Health risk assessment related to cadmium and lead exposure from cigarette smoking among Indonesian smokers in Surakarta, Indonesia: a cross-sectional study

Abstract

Indonesia is one of the developing countries that have the highest number of smokers and ranks third under China and India. Heavy metal such as cadmium and lead poses major health hazards which are found in tobacco smoke. This study aimed 1) to assess the cancer risk and non-cancer risk related to lead and cadmium exposure from cigarette smoking among Indonesian smokers 2) to find the association between socio-demographic, exposure factors, and health risk among Indonesian smokers. This study was a cross-sectional study using an online questionnaire to get the personal information and smoking behavior among Indonesian male smokers who lived in Surakarta city. The survey was conducted on 327 subjects aged 20-35 years old who continue to smoke for at least 6 months. The data analysis was using 4 steps of Health Risk Assessments for inhalation from the US EPA which were; step 1 Hazard identification, step 2 Dose-response assessment, step 3 Exposure Assessment, and step 4 Risk Characterization. For statictical analysis, chi-square was performed using SPSS software version 22 to find the associated factors. The results showed that most of the participants (13.5%) were smoking 7.85 + 5.47 cigarettes per day with an average of 3.18 + 2.56 years. Both cancer risk and non-cancer risk of cadmium (Cd) and lead (Pb) exposure through inhalation were assessed and found the average cancer risk (CR) and non-cancer risk (HQ) of Cd were 4.62x10-6 and 128.2 which ranged from 2.00 x 10-6 to 5.48 x 10-6 and 5.28 – 152.1, respectively. The results found the average cancer risk (CR) and non-cancer risk (HQ) of Pb were 0.076 and 1.83 x 10-11 which ranged from 7.55 x 10-11 to 2.17 x 10-10 and 0.003-0.905, respectively. The mean Hazard Index (HI) result showed 128.3 and the mean Total Cancer Risk (TCR) shown 4.62 x 10-6. According to the risk assessment results, all of the respondents (100%) found non-cancer risk, while 87.7 % found cancer risk. While there were associations between weight, cigarette number, smoking times, and smoking duration in minutes to the cancer risk and non-cancer risk of cadmium and lead. This study concluded that cadmium and lead contained in cigarettes may pose adverse health risks to smokers for both cancer risks and non-cancer risks. These findings suggest that smokers should give more concerned on the frequency and duration of smoking, related to the heavy metals contamination in cigarettes that may cause non-cancer and cancer risk for long term smoking.