title: A novel approach for monitoring tobacco use in local communities by wastewater analysis.
abstract: OBJECTIVE
  We propose a novel approach for measuring tobacco use in a community through the chemical analysis of nicotine metabolites in urban wastewater. It offers frequent monitoring and 'real-time', 'evidence-based' estimates of tobacco consumption which may complement epidemiological surveillance systems normally repeated only every few years.
  
  
  METHODS
  Two urinary metabolites of nicotine, namely cotinine and trans-3'-hydroxycotinine, were selected as biomarkers of tobacco consumption in urban wastewater. During smoking, a known amount of nicotine is absorbed and after metabolism excreted as metabolites in urine, ending up in the wastewater; quantitative analysis of the metabolites in the wastewater allows back-calculation of the nicotine collectively absorbed by the population producing the sewage and, indirectly, their tobacco use. Representative samples of wastewater were collected from sewage treatment plants in eight Italian cities and analysed by mass spectrometry. Mass loads of the metabolites were used to estimate nicotine consumption.
  
  
  RESULTS
  Wastewater analysis in the cities under study was used to estimate the number of cigarettes smoked, in order to compare the results of this study with those obtained from population surveys. The number of cigarettes calculated with the two methods were closely comparable and wastewater analysis was sufficiently sensitive to confirm the differences in tobacco consumption between northern and southern Italy, previously described in population surveys.
  
  
  CONCLUSIONS
  The described approach can serve as a supplementary indicator of tobacco consumption in local communities. This approach can provide objective and updated information, which are useful to assess the efficacy of tobacco-control interventions, with the aim of designing and implementing effective tobacco control plans.
authors.affiliation: Department of Environmental Health Sciences, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Castiglioni
authors.affiliation: Division for Marine and Environmental Research, Rudjer Boskovic Institute, Zagreb, Croatia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Senta
authors.affiliation: Department of Environmental Health Sciences, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Borsotti
authors.affiliation: Department of Environmental Health Sciences, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Davoli
authors.affiliation: Department of Environmental Health Sciences, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Zuccato
mesh_terms: D003367:Cotinine / Q000031:analogs & derivatives* / Q000032:analysis; D006801:Humans; D007558:Italy; D009538:Nicotine / Q000032:analysis*; D011159:Population Surveillance / Q000379:methods*; D012111:Residence Characteristics; D012907:Smoking / Q000652:urine; D062789:Tobacco Products; D062065:Wastewater / Q000032:analysis*
chemical_list: D003367:Cotinine; D009538:Nicotine; D062065:Wastewater; C001381:hydroxycotinine
keywords: Cotinine; Nicotine; Surveillance and monitoring