Background
The International Agency for Research on Cancer classifies 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) as a known carcinogen. This study aimed to investigate the association between exposure to secondhand smoke (SHS) and NNAL concentrations in non-smokers.
Methods
This was a cross-sectional study based on data from the 2016 to 2018 Korea National Health and Nutrition Examination Survey. Urine NNAL concentrations were categorized into tertiles of 3,615 study participants who were non-smokers. All sampling and weight variables were stratified, and analyses to account for the complex sampling design were conducted.
Results
The overall, male, and female percentages of SHS exposure among non-smokers were 22.4%, 29.2%, and 20.4%, respectively. The geometric means of urine NNAL concentrations were 1.896±0.098 pg/mL and 1.094±0.028 pg/mL in the SHS exposure and non-exposure groups, respectively. After adjusting for confounding variables, in the total group, the geometric mean of urine NNAL concentrations was significantly higher in the SHS exposure group than in the SHS non-exposure group (adjusted P-value <0.001). Compared with the non-exposure group, the adjusted odds ratios (95% confidence intervals) for the highest NNAL tertile group of overall SHS exposure in the total, men, and women groups were 2.44 (1.95–3.05), 1.65 (1.08–2.53), and 2.73 (2.11–3.52), respectively, after full adjustment.
Conclusion
The urine NNAL concentration in the SHS exposure group was significantly higher than that in the non-exposure group. Exposure to SHS was associated with a higher risk of elevated urine NNAL concentrations in non-smokers.

Citations

• Differences in biomarkers of potential harm after 2+ years of tobacco heating system use compared to cigarette smoking: a cross-sectional study
  S. Michael Ansari, Patrice Leroy, Guillaume de La Bourdonnaye, Sandrine Pouly, Lindsay Reese, Christelle Haziza
  Biomarkers.2025; 30(2): 178.     CrossRef
• Secondhand smoke exposure at home in a representative sample of adults in Poland in 2024: A cross-sectional survey
  Mateusz Jankowski
  European Journal of Health Policy, Humanization of Care and Medical Ethics.2025; 4(1): 41.     CrossRef
• High throughput and sensitive quantitation of tobacco-specific alkaloids and nitrosamines in wastewater
  Zhe Wang, Qiuda Zheng, Benjamin J. Tscharke, Jinglong Li, Jake W. O'Brien, Brad Patterson, Zeyang Zhao, Kevin V. Thomas, Jochen F. Mueller, Phong K. Thai
  Talanta.2024; 277: 126401.     CrossRef
• Association Between Second-Hand Smoke Exposure and Respiratory Symptoms Among the General Population of Non-smoker Adults in Saudi Arabia: A Cross-Sectional Study
  Mohammed Madkhali, Safa Shariff, Raghad Albalawi, Abdulrahman Aqeel, Abdulqader Alshahrani, Raghd Alabdullah, Raghad Alasmari, Wajd Aljohani
  Cureus.2023;[Epub]     CrossRef
• Short-Term Effects of Side-Stream Smoke on Nerve Growth Factor and Its Receptors TrKA and p75NTR in a Group of Non-Smokers
  Anna Maria Stabile, Alessandra Pistilli, Desirée Bartolini, Eleonora Angelucci, Marco Dell’Omo, Gabriele Di Sante, Mario Rende
  International Journal of Environmental Research and Public Health.2022; 19(16): 10317.     CrossRef

Background
Cotinine, a nicotine metabolite detected in urine, has been recommended as the best quantitative marker of smoking and environmental tobacco smoke (ETS) exposure. The aim of this study was to analyze the relationship between indoor ETS and urinary cotinine level of the passive smokers. Methods: We selected 42 nonsmokers who lived in Seoul and were not exposed to passive smoking at least 5 days before test. Urinary cotinine levels were measured by Smokescreen Colorimeter (Surescreen Diagnostics LTD, U.K.). We measured urinary cotinine levels twice (before and after smoking exposure). Results: The mean urinary cotinine level was 0.33μg/mL before smoking exposure, and 0.46μg/mL after smoking exposure. There was statistically significant difference (P-value=0.003). There was no significant difference between exposure time and increase of urinary cotinine level(P=0.138, r=⁣0.233). There was also no significant difference between measuring time taking after exposure and increase of urinary cotinine level (P=0.671, r=0.067). Conclusion: One experience of indoor exposure to ETS caused significant elevation of urinary cotinine level. (J Korean Acad Fam Med 2007;28:379-382)

Background
: Because passive smoking causes lung cancer, ischemic heart disease, and stroke in nonsmokers, implementation of policy to prevent workplace environmental tobacco smoke (ETS) are strongly needed. Most of our hospital employees desire more strict smoke-free policy as shown in a questionnaire survey conducted in January 1999. This study was to investigate the short-term effect of a comprehensive smoke-free policy on hospital employees which prohibited any smoking within the hospital building since March 15, 1999.

Methods : The first survey was carried out on January 1999 including all the employees of Sanggye Paik Hospital as subjects. After two months a second round of survey was done to monitor the effects of the new regulation. Questions included in the survey were subjects' demographic characteristics, smoking history, perception and observance of no-smoking areas, and change in perception of ETS. Smokers were questioned about changes in smoking rate after the new policy. Statistical analysis was done using x² and paired t-test to detect if there was any statistical significance after enforcing the new smoke-free policy.

Results : Among total 1,026 employees, 621 subjects (men 146, women 475) in the first survey and 552 subjects (men 146, women 406) in the second survey responded. There was no significant difference in demographic characteristics and occupation mix between the two surveys. Although the perception and observance of no-smoking areas were increased after the new policy. half of nonsmokers replied that the new policy was not well observed. 76.9% of subjects replied the exposure to cigarette smoke during work decreased. The question item asking the smokers of the amount of cigarettes smoked after the new policy adoption revealed a decrease in 2.83(±0.48) cigarettes during the working hours (p=0.0001), a decrease in 1.18(±0.29) cigarettes during the premises of hospital or more stringent regulation for violation of the policy.

Conclusion : Despite several limitations, this study suggests that a comprehensive smoke-free policy in hospital has a positive impact on the reduction of smoker's cigarettes consumption as well as reduction of ETS exposure on the nonsmokers.

Background
: Although institution of the no-smoking areas have been required in hospitals since 1995, It has not been evaluated. This study was conducted to assess the effectiveness of the current no-smoking areas, and to collect employee's opinions about no-smoking policy in th hospital.

Methods : The self-administered anonymous survey was distributed to all employees of a university hospital in January 1999. Respondents were asked about their smoking status, awareness and compliance of the no-smoking areas, perception of tobacco smoke during work, preference for the type of no-smoking policy. Differences in outcome vairables' distribution by sex, smoking status, and occupation were analyzed using x² analysis.

Results : The overall response rate for the survey was 65.3%(670/1026). Among the total, 77.9% were females, and mean age of the respondents was 31.6 years(±80). While the overall smoking prevalence was 10.6%, men's prevalence was 46.6%. Although the awareness of the no-smoking areas was high in most areas, the rate of which all of the 10 no-smoking areas had been well kept was only 15.2%, 47.% of non-smokers reported that they could still smell some tobacco smoke while on duty. While 65.5% agreed on the opinion that penal regulations should be strengthened in order not to violate no-smoking areas, only 32.1% agreed on the current policy without penalty. 80% of smokers replied that they would follow the strict no-smoking policy.

Conclusion : The current no-smoking areas was not well observed. However, most employees wanted the no-smoking policy with penal regulation. Therefore, this survey could provide a solid foundation to implement a strict no-smoking policy.