Validity of self-reported intensity of exposure to second-hand smoke at home against environmental and personal markers

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Martínez-Sánchez, Adrián González-Marrón, Juan Carlos Martín-Sánchez, Xisca Sureda, Marcela Fu, Raúl Pérez-Ortuño, Cristina Lidón-Moyano, Iñaki Galán, José Antonio Pascual, Esteve Fernández" "autores" => array:10 [ 0 => array:4 [ "nombre" => "José M." "apellidos" => "Martínez-Sánchez" "email" => array:1 [ 0 => "jmmartinez@uic.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Adrián" "apellidos" => "González-Marrón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Juan Carlos" "apellidos" => "Martín-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Xisca" "apellidos" => "Sureda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Marcela" "apellidos" => "Fu" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Raúl" "apellidos" => "Pérez-Ortuño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "Cristina" "apellidos" => "Lidón-Moyano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Iñaki" "apellidos" => "Galán" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] 1 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "José Antonio" "apellidos" => "Pascual" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] 1 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "Esteve" "apellidos" => "Fernández" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Tobacco Control Unit, Cancer Prevention and Control Programme, Catalan Institute of Oncology-ICO, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación de la intensidad de la exposición pasiva al tabaco en el hogar reportada mediante cuestionario" ] ] "textoCompleto" => "IntroductionWorld Health Organization proposed the MPOWER package in order to achieve a world where no child and adult will be exposed to second hand smoke (SHS).<a class="elsevierStyleCrossRef" href="#bib0055">1</a> Among the measures of MPOWER, WHO encourages the monitoring (the M of MPOWER acronym) of the tobacco epidemic.Monitoring and measurement of SHS exposure can be performed by direct and indirect methods. Among the direct methods, environmental markers (e.g., airborne nicotine and benzene) and/or personal biomarkers such as cotinine in biological matrices can be measured. Although direct methods are the most reliable to measure the SHS exposure, indirect methods –such as questionnaires– are the most commonly used in the scientific literature<a class="elsevierStyleCrossRefs" href="#bib0060">2,3</a> because they are low cost and simple to implement.<a class="elsevierStyleCrossRef" href="#bib0070">4</a>In a previous study,<a class="elsevierStyleCrossRef" href="#bib0075">5</a> two new questions were included to self-report the perception of intensity of exposure to SHS in hospitality venues. The main objective of this study was to assess the validity of these two questions to measure the intensity of exposure to SHS at home using environmental markers (nicotine and benzene) and personal biomarkers (salivary and urinary cotinine) as reference.MethodsWe conducted a cross-sectional study in a convenience sample of 49 non-smoking volunteers from different houses: 25 non-smokers who lived with at least one smoker and 24 non-smokers who lived in totally smoke-free homes. The fieldwork was conducted between November 2011 and February 2012.After an initial telephone or direct approach, a member of the research team went to the volunteer's home to explain the objective and procedures of the study. In that visit, the researcher installed two devices to passively collect nicotine and benzene in the main room of the house (usually the living room). In the second visit, one week later, the researcher returned to the volunteer's home to remove both devices from the room, to obtain saliva and urine samples from the volunteer, and to administrate a face-to-face questionnaire on SHS exposure at home. The research and ethics committee of the Bellvitge University Hospital provided ethical approval for the study protocol.The two questions validated were: 1) “How would you describe, during the last week, secondhand smoke exposure in the room of your home where the devices were installed?” (Likert scale-based question with four possible answers: high, medium, low, and very low intensity); and 2) “What score from 0 to 10 would you give the room where devices were installed regarding the amount of secondhand smoke exposure during the last week, bearing in mind that 0 would be minimum contamination and 10 maximum contamination?”. The questionnaire also included three conventional questions to measure the intensity and duration of SHS exposure at home:<a class="elsevierStyleCrossRef" href="#bib0065">3</a> 1) “During the past week, how many persons per day usually smoked inside your home?”; 2) “During the past week, how many cigarettes (per day) have been smoked in your presence in the room where devices were installed?”; and 3) “During the past week, how many hours (per day) have you been exposed in the room where the devices were installed?”.The sampling devices were installed in the main room following a standard protocol.<a class="elsevierStyleCrossRef" href="#bib0080">6</a> Nicotine and benzene were extracted and analyzed by gas chromatography with detection by mass spectrometry (GC/MS) at the Laboratory of the Public Health Agency of Barcelona (Spain). The analysis of the samples of saliva and urine were performed at IMIM Hospital del Mar Medical Research Institute in Barcelona. Salivary and urinary cotinine were measured by liquid chromatography coupled to tandem mass spectrometry with multiple reactions monitoring (LC/MS/MS).Medians and interquartile ranges (IQR) were calculated. We performed a Kruskal-Wallis test and a linear trend test to compare the concentrations of the environmental markers and personal biomarkers with the answers to the Likert scale question proposed.Spearman correlation coefficients (rsp) were computed to assess the relationship between the intensity of exposure elicited by the score question and the markers of exposure. We compared the correlations between the scores of perceived SHS exposure proposed and the concentrations of airborne markers and biomarkers were statistically compared with those correlations between the conventional questions and the concentrations of airborne markers and biomarkers using the Meng's test.<a class="elsevierStyleCrossRef" href="#bib0085">7</a>Results<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the median concentrations and IQR of environmental and personal markers categorized according to the Likert scale-based question (p <0.05). We observed a positive linear relationship between the perception of SHS exposure and each of the direct measures (p <0.05).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>We found a high correlation of the score question with airborne nicotine (rsp=0.806, p <0.05) and moderate with benzene (rsp=0.464, p <0.05). We also found a high correlation of the score question with salivary cotinine (rsp=0.752, p <0.05) and urinary cotinine (rsp=0.626, p <0.05). We did not find statistically significant differences between the correlations of the score question proposed and the conventional ones (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). When we stratified the data according to sex, age (<30 and ≥30 years), and size of the room where the devices were installed (<20 and ≥20 m2) all the correlations were similar (data not shown).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionOur results show that the questions proposed to self-report the intensity of SHS exposure at home were valid when assessed against concentrations of selected markers of SHS exposure (airborne nicotine and cotinine in body fluids). Moreover, the correlations between the score question and all objective markers were statistically similar to those between the conventional questions and the objective markers. In this sense, the proposed question was at least as good as the conventional quantitative questions at assessing the exposure to SHS at home. The poorest discrimination was obtained for benzene concentrations for both the conventional questions and the new questions to validate. This may be because benzene is a less specific airborne marker of SHS exposure.Previous studies showed similar results in the assessment of self-reported SHS exposure against biomarkers<a class="elsevierStyleCrossRef" href="#bib0090">8</a> and against airborne markers in other settings such as workplaces.<a class="elsevierStyleCrossRef" href="#bib0095">9</a> However, many of the studies reported lower correlations to the ones obtained in ours. These differences may be explained by the fact that our questionnaire was applied immediately after the week the markers were collected, avoiding a recall bias.The main limitation of our study is related to the use of an opportunistic limited-sized sample of volunteers. In this sense, external validity could be hampered by the non-random sample selection and the power of the experiment could be relatively low. Nevertheless, the use of an opportunistic sample allowed us to include those participants who confirmed no other potential sources of tobacco exposure in other settings. Other potential limitation is the lack of assessment of other potential sources of nicotine and benzene, such as those cumulated in the dust of homes (thirdhand smoke) from previous tobacco consumption in the homes of smokers.<a class="elsevierStyleCrossRef" href="#bib0100">10</a> Finally, as a strength, whereas many of the previous studies measured either biomarkers or environmental markers, we were able to compare our questions to both types of markers and other conventional questions of SHS exposure.In conclusion, the questions proposed to evaluate the perceived intensity of SHS exposure at home distinguished between different concentrations of nicotine in air and cotinine in saliva and urine. Moreover, we observed a similar discrimination with conventional questions of SHS exposure. These questions may be valid for use in future investigations to characterize SHS exposure at home, although further research in larger and more diverse samples should be conducted.Authorship contributionsJ.M. Martínez-Sánchez, E. Fernández and I. Galán conceived the study and questions proposed to measure second hand smoke exposure. X. Sureda, M. Fu, E. Fernández and J.M. Martínez-Sánchez conducted the fieldwork. R. Pérez-Ortuño and J.A. Pascual developed the analytical method to quantify the cotinine in saliva and urine and also performed the analyses of biological samples. J.C. Martín-Sánchez and C. Lidón-Moyano prepared and analyzed the database. J.M. Martínez-Sánchez and A. González-Marrón drafted the first draft of the manuscript. All authors contributed substantially to the conception, design, and interpretation of data. All authors contributed to the manuscript and approved its final version. J.M. Martínez-Sánchez is the guarantor.FundingThis work was supported by the Instituto de Salud Carlos III, Subdirección General de Evaluación, Government of Spain (PI081436, PI081339 and RTICC RD12/0036/0053), the Ministry of Universities and Research, Government of Catalonia (grant 2009SGR192 and 2014SGR689), the Directorate of Public Health, Ministry of Health (GFH 20051) from the Government of Catalonia, ISCIII-Subdirección General de Evaluación and by FEDER funds/European Regional Development Fund (ERDF)−a way to build Europe−. This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 681040.Conflicts of interestNone." 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This was a cross-sectional study in a convenience sample of 49 non-smoking volunteers. We found a high correlation between self-reported SHS exposure and airborne nicotine (rsp=0.806, p<0.05), salivary cotinine (rsp=0.752, p<0.05), and urinary cotinine (rsp=0.626, p<0.05). We did not find differences between the score question and the conventional ones (p >0.05). In conclusion, the significant correlation of the two questions proposed with environmental markers and personal markers indicates their potential validity to assess exposure to SHS at home." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "El objetivo de este trabajo es evaluar la validez de dos preguntas sobre la exposición al humo ambiental de tabaco (HAT) en el hogar utilizando como referencia marcadores ambientales (nicotina y bencenos en el aire) y biomarcadores específicos (cotinina en saliva y orina) de la exposición pasiva al tabaco. Para ello se realizó un estudio transversal de una muestra de conveniencia de 49 voluntarios no fumadores mayores de edad de la ciudad de Barcelona. Se encontró una alta correlación entre la pregunta de intensidad de la exposición pasiva autodeclarada en casa y la nicotina en el aire (rsp=0,806, p <0,05), la cotinina en saliva (rsp=0,752, p <0,05) y la cotinina en orina (rsp=0,626, p <0,05). No encontramos diferencias entre las preguntas puntuables y las convencionales (p>0,05). En conclusión, la alta correlación de las preguntas propuestas con los marcadores ambientales y los biomarcadores indica su validez para evaluar la intensidad de la exposición pasiva al tabaco en el hogar." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "IQR: interquartile range." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Perceived intensity of exposure to SHS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Airborne nicotine (μg/m3) Median (IQR) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Airborne benzene (μg/m3) Median (IQR) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Salivary cotinine (ng/ml) Median (IQR) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Urinary cotinine (ng/ml) Median (IQR) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.35 (0.55, 5.43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.38 (0.31, 4.90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.95 (0.41, 1.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.57 (2.08, 6.16) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.03 (0.30, 1.92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.46 (0.39, 3.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.29 (0.19, 0.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.25 (0.71, 2.57) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 (0.01, 0.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.32 (0.24, 0.50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.05 (0.05, 0.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.44 (0.28, 1.23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p-value<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p-value<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1784221.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Kruskal-Wallis test." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Linear trend test." ] ] ] "descripcion" => array:1 [ "en" => "Median concentrations and IQR of airborne markers and personal markers according to the perception of exposure to secondhand smoke at home through a Likert scale question." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "CI: confidence interval; SHS: secondhand smoke." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Airborne nicotine rsp 95%CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Airborne benzene rsp 95%CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Salivary cotinine rsp 95%CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Urinary cotinine rsp 95%CI \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Score question for the perception of exposure to SHS<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.806 (0.679, 0.886)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.464 (0.210, 0.659)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.752 (0.597, 0.853)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.626 (0.418, 0.771)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of cigarettes smoked at home p-value<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.796 (0.663, 0.880)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> 0.792 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.396 (0.129, 0.609)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> 0.255 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.713 (0.540, 0.828)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> 0.375 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.602 (0.386, 0.755)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> 0.643 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of hours of exposure at home p-value<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.793 (0.659, 0.878)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> 0.724 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.448 (0.191, 0.648)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> 0.777 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.703 (0.526, 0.822)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> 0.250 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.601 (0.385, 0.755)<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> 0.615 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of smokers at home p-value<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.854 (0.754, 0.915)* 0.173 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.525 (0.286, 0.702)* 0.295 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.807 (0.680, 0.887)* 0.173 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.652 (0.454, 0.789)* 0.610 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1784222.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Score scale for the perception of exposure to SHS from 0 (not contaminated) to 10 (highly contaminated)." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "Meng's Z-test for correlated correlation coefficients." ] 2 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "c" "nota" => "p <0.05." ] ] ] "descripcion" => array:1 [ "en" => "Spearman correlations (rsp) and 95%CI between airborne markers, personal markers and the score question for the perception of exposure to secondhand smoke (SHS) at home and two conventional questions for SHS assessment." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "WHO Report on the Global tobacco epidemic, 2008. 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Estadísticas

Metodological note

Validity of self-reported intensity of exposure to second-hand smoke at home against environmental and personal markers

Validación de la intensidad de la exposición pasiva al tabaco en el hogar reportada mediante cuestionario

José M. Martínez-Sáncheza,b,c,

Autor para correspondencia

jmmartinez@uic.es

Corresponding author.

, Adrián González-Marróna, Juan Carlos Martín-Sáncheza, Xisca Suredad, Marcela Fub,c,e, Raúl Pérez-Ortuñof, Cristina Lidón-Moyanoa, Iñaki Galáng,h, José Antonio Pascualf,i, Esteve Fernándezb,c,e

a Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

b Tobacco Control Unit, Cancer Prevention and Control Programme, Catalan Institute of Oncology-ICO, L’Hospitalet de Llobregat, Barcelona, Spain

c Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain

d Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain

e Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain

f Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain

g National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain

h Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

i Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">World Health Organization proposed the MPOWER package in order to achieve a world where no child and adult will be exposed to second hand smoke &#40;SHS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Among the measures of MPOWER&#44; WHO encourages the <span class="elsevierStyleItalic">monitoring</span> &#40;the M of MPOWER acronym&#41; of the tobacco epidemic&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Monitoring and measurement of SHS exposure can be performed by direct and indirect methods&#46; Among the direct methods&#44; environmental markers &#40;e&#46;g&#46;&#44; airborne nicotine and benzene&#41; and&#47;or personal biomarkers such as cotinine in biological matrices can be measured&#46; Although direct methods are the most reliable to measure the SHS exposure&#44; indirect methods &#8211;such as questionnaires&#8211; are the most commonly used in the scientific literature<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> because they are low cost and simple to implement&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In a previous study&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> two new questions were included to self-report the perception of intensity of exposure to SHS in hospitality venues&#46; The main objective of this study was to assess the validity of these two questions to measure the intensity of exposure to SHS at home using environmental markers &#40;nicotine and benzene&#41; and personal biomarkers &#40;salivary and urinary cotinine&#41; as reference&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional study in a convenience sample of 49 non-smoking volunteers from different houses&#58; 25 non-smokers who lived with at least one smoker and 24 non-smokers who lived in totally smoke-free homes&#46; The fieldwork was conducted between November 2011 and February 2012&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">After an initial telephone or direct approach&#44; a member of the research team went to the volunteer&#39;s home to explain the objective and procedures of the study&#46; In that visit&#44; the researcher installed two devices to passively collect nicotine and benzene in the main room of the house &#40;usually the living room&#41;&#46; In the second visit&#44; one week later&#44; the researcher returned to the volunteer&#39;s home to remove both devices from the room&#44; to obtain saliva and urine samples from the volunteer&#44; and to administrate a face-to-face questionnaire on SHS exposure at home&#46; The research and ethics committee of the Bellvitge University Hospital provided ethical approval for the study protocol&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The two questions validated were&#58; 1&#41; &#8220;How would you describe&#44; during the last week&#44; secondhand smoke exposure in the room of your home where the devices were installed&#63;&#8221; &#40;Likert scale-based question with four possible answers&#58; high&#44; medium&#44; low&#44; and very low intensity&#41;&#59; and 2&#41; &#8220;What score from 0 to 10 would you give the room where devices were installed regarding the amount of secondhand smoke exposure during the last week&#44; bearing in mind that 0 would be minimum contamination and 10 maximum contamination&#63;&#8221;&#46; The questionnaire also included three conventional questions to measure the intensity and duration of SHS exposure at home&#58;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> 1&#41; &#8220;During the past week&#44; how many persons per day usually smoked inside your home&#63;&#8221;&#59; 2&#41; &#8220;During the past week&#44; how many cigarettes &#40;per day&#41; have been smoked in your presence in the room where devices were installed&#63;&#8221;&#59; and 3&#41; &#8220;During the past week&#44; how many hours &#40;per day&#41; have you been exposed in the room where the devices were installed&#63;&#8221;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The sampling devices were installed in the main room following a standard protocol&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Nicotine and benzene were extracted and analyzed by gas chromatography with detection by mass spectrometry &#40;GC&#47;MS&#41; at the Laboratory of the Public Health Agency of Barcelona &#40;Spain&#41;&#46; The analysis of the samples of saliva and urine were performed at IMIM Hospital del Mar Medical Research Institute in Barcelona&#46; Salivary and urinary cotinine were measured by liquid chromatography coupled to tandem mass spectrometry with multiple reactions monitoring &#40;LC&#47;MS&#47;MS&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Medians and interquartile ranges &#40;IQR&#41; were calculated&#46; We performed a Kruskal-Wallis test and a linear trend test to compare the concentrations of the environmental markers and personal biomarkers with the answers to the Likert scale question proposed&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Spearman correlation coefficients &#40;r<span class="elsevierStyleInf">sp</span>&#41; were computed to assess the relationship between the intensity of exposure elicited by the score question and the markers of exposure&#46; We compared the correlations between the scores of perceived SHS exposure proposed and the concentrations of airborne markers and biomarkers were statistically compared with those correlations between the conventional questions and the concentrations of airborne markers and biomarkers using the Meng&#39;s test&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the median concentrations and IQR of environmental and personal markers categorized according to the Likert scale-based question &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; We observed a positive linear relationship between the perception of SHS exposure and each of the direct measures &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">We found a high correlation of the score question with airborne nicotine &#40;r<span class="elsevierStyleInf">sp</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;806&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and moderate with benzene &#40;r<span class="elsevierStyleInf">sp</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;464&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; We also found a high correlation of the score question with salivary cotinine &#40;r<span class="elsevierStyleInf">sp</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;752&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and urinary cotinine &#40;r<span class="elsevierStyleInf">sp</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;626&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; We did not find statistically significant differences between the correlations of the score question proposed and the conventional ones &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; When we stratified the data according to sex&#44; age &#40;&#60;30 and &#8805;30 years&#41;&#44; and size of the room where the devices were installed &#40;&#60;20 and &#8805;20 m<span class="elsevierStyleSup">2</span>&#41; all the correlations were similar &#40;data not shown&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Our results show that the questions proposed to self-report the intensity of SHS exposure at home were valid when assessed against concentrations of selected markers of SHS exposure &#40;airborne nicotine and cotinine in body fluids&#41;&#46; Moreover&#44; the correlations between the score question and all objective markers were statistically similar to those between the conventional questions and the objective markers&#46; In this sense&#44; the proposed question was at least as good as the conventional quantitative questions at assessing the exposure to SHS at home&#46; The poorest discrimination was obtained for benzene concentrations for both the conventional questions and the new questions to validate&#46; This may be because benzene is a less specific airborne marker of SHS exposure&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Previous studies showed similar results in the assessment of self-reported SHS exposure against biomarkers<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> and against airborne markers in other settings such as workplaces&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> However&#44; many of the studies reported lower correlations to the ones obtained in ours&#46; These differences may be explained by the fact that our questionnaire was applied immediately after the week the markers were collected&#44; avoiding a recall bias&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The main limitation of our study is related to the use of an opportunistic limited-sized sample of volunteers&#46; In this sense&#44; external validity could be hampered by the non-random sample selection and the power of the experiment could be relatively low&#46; Nevertheless&#44; the use of an opportunistic sample allowed us to include those participants who confirmed no other potential sources of tobacco exposure in other settings&#46; Other potential limitation is the lack of assessment of other potential sources of nicotine and benzene&#44; such as those cumulated in the dust of homes &#40;thirdhand smoke&#41; from previous tobacco consumption in the homes of smokers&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Finally&#44; as a strength&#44; whereas many of the previous studies measured either biomarkers or environmental markers&#44; we were able to compare our questions to both types of markers and other conventional questions of SHS exposure&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion&#44; the questions proposed to evaluate the perceived intensity of SHS exposure at home distinguished between different concentrations of nicotine in air and cotinine in saliva and urine&#46; Moreover&#44; we observed a similar discrimination with conventional questions of SHS exposure&#46; These questions may be valid for use in future investigations to characterize SHS exposure at home&#44; although further research in larger and more diverse samples should be conducted&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Authorship contributions</span><p id="par0080" class="elsevierStylePara elsevierViewall">J&#46;M&#46; Mart&#237;nez-S&#225;nchez&#44; E&#46; Fern&#225;ndez and I&#46; Gal&#225;n conceived the study and questions proposed to measure second hand smoke exposure&#46; X&#46; Sureda&#44; M&#46; Fu&#44; E&#46; Fern&#225;ndez and J&#46;M&#46; Mart&#237;nez-S&#225;nchez conducted the fieldwork&#46; R&#46; P&#233;rez-Ortu&#241;o and J&#46;A&#46; Pascual developed the analytical method to quantify the cotinine in saliva and urine and also performed the analyses of biological samples&#46; J&#46;C&#46; Mart&#237;n-S&#225;nchez and C&#46; Lid&#243;n-Moyano prepared and analyzed the database&#46; J&#46;M&#46; Mart&#237;nez-S&#225;nchez and A&#46; Gonz&#225;lez-Marr&#243;n drafted the first draft of the manuscript&#46; All authors contributed substantially to the conception&#44; design&#44; and interpretation of data&#46; All authors contributed to the manuscript and approved its final version&#46; J&#46;M&#46; Mart&#237;nez-S&#225;nchez is the guarantor&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Funding</span><p id="par0085" class="elsevierStylePara elsevierViewall">This work was supported by the Instituto de Salud Carlos III&#44; Subdirecci&#243;n General de Evaluaci&#243;n&#44; Government of Spain &#40;PI081436&#44; PI081339 and RTICC RD12&#47;0036&#47;0053&#41;&#44; the Ministry of Universities and Research&#44; Government of Catalonia &#40;grant 2009SGR192 and 2014SGR689&#41;&#44; the Directorate of Public Health&#44; Ministry of Health &#40;GFH 20051&#41; from the Government of Catalonia&#44; ISCIII-Subdirecci&#243;n General de Evaluaci&#243;n and by FEDER funds&#47;European Regional Development Fund &#40;ERDF&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>a way to build Europe<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#46; This project has received funding from the <span class="elsevierStyleGrantSponsor" id="gs1">European Union&#39;s Horizon 2020 research and innovation programme</span> under grant agreement No <span class="elsevierStyleGrantNumber" refid="gs1">681040</span>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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            1 => "Home environment"
            2 => "Validity"
            3 => "Cotinine"
            4 => "Nicotine"
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            0 => "Humo de tabaco ambiental"
            1 => "Hogares"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The objective of this study was to assess the validity of two questions about the perception of intensity of exposure to secondhand smoke &#40;SHS&#41; at home using as a reference environmental markers &#40;airborne nicotine and benzene&#41; and biomarkers of exposure &#40;cotinine in saliva and urine&#41;&#46; This was a cross-sectional study in a convenience sample of 49 non-smoking volunteers&#46; We found a high correlation between self-reported SHS exposure and airborne nicotine &#40;r<span class="elsevierStyleInf">sp</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;806&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; salivary cotinine &#40;r<span class="elsevierStyleInf">sp</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;752&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; and urinary cotinine &#40;r<span class="elsevierStyleInf">sp</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;626&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; We did not find differences between the score question and the conventional ones &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In conclusion&#44; the significant correlation of the two questions proposed with environmental markers and personal markers indicates their potential validity to assess exposure to SHS at home&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este trabajo es evaluar la validez de dos preguntas sobre la exposici&#243;n al humo ambiental de tabaco &#40;HAT&#41; en el hogar utilizando como referencia marcadores ambientales &#40;nicotina y bencenos en el aire&#41; y biomarcadores espec&#237;ficos &#40;cotinina en saliva y orina&#41; de la exposici&#243;n pasiva al tabaco&#46; Para ello se realiz&#243; un estudio transversal de una muestra de conveniencia de 49 voluntarios no fumadores mayores de edad de la ciudad de Barcelona&#46; Se encontr&#243; una alta correlaci&#243;n entre la pregunta de intensidad de la exposici&#243;n pasiva autodeclarada en casa y la nicotina en el aire &#40;r<span class="elsevierStyleInf">sp</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;806&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; la cotinina en saliva &#40;r<span class="elsevierStyleInf">sp</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;752&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y la cotinina en orina &#40;r<span class="elsevierStyleInf">sp</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;626&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; No encontramos diferencias entre las preguntas puntuables y las convencionales &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;0&#44;05&#41;&#46; En conclusi&#243;n&#44; la alta correlaci&#243;n de las preguntas propuestas con los marcadores ambientales y los biomarcadores indica su validez para evaluar la intensidad de la exposici&#243;n pasiva al tabaco en el hogar&#46;</p></span>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Perceived intensity of exposure to SHS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Airborne nicotine &#40;&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#41;<br>Median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Airborne benzene &#40;&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#41;<br>Median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Salivary cotinine &#40;ng&#47;ml&#41;<br>Median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Urinary cotinine &#40;ng&#47;ml&#41;<br>Median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;35 &#40;0&#46;55&#44; 5&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;38 &#40;0&#46;31&#44; 4&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;95 &#40;0&#46;41&#44; 1&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;57 &#40;2&#46;08&#44; 6&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;03 &#40;0&#46;30&#44; 1&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of smokers at home<br>p-value<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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Información del artículo

ISSN: 02139111
Idioma original: Inglés

DOI:10.1016/j.gaceta.2017.08.002

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2020 Agosto	63	42	105
2020 Julio	30	25	55
2020 Junio	59	39	98
2020 Mayo	51	28	79
2020 Abril	50	37	87
2020 Marzo	64	38	102
2020 Febrero	53	43	96
2020 Enero	72	36	108
2019 Diciembre	57	39	96
2019 Noviembre	56	10	66
2019 Octubre	38	20	58
2019 Septiembre	29	10	39
2019 Agosto	43	14	57
2019 Julio	54	10	64
2019 Junio	36	24	60
2019 Mayo	57	101	158
2019 Abril	49	19	68
2019 Marzo	90	28	118
2019 Febrero	80	21	101
2019 Enero	40	14	54
2018 Diciembre	42	29	71
2018 Noviembre	189	34	223
2018 Octubre	195	52	247
2018 Septiembre	161	40	201
2018 Agosto	138	60	198
2018 Julio	237	106	343
2018 Junio	0	22	22
2018 Mayo	0	19	19
2018 Abril	0	24	24
2018 Marzo	0	44	44
2018 Febrero	0	27	27
2018 Enero	0	18	18
2017 Diciembre	0	23	23
2017 Noviembre	0	48	48

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