Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Faculty of Medicine, Kiryat Hadassah, Ein Kerem, Jerusalem, Israel.
BMC Public Health. 2013 Dec 30;13:1241. doi: 10.1186/1471-2458-13-1241.
Cotinine 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.
We 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.
Cotinine 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.
Our 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.
可铁宁水平可有效衡量环境烟草烟雾（ETS）的暴露情况。本研究的目的是检测以色列吸烟和不吸烟成年人的烟草烟雾暴露情况，并确定非吸烟者的 ETS 暴露情况在社会人口统计学因素方面的差异。
我们分析了 2011 年进行的首次以色列人体生物监测研究的尿液可铁宁数据。面对面问卷调查包括社会人口统计学和主动吸烟状况的数据。使用气相色谱-质谱程序测定可铁宁水平。我们计算了吸烟者和不吸烟者的尿肌酐调整后可铁宁几何均数（GM），以及根据社会人口统计学、吸烟习惯和饮食因素的可铁宁 GM。我们在单变量和多变量分析中分析了社会人口统计学变量与尿可铁宁≥1μg/L（定量下限=LOQ）或≥4μg/L 之间的关联。
91 名吸烟者的可铁宁水平明显高于 148 名不吸烟者（GM=89.7μg/g 肌酐；95%置信区间[CI]：47.4-169.6）（GM=1.3；1.1-1.7）。水烟专用吸烟者的可铁宁水平相对较高（GM=53.4；95%CI 12.3-232.7）。非吸烟者的 ETS 暴露情况非常普遍，有 62.2%的人可铁宁水平≥LOQ，且男性（75.8%）高于女性（52.3%）。在多变量模型中，男性（比值比[PR]=1.30；95%CI：1.02-1.64，p=0.032）和教育程度较低者（PR=1.58；1.04-2.38，p=0.031）的尿可铁宁≥LOQ 的可能性更高，而随着年龄的增长（PR=0.99；0.98-1.00，p=0.020，每增加 1 岁）其水平下降。在种族、居住类型或出生地方面无显著差异。
我们的研究结果表明，非吸烟的以色列成年人群体中 ETS 暴露情况普遍存在，特别是在男性、年轻和教育程度较低的参与者中。这些发现表明人体生物监测的重要性，有助于扩大 2012 年 7 月在以色列实施的无烟立法，并将作为衡量新立法影响的基准。
