First nation-wide estimation of tobacco consumption in Spain using wastewater-based epidemiology
Graphical abstract
Introduction
Wastewater-based epidemiology (WBE) has become a well-established technique for assessing the consumption of several legal and illicit drugs (Lorenzo and Picó, 2019; Subedi and Burgard, 2019). This approach is based on the measurement of the excreted biomarkers (parent compounds or metabolites) of the substances of interest in wastewater from a specific population. Subsequently, some back-calculations are performed to estimate consumption rates (Choi et al., 2018). WBE has been applied so far to estimate consumption of illicit drugs (González-Mariño et al., 2020), new psychoactive substances (Bijlsma et al., 2019), caffeine (Senta et al., 2015), alcohol (Boogaerts et al., 2016), nicotine (Castiglioni et al., 2015; Rodríguez-Álvarez et al., 2014), some pharmaceuticals and personal care products (PPCPs) (Lopardo et al., 2018), and also to evaluate the exposure to different contaminants, e.g. phthalates (González-Mariño et al., 2017) or pesticides (Rousis et al., 2016).
Nicotine (NIC) is the most consumed substance of licit abuse after alcohol worldwide (Global Drug Survey, 2019). According to the World Health Organization (WHO), smoking is one of the main risk factors for several chronic diseases, such as cancer, and respiratory and cardiovascular diseases (World Health Organization, 2020). Although legislation on its consumption and sale has been tightened in recent years, its use is still very prevalent worldwide (Global Drug Survey, 2019). In Spain, ca. 22% of the adult population consumes tobacco daily (Instituto Nacional de Estadística, 2018). Thus, identifying areas and regions with the highest incidence of consumption, and potential reasons for these figures, is crucial to design strategies to reduce tobacco use and evaluate the success of the actions undertaken (Drope et al., 2018). Furthermore, other sociodemographic factors, such as the average age or the unemployment rate, and the relationship with factors usually associated with tobacco use, such as the incidence of pulmonary or cardiovascular diseases need to be explored.
So far, the main sources of information to determine the prevalence of tobacco use are self-reported surveys, sales statistics, and medical diagnosis records. However, conventional approaches typically underestimate the actual prevalence due to non-response bias and bias in the selection of the sampled populations (case of surveys), the illicit trade markets that are not taken into account (case of sales records), and incomplete medical reports (Subedi and Burgard, 2019). WBE provides additional information to these traditional sources, and it is considered as a fast and not overly expensive technique to complement and validate consumption figures (Baz-Lomba et al., 2016; Bijlsma et al., 2018).
WBE has been used to estimate tobacco consumption in different countries including the United States (Chen et al., 2019), Australia (Lai et al., 2018; Mackie et al., 2019), China (Gao et al., 2020; Zheng et al., 2017), Maldives (Fallati et al., 2020), Italy (Senta et al., 2015; Castiglioni et al., 2015), Spain (Rodríguez-Álvarez et al., 2014; Baz-Lomba et al., 2016), and other European countries (Baz-Lomba et al., 2016; Lopes et al., 2014; Mackul'ak et al., 2015; van Wel et al., 2016). In most published studies, the metabolites of NIC, cotinine (COT), trans-3′-hydroxycotinine (OH-COT), and their glucuronides have been analyzed, and back-calculations performed to estimate the amount of NIC consumed by the population. To a lesser extent, other biomarkers of tobacco consumption, such as the alkaloids anabasine and anatabine, have also been used (Tscharke et al., 2016). These compounds are exclusively found in tobacco and not in the products used for nicotine replacement therapies (NRT), so they can be used to discern nicotine metabolites in wastewater coming from such products. However, their concentrations in tobacco are much lower than NIC and their determination in wastewater far more difficult, while there is no data on metabolism for back-calculating tobacco use (Mackie et al., 2019).
The aim of this study was to perform the most ambitious assessment of tobacco consumption in Spain by means of WBE. To this end, 17 wastewater treatment plants (WWTPs) from 13 cities belonging to seven different regions were sampled every day during a whole week. NIC metabolites, COT and OH-COT, were measured in the wastewater samples to estimate NIC consumption. The results obtained through the WBE approach were compared with consumption estimates derived from the official data on tobacco sales and with survey data on smoking prevalence. Moreover, potential correlations between tobacco consumption and socio-economic and health conditions of the population were explored.
Section snippets
Reagents and materials
High-performance liquid chromatography (HPLC)-grade methanol and acetic acid were supplied by Merck (Darmstadt, Germany); the enzyme β-glucuronidase (from Helix pomatia, Type H-2), ammonium acetate, sodium acetate, and sodium chloride were obtained from Sigma–Aldrich (Steinheim, Germany). GHP polypropylene syringe filters (0.22 μm) were acquired from Merck. Ultrapure water was obtained from a Milli-Q water generator (Millipore, Bedford, MA, USA). Standards of COT and OH-COT, as well as their
Levels of NIC metabolites in wastewater
COT and OH-COT were detected in all samples analyzed at average concentrations per WWTP ranging from 0.6 to 7.7 μg/L and from 0.9 to 13.3 μg/L, respectively, being the lowest values found in the WWTP of Santiago de Compostela and the highest ones in Móstoles and some sampling points in Catalonia (Table S3). Some authors performed the back-calculations for the estimation of NIC using both metabolites (as sum) (Castiglioni et al., 2015), however, other authors preferred to use only COT, due to
Conclusions
The results estimated in this study of NIC consumption using both metabolites (COT and OH-COT) are comparable, with no specific trend of consumption observed between the different days of the week. The results of tobacco use differ between the different cities and regions, but they are not correlated with the results of prevalence of consumption reflected in the official surveys. However, these estimated values are a better approximation to the actual consumption reflected by the official sales
CRediT authorship contribution statement
Rosa Montes:Resources, Investigation, Formal analysis, Visualization, Writing - original draft.Rosario Rodil:Visualization, Supervision, Writing - review & editing.Andreu Rico:Resources, Supervision, Visualization, Writing - review & editing.Rafael Cela:Supervision, Writing - review & editing.Iria González-Mariño:Resources, Investigation, Writing - review & editing.Félix Hernández:Resources, Writing - review & editing.Lubertus Bijlsma:Resources, Writing - review & editing.Alberto Celma:
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Financial support
This study was supported by MINECO/AEI projects (CTM2016-81935-REDT, CTM2017-84763-C3-2-R, CTM2017-84763-C3-1-R, CTM2017-84763-C3-3-R), MICINN project (CEX2018-000794-S), Galician Council of Culture, Education and Universities (ED481D 2017/003 and ED431C2017/36), cofunded by FEDER/ERDF.
Sampling and analytical support
Viaqua and Concello de Santiago, Jordi Palatsi from AQUALIA (Lleida WWTP), Cristian Mesa and Angela Vidal from Aigues de Barcelona (Barcelona WWTP), Santiago Querol and Sara Gargallo from Sociedad de Fomento
References (40)
- et al.
Comparison of pharmaceutical, illicit drug, alcohol, nicotine and caffeine levels in wastewater with sale, seizure and consumption data for 8 European cities
BMC Public Health
(2016) - et al.
Wastewater-based epidemiology: applications towards the estimation of drugs of abuse consumption and public health in general. The Spanish network ESAR-net (In Spanish)
Revista Española de Salud Pública
(2018) - et al.
Monitoring new psychoactive substances use through wastewater analysis: current situation, challenges and limitations
Current Opinion in Environmental Science & Health
(2019) - et al.
Spatial and temporal trends in alcohol consumption in Belgian cities: a wastewater-based approach
Drug Alcohol Depend.
(2016) - et al.
Evidence for urinary excretion of glucuronide conjugates of nicotine, cotinine, and trans-3′-hydroxycotinine in smokers
Drug Metab. Dispos.
(1992) - et al.
Evaluation of uncertainties associated with the determination of community drug use through the measurement of sewage drug biomarkers
Environmental Science & Technology
(2013) - et al.
A novel approach for monitoring tobacco use in local communities by wastewater analysis
Tob. Control.
(2015) - et al.
Alcohol and nicotine consumption trends in three U.S. communities determined by wastewater-based epidemiology
Sci. Total Environ.
(2019) - et al.
Wastewater-based epidemiology biomarkers: past, present and future
TrAC Trends Anal. Chem.
(2018)
The Tobacco Atlas. Atlanta: American Cancer Society and Vital Strategies
Use of legal and illegal substances in Malé (Republic of Maldives) assessed by wastewater analysis
Sci. Total Environ.
Stability of alcohol and tobacco consumption biomarkers in a real rising main sewer
Water Res.
Systematic evaluation of biomarker stability in pilot scale sewer pipes
Water Res.
Using wastewater-based epidemiology to estimate consumption of alcohol and nicotine in major cities of China in 2014 and 2016
Environ. Int.
GDS 2019 key findings report
Wastewater-based epidemiology as a new tool for estimating population exposure to phthalate plasticizers
Environmental Science & Technology.
Spatio-temporal assessment of illicit drug use at large scale: evidence from 7 years of international wastewater monitoring
Addiction
Ministerio de Sanidad
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