Assessment of Urine Cotinine Levels in Active and Passive Smokers, and Studies of Cardiovascular Risk Factors in Ogolcho Town, Oromia, Ethiopia
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Date
2015-06
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Addis Ababa University
Abstract
Introduction: Tobacco use is a global escalating public health problem, especially in low-income
countries, one-third of the adult males. Non-communicable diseases (NCDs) are a growing problem in
Africa and it is partially caused by tobacco use. There are few studies of smoking practices and other
cardiovascular risk factors in Ethiopia and it is unclear how prevalent many of these problems are,
because their prevalence varies in different areas of the country. A more recently survey of smoking
prevalence in 187 countries showed that global smoking prevalence fell from 41% in 1980 to 31% in
2012, and that Ethiopia ranks in the bottom five countries with the lowest smoking prevalence (below
10%), but there is evidence that smoking prevalence is increasing in Ethiopia.
Objective: To assess active tobacco and passive smoking, for further screening of major cardiovascular
risk factors (serum cholesterol levels, hypertension, fasting blood glucose, Body Mass Index and waist
circumference) among residents of Ogolcho town, Oromia; and to examine carbon monoxide levels in
homes in Ogolcho town.
Methods:Across-sectional study was conducted on tobacco users, passive smokers and non-smokers in a
rural population of Ethiopia in Ogolcho, from May 2014– May 2015.Subjects were interviewed, using a
standardized WHO questionnaire, about their lifestyle habits and substance use. Blood specimens from
individuals over 18 years old were taken for serum lipid profile and blood glucose levels. Urine was
screened for cotinine (a nicotine metabolite) in active and passive smokers, using a One Step cotinine test
that detects urine cotinine levels above 200 ng/mL.Anthropometric indices (BMI, waist circumference)
and blood pressure were measured. Frequencies ofthe different variables were analyzed statistically.
Results: Of 95 total participants, 33% (31) were active smokers, 56.3% (54) were passive smokers, 8.6%
(8) were neither active nor passive smokers, and 2% (2) were purely shisha smokers. Over 80% of active
and passive smokers chewed khat regularly, whereas about a half of smokers and non-smokers used
alcohol. All active smokers smoked either in their house or in public places, where exposure of many
nonsmokers, especially children and women, occurs. A high percentage of smokers smoked at home
(41%), and passive smokers that were strongly positive for urine cotinine included two children aged 4
and 5. Of 85 passive and active smokers, 67 % (57) were positive for urine cotinine. Almost all (90%)
active smokers, and 54% of passive smokers, were positive for urine cotinine. Cardiovascular risk factors
other than smoking were common in the population studied. Active smokers had 25.8% prevalence of
abdominal obesity, 48.4% were underweight, 3.2% overweight, 54.8% had elevated triglycerides, 42%
were hypertensive, 48.4% had low HDL and 3.2% high fasting glucose. 10.3% of passive smokers had
abdominal obesity, 17% were underweight, 24% overweight, 55% hypertensive, 38 % had elevated
triglycerides and 24% had low HDL. Prevalence of CVD risk factors among non-smokers were: 12.5%
elevated blood pressure, 50% abdominal obesity, 12.5% overweight and 37.5% overweigh. Non- smoker
lipid profile prevalence was: elevated total cholesterol in 37.5% of subjects and decreased HDL level
prevalence in 25% of non-smokers. Carbon monoxide levels were generally safe in homes, except within
centimeter distances of charcoal stoves.
Conclusion: This cross-sectional analysis indicates that khat and alcohol consumption, or both combined,
are common among smokers and non-smokers in Ogolcho, and the prevalence of passive smoking is high.
Urine cotinine testing was an effective way of studying passive and active exposure to cigarette smoke.
The prevalence of CVD risk factors was high in the studied population, strongly supporting the
importance of screening, prevention and treatment of smoking and other cardiovascular risk factors in
Ethiopia.
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Keywords
Urine; Smokers