Secondhand Smoke Exposure and Cardiovascular Effects Making Sense of the Evidence (2010) / Chapter Skim
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2 Evaluating Exposure to Secondhand Smoke
2 Evaluating Exposure to Secondhand Smoke
Pages 31-58
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From page 31... ...
, hydrocarbons (such as benzene, toluene, and some polycyclic aromatic hydrocarbons 1 For the purpose of this report, the committee defined secondhand smoke as a complex mixture that is made up of gases and particles and includes smoke from burning cigarettes, cigars, and pipe tobacco (sidestream smoke) and exhaled mainstream smoke (CDC, 2006)
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. The measured sidestream emissions of chemicals are quite similar among a wide range of cigarette brands and styles, including regular, unfiltered, filtered, and "low tar, low nicotine" cigarettes.3 Although the composition of sidestream and mainstream smoke are qualitatively similar, there are substantial quantitative differences in composition between mainstream and sidestream smoke because the chemicals emitted in tobacco smoke change with temperature, oxygen concentration, pH, and the extent of combustion.4 Those factors are different in mainstream and sidestream smoke (Jenkins et al., 2000)
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A partial list of cigarette smoke constituents in mainstream and sidestream smoke in amounts exceeding 10 μg/per cigarette is presented in Table 2-1. MEASuREMENT OF SECONDHAND SMOkE Tobacco smoke is a complex mixture of thousands of compounds.
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The criteria include the sensitivity of the assay for the biomarker, the specificity of the TABLE 2-1 Amount of Cigarette Smoke Constituents in Tobacco Smoke and Smoking Environments. Partial List of the Cigarette Smoke Constituents Generated in Mainstream and Secondhand Smoke in Amounts Exceeding 10 μg per Cigarette or That Have Been Shown to Be Cardiotoxic Present in Average Amount Secondhand Smoke Mean Concentration (>10 μg per (μg per cigarette in Smoking Compound except where noted)
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Benzene concentration present in sidestream smoke is 163–353 μg per cigarette. b c Amount is for sidestream smoke.
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Although few, if any, biomarkers have been shown to meet all the criteria, a number of biomarkers of secondhand-smoke exposure that meet many of the criteria are available. Measures of exposure in the air and of biomarkers of exposure are complementary.
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Less sensitive than nicotine because present in lower concentration (therefore can not measure as low secondhand smoke concentrations) Particulate matter Present at high levels in Not specific to tobacco secondhand smoke so can smoke and many other measure a wide range of sources present at all times, concentrations relatively easily therefore not distinguishable Can measure with continuous from other sources of PM sampler and get information at lower secondhand-smoke directly, without laboratory concentrations Initial investment in equipment expensive, but little operating cost Airborne Nicotine Specific to tobacco smoke Different decay rate than Of intrinsic health interest other secondhand smoke (known cardiovascular agent)
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One major characteristic that contributes to the widespread use of airborne nicotine and cotinine is that tobacco is virtually the only source of both compounds, so they meet the criterion noted earlier. Furthermore, tobacco smoke contains large amounts of nicotine, so tobacco smoke can be detected even at low concentrations.
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. Therefore, cotinine concentrations are more stable throughout the day, and this makes it the preferred biomarker of smoke exposure in blood, saliva, and urine.
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. Despite that, cotinine levels are useful to differentiate smokers from nonsmokers, to categorize nonsmokers into groups with varying levels of exposure to secondhand smoke, and to track changes in population exposure to secondhand smoke.
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Although urinary NNAL is sensitive and specific as a biomarker of secondhandsmoke exposure, no studies have evaluated the relationship between urinary NNAL concentration and cardiovascular disease. ExPOSuRES TO SECONDHAND SMOkE General Trends in Exposure to Secondhand Smoke Nicotine concentrations measured in diverse environments that allow smoking range over 4 orders of magnitude, from less than 0.1 μg/m3 to several hundred μg/m3.
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(2008) analyzed serum cotinine concentrations from NHANES data in the same period in workers in different sectors (blue-collar, farm, service industry, and white-collar workers)
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0.2 0.15 0.1 0.05 0 1988–1991 1991–1994 1999–2000 2001–2002 National Center for Health Statistics Occupational Category FIGuRE 2-3 Serum cotinine in select U.S. populations, 1988–2002.
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The reduction in exposure, therefore, could in part reflect voluntary smoking bans in private workplaces, which increased. Changes in PM, nicotine, and cotinine concentrations after the implementation of smoking bans have been studied.
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In Italy and Scotland, post-ban levels in restaurants were half of pre-ban levels and 10–40% of pre-ban levels in other public places. Airborne Nicotine Airborne concentrations of nicotine, a tracer that is specific for tobacco smoke, decreased even more dramatically after the implementation of smoking bans.
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restaurants and (b) public places before and after implementation of smoking bans.
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(2005) measured the effect of the Irish smoking ban on airborne nicotine concentrations in pubs and cotinine concentrations in hospitality workers.
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other public places before and after implementation of smoking bans. Nicotine concentrations representFigure 4-6b median not mean amounts in Ireland study.
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. A study of 14 office buildings in China evaluated weekly average nicotine concentrations in buildings according to their smoking policies regardless of extent of enforcement (see Figure 2-6b)
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15 10.7 10 4.9 4.89 5 2.5 0.8 0.3 0.2 0 Missouri: Missouri: Office China: Nonsmoking China: Office with with ≥1 Smoker ≥ 1 Smoker Nonsmoking Office Office FIGuRE 2-6 Occupational exposures to airborne nicotine in (a) a sampling at nonsmokers' desks in 25 office and nonoffice workplaces.
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For example, nicotine concentrations in offices with at least one smoker fell 90% from 18.8 to 1.9 μg/m3. Biomarkers of Secondhand-Smoke Exposure Before and After Smoking Bans Evidence indicates that the implementation of smoking bans is effective in reducing individual exposures to secondhand smoke but that exposures do not decrease to zero, because there are other sources of exposure (such as homes and vehicles)
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Data from New York state and Ireland are salivary cotinine concentrations. Data from Scotland are serum cotinine concentrations.
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(2008) showed reductions in serum cotinine concentrations in a variety of demographic groups after implementation of the Scottish smoking ban, including former smokers, male and female nonsmokers, nonsmokers with acute coronary syndrome, and nonsmokers over 45 years old (Figure 2-7c)
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2004. Effectiveness of clean in door air ordinances in controlling environmental tobacco smoke in restaurants.
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1993. Relationship between environmental tobacco smoke exposure and carcinogen-hemoglobin adduct levels in nonsmokers.
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2005. Secondhand smoke exposure and risk following the Irish smoking ban: An assessment of salivary cotinine concentrations in hotel workers and air nicotine levels in bars.
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2002. Gas-phase organics in environmental tobacco smoke.
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