Judy L. Mumford

In Xuan Wei County, Yunnan Province, lung cancer mortality is among China's highest and, especially in females, is more closely associated with indoor burning of "smoky" coal, as opposed to wood or "smokeless" coal, than with tobacco smoking. Indoor air samples were collected during the burning of all three fuels. In contrast to wood and smokeless coal emissions, smoky coal emission has high concentrations of submicron particles containing mutagenic organics, especially in aromatic and polar fractions. These studies suggested an etiologic link between domestic smoky coal burning and lung cancer in Xuan Wei.

The lung cancer mortality rate in Xuan Wei (XW) county, China, is 5-fold the national average of China; the rate for women is the highest in China. Xuan Wei residents have been exposed to unvented coal or wood smoke during cooking or heating in homes. This study investigated indoor air exposure and dosimetry of polycyclic aromatic hydrocarbons (PAHs) in XW residents using smoky coal. Indoor air particles collected during cooking in four XW homes using smoky coal were analyzed for PAHs by GC/MS. Urine samples from 16 XW non-smoking women and six XW smoking men, eight Kunming non-smoking controls and four non-smoking Chinese American controls were analyzed for PAHs and hydroxy-PAHs by GC/MS. The results showed that XW residents were exposed to PAHs at occupational levels. The potent carcinogen, dibenzo[a,l] pyrene (4.9 +/- 1.3 micrograms/m3) was found in the indoor air of the XW homes. The levels of urinary hydroxy-PAH were higher than those of the parent compounds in most subjects, indicating that most PAHs were metabolized. In urine, the mean levels of 9-hydroxy BaP (BaP) and BaP are 1.5 +/- 0.5 mumol/mol creatinine and 0.5 +/- 0.3 microns/mol for XW men, 1.9 +/- 0.9 microns/mol and 0.5 +/- 0.3 microns/mol for XW women. In general, the levels of PAH metabolites in urine were higher in the XW residents than in Kunming and Chinese American controls; however only the concentrations of 9-hydroxy BaP in XW women showed statistically significant difference from the Kunming controls (P < 0.05 by ranking test). The mean levels of 3 methylated-PAHs analyzed were 4.8-fold higher than that of the parent PAHs in XW subjects. This is consistent with previous findings that alkylated PAHs are the major mutagens in the XW indoor air and may be etiologically important in XW lung cancer.

We examined the extent of correlation between home air nicotine levels and urine cotinine/creatinine ratios (CCR) in 27 children who attended a research day care program where they were not exposed to environmental tobacco smoke (ETS) during the daytime hours. Average concentrations of nicotine in home air were determined by active air sampling during the evening and night hours on 2 consecutive days. Urine samples for cotinine and creatinine determinations were collected before, during, and after the two sampling periods. In addition, four sequential weekly urine samples for CCR were obtained from study children to determine the extent to which single determinations of CCR were representative for individual children. Fifteen children resided in homes with smokers, and 12 did not. Urine CCR consistently distinguished most exposed and unexposed children. However, three exposed children had urine CCRs that clustered routinely around the criterion CCR (30 ng/mg cotinine-creatinine) that best distinguished exposed and unexposed children. In children exposed to ETS in the home, there was a significant correlation between average home air nicotine levels and the average logarithm of urine CCR the two mornings after the home air monitoring periods (r = 0.68; p = 0.006). In study children, urine CCRs were remarkably stable over the 1-month observation period. Rank correlation coefficients for sequential weekly determinations of CCR were consistently greater than r = 0.88; p less than 0.0001.