测量二手烟

1. How do we Measure Secondhand Smoke Exposure?
Dr. Erika Avila Tang
Department of Epidemiology
Institute for Global Tobacco Control

2. FAMRI Expert SHSe Assessment
 Goal:
 To catalogue the approaches for Secondhand Smoke exposure (SHSe) assessment
 Provide a set of uniform methods for future use to facilitate comparisons of findings
across studies
 Comprehensive topic assessments on:
 Questionnaires and self-reported methods
 Biological samples
 Environmental samples
 Flight Attendant Medical Research Institute (FAMRI) Centers of Excellence
 American Academy of Pediatrics Julius B. Richmond, Illinois, USA
 Johns Hopkins University, Maryland, USA
 University of California, San Francisco Bland Lane, California, USA
 More than 20 researchers on SHSe assessment involved
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3. Why would we want to measure SHSe?
 SHSe is a key element of tobacco control
research and implementation worldwide
 To estimate the SHSe overall burden of disease
 To determine the risks associated with SHSe
 To assess population trends in support of and
evaluate tobacco control policies
 To support and evaluate behavioral interventions

4. Topic assessments
 Questionnaires and self-reported methods
 Biological samples
 Environmental samples
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5. Self-reported methods of assessment
 Questionnaires
 Most commonly used
 Inexpensive and feasible for large studies
 Assessment of :
 Current and long-term exposure
 Time-activity patterns
 Recall can be an issue
 Diaries
 Recall burden is reduced but respondent’s burden is increased
 E.g. Report over the past day vs. past week/month
 Higher awareness of instances of exposure

6. Accuracy: validity and reliability
 Review of studies assessing the validity and/or
reliability of questions
 Validation of questions against a “gold
standard”:
 Air measurement
 Biomarker
 Reliability=repeatability
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7. Conclusions for questionnaires and self-
reported methods
 Reliable responses for SHSe in their lifetime, childhood,
and current among adults.
 For children, CPD from parents, in their presence, and in
places
 Research on testing the accuracy of questions are still
needed
 Current exposure for adults and children, including intensity and
duration of exposure
 Exposure at home, in transport, and in social settings
 Collaboration of FAMRI CoEs: AAP Richmond, Johns
Hopkins, and UCSF Bland Lane are testing questions in
pilot studies to continue building a set of core questions
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8. Topic assessments
 Questionnaires and self-reported methods
 Biological samples
 Environmental samples
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9. Biomarkers
 Tobacco-specific biomarkers
 Cotinine
 Reflects recent SHSe (t1/2 16 hours (average))
 Nicotine/cotinine in hair or toenails
 Reflects “longer exposure”: 1 cm of hair proximal to the
scalp ≈ last month’s exposure; 1 mm ≈ last month’s
exposure
 NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol)
 Reflects “longer exposure” (t1/2 up to 3 weeks)
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10. Biomarker- Cotinine
Matrix Cut-off Pros Cons
Urine 50 ng/ml for higher Higher Need of facilities with
Non-invasive SHSe concentrations privacy during collection
than other Difficulty for population-
matrices based or children studies
(higher Need for creatinine
sensitivity) clearance adjustment
Collect data on renal
disease and some
prescription drugs
Blood 12 ng/ml for higher No adjustment Pregnant women have
Invasive SHSe required for increased clearance rate
hydration Difficulty for infants and
3 ng/ml for lower young children
SHSe Lower sensitivity
Saliva 14 ng/ml for higher Good for Potential issues with age,
Non-invasive SHSe multiple gender, race, oral pH, type
measurements of diet, dehydration, or
over a limited drug treatment
period of time Lower sensitivity
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11. Biomarker- Nicotine/Cotinine
Matrix Cut-off Pros Cons
Hair 0.8 ng/mg Easy to collect, ship, and Scarcity of hair in infants
Non-invasive (Women) store (room temperature ≤ 5 and adults
years) Chemical hair treatments
0.2 ng/mg Less affected by daily can reduce concentrations
(Pregnant) variability (fluctuating by 9%-30%
exposure, varying Age, gender, and race may
0.2 ng/mg metabolism, and nicotine play roles in determining
(Children) elimination) hair nicotine concentrations
Represents longer exposure
Toenails Not Easy to collect, ship, and Need for further research
Non-invasive available store (room temperature ≤ and population
20 years) concentrations
Overcomes day-to-day
exposure variability
Represents longer exposure
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12. Biomarker- NNAL
Matrix Cut-off Pros Cons
Urine Not Related to a lung carcinogen Analytical expertise
available Represents longer exposure Costly equipment
than cotinine NNAL is carcinogenic and
(urine/blood/saliva) mutagenic, special lab
handling
Further research needed
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13. Topic assessments
 Questionnaires and self-reported methods
 Biological samples
 Environmental samples
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14. Environmental measurements
 Most widely used methods:
 Nicotine: passive air monitor
 Particulate matter (< 2.5µ (PM2.5)) monitor
 Correlation between nicotine and PM when
measured in the same setting using a common
sampling period
 An increase in 1 µg/m3 of nicotine concentration ≈ an
average increase of 10 µg/m3 of PM
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15. Air nicotine monitoring
 Highly specific to tobacco smoke
 Monitors (1-3) placed in each venue (hung from the
ceiling) for 5 to14 days
 Filters are soaked in a bi-sodium sulfate solution that
captures nicotine on the filter
 No expensive equipment to buy
up front and minimal operating
cost but requires lab analysis
 Per sample laboratory costs
including the filter badge are
~$40-$100 USD

16. Particulate matter monitoring
 Active, real-time monitor
 Uses light scattering to measure particulate
matter concentrations (e.g. PM2.5)
 Air quality standards makes easier
dissemination
 Other causes of indoor air particles
 High initial investment
 ~3,000 USD
 Minimal operating cost
 No per sample costs
 Potential costs in labor for data analysis

17. Overall findings
 Questionnaires are the most effective way to know if
people are exposed – but not how much they are exposed
 Research on testing the accuracy of questions are still
needed
 Choice of any SHSe assessment method depends on your
needs
 Study’s objectives, subjects, design and setting and funding
 Selection of a biomarker will dependent on:
 Issues of privacy, invasiveness, and subject’s age
 The length of SHSe may result in selecting hair or toenails over bio-
fluids
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18. Acknowledgements
Wael Al-Delaimy Melbourne Hovell
Benjamin Apelberg Andrew Hyland
David Ashley Sungroul Kim
Erika Avila-Tang Jonathan Klein
Neil Benowitz Neil Klepeis
Thomas Bernert Robert McMillen
Dana Best James Repace
Patrick Breysse Jonathan Samet
Michael Cummings Jonathan Winickoff
Geoffrey Fong Ana Navas-Acien
Lara Gundel Lisa Hepp
Kathie Hammond Jessica Elf
Stephen Hecht Camille Madsen
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