presented; all results are in aggregate form.

  • Ethics approval Ethics approval was approved by the Naval Submarine Medical Research Laboratory's Human Research Protection Program's Institutional Review Board (Groton, Connecticut).

  • Provenance and peer review Not commissioned; externally peer reviewed.