Exposure to tobacco smoke based on urinary cotinine levels among Israeli smoking and nonsmoking adults: a cross-sectional analysis of the first Israeli human biomonitoring study

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.

Exposure to metals and congenital anomalies: A biomonitoring study of pregnant Bedouin-Arab women

“…The latter finding is surprising in view of the potentially high prevalence of exposure to secondhand smoke among Bedouin-Arab women considering that 92% of their husbands smoke. This finding is supported by a similar result by another study (Levine et al, 2013), which reported that urine samples from Arab-Israeli women had unexpectedly low levels of cotinine. Maziak et al (2006) reported the same finding for Syrian women and explained it by the social customs of a traditional society, where females cannot freely mix with the men, and as such, their exposure to secondhand smoke was lower despite the high rates of smoking among their husbands.…”

Tobacco policy in Israel: 1948–2014 and beyond

“…A study conducted in 2010 and based on a representative sample of Israeli adults found that roughly 70% of Israelis reported exposure at least weekly to tobacco smoke [ 15 ]. Results from the first Israeli Human Biomonitoring Study, conducted in 2011, showed that 62.2% of nonsmoking Israelis had urinary cotinine levels indicative of tobacco smoke exposure [ 16 ]. Data from 2013 showed that about 40% of nonsmoking Israeli adults reported exposure to secondhand smoke [ 4 ].…”

Urine Cotinine Should Be Involved in Initial Evaluation of Tinnitus in Adolescents

“…There has been no prior study that has evaluated this biomarker for pediatric tinnitus. Nicotine is a specific biomarker of exposure to tobacco smoke, but it is limited in this task because of its short half-life (1 to 3 hours) [ 31 ]. Cotinine, which is the primary proximate metabolite of nicotine, is used more frequently as a biomarker of tobacco smoke exposure because its half-life approximately 16 to 18 hours, and its levels remain fairly constant throughout the day [ 32 ].…”