Tobaccousage leads to 7 million deaths in a year all over the world . Out of this 7million deaths- 6 million are due to direct tobacco usage and 890000 are due tosecond hand smoking by non smokers. Nearly one person dies every 6 seconds dueto tobacco usage1,2. Smoking is the preventable risk factor for manynon communicable diseases and is responsible for various diseases and a numberof cancers in particular lung cancer, oral, laryngeal cancers and somecardiovascular disorders3. Vast number of chemicals nearly 5000toxic and 70 carcinogenic compounds is found in the tobacco smoke4.
A few toxic metabolites intobaccosmokeare nicotine,thiocyanate, carbonmonoxide, carboxyhaemoglobin, aromatic aminoacids, hydroxyprolinee.t.c5.Nicotineis the addictive and dangerous alkaloid present in cigarettes6. Themajor metabolite of nicotine is cotinine. In liver cotinine is oxidised byCYP2A6 and it is distributed among various body fluids including blood, saliva,urine7. Cotinine levels are four to six times higher in urine thanthat in saliva and blood8. Cotinine has longer half life thannicotine.
Hence cotinine is considered as a good biomarker to distinguishnon-smokers along with smokers9. other metabolites in tobacco smoke possess low specificity andsensitivity as they are influenced by many environmental factors10. Thusthis study is directed to measure cotinine levels in adult active and passivesmoker.Objectives: · To determine the active smokers in a ruralarea & know their smoking habits.
· To determine the passive smokers in the ruralarea & to know the details pertaining to their exposure.· To determine the levels of cotinine in urineamong active and passive smokers.· To educate them on the hazardous effects ofsmoking.· From the questionnaire current awareness ofthe people can be accessed.Methodology: Conducting such research may addimmense value as review of literature showed that study on urinary assessmentof cotinine levels in both active and passive smokers was not conductedpreviously in the rural areas around Guntur. There is a study which hasestimated parameters of smoking habits and on prevalence patterns of tobacco butassessment of cotinine levels was not done. Present study can thus becomeuseful to the society.The present study is a crosssectional, community based, non-interventional study.
The study consists of a questionnaire which has general details of the participant,information on smoking habits among smokers and details pertaining to theirexposure in passive smokers. A few questions regarding the hazardouseffects of smoking are also added. The sample size would be 100people selectedrandomly from the rural community. The questionnaires will be distributed,translated in to the local language and will be explained to the participants.
30active smokers and 30 passive smokers will be randomly selected. Biochemicalparameters i.e; cotinine levels in urine will be tested among active smokersand passive smokers identified with the help of questionnaires.A clean, dry wide mouthed sterile containerwith a screw top will be given for the collection of mid stream urine samplesby the participants. Cotinine leveltesting will be done with the help of one step cotinine test device.It is alateral flow chromatogrhapic immunoassay for the detection of cotinine in humanurine at a cut-off concentration 200 nanograms/ml. The test device will be placedon a clean and level surface and a few drops of urine sample are placed in thespecimen well. The test will be read after 5 minutes.
Appearance of onecoloured line in the control region indicates that the test is positive;appearance of two coloured lines in the test and control regions indicates thatthe test is negative. The research will commence only after getting approvalfrom the institutional ethics committee. Informed consent will be obtained fromall the subjects involved in the study.
After obtaining results, statistical analysis will be done withappropriate statistical tools. Confidentiality will be maintained throughoutthe studyImplications:The studyenables learning basic details of conducting research. It also enhancescommunication skills in researcher in interacting with subjects. The study alsoaddresses most important problem of society i.e, smoking & its deleterious effects.Paying attention to both active and passive smoking and creating awareness amongpeople in rural area can considerably reduce hazards of smoking in society.
Thecotinine levels in urine to determine the smoking among active and passivesmokers can be learnt in detail. The population in the rural area along withthe smokers can be councelled and chances of preventing complications ofsmoking will increase.