Exposure to environmental tobacco smoke (ETS) is the reason for approximately 1% of global mortality. ETS exposure can happen either as inhalation of direct cigarette smoke (second-hand smoke) or its associated residue particles (third-hand smoke), especially when living with a smoker in the same family. This study investigated the association between the urinary cotinine levels, as biomarkers of exposure to tobacco smoke, of smokers and those exposed to second-hand and third-hand smoke while living in the same family, through a Korean nationwide survey. Direct assessment of ETS exposure and its lifetime effect on human health is practically difficult. Therefore, this study evaluated the internal estimated daily intake (I-EDI) of nicotine and equivalent smoked cigarette per day (CPD). The carcinogenic and non-carcinogenic inhalation risks of ETS exposure were assessed by considering the calculated equivalent CPD and composition of cigarette smoke of high-selling cigarette brands in South Korea. The results show that there is a statistically significant positive correlation between the cotinine levels of smokers and those of the non-smokers living in the same family. The risk assessment results yielded that hazard index (HI) and total excess lifetime cancer risk (ECR) for both second-hand and third-hand smoke exposure can exceed 1 and 1 × 10−6, respectively, especially in women and children. In the composition of the cigarette smoke, 1,3-butadiene and acrolein substances had the highest contribution to HI and ECR. Consequently, the provision of appropriate plans for smoking cessation as a strategy for the prevention of ETS exposure to women and children is deemed necessary.
Tobacco smoking is associated with a high global mortality rate since it is known to cause cancers and lung and heart diseases. To control and reduce annual mortality attributed to smoking, it is essential to design applicable smoke cessation programs based on realistic tobacco exposure risk assessment. In this regard, understanding the smoking habits of the smoker is crucial. Using self-report smoking habit surveys is a common approach in measuring basic variables of smoking habits. However, smoking topography measurement devices have recently become available for investigating smoking habit variables accurately. In this study, we conducted a self-report survey to investigate a group of Korean smokers’ smoking habit variables such as the number of smoked cigarettes per day, puff counts, and total smoking time. The survey also included items from the Fagerström Test for Nicotine Dependence (FTND). The results were compared with the corresponding variables from machine-determined data to investigate their correlation and reliability. Results indicate that Korean smokers have a reliable understanding of the average number of cigarettes they smoke daily (ρ = 0.517, Cronbach’s α = 0.754) and the time to first cigarette (TTFC) after waking up (ρ = -0.587, Cronbach’s α = 0.623), as fundamental items of the FTND score. Nevertheless, these smokers significantly under-reported the puff number and total smoking time, which can cause significant underestimation in the tobacco exposure risk assessment. Consequently, we suggest the application of self-report surveys that are based on the amount of daily smoked cigarettes (e.g. FTND) for clinical or risk assessment purposes. Using smoking topography measurement devices is recommended overusing self-report surveys in measuring smoking habit variables such as puff count and smoking time more accurately.
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