Measured exposures by personal monitoring for respirable suspended particles and environmental tobacco smoke of housewives and office workers resident in Bremen, Germany

Epidemiological evidence relating environmental smoke to COPD in lifelong non-smokers: a systematic review

Background: Some evidence suggests environmental tobacco smoke (ETS) might cause chronic obstructive pulmonary disease (COPD). We reviewed available epidemiological data in never smokers. Methods: We identified epidemiological studies providing estimates of relative risk (RR) with 95% confidence interval (CI) for various ETS exposure indices. Confounder-adjusted RRs for COPD were extracted, or derived using standard methods. Meta-analyses were conducted for each exposure index, with tests for heterogeneity and publication bias. For the main index (spouse ever smoked or nearest equivalent), analyses investigated variation in RR by location, publication period, study type, sex, diagnosis, study size, confounder adjustment, never smoker definition, and exposure index definition. Results: Twenty-eight relevant studies were identified; nine European or Middle Eastern, nine Asian, eight American and two from multiple countries. Five were prospective, seven case-control and 16 cross-sectional. The COPD definition involved death or hospitalisation in seven studies, GOLD stage 1+ criteria in twelve, and other definitions in nine. For the main index, random-effects meta-analysis of 33 heterogeneous (p<0.001) estimates gave a RR of 1.20 (95%CI 1.08-1.34). Higher estimates for females (1.59,1.16-2.19, n=11) than males (1.29,0.94-1.76, n=7) or sexes combined (1.10,0.99-1.22, n=15 where sex-specific not available), and lower estimates for studies of 150+ cases (1.08,0.97-1.20, n=13) partly explained the heterogeneity. Estimates were higher for Asian studies (1.34,1.08-1.67, n=10), case-control studies (1.55,1.04-2.32, n=8), and COPD mortality or hospitalisation (1.40,1.12-1.74, n=11). Some increase was seen for severer COPD (1.29,1.10-1.52, n=7). Dose-response evidence was heterogeneous. Evidence for childhood (0.88,0.72-1.07, n=2) and workplace (1.12,0.77-1.64, n=4) exposure was limited, but an increase was seen for overall adulthood exposure (1.20,1.03-1.39, n=17). We discuss study weaknesses that may bias estimation of the association of COPD with ETS. Conclusions: Although the evidence suggests ETS increases COPD, study weaknesses and absence of well-designed large studies precludes reliable inference of causality. More definitive evidence is required.

Epidemiological evidence relating environmental smoke to COPD in lifelong non-smokers: a systematic review

Background: Some evidence suggests environmental tobacco smoke (ETS) might cause chronic obstructive pulmonary disease (COPD). We reviewed available epidemiological data in never smokers. Methods: We identified epidemiological studies providing estimates of relative risk (RR) with 95% confidence interval (CI) for various ETS exposure indices. Confounder-adjusted RRs for COPD were extracted, or derived using standard methods. Meta-analyses were conducted for each exposure index, with tests for heterogeneity and publication bias. For the main index (spouse ever smoked or nearest equivalent), analyses investigated variation in RR by location, publication period, study type, sex, diagnosis, study size, confounder adjustment, never smoker definition, and exposure index definition. Results: Twenty-eight relevant studies were identified; nine European or Middle Eastern, nine Asian, eight American and two from multiple countries. Five were prospective, seven case-control and 16 cross-sectional. The COPD definition involved death or hospitalisation in seven studies, GOLD stage 1+ criteria in twelve, and other definitions in nine. For the main index, random-effects meta-analysis of 33 heterogeneous (p<0.001) estimates gave a RR of 1.20 (95%CI 1.08-1.34). Higher estimates for females (1.59,1.16-2.19, n=11) than males (1.29,0.94-1.76, n=7) or sexes combined (1.10,0.99-1.22, n=15 where sex-specific not available), and lower estimates for studies of 150+ cases (1.08,0.97-1.20, n=13) partly explained the heterogeneity. Estimates were higher for Asian studies (1.34,1.08-1.67, n=10), case-control studies (1.55,1.04-2.32, n=8), and COPD mortality or hospitalisation (1.40,1.12-1.74, n=11). Some increase was seen for severer COPD (1.29,1.10-1.52, n=7). Dose-response evidence was heterogeneous. Evidence for childhood (0.88,0.72-1.07, n=2) and workplace (1.12,0.77-1.64, n=4) exposure was limited, but an increase was seen for overall adulthood exposure (1.20,1.03-1.39, n=17). We discuss study weaknesses that may bias estimation of the association of COPD with ETS. Conclusions: Although the evidence suggests ETS increases COPD, study weaknesses and absence of well-designed large studies precludes reliable inference of causality. More definitive evidence is required.

Environmental tobacco smoke exposure and heart disease: A systematic review

AIM

To review evidence relating passive smoking to heart disease risk in never smokers.

METHODS

Epidemiological studies were identified providing estimates of relative risk (RR) of ischaemic heart disease and 95%CI for never smokers for various indices of exposure to environmental tobacco smoke (ETS). “Never smokers” could include those with a minimal smoking experience. The database set up included the RRs and other study details. Unadjusted and confounder-adjusted RRs were entered, derived where necessary using standard methods. The fixed-effect and random-effects meta-analyses conducted for each exposure index included tests for heterogeneity and publication bias. For the main index (ever smoking by the spouse or nearest equivalent, and preferring adjusted to unadjusted data), analyses investigated variation in the RR by sex, continent, period of publication, number of cases, study design, extent of confounder adjustment, availability of dose-response results and biomarker data, use of proxy respondents, definitions of exposure and of never smoker, and aspects of disease definition. Sensitivity analyses were also run, preferring current to ever smoking, or unadjusted to adjusted estimates, or excluding certain studies.

RESULTS

Fifty-eight studies were identified, 20 in North America, 19 in Europe, 11 in Asia, seven in other countries, and one in 52 countries. Twenty-six were prospective, 22 case-control and 10 cross-sectional. Thirteen included 100 cases or fewer, and 11 more than 1000. For the main index, 75 heterogeneous (P < 0.001) RR estimates gave a combined random-effects RR of 1.18 (95%CI: 1.12-1.24), which was little affected by preferring unadjusted to adjusted RRs, or RRs for current ETS exposure to those for ever exposure. Estimates for each level of each factor considered consistently exceeded 1.00. However, univariate analyses revealed significant (P < 0.001) variation for some factors. Thus RRs were lower for males, and in North American, larger and prospective studies, and also where the RR was for spousal smoking, fatal cases, or specifically for IHD. For case-control studies RRs were lower if hospital/diseased controls were used. RRs were higher when diagnosis was based on medical data rather than death certificates or self-report, and where the never smoker definition allowed subjects to smoke products other than cigarettes or have a limited smoking history. The association with spousal smoking specifically (1.06, 1.01-1.12, n = 34) was less clear in analyses restricted to married subjects (1.03, 0.99-1.07, n = 23). In stepwise regression analyses only those associations with source of diagnosis, study size, and whether the spouse was the index, were independently predictive (at P < 0.05) of heart disease risk. A significant association was also evident with household exposure (1.19, 1.13-1.25, n = 37). For those 23 studies providing dose-response results for spouse or household exposure, 11 showed a significant (P < 0.05) positive trend including the unexposed group, and two excluding it. Based on fewer studies, a positive, but non-significant (P > 0.05) association was found for workplace exposure (RR = 1.08, 95%CI: 0.99-1.19), childhood exposure (1.12, 0.95-1.31), and biomarker based exposure indices (1.15, 0.94-1.40). However, there was a significant association with total exposure (1.23, 1.12-1.35). Some significant positive dose-response trends were also seen for these exposure indices, particularly total exposure, with no significant negative trends seen. The evidence suffers from various weaknesses and biases. Publication bias may explain the large RR (1.66, 1.30-2.11) for the main exposure index for smaller studies (1-99 cases), while recall bias may explain the higher RRs seen in case-control and cross-sectional than in prospective studies. Some bias may also derive from including occasional smokers among the “never smokers”, and from misreporting smoking status. Errors in determining ETS exposure, and failing to update exposure data in long term prospective studies, also contribute to the uncertainty. The tendency for RRs to increase as more factors are adjusted for, argues against the association being due to uncontrolled confounding.

CONCLUSION

The increased risk and dose-response for various exposure indices suggests ETS slightly increases heart disease risk. However heterogeneity, study limitations and possible biases preclude definitive conclusions.

Epidemiological evidence on environmental tobacco smoke and cancers other than lung or breast

We reviewed 87 epidemiological studies relating environmental tobacco smoke (ETS) exposure to risk of cancer other than lung or breast in never smoking adults. This updates a 2002 review which also considered breast cancer. Meta-analysis showed no significant relationship with ETS for nasopharynx cancer, head and neck cancer, various digestive cancers (stomach, rectum, colorectal, liver, pancreas), or cancers of endometrium, ovary, bladder and brain. For some cancers (including oesophagus, colon, gall bladder and lymphoma) more limited data did not suggest a relationship. An increased cervix cancer risk (RR 1.58, 95%CI 1.29-1.93, n = 17 independent estimates), reducing to 1.29 (95%CI 1.01-1.65) after restriction to five estimates adjusting for HPV infection or sexual activity suggests a causal relationship, as do associations with nasosinus cancer observed in 2002 (no new studies since), and less so kidney cancer (RR 1.33, 95%CI 1.04-1.70, n = 6). A weaker association with total cancer (RR 1.13, 95%CI 1.03-1.35, n = 19) based on heterogeneous data is inconclusive. Inadequate confounder control, recall bias, publication bias, and occasional reports of implausibly large RRs in individual studies contribute to our conclusion that the epidemiological evidence does not convincingly demonstrate that ETS exposure causes any of the cancers studied.

Environmental tobacco smoke exposure and lung cancer: A systematic review

AIM: To review evidence relating passive smoking to lung cancer risk in never smokers, considering various major sources of bias.

METHODS: Epidemiological prospective or case-control studies were identified which provide estimates of relative risk (RR) and 95%CI for never smokers for one or more of seven different indices of exposure to environmental tobacco smoke (ETS): The spouse; household; workplace; childhood; travel; social and other; and total. A wide range of study details were entered into a database, and the RRs for each study, including descriptions of the comparisons made, were entered into a linked database. RRs were derived where necessary. Results were entered, where available, for all lung cancer, and for squamous cell cancer and adenocarcinoma. “Most adjusted” results were entered based on results available, adjusted for the greatest number of potential confounding variables. “Least adjusted” results were also entered, with a preference for results adjusted at least for age for prospective studies. A pre-planned series of fixed-effects and random-effects meta-analyses were conducted. Overall analyses and analyses by continent were run for each exposure index, with results for spousal smoking given by sex, and results for childhood exposure given by source of ETS exposure. For spousal exposure, more extensive analyses provide results by various aspects of study design and definition of the RR. For smoking by the husband (or nearest equivalent), additional analyses were carried out both for overall risk, and for risk per 10 cigarettes per day smoked by the husband. These adjusted for uncontrolled confounding by four factors (fruit, vegetable and dietary fat consumption, and education), and corrected for misclassification of smoking status of the wife. For the confounding adjustment, estimates for never smoking women were derived from publications on the relationship of the four factors to both lung cancer risk and at home ETS exposure, and on the correlations between the factors. The bias due to misclassification was calculated on the basis that the proportion of ever smokers denying smoking is 10% in Asian studies and 2.5% elsewhere, and that those who deny smoking have the same risk as those who admit it. This approach, justified in previous work, balances higher true denial rates and lower risk in deniers compared to non-deniers.

RESULTS: One hundred and two studies were identified for inclusion, published in 1981 onwards, 45 in Asia, 31 in North America, 21 in Europe, and five elsewhere. Eighty-five were of case-control design and 17 were prospective. Significant (P < 0.05) associations were noted, with random-effects of (RR = 1.22, 95%CI: 1.14-1.31, n = 93) for smoking by the husband (RR = 1.14, 95%CI: 1.01-1.29, n = 45) for smoking by the wife (RR = 1.22, 95%CI: 1.15-1.30, n = 47) for workplace exposure (RR = 1.15, 95%CI: 1.02-1.29, n = 41) for childhood exposure, and (RR = 1.31, 95%CI: 1.19-1.45, n = 48) for total exposure. No significant association was seen for ETS exposure in travel (RR = 1.34, 95%CI: 0.94-1.93, n = 8) or in social situations (RR = 1.01, 95%CI: 0.82-1.24, n = 15). A significant negative association (RR = 0.78, 95%CI: 0.64-0.94, n = 8) was seen for ETS exposure in childhood, specifically from the parents. Significant associations were also seen for spousal smoking for both squamous cell carcinoma (RR = 1.44, 95%CI: 1.15-1.80, n = 24) and adenocarcinoma (RR = 1.33, 95%CI: 1.17-1.51, n = 30). Results generally showed marked heterogeneity between studies. For smoking by either the husband or wife, where 119 RR estimates gave an overall estimate of (RR = 1.21, 95%CI: 1.14-1.29), the heterogeneity was highly significant (P < 0.001), with evidence that the largest RRs were seen in studies published in 1981-89, in small studies (1-49 cases), and for estimates unadjusted by age. For smoking by the husband, the additional analyses showed that adjustment for the four factors reduced the overall (RR = 1.22, 95%CI: 1.14-1.31) based on 93 estimates to (RR = 1.14, 95%CI: 1.06-1.22), implying bias due to uncontrolled confounding of 7%. Further correction for misclassification reduced the estimate to a marginally non-significant (RR = 1.08, 95%CI: 0.999-1.16). In the fully adjusted and corrected analyses, there was evidence of an increase in Asia (RR = 1.18, 95%CI: 1.07-1.30, n = 44), but not in other regions (RR = 0.96, 95%CI: 0.86-1.07, n = 49). Studies published in the 1980’s, studies providing dose-response data, and studies only providing results unadjusted for age showed elevated RRs, but later published studies, studies not providing dose-response data, and studies adjusting for age did not. The pattern of results for RRs per 10 cigs/d was similar, with no significant association in the adjusted and corrected results (RR = 1.03, 95%CI: 0.994-1.07).

CONCLUSION: Most, if not all, of the ETS/lung cancer association can be explained by confounding adjustment and misclassification correction. Any causal relationship is not convincingly demonstrated.

Environmental monitoring of secondhand smoke exposure

The complex composition of secondhand smoke (SHS) provides a range of constituents that can be measured in environmental samples (air, dust and on surfaces) and therefore used to assess non-smokers' exposure to tobacco smoke. Monitoring SHS exposure (SHSe) in indoor environments provides useful information on the extent and consequences of SHSe, implementing and evaluating tobacco control programmes and behavioural interventions, and estimating overall burden of disease caused by SHSe. The most widely used markers have been vapour-phase nicotine and respirable particulate matter (PM). Numerous other environmental analytes of SHS have been measured in the air including carbon monoxide, 3-ethenylpyridine, polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines, nitrogen oxides, aldehydes and volatile organic compounds, as well as nicotine in dust and on surfaces. The measurement of nicotine in the air has the advantage of reflecting the presence of tobacco smoke. While PM measurements are not as specific, they can be taken continuously, allowing for assessment of exposure and its variation over time. In general, when nicotine and PM are measured in the same setting using a common sampling period, an increase in nicotine concentration of 1 μg/m³ corresponds to an average increase of 10 μg/m³ of PM. This topic assessment presents a comprehensive summary of SHSe monitoring approaches using environmental markers and discusses the strengths and weaknesses of these methods and approaches.

Environmental tobacco smoke and coronary heart disease mortality in the United States--a meta-analysis and critique

Several major meta-analyses have concluded that exposure to environmental tobacco smoke (ETS) increases the risk of coronary heart disease (CHD) by about 25% among never smokers. However, these reviews have excluded a large portion of the epidemiologic evidence on questionable grounds and have been inconsistent in the selection of the results that are included. We conducted an updated meta-analysis and critique of the evidence on ETS exposure and its relationship to death from CHD among never smokers. Our focus is on the U.S. cohort studies, which provide the vast majority of the available evidence. ETS exposure is assessed in terms of spousal smoking, self-reported estimates, and personal monitoring. The epidemiologic results are summarized by means of overall relative risks and dose-response relationships. The methodological issues of publication bias, exposure misclassification, and confounding are discussed. Several large studies indicate that spousal smoking history is a valid measure of relative exposure to ETS, particularly for females. Personal monitoring of nonsmokers indicates that their average ETS exposure from a smoking spouse is equivalent in terms of nicotine exposure to smoking less than 0.1 cigarettes per day. When all relevant studies are included in the meta-analysis and results are appropriately combined, current or ever exposure to ETS, as approximated by spousal smoking, is associated with roughly a 5% increased risk of death from CHD in never smokers. Furthermore, there is no dose-response relationship and no elevated risk associated with the highest level of ETS exposure in males or females. An objective assessment of the available epidemiologic evidence indicates that the association of ETS with CHD death in U.S. never smokers is very weak. Previous assessments appear to have overestimated the strength of the association.

Identification of oxidation products of solanesol produced during air sampling for tobacco smoke by electrospray mass spectrometry and HPLC

Solanesol, a 45-carbon, trisesquiterpenoid alcohol found in tobacco leaves and tobacco smoke, has been used as a quantitative marker for tobacco smoke for years. However, solanesol appears to be unreliable as a quantitative marker for tobacco smoke during environmental air sampling because it can be degraded substantially when present as a component of tobacco smoke and by as much as 100% when present as pure solanesol on fortified filters during air sampling. Since there is strong evidence that ozone is the agent responsible for the degradation, solanesol appears to be unreliable as a quantitative marker during indoor air sampling when indoor levels of ozone are greater than about 15 ppb. The degree of loss of pure solanesol is directly proportional to the concentration of ozone and the length of the sampling period and depends on the type of 37 mm membrane filter used for air sampling (PTFE or quartz fiber). While the degree of loss of solanesol is inversely proportional to the relative humidity of the air at a sampling rate of 1.7 L min(-1), the degree of loss is virtually independent of relative humidity at a lower sampling rate; i.e., 0.25 L min(-1). A curve of loss of solanesol on a filter versus concentration of ozone from an ozone generator is virtually identical to a curve segment based on atmospheric ozone under the same conditions of air sampling. Oxidation of solanesol by ozone to approximately 25 to 60% completion produces at least three series of products for a total of at least 26 compounds: (1) isoprenoid acetones, (2)omega-hydroxyisoprenoid acetaldehydes, and (3) isoprenoid oxoaldehydes. All products in each series were tentatively identified as their derivatives with 2-(p-aminophenyl)ethanol (APE) by electrospray mass spectrometry (ES-MS). Ten ozonation products were detected as their 2,4-dinitrophenylhydrazine derivatives by HPLC at 360 nm: 4-oxopentanal and nine isoprenoid acetones (acetone, 6-methyl-5-hepten-2-one, geranylacetone, farnesylacetone, tetraprenylacetone, geranylfarnesylacetone, farnesylfarnesylacetone, farnesylgeranylgeranylacetone and bombiprenone.

Nicotine and surface of particulates as indicators of exposure to environmental tobacco smoke in public places in Austria

As part of a Europe-wide project the amount of exposure to environmental tobacco smoke (ETS) in public places like schools, restaurants, and public transport facilities was investigated. Three methods were applied: nicotine passive samplers (with a filter treated with sodium bisulphate), the same filters with an active sampling device, and the measurement of fine particles' active surface by unipolar diffusion charging. Settings were selected where either high or low ETS concentrations were expected and where non-smokers would have to stay or at least to pass by. Highest ETS concentrations were found in discos (mean nicotine concentration 154.4 maximum 487.1 microg/m3) and intermediate concentrations in restaurants with no significant difference between smoking (21.3 +/- 6.1 microg/m3) and non-smoking areas (23.3 +/- 15.9 microg/m3) but on average higher values in restaurants with no separation between smoking and non-smoking areas (38.0 +/- 60.6 microg/m3). Concentrations usually below 10 microg/m3 were found in transport facilities (8.9 +/- 8.0 microg/m3, maximum 20.6 in the restaurant section of a railway station's waiting room) and in schools (3.0 +/- 4.6 microg/m3). In hospitals "problem spots" were sought and so concentrations from very low to as high as 45.1 microg/m3 next to a smoking area with no physical barrier or separation and 47.7 microg/m3 inside a smoking room could be documented (21.4 +/- 39.3 microg/m3). The fine particle's surface correlated well with the nicotine concentration (r = 0.8; p < 0.001). Only in one instance (in a pizza restaurant on a busy road with heavy duty diesel traffic and the sampling spot next to the pizza stove) high concentration of fine particles was detected without high nicotine. Tobacco smoke is a key source of indoor fine particles. Health policy must intervene to change the situation found at present in many public places in Austria.

Fine PM measurements: personal and indoor air monitoring

This review compiles personal and indoor microenvironment particulate matter (PM) monitoring needs from recently set research objectives, most importantly the NRC published "Research Priorities for Airborne Particulate Matter (1998)". Techniques and equipment used to monitor PM personal exposures and microenvironment concentrations and the constituents of the sampled PM during the last 20 years are then reviewed. Development objectives are set and discussed for personal and microenvironment PM samplers and monitors, for filter materials, and analytical laboratory techniques for equipment calibration, filter weighing and laboratory climate control. The progress is leading towards smaller sample flows, lighter, silent, independent (battery powered) monitors with data logging capacity to store microenvironment or activity relevant sensor data, advanced flow controls and continuous recording of the concentration. The best filters are non-hygroscopic, chemically pure and inert, and physically robust against mechanical wear. Semiautomatic and primary standard equivalent positive displacement flow meters are replacing the less accurate methods in flow calibration, and also personal sampling flow rates should become mass flow controlled (with or without volumetric compensation for pressure and temperature changes). In the weighing laboratory the alternatives are climatic control (set temperature and relative humidity), and mechanically simpler thermostatic heating, air conditioning and dehumidification systems combined with numerical control of temperature, humidity and pressure effects on flow calibration and filter weighing.

Personal exposure of Paris office workers to nitrogen dioxide and fine particles

AIMS

(1) To obtain an overall estimate of variability of personal exposure of Paris office workers to fine particles (PM(2.5)) and nitrogen dioxide (NO(2)), and to quantify their microenvironmental determinants. (2) To examine the role of potential determinants of indoor concentrations.

METHODS

Sixty two office workers in a Paris municipal administration (all non-smokers) were equipped with personal samplers: passive samplers for 48 hours for NO(2) (n = 62), and active pumps for 24 hours for PM(2.5) (n = 55). Simultaneous measurements were performed in homes and offices; the local air monitoring network provided ambient concentrations. A time activity diary was used to weight measured concentrations by time spent in each microenvironment in order to estimate exposure concentrations.

RESULTS

On average, PM(2.5) personal exposure (30.4 microg/m(3)) was higher than corresponding in-home (24.7 microg/m(3)) and ambient concentrations (16.7 microg/m(3)). Personal exposure to NO(2) (43.6 microg/m(3)) was significantly higher than in-home concentrations (35.1 microg/m(3)) but lower than the background outdoor level (60.1 microg/m(3)). Personal exposures to PM(2.5) and NO(2) were not significantly different from in-office concentrations. PM(2.5) and NO(2) personal exposures were not significantly correlated. In-home, in-office, in-transit, outdoor time weighted concentrations, and time spent in other indoor microenvironments explain respectively 86% and 78% of personal variations in PM(2.5) and NO(2). In-home PM(2.5) concentration was primarily influenced by exposure to environmental tobacco smoke, and secondly by the ambient level (R(2) = 0.20). NO(2) in-home concentration was affected mostly by the ambient level and gas cooking time (R(2) = 0.14).

CONCLUSION

While results show the major contribution of in-home and in-office concentrations to both NO(2) and PM(2.5) personal exposures, the identification of indoor level determinants was not very conclusive.

Perceptions of indoor air quality associated with ventilation system types in elementary schools

With the increased utilization of school buildings on a year-round basis, school indoor air quality has become a national concern. The purpose of this study was to evaluate possible associations between ventilation system type and occupant perception of indoor air quality. Staff (n = 403) from 12 schools completed a self-administered questionnaire. Carbon dioxide (CO2) levels, air exchange rates, and particle counts were also measured for each school. Schools with unit ventilator (UV) systems had the lowest mean CO2 level at 637 ppm, followed by the variable air volume (VAV) systems with 664 ppm, and constant volume (CV) systems with a mean of 703 ppm. Schools with UV systems had the lowest mean air exchange rate at 2.67 air changes per hour (ACH), followed by the VAV system type at 2.80 ACH and the CV system type at 4.61 ACH. Indoor versus outdoor particle ratios were calculated for each ventilation system type. Particles with aerodynamic diameters ranging from 0.1-1.0 microm had a geometric mean ratio ranging from 0.38 to 0.68; particles with aerodynamic diameters ranging from 1-3 microm had ratios ranging from 1.39 to 5.47, and particles with aerodynamic diameters greater than 3 microm had ratios ranging from 3.20 to 14.76. Schools using VAV systems had a significantly lower prevalence of red and watery eyes while schools with UV systems had an elevated prevalence of nasal congestion, sore throat, headache, and dustiness complaints. This increased prevalence of complaints in buildings with UV systems may be due to the increased particulate levels.

Seasonal assessment of environmental tobacco smoke and respirable suspended particle exposures for nonsmokers in Bremen using personal monitoring

The study was designed to determine seasonal differences in personal exposures to respirable suspended particles (RSP) and environmental tobacco smoke (ETS) for nonsmokers in Bremen, Germany. The subjects were office workers, either living and working in smoking locations or living and working in nonsmoking locations. One hundred and twenty four randomly selected nonsmoking subjects collected air samples close to their breathing zone by wearing personal monitors for 24 h or, in some cases, for 7-day periods during the winter of 1999. The investigation was repeated in the summer with 126 subjects, comprised of as many of the studied winter population (89 subjects) as possible. Saliva cotinine analyses were undertaken to verify the nonsmoking status of the subjects. Subjects wore one personal monitor while at work and one while away from the workplace on weekdays, and a third monitor at the weekend. Collected air samples were analysed for RSP, nicotine, 3-ethenylpyridine (3-EP) and ETS particles. The latter were estimated using ultraviolet absorbance (UVPM), fluorescence (FPM) and solanesol (SolPM) measurements. ETS exposure was consistently higher in the winter than in the summer, this pattern being particularly evident for subjects both living and working with smokers. The highest median 24-h time weighted average (TWA) concentrations of ETS particles (SolPM, 25 microg m(-3)) and nicotine (1.3 microg m(-3)) were recorded for subjects performing weekday monitoring during the winter. These were significantly higher than equivalent levels of ETS particles (SolPM, 2.4 microg m(-3)) and nicotine (0.26 microg m(-3)) determined during the summer. There were no appreciable differences between winter and summer percent workplace contributions to median TWA ETS particle and nicotine weekday concentrations, the workplace in Bremen, in general, contributing between 35% and 61% of reported median concentrations. Workers, on average, spent one-third of their time at work during a weekday, indicating that concentrations were either comparable or higher in the workplace than in the home and other locations outside the workplace. Median 24-h weekend ETS particle and nicotine concentrations for smoking locations were not significantly different from equivalent weekday levels during the winter, but were significantly lower during the summer. Based upon median 24-h TWA SolPM and nicotine concentrations for the winter, extrapolated to 1 year's ETS exposure, those subjects both living and working in smoking locations (the most highly exposed group) would potentially inhale 13 cigarette equivalents/year (CEs/y). However, based on a similar extrapolation of summer measurements, the same group of subjects would potentially inhale between 1.3 and 1.9 CEs/y. The most highly exposed subjects in this study, based upon 90th percentile concentrations for those both living and working in smoking locations during the winter, would potentially inhale up to 67 CEs/y in the winter and up to 22 CEs/y in the summer. This clearly demonstrates that seasonal effects should be taken into account in the design and interpretation of ETS exposure studies. Air sampling over a 7-day period was shown to be technically feasible, and subsequent RSP, ETS particle and nicotine levels determined by 7-day monitoring were not found to be significantly different from equivalent levels determined by 24-h monitoring. However, the longer sampling period resulted in the collection of an increased quantity of analytes, which improved the limits of quantitation (LOQ) and allowed a more accurate determination of low level ETS exposure. This was reflected by a reduced percentage of data falling below the LOQ for 7-day monitoring compared with 24-h monitoring. The use of a liquid chromatographic method with tandem mass spectrometric detection for saliva cotinine measurement afforded a greatly improved LOQ and greater accuracy at low concentrations compared with the radioimmunoassay (RIA) method used in previous studies by these authors. In this study, 17 subjects out of 180 tested (9.4%) were found to have saliva cotinine levels exceeding the selected threshold of 25 ng ml(-1) used to discriminate between smokers and nonsmokers.

Tobacco industry efforts subverting International Agency for Research on Cancer's second-hand smoke study

Scientific reports on second-hand smoke have stimulated legislation on clean indoor air in the USA, but less so in Europe. Recently, the largest European study, by the International Agency for Research on Cancer (IARC), demonstrated a 16% increase in the point estimate of risk in lung cancer for nonsmokers, a result consistent with earlier studies. However, the study was described by newspapers and the tobacco industry as demonstrating no increase in risk. To understand the tobacco industry's strategy on the IARC study we analysed industry documents released in US litigation and interviewed IARC investigators. The Philip Morris tobacco company feared that the study (and a possible IARC monograph on second-hand smoke) would lead to increased restrictions in Europe so they spearheaded an inter-industry, three-prong strategy to subvert IARC's work. The scientific strategy attempted to undercut IARC's research and to develop industry-directed research to counter the anticipated findings. The communications strategy planned to shape opinion by manipulating the media and the public. The government strategy sought to prevent increased smoking restrictions. The IARC study cost $2 million over ten years; Philip Morris planned to spend $2 million in one year alone and up to $4 million on research. The documents and interviews suggest that the tobacco industry continues to conduct a sophisticated campaign against conclusions that second-hand smoke causes lung cancer and other diseases, subverting normal scientific processes.

Development of a simple sample preparation technique for gas chromatographic-mass spectrometric determination of nicotine in edible nightshades (Solanaceae)

The purpose of this study was to develop a rapid analytical method for the reliable determination of low concentrations of nicotine in foods for large numbers of samples. Food material was extracted using a simple liquid-liquid extraction method. For processed foods, further clean-up steps had to be employed to eliminate interfering compounds. The determination of nicotine was performed by gas chromatography-mass spectrometry. Quantitative analysis was accomplished using deuterium labeled nicotine as an internal standard. Recoveries of over 95% were obtained for a single step extraction, as well as for a multiple-stage extraction procedure, respectively. The method has been applied to the determination of nicotine in edible nightshades (i.e. tomatoes, potatoes and aubergines) and their processed products.

Low level saliva cotinine determination and its application as a biomarker for environmental tobacco smoke exposure

1. The determination of personal exposures to environmental tobacco smoke (ETS) and respirable suspended particles (RSP) for housewives, and fixed site monitoring of their homes, have been undertaken by these authors throughout Europe, South East Asia and Australia. Median 24 h time weighted average (TWA) concentrations for ETS particles and nicotine were found to be significantly higher for housewives living in smoking households compared with those living in nonsmoking households. For Europe, median TWA concentrations of 4.1 and <0.26 microg/ml for ETS particles and 0.63 and < 0.08 microg/m3 for nicotine were found for housewives living in smoking and nonsmoking households respectively. 2. In addition to the measurement of RSP, ETS particles and nicotine, saliva cotinine concentrations were determined using a radioimmunoassay method with a limit of quantitation of 1 ng/ml. Median saliva cotinine concentrations of 1.4 and <1 ng/ml were determined for European housewives living in smoking and nonsmoking households respectively, which reflected the poor limit of quantitation of this methodology. A chromatographic method utilising tandem mass-spectrometric detection was developed and validated for the determination of both cotinine and 3-hydroxycotinine, two of the main metabolites of nicotine, with lower limits of quantitation of 0.05 and 0.10 ng/ml respectively. This method was applied to samples collected from subjects with a known ETS exposure history and median cotinine concentrations of <0.05 ng/ml for self-reported unexposed nonsmokers, 0.65 ng/ml for nonsmokers reporting some ETS exposure and 1.28 ng/ml for nonsmokers living with smokers were found. 3. In conclusion, the measurement of RSP and ETS concentrations derived from personal or fixed site monitors for housewives may provide some indication of potential exposures to dependent children. The recent development and application of a highly sensitive assay for the determination of cotinine in saliva has provided evidence to suggest that concentrations determined at sub-nanogram levels may be used as a biomarker for ETS exposure. This improved methodology, coupled with non-invasive sampling for saliva, may be of significance when considering the application of cotinine as a biomarker for ETS exposure in children.