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Tobacco
usage leads to 7 million deaths in a year all over the world . Out of this 7
million deaths- 6 million are due to direct tobacco usage and 890000 are due to
second hand smoking by non smokers. Nearly one person dies every 6 seconds due
to tobacco usage1,2. Smoking is the preventable risk factor for many
non communicable diseases and is responsible for various diseases and a number
of cancers in particular lung cancer, oral, laryngeal cancers and some
cardiovascular disorders3. Vast number of chemicals nearly 5000
toxic and 70 carcinogenic compounds is found in the tobacco smoke4.  A few toxic metabolites intobaccosmokeare nicotine,
thiocyanate, carbonmonoxide, carboxyhaemoglobin, aromatic aminoacids, hydroxyproline
e.t.c5.

Nicotine
is the addictive and dangerous alkaloid present in cigarettes6. The
major metabolite of nicotine is cotinine. In liver cotinine is oxidised by
CYP2A6 and it is distributed among various body fluids including blood, saliva,
urine7. Cotinine levels are four to six times higher in urine than
that in saliva and blood8. Cotinine has longer half life than
nicotine. Hence cotinine is considered as a good biomarker to distinguish
non-smokers along with smokers9. other metabolites  in tobacco smoke possess low specificity and
sensitivity as they are influenced by many environmental factors10.

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Thus
this study is directed to measure cotinine levels in adult active and passive
smoker.

Objectives:

·        
To determine the active smokers in a rural
area & know their smoking habits.

·        
To determine the passive smokers in the rural
area & to know the details pertaining to their exposure.

·        
To determine the levels of cotinine in urine
among active and passive smokers.

·        
To educate them on the hazardous effects of
smoking.

·        
From the questionnaire current awareness of
the people can be accessed.

Methodology:

Conducting such research may add
immense value as review of literature showed that study on urinary assessment
of cotinine levels in both active and passive smokers was not conducted
previously in the rural areas around Guntur. There is a study which has
estimated parameters of smoking habits and on prevalence patterns of tobacco but
assessment of cotinine levels was not done. Present study can thus become
useful to the society.

The present study is a cross
sectional, 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 their
exposure in passive smokers. A few questions regarding the hazardous
effects of smoking are also added. The sample size would be 100people selected
randomly from the rural community. The questionnaires will be distributed,
translated in to the local language and will be explained to the participants. 30
active smokers and 30 passive smokers will be randomly selected. Biochemical
parameters i.e; cotinine levels in urine will be tested among active smokers
and passive smokers identified with the help of questionnaires.

A clean, dry wide mouthed sterile container
with a screw top will be given for the collection of mid stream urine samples
by the participants.  Cotinine level
testing will be done with the help of one step cotinine test device.It is a
lateral flow chromatogrhapic immunoassay for the detection of cotinine in human
urine at a cut-off concentration 200 nanograms/ml. The test device will be placed
on a clean and level surface and a few drops of urine sample are placed in the
specimen well. The test will be read after 5 minutes. Appearance of one
coloured line in the control region indicates that the test is positive;
appearance of two coloured lines in the test and control regions indicates that
the test is negative.

The research will commence only after getting approval
from the institutional ethics committee. Informed consent will be obtained from
all the subjects involved in the study.

After obtaining results, statistical analysis will be done with
appropriate statistical tools. Confidentiality will be maintained throughout
the study

Implications:

The study
enables learning basic details of conducting research. It also enhances
communication skills in researcher in interacting with subjects. The study also
addresses most important problem of society i.e, smoking & its deleterious effects.
Paying attention to both active and passive smoking and creating awareness among
people in rural area can considerably reduce hazards of smoking in society. The
cotinine levels in urine to determine the smoking among active and passive
smokers can be learnt in detail. The population in the rural area along with
the smokers can be councelled and chances of preventing complications of
smoking will increase.

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