The Secondhand Smoke Exposure Scale (SHSES): A hair nicotine validated tool for assessing exposure to secondhand smoke among elderly adults in primary care

Abstract

INTRODUCTION Accurate estimation of exposure to Secondhand Smoke (SHS) is important in both research and clinical practice. We aimed to develop, an easy to implement, biomarker validated scale to provide an estimation of adult exposure to SHS for use within primary health care or epidemiological research. METHODS A pool of 26 baseline questions evaluating exposure to SHS was administered to 178 non-smoking adults (mean age 68.1 years), recruited from both urban and rural primary health care practices in Crete, Greece in November 2011, while concurrent hair samples were collected and nicotine concentrations were measured. To generate scores for each question item, we fitted a backward linear regression using the main predictors of SHS exposure selected from the initial pool of questions, weighted against each individuals biomarker evaluated exposure. RESULTS Among the pool of participants and weighted according to hair nicotine levels, in descending order, the most important sources of SHS exposure were the home (5 points, β=0.37), the family car (3 points, β=0.20), public places (2 points, β=0.15) and the workplace (1 point, β=0.013), the relative weighting of which led to the development of an 11-point scale to assess exposure to SHS. For every unit increase in the score, there was an associated increase in mean hair nicotine concentrations by 1.35 ng/mg (95%CI: 1.25-1.45, p<0.0001) CONCLUSIONS The SHS exposure score (SHSES) may be a useful tool in an estimating the level of the exposure to SHS among elderly adults and investigating the relationship between SHS exposure and potential health outcomes.

Levels of nicotine dependence in the elderly and cognitive impairment

“…The development of new models aimed at promoting the quality of life of the elderly population related to tobacco consumption has become a priority today (Vardavas et al, 2017). In this study, the results showed that the elderly who use tobacco and have very low and low levels of nicotine dependence did not present significant differences between the cognitive domains of executive functions compared to the control groups.…”

Environmental Tobacco Smoke Exposure Estimated Using the SHSES Scale and Epicardial Adipose Tissue Thickness in Hypertensive Patients

“…In our opinion the advantage of the scale is that it is easy to use and constitutes a biomarker-validated approach. According to Vardavas et al the correlation between the SHSES and the participants biomarker validated exposure (hair nicotine), indicated a Pearson’s correlation of 0.4939, with a p -value < 0.0001 [ 19 ]. Second of all, we have decided to measure EAT thickness by means of multislice computed tomography.…”

“…Environmental tobacco smoke exposure was assessed with SHSES according to Vardavas et al [ 19 ]. SHSES sheet contains four questions, each relating to different site of exposure.…”

“…ETS exposure level can also be assessed by means of a questionnaire with relevant questions concerning the exposure. Vardavas et al suggested the use of The Secondhand Smoke Exposure Scale (SHSES) [ 19 ]. It is a biomarker validated 11-point scale, which comprises four ranked questions, weighted to each response’s relative contribution to overall nicotine levels among adults.…”

“…Clinical characteristics of the studied group ACE angiotensin-converting enzyme, BMI body mass index, HDL high density lipoprotein, LDL low density lipoprotein The Secondhand Smoke Exposure Scale (SHSES) and its interpretation[19] …”