Assessment of exposure to secondhand smoke by questionnaire and salivary cotinine in the general population of Barcelona, Spain (2004–2005)
Introduction
Secondhand smoke (SHS) has been associated with a variety of health effects among non-smokers, especially lung cancer and ischemic heart disease, as well as other respiratory effects and diseases in children and adults (US Department of Health and Human Services, 2006, IARC, 2004). In Spain, little attention was directed at exposure to SHS, until a national smoke-free law came into effect in January, 2006 to protect non-smokers' health. The law bans smoking in all enclosed workplaces except in some hospitality venues (Fernandez, 2006). Exposure to SHS had been assessed in Spain using questionnaires (Nebot et al., 2004, Perez-Rios et al., 2007, Twose et al., 2007) and airborne markers (Jane et al., 2002, Lopez et al., 2004, Nebot et al., 2005) before the law was enacted. The prevalence of self-reported SHS exposure in any setting among non-smokers was approximately 60–70% before January 2006 (Twose et al., 2007). Airborne nicotine measurements showed high levels of SHS in bars and restaurants, schools, airports, and subways (Lopez et al., 2004). However, studies using personal biomarkers, such as nicotine or cotinine in body fluids, at the population level have not been conducted in Spain. Salivary cotinine is a specific biomarker of recent exposure to SHS that has been used in observational studies (Benowitz, 1996).
Our aims were to describe the salivary cotinine concentrations among the smoking and non-smoking population, to estimate the prevalence of self-reported SHS exposure in a variety of settings and the determinants of salivary concentrations among the adult non-smoking population of Barcelona (Spain). The study was carried out before the new national regulations went into effect.
Section snippets
Design and study participants
This is a cross-sectional study conducted between March 2004 and December 2005 on a representative random sample (1245 people, 694 women and 551 men) of the non-institutionalized population of Barcelona, Spain. We obtained the personal data and addresses from the updated official Census, as provided by the Municipal Institute of Statistics of Barcelona. We sent a letter of introduction about the study; afterwards trained interviewers visited the subjects at home. When the index person was not
Salivary cotinine in smokers and non-smokers
The distribution of the salivary cotinine concentrations is shown in Fig. 1. The distribution for the entire sample (smokers and non-smokers) is bimodal (panel A), with peaks at approximately 1.1 and 150.0 ng/ml. The distributions of the salivary cotinine concentration for smokers (panel B) and non-smokers (panel C) showed some overlap. All subjects had detectable cotinine concentrations and 66.3% of subjects who had reported being non-smokers had a cotinine concentration ≥ 1 ng/ml.
Self-reported exposure to SHS in non-smokers
The
Discussion
In this study, data from questionnaires and measurement of salivary cotinine concentrations provided information about exposure to SHS. The salivary cotinine concentrations in non-smokers were most strongly related to SHS exposure at home, and were associated with both the number of smokers at home and the number of cigarettes smoked in presence of the subject at home.
Conclusions
This study jointly describes the exposure to SHS by means of self-report and salivary cotinine, the first to do so at the population level in Spain. The prevalence of exposure to SHS in this population is high and is inversely associated with age. Moreover, the main setting of exposure to SHS is the home, as shown by the association between salivary cotinine concentrations and the number of smokers and cigarettes smoked at home in the presence of non-smokers. The results of this study,
Determinants of COTinine (DCOT) Study investigators
Antoni Agudo, Carles Ariza, Josep M. Borràs, Esteve Fernández, Marcela Fu, Mireia Jané, Jose M. Martínez-Sánchez, Albert Moncada, Manel Nebot, José A. Pascual, Mercè Peris, Esteve Saltó, Jonathan M. Samet, Anna Schiaffino, Jorge Twose.
Conflicts of interest
The authors declare that there are no conflicts of interest.
Acknowledgments
This project was funded by Instituto de Salud Carlos III (FIS PI020261) and the Thematic Network of Cooperative Research on Cancer RD06/0020/0089) from the Government of Spain, and the Ministry of Universities and Research (SGR200500646), Government of Catalonia. The authors acknowledge the patient collaboration of the participants and field workers, and Chupa-Chups Spain for providing the Smint® candies.
References (32)
- et al.
An evaluation of the relationship between self-report and biochemical measures of environmental tobacco smoke exposure
Prev. Med.
(1994) A review of the use of saliva cotinine as a marker of tobacco smoke exposure
Prev. Med.
(1990)- et al.
Determinants of salivary cotinine concentrations in Chinese male smokers
Prev. Med.
(2003) - et al.
Measurement of exposure to environmental tobacco smoke in education centers, health centers, transport facilities and leisure places
Gac. Sanit.
(2004) - et al.
Secondhand smoke exposure in Spanish adult non-smokers following the introduction of an anti-smoking law
Rev. Esp. Cardiol.
(2008) - et al.
A questionnaire for assessing environmental tobacco smoke exposure
Environ. Res.
(2005) Cotinine as a biomarker of environmental tobacco smoke exposure
Epidemiol. Rev.
(1996)Biomarkers of environmental tobacco smoke exposure
Environ. Health Perspect.
(1999)- et al.
Cotinine concentration in smokers from different countries: relationship with amount smoked and cigarette type
Cancer Epidemiol. Biomark. Prev.
(2006) - et al.
Determinants of salivary cotinine levels among current smokers in Mexico
Nicotine Tob. Res. Gac. Sanit.
(2004)
Spain: going smoke free
Tob. Control
Validez de un cuestionario sobre exposición percibida al humo ambiental del tabaco
Gac. Sanit.
Impact of the “Tobacco control law” on exposure to environmental tobacco smoke in Spain
BMC Public Health
Nicotine concentrations in deciduous teeth and cumulative exposure to tobacco smoke during childhood
JAMA
Changes in exposure of adult non-smokers to secondhand smoke after implementation of smoke-free legislation in Scotland: national cross sectional survey
BMJ
Tobacco smoke and involuntary smoking
IARC Monographs Volume 83
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Determinants of COTinine (DCOT) Study investigators listed at the end of manuscript.