Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Jul;120(7):1010-6.
doi: 10.1289/ehp.1104413. Epub 2012 Apr 6.

Exposure to secondhand smoke outside of a bar and a restaurant and tobacco exposure biomarkers in nonsmokers

Gideon St Helen  1 , J Thomas Bernert, Daniel B Hall, Connie S Sosnoff, Yang Xia, John R Balmes, John E Vena, Jia-Sheng Wang, Nina T Holland, Luke P Naeher
Affiliations

Exposure to secondhand smoke outside of a bar and a restaurant and tobacco exposure biomarkers in nonsmokers

Gideon St Helen et al. Environ Health Perspect. 2012 Jul.

Abstract

Background: With an increase in indoor smoking bans, many smokers smoke outside establishments and near their entrances, which has become a public health concern.

Objectives: We characterized the exposure of nonsmokers to secondhand smoke (SHS) outside a restaurant and bar in Athens, Georgia, where indoor smoking is banned, using salivary cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL).

Methods: In a crossover study, we assigned 28 participants to outdoor patios of a restaurant and a bar and an open-air site with no smokers on three weekend days; participants visited each site once and stayed for 3 hr. We collected saliva and urine samples immediately before and after the visits (postexposure) and on the following morning and analyzed samples for cotinine and total NNAL, respectively. Regression models were fitted and changes in biomarkers were contrasted between locations.

Results: Postexposure and preexposure geometric mean salivary cotinine concentrations differed by 0.115 ng/mL [95% confidence interval (CI): 0.105, 0.126)] and by 0.030 ng/mL (95% CI: 0.028, 0.031) for bar and restaurant visits, respectively. There were no significant post- and preexposure differences in cotinine levels after control site visits, and changes after bar and restaurant site visits were significantly different from changes after control site visits (p < 0.001). Results comparing next-day and preexposure salivary cotinine levels were similar. Next-day creatinine-corrected urinary NNAL concentrations also were higher than preexposure levels following bar and restaurant visits [1.858 pg/mg creatinine higher (95% CI: 0.897, 3.758) and 0.615 pg/mg creatinine higher (95% CI: 0.210, 1.761), respectively], and were significantly different from changes after the control visits (p = 0.005).

Conclusion: Salivary cotinine and urinary NNAL increased significantly in nonsmokers after outdoor SHS exposure. Our findings indicate that such exposures may increase risks of health effects associated with tobacco carcinogens.

PubMed Disclaimer

Conflict of interest statement

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

J.R.B. was funded in part through a grant from the Flight Attendant Medical Research Institute (FAMRI) that awards competitive grants through requests for proposals, which can be initiated by the board of trustees of FAMRI. Once funded, FAMRI has no role in the design, conduct, interpretation, or publication of the research. The organization does not gain or lose financially through publication of any article. The other authors declare they have no actual or potential competing financial interests.

Figures

Figure 1
Figure 1
Salivary cotinine (ng/mL) for control, restaurant, and bar (A, B, and C, respectively), urinary uncorrected NNAL (pg/mL) for control, restaurant, and bar (D–F), and creatinine-corrected NNAL (pg/mg creatinine) for control, restaurant, and bar (G–I) measured preexposure, immediately after 3-hr SHS exposure, and in first-void next-day samples of participants (n = 27). Blue boxes represent third quartiles, black lines in the boxes are medians, gray boxes are first quartiles, and whiskers represent 5th and 95th percentiles.
Figure 2
Figure 2
Saliva-cotinine and urinary-NNAL changes after a 3-hr visit to outdoor seating areas of a restaurant and a bar where outdoor smoking was allowed and to an open-air control location with no smokers. (A) Salivary cotinine postexposure minus preexposure (ng/mL). (B) Salivary cotinine next-day minus preexposure (ng/mL). Urinary uncorrected (pg/mL) and creatinine-corrected postexposure minus preexposure NNAL (pg/mg creatinine) (C), and urinary uncorrected (pg/mL) and creatinine-corrected (pg/mg creatinine) next-day minus preexposure NNAL (D). Values represent differences in geometric means and 95% CIs. *Statistically higher than control at α = 0.05 level of significance.
See this image and copyright information in PMC

References

    1. Anderson KE, Carmella SG, Ye M, Bliss RL, Le C, Murphy L, et al. Metabolites of a tobacco-specific lung carcinogen in nonsmoking women exposed to environmental tobacco smoke. J Natl Cancer Inst. 2001;93(5):378–381. - PubMed
    1. Anderson KE, Kliris J, Murphy L, Carmella SG, Han S, Link C, et al. Metabolites of a tobacco-specific lung carcinogen in nonsmoking casino patrons. Cancer Epidemiol Biomarkers Prev. 2003;12(12):1544–1546. - PubMed
    1. Athens-Clarke County, Georgia. Code of Ordinances, Section 4.3. July 5, 2005. Available: http://library.municode.com/index.aspx?clientId=12400&stateId=10&stateNa... [accessed 7 June 2012]
    1. Barnoya J, Glantz SA. Cardiovascular effects of secondhand smoke—nearly as large as smoking. Circulation. 2005;111(20):2684–2698. - PubMed
    1. Benowitz NL. Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiol Rev. 1996;18(2):188–204. - PubMed

Publication types