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Otálvaro S, Gallego JM, Rodríguez-Lesmes P. De-normalizing smoking in urban areas: Public smoking bans and smoking prevalence. ECONOMICS AND HUMAN BIOLOGY 2023; 48:101202. [PMID: 36463577 DOI: 10.1016/j.ehb.2022.101202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/26/2022] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
The effectiveness of command-and-control policies related to tobacco use has been studied in high-income countries. Still, there is limited evidence of their effects in low and middle-income countries. We explore the case of Colombia, a country that introduced a business-supported smoking ban in bars and restaurants and all public indoor spaces in 2010. This paper investigates the effect of smoking bans in bars and restaurants on smoking prevalence in Bogotá, Colombia. In this paper, we use the matching with triple-differences technique in analyzing household consumption data from the 2007 and 2011 quality of life surveys. This is done by exploiting their geographical proximity and variation in the density of commercial areas. We found that after the smoking ban implementation, smoking prevalence reduced in households near high-density commercial blocks compared to households near low-density commercial blocks (-10.8 pp.). The impact is larger for households with children and older household heads. Since households near high-density commercial blocks are more frequently exposed to smoking than households near low-density commercial blocks, the former would be more willing to internalize the smoking de-normalization process.
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Affiliation(s)
- Susana Otálvaro
- University of California, Santa Barbara, Santa Barbara, CA 93106, United States.
| | - Juan Miguel Gallego
- School of Economics, Universidad del Rosario, Calle 12C No. 4 - 69, Bogotá 111711, Colombia.
| | - Paul Rodríguez-Lesmes
- School of Economics, Universidad del Rosario, Calle 12C No. 4 - 69, Bogotá 111711, Colombia.
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Mahabee-Gittens EM, Matt GE, Ding L, Merianos AL. Comparison of Levels of Three Tobacco Smoke Exposure Biomarkers in Children of Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211803. [PMID: 34831559 PMCID: PMC8622785 DOI: 10.3390/ijerph182211803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022]
Abstract
Objectives: Cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and N-oxides are biomarkers of tobacco smoke exposure (TSE) used to assess short- and longer-term TSE. The objective of this study was to assess the associations between these TSE biomarkers, sociodemographics, parental smoking, and child TSE patterns among 0–17-year-olds. Methods: A convenience sample of 179 pediatric patients (mean (SD) age = 7.9 (4.3) years) who lived with ≥1 smoker and who had parental assessments completed and urine samples analyzed for the three TSE biomarkers of interest were included. Biomarker levels were log-transformed, univariate regression models were built and Pearson correlations were assessed. Results: In total, 100% of children had detectable levels of cotinine and >96% had detectable NNAL and N-oxide levels. The geometric means of cotinine, NNAL, and N-oxide levels were 10.1 ng/mL, 25.3 pg/mL, and 22.9 pg/mL, respectively. The mean (SD) number of daily cigarettes smoked by parents was 10.6 (6.0) cigarettes. Child age negatively correlated with urinary cotinine (r = −0.202, p = 0.007) and log NNAL levels (r = −0.275, p < 0.001). The highest log-cotinine levels were in children who were younger, of African American race, and whose parents had a lower education, an annual income ≤USD15,000, and no smoking bans. The highest log-NNAL and N-oxide levels were in children whose parents had a lower education, had no smoking bans, and were around higher numbers of cigarettes. Conclusion: Children of smokers who were younger, African American, and had no smoking bans had the highest TSE biomarker levels. Targeted interventions are needed to reduce TSE levels among high-risk children.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Correspondence: ; Tel.: +1-513-636-7966; Fax: +1-513-636-7967
| | - Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, CA 92123, USA;
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA;
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Junus S, Chew CC, Sugunan P, Meor-Aziz NF, Zainal NA, Hassan HM, Abu-Mansor MA, Abu-Zamri H, Hss AS. Parental health risk perceptions and preventive measures related to Children's second-hand cigarette smoke exposure in Malaysia. BMC Public Health 2021; 21:1860. [PMID: 34654405 PMCID: PMC8518244 DOI: 10.1186/s12889-021-11825-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Secondhand smoke (SHS) exposure can affect physical development in children. An understanding of parental risk perception of SHS could guide efforts to develop measures for prevention of SHS exposure among children. This study aimed to assess parental risk perceptions of SHS and action taken by parents to minimise SHS exposure in their children. Methods This cross-sectional nationwide study conducted in 2018 recruited convenience sample of 289 parents with children up to age 12 at public areas. Parents were asked to rate the risk level from 1 (no risk) to 5 (extremely high risk) by looking at photographs of an adult smoking in the presence of a child in 8 different situations. The implementation of smoking restriction rules was assessed. Mean scores were calculated with higher scores representing higher risk perception of SHS to child’s health. Linear regression analysis was used to determine factors associated with the level of parental risk perception of SHS exposure to their children’s health. Results A total of 246 parents responded. Their mean age was 35 years (SD 6.4). The majority were mothers (75.6%), Malays (72.0%) and had tertiary education level (82.5%), and non-smoker (87.1%). The mean age of respondents’ youngest child was 3 years (SD 3.1). The risk perception level was high [mean scores: 4.11 (SD: 0.82)]. Most parents implemented household (65.0%) and car (68.3%) smoking restriction rules. Lower levels of risk perception were observed among participants who were current smokers (p < 0.001), lived with a smoker (p < 0.001), allowed household smoking with an open window (p = 0.027). Conclusion Most parents perceived that risks of SHS exposure to their children were high but only two-thirds of them had set rules prohibiting smoking. Health policymakers should pay attention to factors associated with lower risk perception among parents. Trial registration This study was approved by the Medical Research Ethics Committee, Ministry of Health Malaysia (Registration Number: NMRR-18-3299-44967).
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Affiliation(s)
- Suria Junus
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.
| | - Pravin Sugunan
- Paediatric Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Nurul-Fazlin Meor-Aziz
- Institute of Training Ministry of Health, Ministry of Health, Ulu Kinta, Perak, Malaysia
| | - Nurul Ain Zainal
- Institute of Training Ministry of Health, Ministry of Health, Ulu Kinta, Perak, Malaysia
| | - Husna Mat Hassan
- Institute of Training Ministry of Health, Ministry of Health, Ulu Kinta, Perak, Malaysia
| | | | - Hazirah Abu-Zamri
- Institute of Training Ministry of Health, Ministry of Health, Ulu Kinta, Perak, Malaysia
| | - Amar-Singh Hss
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.,Paediatric Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
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Mahabee-Gittens EM, Ding L, Merianos AL, Khoury JC, Gordon JS. Examination of the '5-2-1-0' Recommendations in Racially Diverse Young Children Exposed to Tobacco Smoke. Am J Health Promot 2021; 35:966-972. [PMID: 33641482 PMCID: PMC8349823 DOI: 10.1177/0890117121995772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The '5-2-1-0' guidelines recommend that children: eat ≥5 servings of fruits/vegetables ('5'), have ≤2 hours of screen-time ('2'), have ≥1 hour of activity ('1'), and drink 0 sugar-sweetened beverages ('0') daily. The pediatric emergency department (PED) treats children at risk for obesity and tobacco smoke exposure (TSE). We examined body mass index (BMI), overweight, obesity, TSE, and '5-2-1-0' rates in children with TSE in the PED. DESIGN Cross-sectional study of PED children. SETTING The PED of a children's hospital. SAMPLE Children with TSE >6 months-5 years old (N = 401). MEASURES Sociodemographics, '5-2-1-0' behaviors, BMI, and cotinine-confirmed TSE. ANALYSIS Associations between '5-2-1-0' and sociodemographics were examined with logistic regression. RESULTS Mean (SD) age = 2.4 (1.6) years; 53.1% were Black; 65.8% had low-income; and 93.4% had TSE. Of 2-5-year-olds, mean (SD) BMI percentile was 66.2 (30.1), 16.1% were overweight and 20.6% were obese. In total, 10.5% attained '5', 72.6% attained '2', 57.8% of 2-5-year-olds attained '1', and 9.8% attained '0'. Compared to White children, "other" race children were more likely to meet '5' (aOR(95% CI):4.67(1.41, 5.45)); 2-5-years-olds (aOR(95%CI):0.60(0.38, 0.95)) and Black children (aOR(95%CI):0.36(0.21, 0.60)) were at decreased odds to meet '2' compared to younger or White children, respectively. Compared to younger children, 2-5-year-olds were at decreased odds to meet '0' (aOR(95%CI):0.08(0.02, 0.26)). CONCLUSION Racially diverse, low-income children with TSE had low '5-2-1-0' attainment. Interventions are needed to improve lifestyle habits in this population.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lili Ding
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jane C. Khoury
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Merianos AL, Gordon JS, Lyons MS, Jandarov RA, Mahabee-Gittens EM. Evaluation of tobacco screening and counseling in a large, midwestern pediatric emergency department. Tob Prev Cessat 2021; 7:39. [PMID: 34056146 PMCID: PMC8145199 DOI: 10.18332/tpc/134751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The study objective was to assess tobacco screening and cessation counseling practices of pediatric emergency department (PED) and urgent care (UC) nurses and physicians, and factors associated with these practices. Secondarily, we assessed factors associated with performing tobacco smoke exposure reduction and tobacco cessation counseling. METHODS We conducted a cross-sectional survey of 30 PED/UC nurses and physicians working at one large, urban, Midwestern children’s hospital. Measures included current practices of performing the 5 As of tobacco counseling (Ask, Advise, Assess, Assist, Arrange), and attitude and practice factors that may influence practices. RESULTS Overall, 90.0% of participants had not received recent tobacco counseling training, 73.3% were unaware of the 5 As, and 63.3% did not have a standardized, routine screening system to identify patients exposed to secondhand smoke. The majority of participants reported that they: asked about patients’ secondhand smoke exposure status (70.0%) and parents’ tobacco use status (53.3%), and advised parental smokers to not smoke around their child (70.0%) and to quit smoking (50%). One in five participants reported they assessed smokers’ interest in quitting smoking, and 16.7% talked with smokers about cessation techniques and tactics; of these, 10% referred/enrolled smokers to the Tobacco Quitline or cessation program, and 6.7% made a quit plan or recommended nicotine replacement therapy medication. CONCLUSIONS Key findings identified are the need for professional tobacco counseling training, standardizing efforts during visits, and emphasizing pediatric patients’ potential health benefits. This information will be used for developing a PED/ UC-based parental tobacco cessation and child tobacco smoke exposure reduction intervention.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, United States.,Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, United States
| | - Judith S Gordon
- College of Nursing, The University of Arizona, Tucson, United States
| | - Michael S Lyons
- Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, United States.,Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, United States
| | - Roman A Jandarov
- Department of Environmental and Public Health Sciences, Division of Biostatistics and Bioinformatics, College of Medicine, University of Cincinnati, Cincinnati, United States
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, United States
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Abstract
Objectives Past research has not examined secondhand and thirdhand smoke (THS) exposure in children of cigar smokers. We examined hand nicotine and cotinine levels in children of cigar smokers to explore the contribution of cigar smoke to tobacco smoke exposure (TSE). Methods Participants were children (N = 24; mean (SD) age = 6.5 (3.6) years) whose parents smoked cigars only or poly-used cigars and/or cigarettes. Primary outcomes were hand nicotine and urinary cotinine levels. Results All children had detectable hand nicotine (range: 7.6-312.5ng/wipe) and cotinine (range: 0.3-100.3ng/ml). Positive correlations were found between hand nicotine and cotinine (r = 0.693, p = .001), hand nicotine and parents who also smoked cigarettes (r = 0.407, p = .048), and hand nicotine and number of smokers around the child (r = 0.436, p = .03). Hand nicotine (r = -0.464, p = .02), but not cotinine (r = -0.266, p = .26), was negatively correlated with child age. Multiple regression results indicated a positive association between hand nicotine and cotinine (p = .002; semi-partial r2 = 0.415), irrespective of child age. Conclusions The significant association of hand nicotine with urinary cotinine suggests that THS pollution should be assessed in evaluating children's overall TSE to cigars and other tobacco products, and hand nicotine may be a proxy for overall TSE. Younger children may have increased THS pollutant uptake.
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Merianos AL, Nabors LA, Fiser KA, Mahabee-Gittens EM. Exposure to Tobacco Smoke and Temperament among U.S. Children 0-5 Years Old. J Pediatr Psychol 2021; 46:454-464. [PMID: 33355348 PMCID: PMC8056209 DOI: 10.1093/jpepsy/jsaa123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study examined the association between tobacco smoke exposure (TSE) and temperament among children 0-5 years old overall and within age groups: 0-2 and 3-5 years. METHODS Data were obtained from the 2017-2018 NSCH (N = 14,345). TSE status was defined as whether children lived with a smoker who: does not smoke inside the home (no home TSE) or smokes inside the home (home TSE). We conducted logistic regression analyses while controlling for covariates. RESULTS Overall, 12.5% of children lived with a smoker with no home TSE and 1.1% had home TSE. Children with home TSE were at increased odds to not always: be affectionate and tender (aOR = 1.74, 95% CI = 1.18-2.58), show interest and curiosity (aOR = 1.81, 95% CI = 1.23-2.68), and smile and laugh (aOR = 1.77, 95% CI = 1.13-2.77) than those with no TSE. Among 0- to 2-year-olds, those with home TSE were more likely to not always be affectionate and tender (aOR = 1.97, 95% CI = 1.04-3.74). Among 3- to 5-year-olds, those who lived with a smoker with no home TSE were more likely to not always: bounce back quickly (aOR = 1.21, 95% CI = 1.05-1.40) and smile and laugh (aOR = 1.26, 95% CI = 1.03-1.54), and those with home TSE were more likely to not always: show interest and curiosity (aOR = 2.24, 95% CI = 1.40-3.59) and smile and laugh (aOR = 2.43, 95% CI = 1.43-4.11). CONCLUSIONS Tobacco smoke-exposed children were at increased odds of not always demonstrating positive early childhood temperament behaviors, with 3- to 5-year-olds having more pronounced odds.
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Affiliation(s)
| | | | | | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati
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Joseph CLM, Mahajan P, Buzzelli-Stokes S, Jacobsen G, Johnson DA, Duffy E, Williams R, Havstad S, Zoratti E, Ownby DR, Johnson CC, Lu M. Participant-level characteristics differ by recruitment setting when evaluating a behavioral intervention targeting adolescents with asthma. J Asthma 2021; 58:370-377. [PMID: 31702415 PMCID: PMC10726210 DOI: 10.1080/02770903.2019.1690661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/03/2019] [Accepted: 11/05/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The recruitment setting plays a key role in the evaluation of behavioral interventions. We evaluated a behavioral intervention for urban adolescents with asthma in three randomized trials conducted separately in three different settings over the course of 8 years. We hypothesized that characteristics of trial participants recruited from the ED and clinic settings would be significantly different from that of youth participating in the school-based trials. The intervention evaluated was Puff City, a web-based program that uses tailoring to improve asthma management behaviors. METHODS The present analysis includes youth aged 13-19 years who reported a physician diagnosis of asthma and symptoms at trial baseline. In the three trials, all participants were randomized post-baseline to a web-based, tailored intervention (treatment) or generic web-based asthma education (control). RESULTS Compared to school-based trial participants, ED participants had significantly more acute-care visits for asthma (p < 0.001) and more caregiver depression (p < 0.001). Clinic-based participants were more likely to have computer/ internet access than participants from the school-based trial (p < 0.001). Both ED and clinic participants were more likely to report controller medication (p's < 0.001) and higher teen emotional support (p's < 0.01) when compared to the schools, but were less likely to report Medicaid (p's < 0.014) and exposure to environmental tobacco smoke (p < 0.001). CONCLUSION Compared to participants in the school-based trials, participants recruited from ED and clinic settings differed significantly in terms of healthcare use, as well as psychosocial and sociodemographic factors. These factors can inform intervention content, and may impact external validity of behavioral interventions for asthma.
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Affiliation(s)
| | - Prashant Mahajan
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Gordon Jacobsen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA, USA
| | - Elizabeth Duffy
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Renee Williams
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Edward Zoratti
- Division of Allergy and Immunology, Henry Ford Health System, Detroit, MI, USA
| | - Dennis R. Ownby
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | | | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
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Mahabee-Gittens EM, Ammerman RT, Khoury JC, Tabangin ME, Ding L, Merianos AL, Stone L, Gordon JS. A Parental Smoking Cessation Intervention in the Pediatric Emergency Setting: A Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218151. [PMID: 33158230 PMCID: PMC7663571 DOI: 10.3390/ijerph17218151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 01/05/2023]
Abstract
We examined the efficacy of a pediatric emergency visit-based screening, brief intervention, and referral to treatment (SBIRT) condition compared to a control condition (Healthy Habits Control, HHC) to help parental smokers quit smoking. We enrolled 750 parental smokers who presented to the pediatric emergency setting with their child into a two-group randomized controlled clinical trial. SBIRT participants received brief cessation coaching, quitting resources, and up to 12-weeks of nicotine replacement therapy (NRT). HHC participants received healthy lifestyle coaching and resources. The primary outcome was point-prevalence tobacco abstinence at six weeks (T1) and six months (T2). The mean (SD) age of parents was 31.8 (7.7) years, and 86.8% were female, 52.7% were Black, and 64.6% had an income of ≤$15,000. Overall abstinence rates were not statistically significant with 4.2% in both groups at T1 and 12.9% and 8.3% in the SBIRT and HHC groups, respectively, at T2. There were statistically significant differences in SBIRT versus HHC participants on the median (IQR) reduction of daily cigarettes smoked at T1 from baseline (−2 [−5, 0] versus 0 [−4, 0], p = 0.0008),at T2 from baseline (−4 [−9, −1] vs. −2 [−5, 0], p = 0.0006), and on the mean (SD) number of quit attempts at T2 from baseline (1.25 (6.5) vs. 0.02 (4.71), p = 0.02). Self-reported quitting rates were higher in SBIRT parents who received NRT (83.3% vs. 50.9%, p = 0.04). The novel use of the pediatric emergency visit to conduct cessation interventions helped parents quit smoking. The near equivalent abstinence rates in both the SBIRT and HHC groups may be due to underlying parental concern about their child’s health. Cessation interventions in this setting may result in adult and pediatric public health benefits.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA;
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Correspondence: ; Tel.: +1-513-636-7966
| | - Robert T. Ammerman
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Jane C. Khoury
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Meredith E. Tabangin
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Lili Ding
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA;
| | - Judith S. Gordon
- College of Nursing, University of Arizona, Tucson, AZ 85721, USA;
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Comparison of Liquid Chromatography Mass Spectrometry and Enzyme-Linked Immunosorbent Assay Methods to Measure Salivary Cotinine Levels in Ill Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041157. [PMID: 32059566 PMCID: PMC7068296 DOI: 10.3390/ijerph17041157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/26/2022]
Abstract
Objective: Cotinine is the preferred biomarker to validate levels of tobacco smoke exposure (TSE) in children. Compared to enzyme-linked immunosorbent assay methods (ELISA) for quantifying cotinine in saliva, the use of liquid chromatography tandem mass spectrometry (LC-MS/MS) has higher sensitivity and specificity to measure very low levels of TSE. We sought to compare LC-MS/MS and ELISA measures of cotinine in saliva samples from children overall and the associations of these measures with demographics and TSE patterns. Method: Participants were nonsmoking children (N = 218; age mean (SD) = 6.1 (5.1) years) presenting to a pediatric emergency department. Saliva samples were analyzed for cotinine using both LC-MS/MS and ELISA. Limit of quantitation (LOQ) for LC-MS/MS and ELISA was 0.1 ng/ml and 0.15 ng/ml, respectively. Results: Intraclass correlations (ICC) across methods = 0.884 and was consistent in sex and age subgroups. The geometric mean (GeoM) of LC-MS/MS = 4.1 (range: < LOQ - 382 ng/mL; 3% < LOQ) which was lower (p < 0.0001) than the ELISA GeoM = 5.7 (range: < LOQ - 364 ng/mL; 5% < LOQ). Similar associations of cotinine concentrations with age ( < -0.10, p < 0.0001), demographic characteristics (e.g., income), and number of cigarettes smoked by caregiver ( > 0.07, p < 0.0001) were found regardless of cotinine detection method; however, cotinine associations with sex and race/ethnicity were only found to be significant in models using LC-MS/MS-derived cotinine. Conclusions: Utilizing LC-MS/MS-based cotinine, associations of cotinine with sex and race/ethnicity of child were revealed that were not detectable using ELISA-based cotinine, demonstrating the benefits of utilizing the more sensitive LC-MS/MS assay for cotinine measurement when detecting low levels of TSE in children.
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