Changes in urinary cotinine concentrations in non-smoking adults from the Korean National Environmental Health Survey (KoNEHS) II (2012-2014) after implementation of partial smoke-free regulations

Abstract

Background: The Korean government implemented partial smoke-free regulations in hospitality venues ≥150 m² in July 2013 and in venues ≥100 m² in February 2014. This study examined changes in urinary cotinine concentrations in the Korean non-smoking adult population, and socio-demographic subgroups thereof, between 2012 and 2014, and the relationships between urinary cotinine concentrations and socio-demographic factors in 2014.

Methods: Data from the Korean National Environmental Health Survey II (2012-2014), a nationally representative cross-sectional study, were used. In total, 4218 non-smoking adults (≥19 years) were selected based on questionnaires and urinary cotinine concentrations. Linear trend tests of urinary cotinine over time and socio-demographic factors associated with urinary cotinine in 2014 were examined based on weighted linear regression models.

Results: Overall, the covariate-adjusted least-square geometric mean concentrations of urinary cotinine were 2.95 μg/g creatinine (Cr) (95% confidence interval, CI = 2.37-3.67) in 2012, 1.54 μg/g Cr (95% CI = 1.26-1.88) in 2013, and 1.47 μg/g Cr (95% CI = 1.23-1.76) in 2014, a significant decrease during 2012-2014. Urinary cotinine concentrations decreased significantly during 2012-2014 in most socio-demographic subgroups. However, concentrations in adults who worked in hospitality venues, including restaurants, bars, cafes, fast-food franchises, and bakeries, remained unchanged. Data from 2014, when smoke-free regulations were implemented in hospitality venues ≥100 m², showed urinary cotinine concentrations were significantly higher in adults working in hospitality venues than in unemployed adults.

Conclusions: Overall, urinary cotinine concentrations of Korean non-smoking adults decreased during 2012-2014. However, implementation of partial smoke-free regulations in hospitality venues was not effective in reducing secondhand smoke exposure in workers at hospitality venues.

Keywords: Cotinine; Hospitality venue; KoNEHS; Public place; Secondhand smoke; Smoke-free regulation.