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Objective: To determine whether measurement of cotinine in saliva is a sensitive measure of exposure to second-hand smoke (SHS) among customers in bars. Design: Before/after comparison of saliva cotinine and subjective assessments of SHS. Setting: Three bars in Wellington, New Zealand, June 2003. Participants: Eleven non-smoking medical students spent three hours in each location. They provided saliva samples before and after the visit, counted numbers of lit cigarettes in each bar, and assessed the smokiness of the venue. Samples were tested for cotinine using liquid chromatography coupled with mass spectrometry. Results: Cotinine levels post-visit were consistently higher than baseline. The mean difference was 1.03 ng/mL with a 95% confidence interval of 0.76-1.30 ng/ mL. Adjustments to post-visit levels for metabolism and clearance of cotinine made very little difference to these results. Males tended to have higher baseline levels than females, and to show smaller increases. The bar with the greatest increase in cotinine was judged to be the smokiest on the basis of averaged cigarette counts and scores for presence of smoke and odour. Conclusion: The cotinine in saliva, when tested with the analytic methods described here, provides a means of assessing relatively short-term exposures to SHS.

Aims: To demonstrate that enhanced screening for Chlamydia over and above the usual opportunistic screening in family planning (FPA) clinics is feasible, practical, and acceptable., Methods: Over a 6-month period from November 2004 to May 2005, all under-25-year-olds attending three Wellington FPA clinics in New Zealand were offered Chlamydia urine testing. Staff interviews before and after the study were carried out to assess the impact of enhanced screening on clinic routines. Interviews were conducted with 50 clients to assess the acceptability to young persons. Additional questions were asked of 22 Chlamydia-positive clients to ascertain the acceptability of the procedures for follow up., Results: From a total of 4674 participants, a valid urine test was carried out on 2533 (54%). The most common reason for exclusion was having passed urine in the last hour. Positive tests were detected in 212 (8%). A positive result was more likely in those with a history of partner change or in Māori and Pacific ethnic groups; it was least likely in those who always used condoms. For the staff, time constraints were the most important barrier to screening. The procedures were acceptable to clients., Conclusions: We demonstrated that improvements in Chlamydia screening are feasible, practical and acceptable to clients

Aims: To measure secondhand smoke (SHS) levels in New Zealand bars prior to smokefree legislation enacted on 10 December 2004., Methods: Thirty bars were randomly selected from urban, surburban, and surrounding rural areas of Auckland, Wellington, and Invercargill. Bars were visited (on a Friday or Saturday night for a 3-hour stay between 1800 and 2400 hours) in July/August/September 2004 (winter) and again in October/November 2004 (spring). Each bar was visited by a group of 4 or 5 non-smokers participating in the study. All groups of participants spent a 3-hour block of continuous time in the bar. Saliva samples (approximately 0.5-2 mL) were provided immediately prior to entering the bar as well as 5-15 minutes after leaving the bar. Each group recorded the initial impression of air quality and ventilation, the number of observed lit cigarettes over three 10-minute intervals throughout the evening, and the number of patrons at each interval. In addition, any general comments about the venue (relevant to bar attendance or air quality on the evening) was recorded. Cotinine, the main metabolite of nicotine, was measured in saliva samples using Liquid Chromatography with tandem Mass Spectrometry (LC-MS-MS)., Results: In all bars, and in all volunteers, exposure to SHS was evident. Saliva cotinine increased after 3 hours in the bar (mean increase=0.66 ng/mL, SE=0.03 ng/mL, p value of <0.0001). The 30 bars randomly selected provided a good spectrum of SHS exposures, with mean cotinine increasing by approximately 8-fold. Smaller population centres showed greater exposures to SHS. A north-south gradient of exposure was also seen (highest exposures were in Southland). Higher exposures were seen in the winter than in the spring. The objective measures of SHS exposure correlated strongly with the volunteers' subjective observation of ventilation, air quality, and counts of lit cigarettes. One exception was where objective salivary markers indicated that even "seemingly smokefree" venues with "good ventilation" produced discernable levels of SHS exposure., Conclusions: We have utilised an objective, non-invasive scientific approach to assess SHS smoke exposure in patrons of New Zealand bars. Our results clearly indicate exposure to SHS, with regional and seasonal variation, prior to the introduction of smokefree legislation.