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Arch Hellen Med, 29(2), March-April 2012, 174-186


Long-term exposure to environmental tobacco smoke: Assessment and contributing factors

M. Misailidi, A.D. Flouris
FAME Laboratory, Institute of Human Performance and Rehabilitation, Centre for Research and Technology Thessaly, Karies, Trikala, Greece

Environmental tobacco smoke (ETS) is a major threat to public health due to its recognized adverse health effects. Despite various anti-smoking campaigns worldwide, today the number of smokers is larger than at any other time in human history. This is a review of current methods for assessing long-term exposure to ETS and its sources of exposure. A literature review was conducted in PubMed using keywords relevant to ETS, up to May 2011. Exposure to ETS in non-smokers is most often assessed via questionnaires, because of their practicality, low cost and the retrospective collection of information, but the vast majority of questionnaires in use have not been validated. The validation of questionnaires is achieved through objective assessment of nicotine or cotinine levels in various body fluids such as saliva, serum and urine. Given their short half-life, however, these biomarkers can only provide information on ETS exposure during the preceding 48 hours. The main sources of reported ETS exposure include the home and workplace environments for adults, and the home environment for children, and there is little or no reference to the effects of ETS in public places. These findings demonstrate the major limitations of methods currently in use for assessment of exposure to ETS, which include lack of validity and reliability of the questionnaires, use of biomarkers with a short half-life and absence of information on the influence of smoking in public places. These limitations should be addressed in future studies in order to provide reliable evidence on which to base public health measures of protection from ETS.

Key words: Assessment, Biomarkers, Cotinine, Nicotine, Questionnaire.

© Archives of Hellenic Medicine