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. 2001 Sep;55(9):674–680. doi: 10.1136/jech.55.9.674

Measurement of self reported active exposure to cigarette smoke

J Etter 1, T Perneger 1
PMCID: PMC1731967  PMID: 11511648

Abstract

STUDY OBJECTIVE—The number of cigarettes smoked per day is an imprecise indicator of exposure to cigarette smoke, and biochemical assessment of exposure is not always feasible. The aim of this study was to develop more accurate measures of self reported active exposure to cigarette smoke.
DESIGN—Mail survey in 386 smokers, retest at one month in 94 participants (24%), analysis of saliva cotinine in 98 participants (25%), collection of empty cigarette packs in 214 participants (55%), collection of cigarette butts in 107 participants (28%). Ten questions and items intended to assess active exposure to cigarette smoke were tested and compared with saliva cotinine, the Fagerström test for nicotine dependence, and self rated dependence.
SETTING—A population sample in Geneva, Switzerland, in 1999.
PARTICIPANTS—323 daily smokers and 63 occasional smokers.
MAIN RESULTS—Measures that were associated with saliva cotinine included the number of cigarettes smoked per day (r2=0.36), smoking intensity (r2=0.40), the type of cigarettes smoked (regular versus light) (r2=0.04), smoking when ill (r2=0.15) and a single item rating of the total quantity of smoke inhaled (r2=0.27). A multivariate model combining the first four items explained the largest proportion of the variance in cotinine (r2=0.63), substantially more than was explained by the number of cigarettes per day alone, by 75% in all smokers and by 110% in daily smokers.
CONCLUSIONS—The study identified measures of exposure to smoke that reflect saliva cotinine better than the number of cigarettes per day. These measures can be used in studies of the dose related risk of smoking and in smoking reduction studies.


Keywords: tobacco smoke; cotinine; inhalation exposure

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Selected References

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  1. Benowitz N. L. Biomarkers of environmental tobacco smoke exposure. Environ Health Perspect. 1999 May;107 (Suppl 2):349–355. doi: 10.1289/ehp.99107s2349. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Benowitz N. L. Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiol Rev. 1996;18(2):188–204. doi: 10.1093/oxfordjournals.epirev.a017925. [DOI] [PubMed] [Google Scholar]
  3. Benowitz N. L., Jacob P., 3rd, Yu L., Talcott R., Hall S., Jones R. T. Reduced tar, nicotine, and carbon monoxide exposure while smoking ultralow- but not low-yield cigarettes. JAMA. 1986 Jul 11;256(2):241–246. [PubMed] [Google Scholar]
  4. Bolliger C. T., Zellweger J. P., Danielsson T., van Biljon X., Robidou A., Westin A., Perruchoud A. P., Säwe U. Smoking reduction with oral nicotine inhalers: double blind, randomised clinical trial of efficacy and safety. BMJ. 2000 Aug 5;321(7257):329–333. doi: 10.1136/bmj.321.7257.329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bridges R. B., Humble J. W., Turbek J. A., Rehm S. R. Smoking history, cigarette yield and smoking behavior as determinants of smoke exposure. Eur J Respir Dis Suppl. 1986;146:129–137. [PubMed] [Google Scholar]
  6. Chapman S., Wilson D., Wakefield M. Smokers' understandings of cigarette yield labels. Med J Aust. 1986 Oct 20;145(8):376–379. doi: 10.5694/j.1326-5377.1986.tb112389.x. [DOI] [PubMed] [Google Scholar]
  7. Cohen J. B. Smokers' knowledge and understanding of advertised tar numbers: health policy implications. Am J Public Health. 1996 Jan;86(1):18–24. doi: 10.2105/ajph.86.1.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Etter J. F., Perneger T. V., Ronchi A. Collecting saliva samples by mail. Am J Epidemiol. 1998 Jan 15;147(2):141–146. doi: 10.1093/oxfordjournals.aje.a009426. [DOI] [PubMed] [Google Scholar]
  9. Etter J. F., Perneger T. V. Snowball sampling by mail: application to a survey of smokers in the general population. Int J Epidemiol. 2000 Feb;29(1):43–48. doi: 10.1093/ije/29.1.43. [DOI] [PubMed] [Google Scholar]
  10. Etter J. F., Vu Duc T., Perneger T. V. Saliva cotinine levels in smokers and nonsmokers. Am J Epidemiol. 2000 Feb 1;151(3):251–258. doi: 10.1093/oxfordjournals.aje.a010200. [DOI] [PubMed] [Google Scholar]
  11. Feyerabend C., Russell M. A. A rapid gas-liquid chromatographic method for the determination of cotinine and nicotine in biological fluids. J Pharm Pharmacol. 1990 Jun;42(6):450–452. doi: 10.1111/j.2042-7158.1990.tb06592.x. [DOI] [PubMed] [Google Scholar]
  12. Foulds J., Bryant A., Stapleton J., Jarvis M. J., Russell M. A. The stability of cotinine in unfrozen saliva mailed to the laboratory. Am J Public Health. 1994 Jul;84(7):1182–1183. doi: 10.2105/ajph.84.7.1182. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Glasgow R. E., Mullooly J. P., Vogt T. M., Stevens V. J., Lichtenstein E., Hollis J. F., Lando H. A., Severson H. H., Pearson K. A., Vogt M. R. Biochemical validation of smoking status: pros, cons, and data from four low-intensity intervention trials. Addict Behav. 1993 Sep-Oct;18(5):511–527. doi: 10.1016/0306-4603(93)90068-k. [DOI] [PubMed] [Google Scholar]
  14. Greeley D. A., Valois R. F., Bernstein D. A. Stability of salivary cotinine sent through the U.S. mail for verification of smoking status. Addict Behav. 1992;17(3):291–296. doi: 10.1016/0306-4603(92)90034-s. [DOI] [PubMed] [Google Scholar]
  15. Heatherton T. F., Kozlowski L. T., Frecker R. C., Fagerström K. O. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991 Sep;86(9):1119–1127. doi: 10.1111/j.1360-0443.1991.tb01879.x. [DOI] [PubMed] [Google Scholar]
  16. Herbert F. A., Enarson D. A., Hackett R. L. Validation of the smoking habits of a sample of the patient population seen in a pulmonary function laboratory. Am Rev Respir Dis. 1989 Dec;140(6):1822–1824. doi: 10.1164/ajrccm/140.6.1822. [DOI] [PubMed] [Google Scholar]
  17. Herning R. I., Jones R. T., Benowitz N. L., Mines A. H. How a cigarette is smoked determines blood nicotine levels. Clin Pharmacol Ther. 1983 Jan;33(1):84–90. doi: 10.1038/clpt.1983.12. [DOI] [PubMed] [Google Scholar]
  18. Hughes J. R. Reduced smoking: an introduction and review of the evidence. Addiction. 2000 Jan;95 (Suppl 1):S3–S7. doi: 10.1080/09652140032008. [DOI] [PubMed] [Google Scholar]
  19. Höfer I., Nil R., Wyss F., Bättig K. The contributions of cigarette yield, consumption, inhalation and puffing behaviour to the prediction of smoke exposure. Clin Investig. 1992 Mar-Apr;70(3-4):343–351. doi: 10.1007/BF00184671. [DOI] [PubMed] [Google Scholar]
  20. Idle J. R. Titrating exposure to tobacco smoke using cotinine--a minefield of misunderstandings. J Clin Epidemiol. 1990;43(4):313–317. doi: 10.1016/0895-4356(90)90117-8. [DOI] [PubMed] [Google Scholar]
  21. Jacob P., 3rd, Yu L., Shulgin A. T., Benowitz N. L. Minor tobacco alkaloids as biomarkers for tobacco use: comparison of users of cigarettes, smokeless tobacco, cigars, and pipes. Am J Public Health. 1999 May;89(5):731–736. doi: 10.2105/ajph.89.5.731. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Klesges R. C., Debon M., Ray J. W. Are self-reports of smoking rate biased? Evidence from the Second National Health and Nutrition Examination Survey. J Clin Epidemiol. 1995 Oct;48(10):1225–1233. doi: 10.1016/0895-4356(95)00020-5. [DOI] [PubMed] [Google Scholar]
  23. Kozlowski L. T., Heatherton T. F., Frecker R. C., Nolte H. E. Self-selected blocking of vents on low-yield cigarettes. Pharmacol Biochem Behav. 1989 Aug;33(4):815–819. doi: 10.1016/0091-3057(89)90476-0. [DOI] [PubMed] [Google Scholar]
  24. Nakayama T., Yokoyama T., Yoshiike N., Ichimura T., Yamamoto A., Tanaka H. Behavioral factors predicting serum cotinine concentrations of male smokers in a Japanese community. J Epidemiol. 1999 Jun;9(3):143–145. doi: 10.2188/jea.9.143. [DOI] [PubMed] [Google Scholar]
  25. Peach H., Shah D., Morris R. W. Validity of smokers' information about present and past cigarette brands--implications for studies of the effects of falling tar yields of cigarettes on health. Thorax. 1986 Mar;41(3):203–207. doi: 10.1136/thx.41.3.203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Pérez-Stable E. J., Benowitz N. L., Marín G. Is serum cotinine a better measure of cigarette smoking than self-report? Prev Med. 1995 Mar;24(2):171–179. doi: 10.1006/pmed.1995.1031. [DOI] [PubMed] [Google Scholar]
  27. Sutton S. R., Russell M. A., Iyer R., Feyerabend C., Saloojee Y. Relationship between cigarette yields, puffing patterns, and smoke intake: evidence for tar compensation? 1982 Aug 28-Sep 4Br Med J (Clin Res Ed) 285(6342):600–603. doi: 10.1136/bmj.285.6342.600. [DOI] [PMC free article] [PubMed] [Google Scholar]

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