How do we Measure Secondhand Smoke Exposure?Dr. Erika Avila TangDepartment of EpidemiologyInstitute for Global Tobacco Con...
FAMRI Expert SHSe Assessment Goal:    To catalogue the approaches for Secondhand Smoke exposure (SHSe) assessment    Pr...
Why would we want to measure SHSe? SHSe is a key element of tobacco control  research and implementation worldwide     T...
Topic assessments Questionnaires and self-reported methods Biological samples Environmental samples                    ...
Self-reported methods of assessment Questionnaires  Most commonly used  Inexpensive and feasible for large studies  As...
Accuracy: validity and reliability Review of studies assessing the validity and/or  reliability of questions Validation ...
Conclusions for questionnaires and self-reported methods Reliable responses for SHSe in their lifetime, childhood,  and c...
Topic assessments Questionnaires and self-reported methods Biological samples Environmental samples                    ...
Biomarkers Tobacco-specific biomarkers    Cotinine        Reflects recent SHSe (t1/2 16 hours (average))     Nicotine/...
Biomarker- Cotinine  Matrix            Cut-off               Pros                    Cons   Urine       50 ng/ml for highe...
Biomarker- Nicotine/Cotinine  Matrix        Cut-off              Pros                           Cons   Hair        0.8 ng/...
Biomarker- NNALMatrix   Cut-off                Pros                         ConsUrine      Not       Related to a lung ca...
Topic assessments Questionnaires and self-reported methods Biological samples Environmental samples                    ...
Environmental measurements Most widely used methods:   Nicotine: passive air monitor   Particulate matter (< 2.5µ (PM2....
Air nicotine monitoring Highly specific to tobacco smoke Monitors (1-3) placed in each venue (hung from the  ceiling) fo...
Particulate matter monitoring Active, real-time monitor    Uses light scattering to measure particulate       matter con...
Overall findings Questionnaires are the most effective way to know if  people are exposed – but not how much they are exp...
Acknowledgements  Wael       Al-Delaimy   Melbourne Hovell  Benjamin   Apelberg     Andrew     Hyland  David      Ashley  ...
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S25 2 how do we measure secondhand smoke- erika avila-tang

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S25 2 how do we measure secondhand smoke- erika avila-tang

  1. 1. How do we Measure Secondhand Smoke Exposure?Dr. Erika Avila TangDepartment of EpidemiologyInstitute for Global Tobacco Control
  2. 2. FAMRI Expert SHSe Assessment Goal:  To catalogue the approaches for Secondhand Smoke exposure (SHSe) assessment  Provide a set of uniform methods for future use to facilitate comparisons of findings across studies Comprehensive topic assessments on:  Questionnaires and self-reported methods  Biological samples  Environmental samples Flight Attendant Medical Research Institute (FAMRI) Centers of Excellence  American Academy of Pediatrics Julius B. Richmond, Illinois, USA  Johns Hopkins University, Maryland, USA  University of California, San Francisco Bland Lane, California, USA  More than 20 researchers on SHSe assessment involved 2
  3. 3. Why would we want to measure SHSe? SHSe is a key element of tobacco control research and implementation worldwide  To estimate the SHSe overall burden of disease  To determine the risks associated with SHSe  To assess population trends in support of and evaluate tobacco control policies  To support and evaluate behavioral interventions
  4. 4. Topic assessments Questionnaires and self-reported methods Biological samples Environmental samples 4
  5. 5. Self-reported methods of assessment Questionnaires  Most commonly used  Inexpensive and feasible for large studies  Assessment of :  Current and long-term exposure  Time-activity patterns  Recall can be an issue Diaries  Recall burden is reduced but respondent’s burden is increased  E.g. Report over the past day vs. past week/month  Higher awareness of instances of exposure
  6. 6. Accuracy: validity and reliability Review of studies assessing the validity and/or reliability of questions Validation of questions against a “gold standard”:  Air measurement  Biomarker Reliability=repeatability 6
  7. 7. Conclusions for questionnaires and self-reported methods Reliable responses for SHSe in their lifetime, childhood, and current among adults. For children, CPD from parents, in their presence, and in places Research on testing the accuracy of questions are still needed  Current exposure for adults and children, including intensity and duration of exposure  Exposure at home, in transport, and in social settings Collaboration of FAMRI CoEs: AAP Richmond, Johns Hopkins, and UCSF Bland Lane are testing questions in pilot studies to continue building a set of core questions 7
  8. 8. Topic assessments Questionnaires and self-reported methods Biological samples Environmental samples 8
  9. 9. Biomarkers Tobacco-specific biomarkers  Cotinine  Reflects recent SHSe (t1/2 16 hours (average))  Nicotine/cotinine in hair or toenails  Reflects “longer exposure”: 1 cm of hair proximal to the scalp ≈ last month’s exposure; 1 mm ≈ last month’s exposure  NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol)  Reflects “longer exposure” (t1/2 up to 3 weeks) 9
  10. 10. Biomarker- Cotinine Matrix Cut-off Pros Cons Urine 50 ng/ml for higher Higher Need of facilities withNon-invasive SHSe concentrations privacy during collection than other Difficulty for population- matrices based or children studies (higher Need for creatinine sensitivity) clearance adjustment Collect data on renal disease and some prescription drugs Blood 12 ng/ml for higher No adjustment Pregnant women have Invasive SHSe required for increased clearance rate hydration Difficulty for infants and 3 ng/ml for lower young children SHSe Lower sensitivity Saliva 14 ng/ml for higher Good for Potential issues with age,Non-invasive SHSe multiple gender, race, oral pH, type measurements of diet, dehydration, or over a limited drug treatment period of time Lower sensitivity 10
  11. 11. Biomarker- Nicotine/Cotinine Matrix Cut-off Pros Cons Hair 0.8 ng/mg Easy to collect, ship, and Scarcity of hair in infantsNon-invasive (Women) store (room temperature ≤ 5 and adults years) Chemical hair treatments 0.2 ng/mg Less affected by daily can reduce concentrations (Pregnant) variability (fluctuating by 9%-30% exposure, varying Age, gender, and race may 0.2 ng/mg metabolism, and nicotine play roles in determining (Children) elimination) hair nicotine concentrations Represents longer exposure Toenails Not Easy to collect, ship, and Need for further researchNon-invasive available store (room temperature ≤ and population 20 years) concentrations Overcomes day-to-day exposure variability Represents longer exposure 11
  12. 12. Biomarker- NNALMatrix Cut-off Pros ConsUrine Not Related to a lung carcinogen Analytical expertise available Represents longer exposure Costly equipment than cotinine NNAL is carcinogenic and (urine/blood/saliva) mutagenic, special lab handling Further research needed 12
  13. 13. Topic assessments Questionnaires and self-reported methods Biological samples Environmental samples 13
  14. 14. Environmental measurements Most widely used methods:  Nicotine: passive air monitor  Particulate matter (< 2.5µ (PM2.5)) monitor Correlation between nicotine and PM when measured in the same setting using a common sampling period  An increase in 1 µg/m3 of nicotine concentration ≈ an average increase of 10 µg/m3 of PM 14
  15. 15. Air nicotine monitoring Highly specific to tobacco smoke Monitors (1-3) placed in each venue (hung from the ceiling) for 5 to14 days Filters are soaked in a bi-sodium sulfate solution that captures nicotine on the filter No expensive equipment to buy up front and minimal operating cost but requires lab analysis  Per sample laboratory costs including the filter badge are ~$40-$100 USD
  16. 16. Particulate matter monitoring Active, real-time monitor  Uses light scattering to measure particulate matter concentrations (e.g. PM2.5)  Air quality standards makes easier dissemination  Other causes of indoor air particles High initial investment  ~3,000 USD  Minimal operating cost  No per sample costs  Potential costs in labor for data analysis
  17. 17. Overall findings Questionnaires are the most effective way to know if people are exposed – but not how much they are exposed Research on testing the accuracy of questions are still needed Choice of any SHSe assessment method depends on your needs  Study’s objectives, subjects, design and setting and funding  Selection of a biomarker will dependent on:  Issues of privacy, invasiveness, and subject’s age  The length of SHSe may result in selecting hair or toenails over bio- fluids 17
  18. 18. Acknowledgements Wael Al-Delaimy Melbourne Hovell Benjamin Apelberg Andrew Hyland David Ashley Sungroul Kim Erika Avila-Tang Jonathan Klein Neil Benowitz Neil Klepeis Thomas Bernert Robert McMillen Dana Best James Repace Patrick Breysse Jonathan Samet Michael Cummings Jonathan Winickoff Geoffrey Fong Ana Navas-Acien Lara Gundel Lisa Hepp Kathie Hammond Jessica Elf Stephen Hecht Camille Madsen 18

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