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A few hours in a casino may cost you more than your paycheck. According to a new study, the amount of secondhand cigarette smoke in a casino or any other smoke-filled room may present a substantial cancer risk to nonsmokers.
Researchers at the University of Minnesota, Minneapolis, found elevated levels of a cancer-causing agent, NNAL, in the urine of nonsmokers after they spent just four hours in a commercial casino. Researchers also found elevated levels of cotinine, a byproduct of nicotine, in the samples. Both NNAL and cotinine are specific to tobacco and were not found in the nonsmokers' urine before their casino visit.
"This evidence could be dynamite," says Robert West, an epidemiologist at University College London. "It is one thing to know that one is breathing in carcinogens; psychologically it is another to know that one's own body has been contaminated by them."
The study, published today in Cancer Epidemiology Biomarkers and Prevention, provides additional evidence to the long-held belief that secondhand smoke poses a health risk. The research is also expected to add fuel to the drive for anti-smoking regulations in public spaces.
Research Offers Real-World Evidence of Exposure
In the study, Kristin Anderson, epidemiologist at the University of Minnesota's School of Public Health, analyzed urine samples of 18 volunteers before their visit to a casino in the upper Midwest. The volunteers, four men and 14 women, spent an average of 4.25 hours in the designated smoking area of the casino. Samples were also collected within 24 hours following the visit.
The samples taken after the casino visit showed a 112 percent average increase in NNAL. The average increase in the amount of cotinine following the casino visit was 456 percent.
Public health professionals note the study adds a real-world element to the evidence linking secondhand smoke to cancer. "The unique aspect of this research is that it simulates real-life exposure," says Andrew Hyland, epidemiologist with the Roswell Park Cancer Institute in Buffalo, N.Y.
"The results show that even a four-hour stay in a smoky casino results in a significantly elevated body burden of a potent carcinogen," adds Hyland. "Previous epidemiologic studies have focused on long-term exposure, but this study shows that nonsmokers are being put at risk every time they go to a smoky establishment."
The use of individuals adds value to the study, according to Dr. John Spangler of Wake Forest University School of Medicine in Winston-Salem, N.C.
"This takes data from the population level down to specific individuals. It is one thing to say that populations who are on average exposed to secondhand smoke have a higher risk of cancer. It is quite another to say an individual does," says Spangler.
He notes that, at the population level, it is difficult to determine what caused those in a group to get cancer.
"The current study nails down the fact that a potent carcinogen is are found in the urine of individuals exposed to secondhand smoke," Spangler adds. "If it is in their urine, it certainly has circulated throughout their system."
More Anti-Smoking Regulations to Come?
Anti-smoking advocates may find this research bolsters their case for smoke-free indoor air. According to Hyland, air monitoring in New York showed a 90 percent decrease in indoor air pollutants after the implementation of that state's smoke-free regulations for restaurants and bars.
"The comprehensive clean indoor air regulations now present in California, Delaware, New York, Maine and Connecticut, which prohibit smoking in virtually all indoor public places including bars and restaurants, are the best way to eliminate exposure to secondhand smoke," says Hyland.
Twenty-one percent of the nations' population lives in the five states that have comprehensive smoke-free indoor air policies that cover all workplaces, according to Hyland. Many more states and communities are looking into similar regulations.
"Data showing that nonsmokers exposed to secondhand smoke have significantly elevated levels of carcinogens will be powerful in advocating for these policies," adds Hyland, "and I suspect the increase in clean indoor air regulations observed nationally will continue."
Like many parents, Spangler, who recently spent 90 minutes with his children in a smoky restaurant, is eager to see these nonsmoking regulations enacted. "We were in a situation where it would have been very difficult to leave," he says. "It infuriates me that their cancer risk has been elevated. It is hard to argue in light of these findings that smoking affects only the individual who smokes; carcinogens show up in innocent bystanders."
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