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Tobacco
Health Effects of Exposure to
Environmental Tobacco Smoke

TABLE 2.1

 

INFLUENCE OF PUFF VOLUME AND FILTER VENTILATION ON DELIVERIES OF PARTICULATE MATTER AND CARBON MONOXIDE IN MAINSTREAM AND SIDESTREAM SMOKE

 

   

Milligrams per Cigarette and SS/MS Ratio

  Number

Particulate Matter

Carbon Monoxide
Variablea of Puffs MS SS SS/MS MS SS SS/MS
Puff Volume              
None, free burn 0 -- 23 -- -- 58 --
17.5 cc 9.6 29 23 0.8 9 63 7
35 cc 8.7 46 20 0.4 19 50 2.6
50 cc 7.4 55 21 0.4 20 56 2.8
Filter Ventilationb              
0% 8.7 46 20 0.4 19 50 2.6
33% 8.8 32 21 0.6 13 49 3.8
48% 9.8 21 21 1.0 7 58 8.3
83% 10.6 12 21 1.8 2 56 2.8

Browne et al. (1980)

 

a USA blend cigarette, FTC smoking conditions unless otherwise noted.

b Percent of mainstream puff air entering through periphery of filter.

  • TABLE 2.2

  • CHEMICAL CONSTITUENTS OF TOBACCO SMOKE THAT HAVE BEEN CLASSIFIED OR IDENTIFIED AS TO THEIR CARCINOGENICITY,
    REPRODUCTIVE TOXICITY OR OTHER HEALTH HAZARD

     

    COMPOUND

    IARC

    CLASSIFICATIONa

    U.S. EPA CLASSIFICATIONb

    CAL/EPA

    PROP 65c//TACd

    Organic Compounds      
    Acetaldehyde

    2B

    B2

  • yes//yes
  • Acetamide

    2B

     
  • yes//yes
  • Acrolein

    3

    C

  • --- //yes
  • Acrylonitrile

    2A

    B1

  • yes//yes
  • 4-Aminobiphenyl

    1

     
  • yes//yes
  • Aniline

    3

    B2

  • yes//yes
  • o-Anisidine

    2B

     
  • yes//yes
  • Benz[a]anthracene

    2A

    B2

  • yes//---
  • Benzene

    1

    A

  • yes//yes
  • Benzo[b]fluoranthene

    2B

    B2

  • yes//---
  • Benzo[j]fluoranthene

    2B

     
  • yes//---
  • Benzo[k]fluoranthene

    2B

    B2

  • yes//---
  • Benzo[a]pyrene

    2A

    B2

  • yes//yes
  • 1,3-Butadiene  

    B2

  • yes//yes
  • Captan

    3

     
  • yes//yes
  • Carbon disulfidee    
  • yes//yes
  • Carbon monoxidee    
  • yes//---
  • Chrysene

    3

    B2

  • yes//---
  • DDT

    2B

     
  • yes//---
  • Dibenz[a,h]acridine

    2B

     
  • yes//---
  • Dibenz[a,j]acridine

    2B

     
  • yes//---
  • Dibenz[a,h]anthracene

    2A

    B2

  • yes//---
  • Sources: ARB (1993); IARC (1985, 1986, 1987, 1992); California Code of Regulations (1994); U.S. EPA (1994)

  • a International Agency for Research on Cancer (IARC) Classification: 1, carcinogenic to humans; 2A, probably carcinogenic to humans; 2B, possibly carcinogenic to humans; 3, not classifiable as to its carcinogenicity to humans.

    b U.S. EPA Classification: A, human carcinogen; B1, probable human carcinogen (primarily on the basis of epidemiological data); B2, probable human carcinogen (primarily on the basis of animal data); C, possible human carcinogen.

    c Chemicals listed under Proposition 65 are known to the State to cause cancer or reproductive toxicity (California Health and Safety Code Section 25249.5 et seq.).

    d Substances identified as Toxic Air Contaminants by the Air Resources Board (ARB), pursuant to the provisions of AB 1807 and AB 2728 (includes all Hazardous Air Pollutants listed in the Federal Clean Air Act Amendments of 1990).

    e Reproductive toxicant

  • TABLE 2.2 (continued)

  • CHEMICAL CONSTITUENTS OF TOBACCO SMOKE THAT HAVE BEEN CLASSIFIED OR IDENTIFIED AS TO THEIR CARCINOGENICITY,
    REPRODUCTIVE TOXICITY OR OTHER HEALTH HAZARD

     

    COMPOUND

    IARC

    CLASSIFICATIONa

    U.S. EPA CLASSIFICATIONb

    CAL/EPA

    PROP 65c/TACd

    Organic Compounds      
    7H-Dibenzo[c,g]carbazole

    2B

     
  • yes//---
  • Dibenzo[a,e]pyrene

    2B

     
  • yes//---
  • Dibenzo[a,h]pyrene

    2B

     
  • yes//---
  • Dibenzo[a,i]pyrene

    2B

     
  • yes//---
  • Dibenzo[a,l]pyrene

    2B

     
  • yes//---
  • 1,1-Dimethylhydrazine

    2B

     
  • yes//yes
  • 1-Naphthylamine

    3

     
  • yes//---
  • 2-Naphthylamine

    1

     
  • yes//---
  • Nicotinee    
  • yes//---
  • 2-Nitropropane

    2B

     
  • yes//yes
  • N-Nitrosodi-n-butylamine

    2B

    B2

  • yes//---
  • N-Nitrosodiethanolamine

    2B

    B2

  • yes//---
  • N-Nitrosodiethylamine

    2A

    B2

  • yes//---
  • N-Nitroso-n-methylethylamine

    2B

    B2

  • yes//---
  • N’-Nitrosonornicotine

    2B

     
  • yes//---
  • N-Nitrosopiperidine

    2B

     
  • yes//---
  • N-Nitrosopyrrolidine

    2B

     
  • ---//yes
  • Styrene

    2B

     
  • ---//yes
  • Toluenee    
  • yes//yes
  • 2-Toluidine

    2B

     
  • yes//yes
  • Urethane

    2B

     
  • yes//---
  • Vinyl chloride

    1

     
  • yes//yes
  • Sources: ARB (1993); IARC (1985, 1986, 1987, 1992); California Code of Regulations (1994); U.S. EPA (1994)

  • a International Agency for Research on Cancer (IARC) Classification: 1, carcinogenic to humans; 2A, probably carcinogenic to humans; 2B, possibly carcinogenic to humans; 3, not classifiable as to its carcinogenicity to humans.

    b U.S. EPA Classification: A, human carcinogen; B1, probable human carcinogen (primarily on the basis of epidemiological data); B2, probable human carcinogen (primarily on the basis of animal data); C, possible human carcinogen.

    c Chemicals listed under Proposition 65 are known to the State to cause cancer or reproductive toxicity (California Health and Safety Code Section 25249.5 et seq.).

    d Substances identified as Toxic Air Contaminants by the Air Resources Board (ARB), pursuant to the provisions of AB 1807 and AB 2728 (includes all Hazardous Air Pollutants listed in the Federal Clean Air Act Amendments of 1990).

    e Reproductive toxicant

  • TABLE 2.2 (continued)

  • CHEMICAL CONSTITUENTS OF TOBACCO SMOKE THAT HAVE BEEN CLASSIFIED OR IDENTIFIED AS TO THEIR CARCINOGENICITY,
    REPRODUCTIVE TOXICITY OR OTHER HEALTH HAZARD

     

    COMPOUND

    IARC

    CLASSIFICATIONa

    U.S. EPA CLASSIFICATIONb

    CAL/EPA

    PROP 65c/TACd

    Inorganic compounds      
    Arsenic

    1

    A

  • yes//yes
  • Cadmium

    2A

    B1

  • yes//yes
  • Chromium V1

    1

    A

  • yes//yes
  • Leade

    2B

    B2

  • yes//yes
  • Nickel

    1

    A

  • yes//yes
  • Sources: ARB (1993); IARC (1985, 1986, 1987, 1992); California Code of Regulations (1994); U.S. EPA (1994)

     

  • a International Agency for Research on Cancer (IARC) Classification: 1, carcinogenic to humans; 2A, probably carcinogenic to humans; 2B, possibly carcinogenic to humans; 3, not classifiable as to its carcinogenicity to humans.

    b U.S. EPA Classification: A, human carcinogen; B1, probable human carcinogen (primarily on the basis of epidemiological data); B2, probable human carcinogen (primarily on the basis of animal data); C, possible human carcinogen.

    c Chemicals listed under Proposition 65 are known to the State to cause cancer or reproductive toxicity (California Health and Safety Code Section 25249.5 et seq.).

    d Substances identified as Toxic Air Contaminants by the Air Resources Board (ARB), pursuant to the provisions of AB 1807 and AB 2728 (includes all Hazardous Air Pollutants listed in the Federal Clean Air Act Amendments of 1990).

    e Reproductive toxicant

  • Table 2.3

  • MEAN CONCENTRATIONS OF NICOTINE AND COTININE IN THE SALIVA,
    PLASMA, AND URINE OF ETS - EXPOSED VOLUNTEERSa

     

     

    Saliva (ng/ml) Plasma (ng/ml) Urine (ng/ml creatinine)

    Time Nicotine Cotinine Nicotine Cotinine Nicotine Cotinine

     

    Minutes of exposure
    0 (baseline) 3 1.0 0.2 0.9 17 14

    40 830 1.1 0.3 0.9 --b ---

    60 880 2.1 0.3 1.2 -- --

    80 730 1.4 0.5 1.3 84 28

     

    Minutes post exposure
    30 148 1.7 0.4 1.8 -- --

    150 17 3.1 0.7 2.9 100 46

    240 3 2.0 1.1 3.3 -- --

    300 7 3.5 0.6 3.4 48 55

    Source: Hoffman et al. (1984)

     

    a Individuals were exposed to ETS generated from continuous smoking of 4 cigarettes by machine.
    The air concentration of nicotine stabilized at approximately 280 ug/m3 within 10 to 15 minutes.

    b Samples not taken for this exposure interval.

     

  • Table 2.4

  • COMPARISON OF BIOMARKERS IN
    UNEXPOSED AND ETS-EXPOSED NONSMOKERS, AND ACTIVE SMOKERSa

     

    Biochemical parameter Unexposed Nonsmokers

    (n = 46)

    Mean value

    % of active
    smokers’ value

    ETS-Exposed Nonsmokers

    (n = 54)

    Mean value

    % of active
    smokers’ value
    Active smokers
    (n = 94)

    Mean value

    CO in expired air
    (ppm [mg/m3])
    5.7 [6.5] 27 5.5 [6.3] 26 20.8 [24]
               
    COHb (%) 0.9 23 0.8 21 3.9
               
    Nicotine (ng/ml)          
    in plasma 1.0 7 0.8 5.4 14.8
    in saliva 3.8 0.6 5.6 0.8 672.5
    in urine 3.9 0.2 12.1* 0.7 1749.9
               
    Cotinine (ng/ml)          
    in plasma 0.8 0.3 2.0* 0.7 275.2
    in saliva 0.7 0.2 2.5** 0.8 309.9
    in urine 1.6 0.1 7.7** 0.6 1391.0
               
    Thiocyanate (m mol/l)          
    in plasma 48 39 53 43 123
    in saliva

    in urine

    1270

    73

    52

    47

    1327

    77

    54

    50

    2450

    155

     

    a From IARC (1986) using data from Jarvis and Russell (1984).

    * indicates p<0.01 between exposed and unexposed nonsmokers

    ** indicates p<0.001 between exposed and unexposed nonsmokers

    TABLE 2.5

     

    CUT-OFF, SENSITIVITY AND SPECIFICITY OF BIOMARKERS
    FOR DISCRIMINATING TRUE SMOKING STATUSa

     

    Cut-off % Smokers % Nonsmokers 95% CI
    Biomarkers Value Detected Detected for % Accuracy

    Carbon Monoxide
    ECO (ppm) 8.0 90 89 86.2-91.7
    COHb (% ) 1.6 86 92 83.0-89.2

    Nicotine (ng/ml)
    Plasma 2.3 88 99 89.4-93.8
    Saliva 21.8 90 99 91.6-95.2
    Urine 58.6 89 97 93.3-96.3

     

    Cotinine (ng/ml)
    Plasma 13.7 96 100 98.3-99.1
    Saliva 14.2 96 99 98.5-99.3
    Urine 49.7 97 99 98.4-99.2

     

    Thiocyanate
    Plasma (m mol/l) 78.0 84 91 81.1-87.9
    Saliva (mmol/l) 1.64 81 71 66.0-76.0
    Urine (m mol/l) 118.0 59 89 67.0-77.0

    Jarvis et al. (1987), with permission

     

    a True smokers were those who reported smoking cigarettes,
    pipes, or cigars (n = 90) and 21 "deceivers." Non-smokers
    were the self-reported non-smokers minus the deceivers (n = 100).

     

    b Accuracy defined as overall % correct classification, and estimated
    for a population with equal proportions of smokers and nonsmokers.

  • Table 2.6

    Studies of Cotinine Measurements

    in Self-Reported Nonsmokers

    and Criteria Used to Distinguish Smokers from Nonsmokers

  • Self-Reported

    Nonsmokers

    Sample Percent Criteria

    Study Marker Assaya Size Misclassifiedb (ng/ml)

     

    Wald et al. (1986) Urinary cotinine RIA 221 0.9 --c

     

    Cummings et al. Urinary cotinine HPLC 669 0.9 90

    (1990)

     

    Pojer et al. (1984) Plasma cotinine GC 181 3.3 42

     

    Jarvis and Russell Plasma cotinine GC 215 9.8 20

    (1984)

     

    Lee (1987) Saliva cotinine GC 808 2.5 30

     

    Pierce et al. Saliva cotinine GC 622 7.4 25

    (1987)

     

    Coultas et al. Saliva cotinine RIA 683 6.0 20

    (1988)

     

    Haddow et al. Serum cotinine RIA 1,508 1.9 10

    (1988)

     

    Riboli et al. Urinary cotinine RIA 1,369 3.4 50d

    (1990)

     

    Wagenknecht et al. Serum cotinine RIA 3,445 4.2 14

    (1991)

     

    Perez-Stable et al. Serum cotinine GC 189 6.3 14

    (1992)

    Modified from Perez-Stable et al. (1992)

    a Abbreviations: GC, gas chromatography; RIA, radioimmunoassay; HPLC, high pressure
    liquid chromatography

    b percentage of self-reported nonsmokers with cotinine levels above criteria listed

    c >10% smokers’ median

    d ng/mg creatinine

    TABLE 2.7

    CONCENTRATIONS OF NICOTINE AND COTININE IN MOTHERS’ MILK

    Concentration (ng/ml)

    Study Constituent Mean (SD) Range Study population Comments

     

    Smokers
    Ferguson et al. (1976) Nicotine 91 20-512 28 samples from 9 women were

    collected. Most subjects smoked 0.5-1.5 packs/day.

    Concentrations of nicotine varied

    greatly in samples from the same

    donor taken at different times of

    the day.

    Hardee et al. (1983) Nicotine -- 20-150 Samples from 3 women
    Cotinine -- 50-300
    Luck and Nau (1984) Nicotine

    Cotinine

    --

    --

    2-62

    12-222

    44 samples from 23 women were collected. The number of

    cigarettes smoked per day ranged from 5-40. The time between the last cigarette smoked and the collection of samples ranged from 0.25 to 4.0 hours.

    Woodward et al. (1986) Nicotine

    Cotinine

    Nicotine

    Cotinine

    8.3 ( 13.0)

    84.4 ( 93.3)

    32.6 ( 26.6)

    234 ( 110.8)

    --

    --

    --

    --

    Samples from 20 women smoking 1-20 cigarettes 48 hours prior to sample collection.

    Samples from 7 women smoking 21 cigarettes 48 hours prior to sample collection.

     

     

    TABLE 2.7 (continued)

    CONCENTRATIONS OF NICOTINE AND COTININE IN MOTHERS’ MILK

    Concentration (ng/ml)

    Study Constituent Mean (SD) Range Study population Comments

    Luck and Nau (1987) Nicotine

    Cotinine

    Nicotine

    Cotinine

    Nicotine

    Cotinine

    8.3 ( 16)

    76 ( 33)

    28 ( 21)

    125 ( 60)

    48 ( 25)

    230 ( 62)

    --

    --

    --

    --

    --

    --

    Samples from all nursing periods within 24 hours. Samples from 10 women smoking 1-10 cigarettes/day.

    Samples from 11 women smoking 11-20 cigarettes/day.

    Samples from 13 women smoking 21-40 cigarettes/day.

    Determinants of milk nicotine levels were the number of cigarettes consumed during the period immediately prior to nursing and the time interval between the last cigarette smoked and nursing.
    Labrecque et al. (1989) Cotinine 195 ( 122) 28-256 Samples from 33 mothers smoking on average
    9.8 cigarettes in the
    previous 24 hours.
    Cotinine levels were significantly related to the number of cigarettes smoked by the mother in the previous 24 hours (r=0.69, p=0.0002).
    Schulte-Hobein et al. (1992) Cotinine 264 0-738 Samples from 69 mothers who smoked more than 5 cigarettes per day during pregnancy and continued smoking after childbirth. Samples (total = 238) were collected at monthly intervals for 1 year. Cotinine concentrations were dependent on nicotine consumption as reported by mothers (r=0.56, p < 0.0001)

     

    Table 2.7 (continued)

    CONCENTRATIONS OF NICOTINE AND COTININE IN MOTHERS’ MILK

    ____________________________________________________________________________________________________________

    Concentration (ng/ml)

    Study Constituent Mean (SD) Range Study population Comments

    Dahlstrom et al. (1990) Nicotine

    Cotinine

    Nicotine

    Cotinine

    5.16

    112

    55

    136

    0.9-17.3

    18-388

    10-140

    31-467

    Samples from 22 mothers abstaining from cigarettes
    for 12 hours

    Samples from 21 mothers 30 minutes after smoking
    at least 1 cigarette

    Schwartz-Bickenbach

    et al. (1987)

    Cotinine

    Cotinine

    91-322a

    305-439a

    41-580

    0-635

    Samples from 6 mothers smoking < 20 cigarettes/day.

    Samples from 15 mothers smoking > 20 cigarettes/day.

    Nonsmokers
    Hardee et al. (1983) Nicotine

    Cotinine

    --

    --

    1-7 Samples from 10 nonsmoking women. Detected in 3 women reporting workplace exposure to ETS
    Schulte-Hobein et al.

    (1992)

    Cotinine 0 0-277 Samples from 69 nonsmoking women. Detected in 7 women who lived with partners who smoked.

    a Range of median concentrations measured 1 week to 6 months post partum.

     

    Table 2.8
    Studies with Information on ETS Exposure Prevalence in California and the U.S.:
    Adults and Adolescents

    Year/ Measure of Exposure

    Study Location Description Exposure Prevalence (age) Comments

    California

     

    Friedman et al. 1979-1980 37,881 nonsmoking Self-report 63.3% (>18yrs) Exposed individuals
    (1983) Oakland and adults from the defined as those
    San Francisco, Kaiser-Permanente reporting an average
    California Medical Care Program. exposure to ETS of one or more hours per week.

     

    Wiley et al. 1987-1988 1,579 English-speaking Self-report 43% (>18 yrs) Activity-pattern
    (1991a) California adult members of house interview) study. Exposed
    Jenkins et al. (statewide) holds with telephones. 64% (12-17 yrs) individuals defined as
    (1992) those reporting exposure
    to ETS on the day
    preceding the interview.
    Prevalence given for
    nonsmokers.

    Burns and Pierce 1990-1991 Telephone interviews Interview 36.5% (12-17 yrs) Exposed individuals
    (1992) California with 32,135 English- defined as those living
    (statewide) and Spanish-speaking in a household with at
    households least one smoker.

     

     

    Table 2.8 (continued)
    Studies with Information on ETS Exposure Prevalence in California and the U.S.:
    Adults and Adolescents

    Year/ Measure of Exposure

    Study Location Description Exposure Prevalence (age) Comments

    Other U.S. areas

     

    Coultas et al. 1984-1985 698 nonsmoking adults Salivary 39% (>18 yrs) Exposed individuals
    (1987) Albuquerque, from 727 randomly cotinine defined as those with
    New Mexico selected Hispanic 48% (13-17 yrs) salivary cotinine con-
    households. centrations ranging from
    0.78 - 20 ng/ml.

     

    Cummings 1986 663 nonsmoking adults Self-report 76% (>18 yrs) Exposed individuals
    et al. (1990) Buffalo, attending a cancer- (interview) defined as those
    New York screening clinic reporting any exposure
    to ETS during the 4-day
    period preceding the
    interview.

     

    Urinary 91% (>18 yrs) Exposed individuals
    cotinine defined as those with
    detectable concentrations
    of cotinine (detection
    limit not given).

     

     

    Table 2.8 (continued)
    Studies with Information on ETS Exposure Prevalence in California and the U.S.:

    Adults and Adolescents

    Year/ Measure of Exposure

    Study Location Description Exposure Prevalence (age) Comments

     

    Centers for 1988-1992 800 nonsmoking indivi- Serum 100% (----)a Exposed individuals
    Disease United States duals, ages 4-91 years, cotinine defined as those with
    Control (1993b) from 81 U.S. counties. detectable concentrations
    of cotinine. Interpretation of
    the study results limited by the preliminary nature of the
    report and the sensitive method for analyzing for
    cotinine (see text).

     

    a Exposure prevalence reported for entire study population

     

    Table 2.9
    Studies with Information on ETS Exposure Prevalence in California and the U.S.:
    Infants and Children

    Year/ Measure of Exposure

    Study Location Description Exposure Prevalence (age) Comments

    California

     

    Phillips et al. 1989-1990 1,200 children Surrogate 40% (6-11yrs) Exposed individuals
    (1991) California (0 to 11 years old) Report defined as those reporting
    Wiley et al. (statewide) from households with 36% (0-5 yrs) exposure to ETS
    (1991b) telephones and an on the day preceding the
    English-speaking adult interview.

    Burns and Pierce 1990-1991 Telephone interviews Surrogate 32.2%(6-11 yrs) Exposed individuals
    (1992) California with 32,135 English- Report defined as those living
    (statewide) or Spanish-speaking 32.2% (0-5 yrs) in a household with one
    households or more smokers.

     

    Other U.S. areas

     

    Coultas et al. 1984-1985 Hispanic children Salivary 45% (6-12 yrs) Exposed individuals
    (1987) New Mexico participating in a cotinine defined as those with
    population-based 54% (0-5 yrs) salivary cotinine con-
    survey of respiratory centrations ranging from
    disease 0.78 to 20 ng/ml.

     

    Greenberg et al. 1986-1987 433 healthy infants Surrogate 42% (8-51 days) Exposed individuals
    (1989) Central North Report defined as those exposed
    Carolina to ETS during the
    preceding week.

     

    Surrogate 55% (8-51 days) Exposed individuals
    Report defined as those living
    in a household with one
    or more smokers.

     

     

    Table 2.9 (continued)
    Studies with Information on ETS Exposure Prevalence in California and the U.S.:
    Infants and Children

    Year/ Measure of Exposure

    Study Location Description Exposure Prevalence (age) Comments

     

    Greenberg et al. 1986-1987 433 healthy Urinary 60% (8-51 days) Exposed individuals
    (1989) (continued) Central North infants cotinine defined as those with
    Carolina detectable concentrations
    of urinary cotinine.

     

     

    Chilmonczyk et al. 1988 518 infants Surrogate 41% (6-8 wks) Exposed individuals
    (1990) Portland, Maine Report defined as those living
    in a household with one
    or more smokers.

     

    Urinary 80% (6-8 wks) Exposed individuals
    cotinine defined as those with
    detectable concentrations
    of urinary cotinine.

     

     

    Overpeck and Moss 1988 5,356 children Surrogate 48.8% (0-5 yrs) Exposed individuals
    (1991) United States from a cross- Report defined as those living
    sectional survey in a household in which
    of household one member smoked
    populations regularly at any time
    since the child’s birth.

    Surrogate 42% (0-5 yrs) Exposed individuals
    Report defined as those currently
    living in a household with
    one or more smokers.

     


     

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