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Atmospheric and Biological Markers of Exposure of Secondhand Smoke Exposure in a Car: A Systematic Review FREE TO VIEW

Sana Raoof, BA; Constantine Vardavas, MD; Gregory Connolly, PhD
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Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA

Chest. 2013;144(4_MeetingAbstracts):478A. doi:10.1378/chest.1703144
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SESSION TITLE: Occupational/ Environmental Lung Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: While the majority of the US has enacted smoke free legislations, exposure to secondhand smoke (SHS) still takes place in unregulated micro-environments, such as in the family car. With an estimated 88 million US citizens exposed to SHS within private areas, it is imperative to determine the extent of exposure within such environments. With the above in mind we performed a systematic review to assess how SHS exposure within a car has an impact on atmospheric and biological markers.

METHODS: We performed a systematic review of literature using PubMed and Web of Science in January 2013. Articles were screened by two independent reviewers and selected if they met the following criteria: 1) provide a quantitative measure of secondhand smoke exposure, whether via a biological assay or an environmental marker, 2) the study is conducted inside a car, and 3) The exposure measured was due to combustion of cigarettes.

RESULTS: From a pool of 202 articles, we identified 12 articles that met the inclusion criteria. The most commonly assessed atmospheric marker was PM2.5 attributable to SHS, while one study assessed airborne nicotine. The range of PM2.5 concentrations found in all studies with at least one window completely open was 34 μg/m3 to 506 μg/m3 (for side-stream smoke, 705 μg/m3 to 5280 μg/m3). For studies with all windows closed, PM2.5 ranged from 529 μg/m3 to 3850 μg/m3 (for side-stream smoke, 705 μg/m3 to 13,150 μg/m3). It is noteworthy that SHS concentrations in a car were mediated by air conditioning status, number of windows open, inches each window is open and driving speed. Among the biological indexes cotinine was used as the most common marker of exposure.

CONCLUSIONS: Smoking in cars leads to extremely high exposure to SHS, and window status and ventilation reduce but do not eliminate these concentrations. Comparably, SHS exposure in cars can surpass concentrations found in bars prior to smoke free legislations. Based on these findings, the regulation of cigarette smoking in cars may be justified.

CLINICAL IMPLICATIONS: Clinicians should advise their patients to avoid SHS exposure from private sources, such as within a car, due to the notably elevated level of exposure to SHS attributable PM2.5.

DISCLOSURE: The following authors have nothing to disclose: Sana Raoof, Constantine Vardavas, Gregory Connolly

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