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Fine particles in homes of predominantly low-income families with children and smokers: Key physical and behavioral determinants to inform indoor-air-quality interventions. PLoS One 2017; 12:e0177718. [PMID: 28545099 PMCID: PMC5435241 DOI: 10.1371/journal.pone.0177718] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/28/2017] [Indexed: 11/19/2022] Open
Abstract
Children are at risk for adverse health outcomes from occupant-controllable indoor airborne contaminants in their homes. Data are needed to design residential interventions for reducing low-income children's pollutant exposure. Using customized air quality monitors, we continuously measured fine particle counts (0.5 to 2.5 microns) over a week in living areas of predominantly low-income households in San Diego, California, with at least one child (under age 14) and at least one cigarette smoker. We performed retrospective interviews on home characteristics, and particle source and ventilation activities occurring during the week of monitoring. We explored the relationship between weekly mean particle counts and interview responses using graphical visualization and multivariable linear regression (base sample n = 262; complete cases n = 193). We found associations of higher weekly mean particle counts with reports of indoor smoking of cigarettes or marijuana, as well as with frying food, using candles or incense, and house cleaning. Lower particle levels were associated with larger homes. We did not observe an association between lower mean particle counts and reports of opening windows, using kitchen exhaust fans, or other ventilation activities. Our findings about sources of fine airborne particles and their mitigation can inform future studies that investigate more effective feedback on residential indoor-air-quality and better strategies for reducing occupant exposures.
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Kalkbrenner AE, Hornung RW, Bernert JT, Hammond SK, Braun JM, Lanphear BP. Determinants of serum cotinine and hair cotinine as biomarkers of childhood secondhand smoke exposure. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2010; 20:615-624. [PMID: 20237497 PMCID: PMC2972673 DOI: 10.1038/jes.2010.7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 02/02/2010] [Indexed: 05/27/2023]
Abstract
Understanding the determinants of childhood secondhand smoke (SHS) exposure is important in measuring and preventing exposure to this widespread environmental contaminant. We evaluated the ability of a broad set of factors to explain variability in serum cotinine, reflecting recent exposure, and hair cotinine, reflecting longer-term exposure. We included repeated measures from 223 elementary-school-age asthmatic children residing with a smoker. We used a manual model-building approach and likelihood ratio tests to select a model predicting each biomarker, and also compared the predictive ability of determinants using Akaike Information Criteria. Potential determinants included a comprehensive parent questionnaire, household nicotine, home ventilation characteristics, exposure in vehicles and others' homes, child demographics, and family social class. Variables in each of these categories remained in the final model for both serum (R(2) of 0.61) and hair cotinine (R(2) of 0.45). A comprehensive set of factors was required to best predict cotinine. Studies should use biomarkers for the best quantitative assessment of SHS exposure. Hair cotinine may be a problematic measure because it was highly influenced by racial differences that were unexplained by SHS exposure. When biospecimen collection is not possible, a household nicotine measurement is warranted. If only questionnaires are available, multiple questions are required to best characterize exposure, such as number of cigarettes, hours spent in a room with concurrent smoking, maternal smoking, and approximate home size.
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Affiliation(s)
- Amy E Kalkbrenner
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
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White blood cell DNA adducts in a cohort of asthmatic children exposed to environmental tobacco smoke. Int Arch Occup Environ Health 2010; 84:19-27. [PMID: 20336464 PMCID: PMC2922034 DOI: 10.1007/s00420-010-0529-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 03/09/2010] [Indexed: 11/06/2022]
Abstract
Purpose Exposure to environmental tobacco smoke (ETS) leads to molecular damage in the form of DNA adducts. While lung cancer risk is higher among African Americans compared to White Americans, a few studies have tested for racial differences in DNA adducts among children exposed to ETS. The purpose of this study was to test whether African American children have higher DNA adducts levels compared to White children adjusted for ETS exposure. Methods Data and biologic specimens were drawn from an existing cohort of 212 asthmatic children. These subjects participated in a 12-month ETS-reduction trial that employed HEPA air cleaners with active filter cartridges and sham filter cartridges. White blood cell (WBC) DNA was analyzed for DNA adducts using 32P-postlabeling. We assessed ETS exposure using a validated air nicotine dosimeter. We determined the independent relationship between African American race and DNA adduct levels adjusted for ETS exposure and air cleaner use. Results The mean age of the subjects was 8.4 years; 55% were African American. There was no difference in DNA adduct levels between African American and White children (11.8 vs. 11.2 adducts per 109 nucleotides, p = 0.86), despite slightly higher levels of air nicotine exposure (3.4 vs. 2.2 μg/m3, p = 0.14). African American children used their air cleaners less often than White children. We found that the best predictor of DNA adduct levels was the duration of air cleaner use (r = −0.133, p = 0.056). This association was independent of cartridge type. Conclusions We did not see differences in adduct levels by race even after accounting for the level of ETS exposure. However, there was a marginal inverse association between air cleaner use and adducts. Additional research is required to understand this phenomenon.
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Abstract
OBJECTIVES Active smoking has a well-documented role in the etiology of inflammatory bowel disease (IBD), but the role of passive smoking has been unclear. This meta-analysis examined the relationship between prenatal smoke exposure and childhood passive smoke exposure and the development of IBD. METHODS We searched the MEDLINE and EMBASE databases to identify observational studies regarding the relationship between prenatal and/or childhood passive smoke exposure and the development of Crohn's disease (CD) and/or ulcerative colitis (UC). Pooled odds ratios (OR) were calculated for each relationship. RESULTS A total of 534 and 699 potential studies were identified from the MEDLINE and EMBASE databases, respectively, of which 13 met all of our inclusion criteria. Overall, we did not observe a positive relationship between childhood passive smoke exposure and CD (OR 1.10, 95% confidence interval [CI] 0.92-1.30) or UC (OR 1.01, 95% CI 0.85-1.20). Likewise, we did not observe an association between prenatal smoke exposure and CD (OR 1.10, 95% CI 0.67-1.80), or prenatal smoke exposure and UC (OR 1.11, 95% CI 0.63-1.97). CONCLUSIONS Our meta-analysis suggests that there is not a strong association between childhood passive smoke exposure and the development of CD. We found no evidence that childhood passive smoke exposure exerts a protective effect against UC, as is the case in active smoke exposure. The heterogeneity among the small number of studies limited the ability to draw conclusions about prenatal smoke exposure.
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Affiliation(s)
- Deborah T. Jones
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Mark T. Osterman
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA, Department of Medicine, Philadelphia, PA, USA
| | - Meenakshi Bewtra
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA, Department of Medicine, Philadelphia, PA, USA
| | - James D. Lewis
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA, Department of Medicine, Philadelphia, PA, USA, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA
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A longitudinal study of environmental tobacco smoke exposure in children: parental self reports versus age dependent biomarkers. BMC Public Health 2008; 8:47. [PMID: 18254964 PMCID: PMC2276212 DOI: 10.1186/1471-2458-8-47] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 02/06/2008] [Indexed: 11/11/2022] Open
Abstract
Background Awareness of the negative effects of smoking on children's health prompted a decrease in the self-reporting of parental tobacco use in periodic surveys from most industrialized countries. Our aim is to assess changes between ETS exposure at the end of pregnancy and at 4 years of age determined by the parents' self-report and measurement of cotinine in age related biological matrices. Methods The prospective birth cohort included 487 infants from Barcelona city (Spain). Mothers were asked about maternal and household smoking habit. Cord serum and children's urinary cotinine were analyzed in duplicate using a double antibody radioimmunoassay. Results At 4 years of age, the median urinary cotinine level in children increased 1.4 or 3.5 times when father or mother smoked, respectively. Cotinine levels in children's urine statistically differentiated children from smoking mothers (Geometric Mean (GM) 19.7 ng/ml; 95% CI 16.83–23.01) and exposed homes (GM 7.1 ng/ml; 95% CI 5.61–8.99) compared with non-exposed homes (GM 4.5 ng/ml; 95% CI 3.71–5.48). Maternal self-reported ETS exposure in homes declined in the four year span between the two time periods from 42.2% to 31.0% (p < 0.01). Nevertheless, most of the children considered non-exposed by their mothers had detectable levels of cotinine above 1 ng/mL in their urine. Conclusion We concluded that cotinine levels determined in cord blood and urine, respectively, were useful for categorizing the children exposed to smoking and showed that a certain increase in ETS exposure during the 4-year follow-up period occurred.
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Cobanoglu N, Kiper N, Dilber E, Gurcan N, Gocmen A, Ozcelik U, Dogru D, Yalcin E, Pekcan S, Kose M. Environmental tobacco smoke exposure and respiratory morbidity in children. Inhal Toxicol 2007; 19:779-85. [PMID: 17613087 DOI: 10.1080/08958370701402085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Environmental tobacco smoke (ETS) contains carcinogenic and toxic agents. Smoking might have a more serious effect on children than adults. We aimed to examine the effects of passive smoking on pulmonary function and respiratory health in children and to assess the concordance between parental self-reported smoking habits and urinary cotinine levels in their children. This cross-sectional study was conducted in the winter with the participation of 131 children (9-12 yr old). The procedure for each subject consisted of administration of a questionnaire to the parents, and collection of a urine sample and measurement of lung function in each child. Cotinine level excreted into urine was analyzed with respect to parental self-reported smoking behavior. Working mothers and mothers with higher level of education tended to smoke more at home (p values, respectively, .002 and .005). There was a statistical difference between the urinary cotinine levels of children when divided into two groups according to their fathers' smoking behavior at home (p = .0001). No statistically significant difference was determined in the mean episodes of respiratory infections treated during the last 12 mo among the groups formed according to daily number of cigarettes smoked by the parents at home (1: not exposed; 2: < 5 cigarettes; 3: 5-10 cigarettes; 4: > 10 cigarettes), or among the groups formed according to urinary cotinine levels (1: < 10 ng/ml; 2: > or =10 ng/ml). No significant difference was demonstrated in any of the respiratory function parameters investigated between the groups considered. The reliability of the declarations of the parents in the estimation of ETS exposure of children was low. Children are unable to remove themselves from ETS exposure. It is better to reduce the percentage of parents who smoke rather than to isolate smokers or increase ventilation.
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Affiliation(s)
- Nazan Cobanoglu
- Hacettepe University Pediatric Pulmonary Diseases Unit, Ankara, Turkey
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Gonçalves-Silva RMV, Valente JG, Lemos-Santos MGF, Sichieri R. [Household smoking and respiratory disease in under-five children]. CAD SAUDE PUBLICA 2006; 22:579-86. [PMID: 16583102 DOI: 10.1590/s0102-311x2006000300013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Environmental tobacco smoke is an important respiratory tract irritant in young children. To identify factors associated with respiratory disease and determine the main source of smoking exposure in the household, a cross-sectional study of 2,037 children who were immunized in primary health care clinics was conducted (in a sample of 10 out of 38 clinics with 200 children each). Parents answered a questionnaire about children's birth, passive smoking, former and current respiratory morbidity, socio-demographic characteristics, and living conditions. Analysis was based on hierarchical logistic regression. Prevalence of respiratory symptoms was 59.9% for children who live with smokers. Asthma and bronchitis showed the strongest association with smoking. In multivariate logistic regression, the following variables remained associated with asthma/bronchitis: socioeconomic status (OR = 2.93; 95%CI: 1.57-5.45), maternal schooling (OR = 1.46; 95%CI: 1.08-1.98)] and occupation (OR = 1.68; 95%CI: 1.04-2.74), neighborhood (OR = 1.47; 95%CI: 1.06-2.02), child's age (OR = 3.38; 95%CI: 2.31-4.95) and sex (OR = 1.46; 95%CI: 1.09-1.94), breastfeeding (OR = 1.66; 95%CI: 1.15-2.40), and household smoking (OR = 1.58; 95%CI: 1.18-2.11). Children with lower socioeconomic status and exposed to household smoking showed increased risk of respiratory disease.
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Kallio K, Jokinen E, Hämäläinen M, Kaitosaari T, Volanen I, Viikari J, Rönnemaa T, Simell O. Impact of repeated lifestyle counselling in an atherosclerosis prevention trial on parental smoking and children's exposure to tobacco smoke. Acta Paediatr 2006; 95:283-90. [PMID: 16497637 DOI: 10.1080/08035250500375145] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM To determine whether repeated infancy-onset lifestyle counselling alters parental smoking and children's exposure to tobacco smoke. METHODS In 1990, 1062 healthy infants were recruited to a randomized, ongoing atherosclerosis prevention trial (STRIP). Intervention families received at least twice a year individualized nutrition and lifestyle counselling. By 1999, 652 8-y-old children continued participation. Exposure to tobacco smoke was evaluated using serum cotinine concentration. Parents' smoking was also assessed using questionnaires and interviews. RESULTS Parents' smoking decreased during the study similarly in the intervention and control groups. Of the 8-y-old children, 46% had detectable serum cotinine concentration, suggesting exposure to tobacco smoke during the past few days. All children were non-smokers. Serum cotinine concentrations did not differ between the intervention and control children. Children's cotinine values were highest in the families where either father or both parents were smokers. CONCLUSION Participation in the atherosclerosis prevention trial slightly decreased smoking among the intervention and control parents. However, counselling led to no differences in parental smoking between the two groups, or in exposure of the intervention and control children to tobacco smoke. This study suggests that more detailed and targeted intervention is required to achieve a significant effect on children's tobacco smoke exposure.
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Affiliation(s)
- Katariina Kallio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
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Cray C, Roskos J, Zielezienski-Roberts K. Detection of Cotinine, a Nicotine Metabolite, in the Plasma of Birds Exposed to Secondhand Smoke. J Avian Med Surg 2005. [DOI: 10.1647/2004-031.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Thaqi A, Franke K, Merkel G, Wichmann HE, Heinrich J. Biomarkers of exposure to passive smoking of school children: frequency and determinants. INDOOR AIR 2005; 15:302-10. [PMID: 16108902 DOI: 10.1111/j.1600-0668.2005.00361.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
UNLABELLED This study aims to assess the extent of children' exposure to ETS and quantify potential determinants. A total of 2767 children aged 5-14 years participated in an environmental survey in East Germany in 1998-1999 (participation rate 75.9%). A subgroup of 979 children between the ages of 11 and 14 years with complete data on nicotine and cotinine in urine were selected for this analysis. This study population consisted of 73 self-reported smokers (7.5%), 793 non-smokers (81%) and 113 children with missing data on smoking status (11.5%). Nicotine and cotinine concentrations in spontaneous urine sample were determined by high-performance liquid chromatography methods with ultraviolet-detection and corrected for creatinine. Approximately 40% of self-reported non-smokers were exposed to environmental tobacco smoke (ETS) at home. Non-smoking children exposed to parental tobacco smoke at home compared with not exposed showed in average higher nicotine and cotinine concentration (geometric mean 4.7 microg/l vs. 1.4 microg/l and 8.1 microg/l vs. 2.7 microg/l) and the adjusted odds ratio (OR) for detectable biomarkers ranged between 17 and 22. There were increased rates of detectable biomarkers in urine with increasing numbers of smoked cigarettes in the household (adjusted OR increased from 8 to 54). Maternal smoking showed a stronger effect than paternal smoking. Furthermore, low parental education, cold season, height of dwelling (<or=2.40), urine collected on Monday were statistically significant associated with high nicotine and cotinine excretion levels. Children exposed to parental smoke showed much higher biomarker levels than the non-smoking spouse of an adult smoker. Therefore, children need specifically protection from ETS at home. PRACTICAL IMPLICATIONS As children showed a higher internal exposure compared with adults the health hazards association with passive smoking might have a more serious effect in children. Children are unable to complain and unable to remove themselves from tobacco smoke exposure. Thus, parents should make sure that their children live in a smoke free environment. Each country should take all necessary legislative and regulatory measures which forbids smoking in public places and the home environment even if it requires sacrifices by the parents.
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Affiliation(s)
- A Thaqi
- GSF National Research Center for Environment and Health, Institute of Epidemiology, Ingolstädter Landstrasse, Neuherberg, Germany
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Gonçalves-Silva RMV, Valente JG, Lemos-Santos MGF, Sichieri R. [Household smoking and stunting for children under five years]. CAD SAUDE PUBLICA 2005; 21:1540-9. [PMID: 16158160 DOI: 10.1590/s0102-311x2005000500027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Maternal tobacco use during pregnancy is one of the most important factors for low birth weight and length. However, postnatal exposure to environmental tobacco smoke has not been explored in children's growth studies. It is known that smoking is more prevalent in low socioeconomic groups and that stunting is also associated with socioeconomic variables. The objective of this study was to verify the effect of socioeconomic variables and environmental tobacco smoke on growth. Children under five years (n = 2,037) attending a primary health care clinic had their weight and stature measured, and a questionnaire on exposure to household passive smoking and socio-demographic characteristics was applied to parents. Prevalence of stunting (defined as a z-score lower than -2) was 4.3%. There was a negative association between stature and smoking during pregnancy, and positive associations with socioeconomic levels, family income, and parents' education. Linear hierarchical regression analysis showed that maternal and paternal smoking remains associated with low stature even after adjusting for maternal smoking during pregnancy and for socio-demographic variables.
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Kasim K, Levallois P, Abdous B, Auger P, Johnson KC. Environmental Tobacco Smoke and Risk of Adult Leukemia. Epidemiology 2005; 16:672-80. [PMID: 16135944 DOI: 10.1097/01.ede.0000173039.79207.80] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of environmental tobacco smoke (ETS) in the causation of lung and breast cancer has been repeatedly evaluated over recent years. In contrast, its impact on the risk of adult leukemia has received little attention. METHODS We used the lifetime residential and occupational ETS exposure histories from a population-based sample of 1068 incident and histologically confirmed adult leukemia cases and 5039 population controls age 20 to 74 years to evaluate the relationship between ETS exposure and adult leukemia risk among nonsmokers in Canada. The duration of exposure and smoker-years index were used as indices of ETS exposure. We restricted our analysis to the 266 case and 1326 control subjects who reported being lifetime nonsmokers and provided residential ETS exposure history for at least 75% of their lifetime. RESULTS No association was found for most leukemia subtypes, and in particular for acute myeloid leukemia. In contrast, the risk for chronic lymphocytic leukemia was clearly associated with ETS exposure, with an adjusted odds ratio of 2.3 (95% confidence interval = 1.2-4.5) for more than 83 smoker-years of residential exposure and 2.4 (1.3-4.3) for more than 72 smoker-years of occupational exposure. There was a dose-response relationship for chronic lymphocytic leukemia with both indices of exposure. Risk was not higher with recent exposure, using time-window-exposure analyses. CONCLUSIONS Regular long-term ETS exposure may be a risk factor for chronic lymphocytic leukemia.
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Affiliation(s)
- Khaled Kasim
- Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Sainte-Foy, Québec, Canada
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Wilson SE, Kahn RS, Khoury J, Lanphear BP. Racial differences in exposure to environmental tobacco smoke among children. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:362-367. [PMID: 15743729 PMCID: PMC1253766 DOI: 10.1289/ehp.7379] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Accepted: 12/09/2004] [Indexed: 05/24/2023]
Abstract
Exposure to environmental tobacco smoke (ETS) is a major cause of morbidity and mortality among U.S. children. Despite African-American children's having a lower reported exposure to tobacco compared to whites, they suffer disproportionately from tobacco-related illnesses and have higher levels of serum cotinine than white children. The goal of this study was to test whether African-American children have higher levels of serum and hair cotinine, after accounting for ETS exposure and various housing characteristics. We investigated the level of cotinine in both hair and serum in a sample of 222 children with asthma. Using a previously validated survey for adult smokers, we assessed each child's exposure to ETS. We collected detailed information on the primary residence, including home volume, ventilation, and overall home configuration. Despite a lower reported ETS exposure, African-American children had higher mean levels of serum cotinine (1.41 ng/mL vs. 0.97 ng/mL; p = 0.03) and hair cotinine (0.25 ng/mg vs. 0.07 ng/mg; p < 0.001) compared with white children. After adjusting for ETS exposure, housing size, and other demographic characteristics, serum and hair cotinine levels remained significantly higher in African-American children (ss = 0.34, p = 0.03) than in white children (ss = 1.06, p < 0.001). Housing volume was significantly associated with both serum and hair cotinine but did not fully explain the race difference. Our results demonstrate that, despite a lower reported exposure to ETS, African-American children with asthma had significantly higher levels of both serum and hair cotinine than did white children. Identifying causes and consequences of increased cotinine may help explain the striking differences in tobacco-related illnesses.
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Affiliation(s)
- Stephen E Wilson
- Division of General Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
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Kaufman FL, Kharrazi M, Delorenze GN, Eskenazi B, Bernert JT. Estimation of environmental tobacco smoke exposure during pregnancy using a single question on household smokers versus serum cotinine. JOURNAL OF EXPOSURE ANALYSIS AND ENVIRONMENTAL EPIDEMIOLOGY 2002; 12:286-95. [PMID: 12087435 DOI: 10.1038/sj.jea.7500224] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2002] [Indexed: 04/18/2023]
Abstract
Environmental tobacco smoke (ETS) exposure has been studied in relation to many diseases. The ability of a study to find an association between exposure and disease is, in part, determined by the accuracy of the exposure measure. This study examined how accurately one question, the number of smokers in the household, asked at birth, predicts ETS exposure in pregnant nonsmokers as assessed by serum cotinine. Blood specimens, drawn at 15-19 weeks gestation, from 783 women who participated in a prenatal screening program in California in 1992 were analyzed for cotinine. Serum cotinine was significantly correlated with the number of smokers in the household (r=0.35, P<0.001, geometric mean cotinine (nanograms per milliliter) for 0 smokers=0.06, 1 smoker=0.18, 2 or more smokers=0.29). Using multiple regression, the number of smokers in the household accounted for 11% of the variation in serum cotinine. Cotinine concentrations were twice as high in women living with one or more smokers compared to women not living with a smoker, when reported exposure (0 or >0 h) at home, work and other places was similar. Thus, the number of household smokers can account for a statistically significant amount of variation in serum cotinine and omission of this information would result in an underestimation of ETS exposure. Although use of this question alone does not provide an adequate estimation of ETS exposure as determined by serum cotinine, the results of this study indicate that this question is an important component of assessing ETS exposure.
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Chen E, Matthews KA, Boyce WT. Socioeconomic differences in children's health: how and why do these relationships change with age? Psychol Bull 2002; 128:295-329. [PMID: 11931521 DOI: 10.1037/0033-2909.128.2.295] [Citation(s) in RCA: 368] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The effects of socioeconomic status (SES) on health are well documented in adulthood, but far less is known about its effects in childhood. The authors reviewed the literature and found support for a childhood SES effect, whereby each decrease in SES was associated with an increased health risk. The authors explored how this relationship changed as children underwent normal developmental changes and proposed 3 models to describe the temporal patterns. The authors found that a model's capacity to explain SES-health relationships varied across health outcomes. Childhood injury showed stronger relationships with SES at younger ages, whereas smoking showed stronger relationships with SES in adolescence. Finally, the authors proposed a developmental approach to exploring mechanisms that link SES and child health.
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Affiliation(s)
- Edith Chen
- Department of Psychology, Washington University, St Louis, Missouri 63130, USA.
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Abstract
Secondhand smoke is one of the more controversial public health issues. It is controversial because laws regulating secondhand smoke create conflict between the rights of smokers and non-smokers. The results of secondhand smoke research frequently focus on risk factors in four areas: heart disease, cancer, respiratory disorders, and middle ear discase. While many studies have found hazards in each of these four areas, there is some disagreement regarding the degree and extent of the threat posed by these hazards. Future research should discover more risks associated with secondhand smoke and suggest appropriate educational, medical, legal, and environmental remedies for this problem. Then society can establish prevention programs and enact laws which protect non-smokers, but at the same time infringe as little as possible on the rights of others.
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Affiliation(s)
- N T Laughlin
- Department of Exercise and Sport Science, University of San Francisco, CA 94117-1080, USA.
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Bazylak G, Brózik H, Sabanty W. HPTLC screening assay for urinary cotinine as biomarker of environmental tobacco smoke exposure among male adolescents. J Pharm Biomed Anal 2000; 24:113-23. [PMID: 11108545 DOI: 10.1016/s0731-7085(00)00402-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For selective screening determination of urinary cotinine, i.e. (S)-1-methyl-5-(3-pyridyl)-2-pyrrolidinone, the major metabolite of nicotine, the high-performance thin-layer chromatographic (HPTLC) method have been proposed. Prior the final HPTLC analysis the procedure required a solid-phase extraction (SPE) of cotinine from collected urine samples with 1-methyl-2-pyrrolidinone as an internal standard. Densitometrical quantitation of cotinine on the chromatograms have been performed with a 16-grayscale scanner using the specialized software implemented on a desktop microcomputer. The lower detection limit of cotinine was 6 microg/l allowing the method to be applied for the measurement a concentration of this compound in urine samples collected from 35 elementary schoolboys exposed on both moderate and/or significant ETS. The mean recovery of cotinine from urine samples was 93%. The mean intra-day accuracy for the analysis of cotinine in range 6-750 microg/l. including four paralell measurements, was 2.9 %. The results of cotinine measurements by proposed SPE-HPTLC procedure were used in the pilot studies for assessment of hazard from home ETS on the health status of elementary schoolboys, especially an increased risk for infectious respiratory track diseases.
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Affiliation(s)
- G Bazylak
- Department of General Chemistry Institute of Physiology and Biochemistry, Medical University of Lodz, Poland.
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Wakefield M, Banham D, Martin J, Ruffin R, McCaul K, Badcock N. Restrictions on smoking at home and urinary cotinine levels among children with asthma. Am J Prev Med 2000; 19:188-92. [PMID: 11020596 DOI: 10.1016/s0749-3797(00)00197-5] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the extent to which various levels of restrictions on smoking in the home may be associated with children's exposure to environmental tobacco smoke (ETS). METHODS The methodology consisted of a cross-sectional survey involving 249 children with asthma aged 1 to 11 attending hospital outpatient clinics, with at least one parent who smoked, linked to the child's urinary cotinine to creatinine ratios (CCR). RESULTS After adjustment for child's age, mother's smoking status, and total parental daily cigarette consumption, a total ban was associated with significantly lower urinary CCR levels (7.6 nmol/mmol) than bans with exceptions or limited smoking in the home. Where exceptions to bans were made (14.9 nmol/mmol), children's urinary CCR levels were no different from homes in which smoking was allowed in rooms the child rarely frequented (14.1 nmol/mmol). These two intermediate levels of restriction were in turn associated with significantly lower CCR levels than unrestricted smoking in the home (26.0 nmol/mmol). CONCLUSIONS Making exceptions to bans on smoking at home measurably undermines the protective effect of a ban. However, making some exceptions to a ban and limiting smoking to rooms where the child rarely goes may result in reduced exposure to ETS, compared with unrestricted smoking.
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Affiliation(s)
- M Wakefield
- Health Research and Policy Centers, University of Illinois at Chicago, Illinois 60607, USA.
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Willers S, Axmon A, Feyerabend C, Nielsen J, Skarping G, Skerfving S. Assessment of environmental tobacco smoke exposure in children with asthmatic symptoms by questionnaire and cotinine concentrations in plasma, saliva, and urine. J Clin Epidemiol 2000; 53:715-21. [PMID: 10941949 DOI: 10.1016/s0895-4356(99)00212-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To validate a detailed questionnaire for assessment of environmental tobacco smoke (ETS) exposure by the biomarker cotinine in various media, a population-based study in the urban area of Malmö, Sweden was performed in children aged 8-13 years with and without asthmatic symptoms. There were strong correlations between urinary and saliva cotinine concentrations and also, though to a lesser extent, between these media and plasma. Even a detailed questionnaire gave only a rough picture of the ETS exposure, as indicated by the biomarkers. In a multivariate model, the most significant questionnaire-derived predictor of the cotinine levels was the maternal smoking habits; other questionnaire variables gave only a minimal explained variance. Children with a history of asthmatic symptoms had statistically significantly lower median cotinine levels in urine and saliva compared to referent children, most likely because of the antismoking information to their parents. This should be considered in epidemiological studies of ETS risks.
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Affiliation(s)
- S Willers
- Department of Occupational and Environmental Medicine, Lund University, Sweden.
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Jordaan ER, Ehrlich RI, Potter P. Environmental tobacco smoke exposure in children: household and community determinants. ARCHIVES OF ENVIRONMENTAL HEALTH 1999; 54:319-27. [PMID: 10501147 DOI: 10.1080/00039899909602494] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To determine the most important sources of environmental tobacco smoke exposure to young children, the authors studied the associations among urinary cotinine, reported household smoking habits, and socioeconomic variables in 575 schoolchildren aged 6-11 y. The school children were among a population of prodigious smokers in Cape Town, South Africa. Eighty percent of the children were exposed to environmental tobacco smoke. Maternal smoking, which was adjusted for creatinine, accounted for 21.8% of the variation in urinary cotinine--more than all other sources combined. The male parent and other household smokers accounted for 12.7% of the variation, and socioeconomic indicators explained an additional 4.8%. By defining the ecological variable of smoking prevalence per school, the authors estimated a "community" contribution of 3.3%. The relative importance of different sources of smoke should be taken into account in the prevention of environmental tobacco smoke exposure in young children. Most importantly, of all the sources of environmental tobacco smoke, mothers' smoking habits had the greatest impact on exposure to children.
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Affiliation(s)
- E R Jordaan
- Centre for Epidemiological Research of Southern Africa, Medical Research Council, Cape Town, South Africa.
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Kuehr J, Frischer T, Karmaus W, Meinert R, Pracht T, Lehnert W. Cotinine excretion as a predictor of peak flow variability. Am J Respir Crit Care Med 1998; 158:60-4. [PMID: 9655707 DOI: 10.1164/ajrccm.158.1.9707123] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Environmental tobacco smoke (ETS) is suspected to be an important risk factor for bronchial hyperresponsiveness. In order to test the effect of ETS, we measured expiratory flow rates and urine cotinine excretion (UCE) within a narrow time window in two consecutive years. Maternal smoking habits and medical history were ascertained by standardized questionnaires. The percentage ratio of the amplitude over the mean (AVAM) of the diurnal peak flow rates of children (complete values from at least five consecutive days) was calculated as an indicator of bronchial responsiveness. The association of UCE and log10AVAM was analyzed by multiple linear regression. Complete data were available for a sample of 417 children. The median of UCE in children of parents who smoked (3.2 ng/mg and 2.9 ng/mg creatinine, Surveys 1 and 2, respectively) was higher than the median in children of nonsmoking parents (0 ng/mg in both surveys). With increasing UCE the log10AVAM rose in the first and second surveys, as well as in the longitudinal analysis (p = 0.003). This association, however, showed up only in boys (p = 0.0001) and not in girls (p = 0.31). Our data suggest that there is a need both for further analysis of the gender difference and for more support of strategies against passive smoking as far as children are concerned, since airway hyperresponsiveness is a risk factor for chronic airway impairment.
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Affiliation(s)
- J Kuehr
- University Children's Hospital, Freiburg, Germany; University Children's Hospital, Vienna, Austria
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Sumida H, Watanabe H, Kugiyama K, Ohgushi M, Matsumura T, Yasue H. Does passive smoking impair endothelium-dependent coronary artery dilation in women? J Am Coll Cardiol 1998; 31:811-5. [PMID: 9525552 DOI: 10.1016/s0735-1097(98)00010-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study sought to examine whether passive smoking is associated with endothelial dysfunction in the coronary arteries. BACKGROUND Long-term exposure to cigarette smoking has been reported to suppress endothelium-dependent arterial dilation in humans. Endothelial dysfunction is an early feature of atherogenesis, and the impairment of acetylcholine (ACh)-induced coronary artery dilation indicates coronary endothelial dysfunction. METHODS We studied 38 women (40 to 60 years old) who had no known risk factors for coronary artery disease other than tobacco smoking: 11 nonsmokers who had never smoked and had never been regularly exposed to environmental tobacco smoke; 19 passive smokers with self-reported histories of exposure to environmental tobacco smoke of > or = 1 h/day for > or = 10 years; and 8 active smokers. We examined the response of the epicardial coronary artery diameters (proximal and distal segments of the left anterior descending [LAD] and left circumflex [LCx] coronary arteries) to the intracoronary injection of ACh into the left coronary artery by means of quantitative coronary angiography. RESULTS ACh significantly dilated the distal segment in nonsmokers (percent change from baseline diameter: LAD 13.7+/-3.4%, p < 0.05; LCx 18.8+/-2.9%, p < 0.01) but not the proximal segment (LAD 7.4+/-3.5%; LCx 3.1+/-5.0%). ACh significantly constricted all segments of the left coronary artery in passive smokers (LAD: proximal -20.3+/-3.7%, p < 0.05; distal -22.3+/-4.1%, p < 0.01; LCx: proximal -20.8+/-3.1%, p < 0.05; distal -17.3+/-2.9%, p < 0.01) and active smokers (LAD: proximal -14.8+/-3.4%, p < 0.05; distal -27.2+/-6.0%, p < 0.01; LCx: proximal -14.5+/-6.6%, p < 0.05; distal -22.4+/-4.0%, p < 0.01). Thus, ACh constricted most coronary arteries in both passive and active smokers and dilated the coronary arteries in nonsmokers. CONCLUSIONS Impairment of ACh-induced coronary artery dilation, indicating coronary endothelial dysfunction, may occur diffusely in passive smokers as well as in active smokers.
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Affiliation(s)
- H Sumida
- Division of Cardiology, Kumamoto Rosai Hospital, Japan
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