Researchers at Berkeley Lab have shed light on the cellular mechanisms linking exposure to thirdhand smoke THS with oxidative stress, DNA damage and cancer risk. They have also identified a biomarker of THS exposure that is absent in cases of secondhand smoke SHS exposure, making the biomarker especially useful in establishing THS exposure and risk.
THS refers to tobacco smoke pollutants remaining on skin, clothing, furniture and other surfaces after tobacco has been smoked. It also includes the secondary pollutants formed when residual tobacco smoke pollutants react with other compounds in the environment. Parent s who stop smoking incur health benefits, model non-smoking and quitting to children and stop exposure to SHS in the home, car and other locations. Effective systems are needed to increase parental smoking cessation and implement home smoking restrictions. We propose preliminary studies to evaluate a novel intervention to accomplish these objectives.
We hypothesize that a clinic system that routinely measures and reports levels of tobacco toxicants tobacco-specific carcinogens, nicotine and cotinine found in the urine of children exposed to SHS will 1 increase provider delivery of tobacco treatment, 2 increase parental participation in tobacco treatment, 3 increase parental smoking cessation and 4 reduce childhood exposure to secondhand smoke.
We propose formative work among healthcare providers and parents to develop the intervention and to pilot test the effects of the intervention on providers and parents.
We will conduct focus groups among staff to identify training needs, develop methods to integrate the intervention with office practice and assess barriers to implementation. We will also conduct focus groups among parents to assess willingness to provide urine specimens, optimal feedback format and reactions to biomarker data. Results from focus groups will be used to develop the experimental treatment protocol.
We will test the intervention in a two-group randomized pilot study in the University of Minnesota Primary Care Clinic. We will recruit 80 children age with a parent who smokes. We will provide brief behavioral counseling in healthy lifestyle options to all parents. One provider team will implement the experimental intervention in 40 parent-child pairs and the other team will serve as the control.
Children who see providers in the experimental group will provide a urine sample to test for nitrosamines a tobacco-specific carcinogen , nicotine and cotinine. We will communicate laboratory results to providers using the electronic medical record and incorporate these results in parental tobacco counseling designed to promote smoking cessation and home smoking restrictions.
The primary outcome will be provider delivery of smoking cessation treatment. We will also measure effects on parental engagement in treatment, smoking cessation and institution of home smoking restrictions in both the experimental and control groups. The research team brings extensive experience with novel tobacco interventions, health services research and biomarker assessment to the project. Routine documentation of tobacco toxicants in children's urine has potential to dramatically alter clinical care for families at risk from smoking.
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This audience is the target for a wave of tobacco products and pharmaceuticals that claim to preserve tobacco pleasure while reducing its toxic effects. Clearing the Smoke addresses the problems in evaluating whether such products actually do reduce the health risks of tobacco use. Within the context of regulating such products, the committee explores key questions:. This book looks at the types of products that could reduce harm and reviews the available evidence for their impact on various forms of cancer and other major ailments. It also recommends approaches to governing these products and tracking their public health effects.
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Visit NAP. Looking for other ways to read this? No thanks. Page Share Cite. TABLE 11—2 Measurements Used For Assessing Harm Reduction Products Factor Comment Type of measurement Types of measurements that can be used include external exposure assessment, biomarkers of exposure, biomarkers that represent the biologically effective dose, and biomarkers of potential harm. Depending on the context, the PREP, and the outcome of interest, different measurements might be more appropriate, although it is likely that a combination will be needed Target tissue and outcome effect Is the measurement used for detecting effects in target or surrogate tissues, and is this a measurement of pathogenesis?
Dose-response data Measurements must have a dose-response relationship that is understood on a mechanistic basis. Biomarker should be able to demonstrate effects from exposure over the range of human experience, so that it can show exposure reduction from a PREP Harm reduction in dose-response data Biomarker should be able to predict a decrease in disease incidence after exposure is reduced Specificity Is the measurement specific for a tobacco product constituent, or does is also measure exposures from nontobacco products?
Sensitivity Is the measurement sensitive enough to measure what it is supposed to measure in humans within the possible exposure ranges? Validation Are there sufficient data to show that the assay is reproducible? TABLE 11—4 External Exposure Assessment a Category Variables Used in Literature Related to a Disease Outcome b Strengths Limitations FTC machine method Tar yield Nicotine yield Individual smoke constituent yield Yes Standardized method for yields Little relationship to actual human experience Subject smoking history Cigarettes per day Years of smoking Age of initiation Recall of inhalation depth Usual type of cigarette smoked Quitting attempts Cumulative tar exposure Yes Inexpensive assessment; generally considered reliable, except in some circumstances listed in limitations Recall is subject to self-perceptions of risk.
Thus, not sufficiently reliable in harm reduction studies Smoking Topography Puff duration Puffs per cigarette Interpuff interval Puff volume No Direct measure of inhalation exposure per cigarette. Can be used to assess effects of cigarette brand switching Measurement performed in artificial environment a References are not provided in this table but can be found in the text of this and disease-related chapters. Short-term marker only Yes except when using NRT Yes addiction only Well validated; can be measured easily in urine, plasma saliva, or hair.
Useful for environmental tobacco smoke Short-term marker only. At higher levels of smoking, dose-response relationship is less clear and there is wide overlap among smokers Yes except when using NRT NDA Allows for assessment of nicotine metabolism Low levels. No benefit over cotinine. Levels vary over the day No Yes Measures cumulative, although short-term exposure to several cigarettes Requires blood draw and special handling.
Saliva easy to obtain Many dietary sources. Adducts found in all tissues, including heart and blood vessels Cannot identify adducts so mechanistic studies are problematic Yes No Yes Can be measured in any tissue and assays are available that are sufficiently sensitive Low sensitivity and technical difficulties make assay use limited in large-scale studies. Diet might be greater contributor than smoking Yes No NDA Can be measured in any tissue; has some specificity for smoking if no known occupational exposure Low sensitivity makes assay use limited in large-scale studies Yes Yes NDA Can be measured in any tissue, although methodology has low sensitivity.
Highly specific for smoking Low sensitivity makes assay use limited in large-scale studies Yes No NDA Can be measured in any tissue Assay has large interlaboratory variation; it is easy to introduce oxidative damage into laboratory assay; low sensitivity makes assay use limited in large-scale studies Yes No Not available Sufficient sensitivity to use for ETS Technically difficult Yes No NDA Can be measured in any tissue Low sensitivity makes assay use limited in large-scale studies.
Specific to Tobacco Related to a Disease Risk c Strengths Limitations No Yes Indicates acquired changes in susceptibility; related to DNA-adduct levels Technically difficult to assess in large epidemiological studies No Yes Indicates acquired changes in susceptibility; related to DNA-adduct levels Technically difficult to assess in large epidemiological studies No NDA Indicates acquired changes in susceptibility; provides analysis of what is likely to be critical part of carcinogenesis Technically difficult No NDA Reflects integrated measure of multiple genotypes, provides complex data potentially usable for rapid identification of important risk factors Difficult to perform; relationship to disease risk is technically difficult to prove; requires extensive laboratory validation; RNA and protein microarray assays are expensive; large-scale studies are needed; refined bioinformatic analysis required No Yes Can be done in blood as surrogate tissue.
Can be measured in persons without cancer Very nonspecific; relationship to target organ is not established; significant lack of specificity and wide overlap between smokers and nonsmokers No NDA Facile assay Lack of specificity No No Easy to do in blood as surrogate tissue. Can be measured in persons without cancer Very nonspecific; relationship to target organ is not established; predictivity for disease risk not established.
Significant lack of specificity and wide overlap between smokers and nonsmokers No NDA Similar lesions observed in cancer Technically complex; relationship to cancer risk unknown No NDA Facile assay in blood Relationship to target tissue or blood unknown. Significant confounders exist No Yes Easy to measure; intraindividual differences may be important for the individual Both interindividual and intraindividual differences are significant.
Substantial confounders exist, and many persons are on medications No No Minimally invasive Very nonspecific No NDA Pathogenically related to disease Does not distinguish levels of smoking. Specific to Tobacco Related to a Disease Risk c Strengths Limitations No No Platelet activation in vivo might be pathophysiologically related to cardiac artery thrombosis Technically difficult to use for large numbers of subjects. Smoking increases platelet counts No Yes Can be a surrogate marker for several processes including atherosclerosis and thrombosis Relationship to disease uncertain, although alterations in levels are linked epidemiologically to disease.
Wide interindividual and intraindividual variation and large number of confounders No No Can reflect both cardiac and respiratory disease risk Insensitive; wide interindividual differences No NDA Provides different types of data with single procedure Bronchoscopy is too invasive for large epidemiological studies No NDA Provides different types of data with single procedure Bronchoscopy is too invasive for large epidemiological studies Yes NDA May be specific to tobacco smoke Requires invasive test; short half-life No NDA May be measured in urine, bronchioalveolar lavage, and serum Substantial number of confounders No Yes Widely available Low sensitivity for mild disease.
Specific to Tobacco Related to a Disease Risk c Strengths Limitations No Yes Data collection is easy Nonspecific; numerous confounders No Yes Both a biomarker for metabolism and an important outcome for some people Some people perceive weight loss as a benefit of smoking, despite significant adverse effects associated with smoking a Selected examples; list is not all-inclusive. Login or Register to save! Within the context of regulating such products, the committee explores key questions: Does the use of such products decrease exposure to harmful substances in tobacco?
Is decreased exposure associated with decreased harm to health? Are there surrogate indicators of harm that could be measured quickly enough for regulation of these products? What are the public health implications? Stay Connected! Harm reduction in dose-response data. Are there sufficient data to show that the assay is reproducible? Polycyclic aromatic hydrocarbon in lung tissue.
Early biological and genetic effects. Alterations in morphology, structure, or function. Measures of interindividual variation. Genetic polymorphisms for genes involved in disease pathways. Enzyme induction of metabolizing enzymes. Does not reflect actual internal doses. Provides integrated measure of external exposure and smoking behavior.
Relationship to disease risk is not fully established. Assessment of mechanistic pathway leading to disease. Greater ability to identify risk for disease with marker. Reflects lifetime response to exposure; high throughput possible. Tissue technically difficult to obtain; laboratory validation difficult.
Variables Used in Literature. Tar yield Nicotine yield Individual smoke constituent yield. Little relationship to actual human experience. Cigarettes per day Years of smoking Age of initiation Recall of inhalation depth Usual type of cigarette smoked Quitting attempts Cumulative tar exposure. Puff duration Puffs per cigarette Interpuff interval Puff volume. Measurement performed in artificial environment. Civilian, noninstitutionalized adults over age 18; children by proxy. Noninstitutionalized adults over age Noninstitutionalized civilian population over age University of Michigan Survey Research Center.
Eighth, tenth, and twelfth grade students. Household interview with responses typed directly in laptop computer; annual. Excludes homeless not in shelters, military personnel, prisoners, hospital patients Data: cigarette, chewing tobacco, cigar, and pipe use since Oversampling of black American and Hispanic populations.
Computer-assisted telephone interviews; annual. Added smokeless tobacco use questions in State level. Approximately 40, participants between and Personal interview with physical exam and blood tests; periodic. Serum cotinine measurements Oversampling of children 1—5years, adults over age 60, black Americans, and Mexican Americans. Approximately 25, participants in Household interview; self-administered through a computer; annual. State level Oversampling of black Americans, Hispanic Americans, and youth.
Approximately 50, students from public and private high schools. Classroom based; self-administered; annual.