Environmental Health

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Is the smokers exposure to environmental tobacco smoke negligible?

Environmental Health 2010, 9:5 doi:10.1186/1476-069X-9-5

Maria Teresa Piccardo ([email protected])

Anna Stella ([email protected])
Federico Valerio ([email protected])

ISSN 1476-069X

Article type Research

Submission date 16 June 2009

Acceptance date 29 January 2010

Publication date 29 January 2010

Article URL http://www.ehjournal.net/content/9/1/5

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Is the smokers exposure to environmental tobacco

smoke negligible?

Maria Teresa Piccardo 1§*, Anna Stella 1*, Federico Valerio 1*

1
Environmental Chemistry Laboratory, National cancer Research Institute, Genoa.

L.go Rosanna Benzi n. 10, 16132 Genoa, Italy

*These authors contributed equally to this work

§
Corresponding author

Email addresses:

MTP: [email protected]

AS: [email protected]

FV: federico.valerio@ istge.it

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Abstract
Background
Very few studies have evaluated the adverse effect of passive smoking exposure

among active smokers, probably due to the unproven assumption that the dose of

toxic compounds that a smoker inhales by passive smoke is negligible compared to

the dose inhaled by active smoke.

Methods
In a controlled situation of indoor active smoking, we compared daily benzo(a)pyrene

(BaP) dose, estimated to be inhaled by smokers due to the mainstream (MS) of

cigarettes they have smoked, to the measured environmental tobacco smoke (ETS)

they inhaled in an indoor environment. For this aim, we re-examined our previous

study on daily personal exposure to BaP of thirty newsagents, according to their

smoking habits.

Results
Daily BaP dose due to indoor environmental contamination measured inside

newsstands (traffic emission and ETS produced by smoker newsagents) was linearly

correlated (p= 0.001 R2 = 0.62) with estimated BaP dose from MS of daily smoked

cigarettes. In smoker subjects, the percentage of BaP daily dose due to ETS, in

comparison to mainstream dose due to smoked cigarettes, was estimated with 95%

confidence interval, between 14.6% and 23% for full flavour cigarettes and between

21% and 34% for full flavour light cigarettes.

Conclusions
During indoor smoking, ETS contribution to total BaP dose of the same smoker, may

be not negligible. Therefore both active and passive smoking exposures should be

considered in studies about health of active smokers.

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Background
Smokers inhale BaP and other toxic compounds present in the MS of their cigarettes

[1], but if they smoke indoors, they inevitably inhale also an amount of pollutants

present in their ETS [2].

Several studies provide evidence of a causal association between passive smoking in

non-smokers and lung cancer or ischemic heart disease [3-5]. A previous study

demonstrated that smokers were 21.2 times more ETS exposed, based on nicotine,

than non–smokers [6]. Despite these results, only a few studies have examined the

adverse effects of passive smoking exposure among active smokers. Two of them [7,

8] found no significant difference, but a more recent study [9], that quantified more

sensitively ETS exposure, concluded that ETS exposure of a current smoker is

strongly associated with increased acute respiratory symptoms.

The low interest in studying the role of ETS on smoker health is probably due to the

assumption that the added dose of toxic compounds to smokers from their own

passive smoking is negligible, compared to the dose they voluntarily inhale by their

cigarettes. According to our bibliographic review, this assumption is not supported by

any experimental measures.

To evaluate the role of ETS in total daily dose of carcinogens inhaled by smokers, a

study regarding the personal exposures to benzo(a)pyrene of newsagents working in

Genoa, Italy, was re-examined [10].

Newsagents were chosen because their personal daily exposures to air and ETS

contaminants may be easily monitored, with very few confounders: a) Italian

newsagents spend 12 hours a day in small (about 4 m2) naturally ventilated

newsstands; b) newsstands are completely closed and only with a window to serve

clients; c) only electric stoves are used for heating; d) newsstands are occupied by

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only one person. Therefore ETS pollutants measured inside the newsstand are strictly

correlated to the number of cigarettes that each newsagent declared to smoke.

Personal sampling was carried out continuously for 24 hours, starting from the

opening of newsstand, early in the morning. After their working-day, all the studied

newsagents went back home, where they spent the rest of the sampling time.

Usually newsstands are placed near heavy traffic streets, therefore newsagents were

exposed also to urban pollution, mainly produced by traffic emissions. Therefore, in

this study, total BaP daily dose inhaled by actively smoking newsagents can be

attributed to three main sources: urban traffic, ETS produced inside their stands and

home, and MS from cigarettes they smoke.

The aim of this study was to estimate the contribution of ETS in daily total BaP dose

of active smoker newsagents.

Methods
Detailed description of materials and methods used to measure daily BaP exposures

of newsagents may be found in a previous published paper [10], together with quality

control practices.

Personal air samplers activated continuously for 24 h were used to collect, on filters,

airborne particulate inside newsstands and in newsagents’ residences.

Fifteen daily personal samples of active smokers and fifteen samples of non-smokers

collected in 1998, during the same seasonal period (February-April and May-June),

were chosen for the present investigation. Smokers had a mean daily consumption of

fourteen cigarettes (min: 6, max: 25) and, according to their statements, none of them,

at home was exposed to ETS produced by other smokers.

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Environmental BaP (Env-BaP) doses (ng/day) were calculated multiplying each

measured BaP exposure by the mean air volume, that is estimated to be breathed daily

by an adult during moderate activity (20 m3) [11].

Therefore, Env-BaP dose includes BaP from urban sources and BaP from

environmental tobacco smoke (ETS-BaP).

Daily BaP doses of smokers, inhaled by mainstream smoke (MS-BaP) were estimated

by the declared cigarette daily consumption, multiplied by the mean BaP amount

measured in the MS of full flavour (FF) and full flavour light (FFL) U.S. cigarettes,

sold in 1998: 10.17 ng/cig (range: 7.89 – 12.81) and 6.75 (range: 4.92 – 8.07)

respectively [1]. These values are acceptable for our study because the six American

cigarettes brands included in the Swauger et al. study [1] are within the ten brands

most sold in Italy. According to their mean “tar” content, 88 per cent of cigarettes

sold in Italy in 1998 may be classified as FFL (5–10 mg tar/cig) and FF (>10 mg tar

/cig) [12].

Correlations between measured Env-BaP and estimated MS-BaP daily doses,

according to the two “tar“ categories were studied taking into account variation

coefficient of BaP yields in MS, according to Swauger et al. [1] and accuracy of the

sampling and analytical methods used to measure BaP air concentration [10].

Results and Discussion

The mean and standard deviation of Env-BaP doses of non-smoker and smoker

newsagents were 18.2 ± 7.1 and 38.4 ± 12.4 ng/d respectively. Inhalation of the MS

of fourteen cigarettes per day (the mean value of our smoker group), according to the

tar cigarette category, increases the BaP dose by an additional 142.4 ng/day (FF) or

94.5 ng/day (FFL).

Figure 1 shows the correlation between measured Env-BaP and estimated MS-BaP

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doses, supposing all smoked cigarettes of FFL category. The weighted least squares

regression line and its 95% confidence limits (dotted curves) are shown in the figure.

Env-BaP and MS-BaP doses are linearly correlated.

The regression equations for the two cigarette categories (FF and FFL) are the

following:

FF) Env-BaP = 13.2 + 0.185 MS-BaP R2 = 0.62; p = 0.0015 eq. 1)

FFL) Env-BaP = 13.3 + 0.274 MS-BaP R2 = 0.62; p = 0.0015 eq. 2)

Smokers’ Env-BaP dose increases linearly with their estimated MS-BaP dose (i.e.

number of cigarettes daily smoked), according to equations 1 and 2.

Therefore, slopes of the two regression equations permit to evaluate the ratio between

the daily BaP dose due to the inhalation of mainstream of smoked cigarettes and the

daily dose due to ETS produced by the same cigarettes.

The 95% confidence interval for slope of equation 1 is 0.146 – 0.230 and for slope of

equation 2, it is 0.210 – 0.340. Since the failure to reject the null hypothesis about

similarity of slopes (tested by Fieller’s theorem), does not mean equivalence, the two

regressions are treated separately to quantify the mean contribution of the doses of

ETS, relative to MS, under the two scenarios.

If FF cigarettes were smoked, the daily dose of BaP inhaled by our smoker group, due

to ETS, might be, with a probability of 95%, between 14.6 and 23.0 percent (mean:

18.5%) of the BaP dose due only to the mainstream smoke. If all smoked cigarettes

were FFL, the estimated ETS contribution should be between 21.0 and 34.0 percent

(mean: 27.4%).

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The average smoker of this study (14 FF cigarettes/d) inhales daily 182 ng of BaP, so

composed: 142.4 ng (78%) from MS, 26.3 ng (14.4%) from ETS, 13.3 ng (7.3%)

from urban pollution.

In this example, the contribution to daily BaP dose due to ETS and urban air pollution

is equivalent to smoking 2.6 and 1.3 FF cigarettes, respectively.

Therefore, this study suggests that to correctly classify smokers, according to their

total ambient air BaP exposures, ETS exposures cannot be ignored as well as

exposures due to heavy air pollution.

There are some uncertainties in these estimations, particularly about the real

inhalation rates during the different daily activities and the different personal smoking

behaviour [13]. However our results are in good agreement with the different mean

urinary cotinine concentrations found in subjects defined as heavy active smokers

(3729 ± 1070 µg/l ) and in non-smokers heavily exposed to ETS (350 ± 120 µg/l)

[14]. It is noteworthy that in this study, the authors aimed to distinguish correctly

non-smokers, passive and active smokers, but the exposure of active smokers to ETS

( i.e. smoking indoors with or without other smokers) was not considered.

Conclusions
Results of this study on BaP exposure of newsagents, according to their smoking

habits, suggest that exposure to their own environmental smoke cannot be negligible,

if smoking occurs in indoor environments. Therefore our conclusions are that both

active and passive smoking contributions should always be considered in studies

about health of active smokers. We suggest that one of the questions to submit to the

participant subjects may be: “How many hours daily do you smoke in closed

environment and together with other smokers?” This indirect estimation of exposure

should be linked with the evaluation of specific markers of tobacco smoke (i.e.

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nicotine, 3-ethenylpyridine), and/or with biomarkers of exposure (i.e. cotinine), in

order to verify the real exposure and prevent misclassification.

List of abbreviations
BaP: Benzo(a)pyrene; MS: mainstream; ETS: environmental tobacco smoke; Env-

BaP: BaP derived from urban air pollution and environmental tobacco smoke; ETS-

BaP: BaP derived from environmental tobacco smoke; MS-BaP: BaP derived from

mainstream of smoked cigarettes; FF: full flavour cigarettes; FFL: full flavour light

cigarettes

Competing interests
The authors declare that they have no competing interests

Authors' contributions
FV have made substantial contribution to conception, design and interpretation of
data

MTP contributed to acquisition, analysis and interpretation of data

AS carried out statistical analysis.

All authors read and approved the final manuscript.

Acknowledgements

The authors would like to tank Dr Marcello Ceppi of Unit of Molecolar

Epidemiology, National cancer Research Institute, for statistical advices.

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Figures
Figure 1 - BaP daily dose from environmental sources versus BaP dose from
mainstream of daily smoked cigarettes
Figure shows linear correlation between daily dose of Env-BaP and MS-BaP dose of
15 non-smoking and 15 smoking newsagents, in Genoa, during 1998. MS-BaP dose
was estimated from mean BaP content in FFL cigarettes mainstream [1]. Dotted
curves define 95% confidence limits, according uncertainty of measured BaP air
concentrations and variability of BaP quantity estimated in mainstream of
FFL<cigarettes sold in U.S. and Italian market, from 1995 and 2000.

- 12 -
Figure 1