Department of Health and Welfare, Pai Chai University, Daejeon, Republic of Korea.
J Formos Med Assoc. 2024 Feb;123(2):218-227. doi: 10.1016/j.jfma.2023.07.021. Epub 2023 Aug 15.
BACKGROUND/PURPOSE: Second-hand smoking (SHS) is usually examined by self-report (SR). However, there is a possibility that SR may not accurately measure SHS exposure. This study aimed to identify yearly trends and gender differences in SHS by SR and cotinine.
We used data from the 2009-2018 Korea National Health and Nutrition Examination Survey (KNHANES) and included adults aged 19 years and older. We analyzed data of 47,907 respondents on SHS exposures in the past week and of 23,572 respondents who had both urine cotinine and creatinine measurements. SHS exposure was defined as those who answered 'yes' to whether or not they were exposed to smoking by SR. We performed descriptive analysis, Average annual percentage change (AAPC), and multiple regression analysis. All analyses were weighted reflecting the multi-stratified cluster sampling.
Exposure to SHS indoors at the work place (WSHS) (2009: 44.8%, 2018: 12.3%), indoors at home (HSHS) (2009: 14.1%, 2018: 3.9%), and indoors at public places (PSHS) (2013: 55.6%, 2018: 15.4%) decreased steadily over the years. WSHS and PSHS exposure was higher for males but HSHS was higher for females. However, the concentration of cotinine-to-creatinine ratio (Co/Cr) was higher among females regardless of SHS exposure status and environment. Multiple regression analysis showed that among males, the association between Co/Cr education level and WSHS was the strongest, and among females, the association was the strongest with HSHS. In addition, home exposure to SHS intensified the differences in Co/Cr levels between males and females.
Our study confirmed that cotinine-induced SHS showed different results by year and gender compared to SR. In particular, Co/Cr level in females was higher than in males regardless of exposure by SR, suggesting that SR did not correctly evaluate SHS. To reflect reality more accurately, biomarkers should be monitored along with SR.
背景/目的：二手烟（SHS）通常通过自我报告（SR）进行检查。然而，SR 可能无法准确测量 SHS 暴露。本研究旨在通过 SR 和可替宁识别 SHS 的年度趋势和性别差异。
我们使用了 2009-2018 年韩国国家健康和营养检查调查（KNHANES）的数据，包括年龄在 19 岁及以上的成年人。我们分析了过去一周内 47907 名回答 SHS 暴露情况的受访者和 23572 名同时进行尿液可替宁和肌酐测量的受访者的数据。SHS 暴露定义为通过 SR 回答“是”是否暴露于吸烟的人。我们进行了描述性分析、平均年百分比变化（AAPC）和多元回归分析。所有分析均反映了多分层聚类抽样进行加权。
室内工作场所（WSHS）（2009 年：44.8%，2018 年：12.3%）、室内家庭（HSHS）（2009 年：14.1%，2018 年：3.9%）和室内公共场所（PSHS）（2013 年：55.6%，2018 年：15.4%）的 SHS 暴露率逐年稳步下降。WSHS 和 PSHS 暴露在男性中更高，但 HSHS 在女性中更高。然而，无论 SHS 暴露状况和环境如何，女性的可替宁与肌酐比值（Co/Cr）浓度均较高。多元回归分析表明，在男性中，Co/Cr 与教育水平和 WSHS 之间的关联最强，而在女性中，与 HSHS 的关联最强。此外，家庭暴露于 SHS 加剧了 Co/Cr 水平在男性和女性之间的差异。
我们的研究证实，与 SR 相比，可替宁诱导的 SHS 在年度和性别方面表现出不同的结果。特别是，无论 SR 暴露如何，女性的 Co/Cr 水平均高于男性，这表明 SR 未正确评估 SHS。为了更准确地反映现实，应结合 SR 监测生物标志物。
