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. 2018 Jun 25;7(1):33.
doi: 10.1186/s13584-018-0229-9.

Exposure to environmental tobacco smoke in non - smoking adults in Israel: results of the second Israel biomonitoring survey

Tamar Berman  1   2 , Zohar Barnett-Itzhaki  3   4 , Nisim Mery  5 , Lital Keinan-Boker  5 , Tal Shimony  5 , Rebecca Goldsmith  3 , Thomas Göen  6 , Haim Geva  3 , Laura Rosen  7
Affiliations

Exposure to environmental tobacco smoke in non - smoking adults in Israel: results of the second Israel biomonitoring survey

Tamar Berman et al. Isr J Health Policy Res. .

Abstract

Background: Exposure to environmental tobacco smoke (ETS) increases the risk of heart and respiratory disease, cancer, and premature mortality in non-smoking individuals. Results from the first Israel Biomonitoring Study in 2011 showed that over 60% of non-smoking adults are exposed to ETS. The purpose of the current study was to assess whether policies to restrict smoking in public places have been associated with reductions in exposure to ETS, and to examine predictors of exposure.

Methods: We analyzed urinary cotinine and creatinine concentrations in 194 adult participants in the National Health and Nutrition (RAV MABAT) Survey in 2015-2016. Study participants were interviewed in person on smoking status and exposure to ETS. We calculated creatinine-adjusted and unadjusted urinary cotinine geometric means and medians among smokers and non-smokers. We analyzed associations in univariable analyses, between socio-demographic variables and self - reported exposure, and urinary cotinine concentrations.

Results: There was no reduction in geometric mean urinary cotinine levels in non-smokers in the current study (1.7 μg/g) compared to that in 2011 (1.6 μg/g). Median cotinine levels among the non - smoking Arab participants were higher in comparison to the Jewish and other participants (2.97 versus 1.56 μg/l, p = 0.035). Participants who reported that they were exposed to ETS at home had significantly higher median levels of creatinine adjusted urinary cotinine than those reporting they were not exposed at home (4.19 μg/g versus 2.9 μg/g, p = 0.0039).

Conclusions: Despite additional restrictions on smoking in public places in 2012-2016, over 60% of non-smoking adults in Israel continue to be exposed to ETS. Urinary cotinine levels in non-smokers have not decreased compared to 2011. Results indicate higher exposure to ETS in Arab study participants and those reporting ETS exposure at home. There is an urgent need: (1) to increase enforcement on the ban on smoking in work and public places; (2) for public health educational programs and campaigns about the adverse health effects of ETS; and (3) to develop and disseminate effective interventions to promote smoke free homes. Periodic surveys using objective measures of ETS exposure (cotinine) are an important tool for monitoring progress, or lack thereof, of policies to reduce exposure to tobacco smoke in non-smokers.

Keywords: Environmental tobacco smoke; Exposure; Human biomonitoring; Urinary cotinine.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Sheba Hospital Ethical Committee. All participants provided written informed consent. Researchers analysing urinary cotinine levels and conducting data analysis had no access to identifying details of study participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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References

    1. U.S. Department of Health and Human Services . The health consequences of involuntary exposure to tobacco smoke: a report of the surgeon general. Atlanta: CDC; 2006. - PubMed
    1. Oberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011;377(9760):139–146. doi: 10.1016/S0140-6736(10)61388-8. - DOI - PubMed
    1. Ginsberg GM, Geva H. The burden of smoking in Israel-attributable mortality and costs (2014) Isr J Health Policy Res. 2014;3:28. doi: 10.1186/2045-4015-3-28. - DOI - PMC - PubMed
    1. Centers for Disease Control, Cotinine. 2009. https://www.cdc.gov/biomonitoring/pdf/Cotinine_FactSheet.pdf. Accessed Feb 2018.
    1. Benowitz NL. Biomarkers of environmental tobacco exposure. Environ Health Perspect. 1999;107(Suppl 2):349–55. - PMC - PubMed

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