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Mendy A, Burcham S, Merianos AL, Mersha TB, Yolton K, Chen A, Mahabee-Gittens EM. Urinary Volatile Organic Compound Metabolites Are Associated with Reduced Lung Function in U.S. Children and Adolescents. Toxics 2024; 12:289. [PMID: 38668512 PMCID: PMC11054577 DOI: 10.3390/toxics12040289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
(1) Background: Volatile organic compounds (VOCs) are indoor pollutants absorbed by inhalation. The association of several VOCs with lung function in children and adolescents is unknown. (2) Methods: We analyzed 505 participants, 6-17-year-olds from the 2011-2012 National Health and Nutrition Examination Survey. Multiple linear regression models were fitted to estimate the associations of VOC metabolites with spirometry outcomes adjusting for covariates. (3) Results: Urinary metabolites of xylene, acrylamide, acrolein, 1,3-butadiene, cyanide, toluene, 1-bromopropane, acrylonitrile, propylene oxide, styrene, ethylbenzene, and crotonaldehyde were all detected in ≥64.5% of participants. Forced expiratory volume in 1 s (FEV1) % predicted was lower in participants with higher levels of metabolites of acrylamide (β: -7.95, 95% CI: -13.69, -2.21) and styrene (β: -6.33, 95% CI: -11.60, -1.07), whereas the FEV1 to forced vital capacity (FVC) ratio % was lower in children with higher propylene oxide metabolite levels (β: -2.05, 95% CI: -3.49, -0.61). FEV1 % predicted was lower with higher crotonaldehyde metabolite levels only in overweight/obese participants (β: -15.42, 95% CI: -26.76, -4.08) (Pinteraction < 0.001) and with higher 1-bromopropane metabolite levels only in those with serum cotinine > 1 ng/mL (β: -6.26, 95% CI: -9.69, -2.82) (Pinteraction < 0.001). (4) Conclusions: We found novel associations of metabolites for acrylamide, propylene oxide, styrene, 1-bromopropane and crotonaldehyde with lower lung function in children and adolescents.
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Affiliation(s)
- Angelico Mendy
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (A.M.); (S.B.)
| | - Sara Burcham
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (A.M.); (S.B.)
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Tesfaye B. Mersha
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Kimberly Yolton
- General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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Mahabee-Gittens EM, Priyanka Illapani VS, Merhar SL, Kline-Fath B, Harun N, He L, Parikh NA. Prenatal Opioid Exposure and Risk for Adverse Brain and Motor Outcomes in Infants Born Premature. J Pediatr 2024; 267:113908. [PMID: 38220065 DOI: 10.1016/j.jpeds.2024.113908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To compare brain magnetic resonance imaging (MRI) biomarkers and neurodevelopmental test scores in infants born preterm with and without prenatal opioid exposure (POE). STUDY DESIGN We examined 395 preterm infants (≤32 weeks gestational age) who had term-equivalent brain MRIs, composite scores from the Bayley Scales of Infant and Toddler Development-III at 2 years corrected age, and POE data. MRI parameters included total/regional brain volumes and severe punctate white matter lesions (PWMLs). We conducted bivariable analysis and multivariable logistic regression analyses. RESULTS The mean ± SD gestational age was 29.3 ± 2.5 weeks; 35 (8.9%) had POE and 20 (5.1%) had severe PWML. Compared with unexposed infants, those with POE exhibited higher rates of severe PWML (17.1% vs 3.9%, respectively; P = .002); findings remained significant with an OR of 4.16 (95% CI, 1.26-13.68) after adjusting for confounders. On mediation analysis, the significant relationship between POE and severe PWML was not indirectly mediated through preterm birth/gestational age (OR, 0.93; 95% CI, 0.78-1.10), thus suggesting the association was largely driven by a direct adverse effect of POE on white matter. In multivariable analyses, POE was associated with a significantly lower score by -6.2 (95% CI, -11.8 to -0.6) points on the Bayley Scales of Infant and Toddler Development-III Motor subscale compared with unexposed infants. CONCLUSIONS POE was associated with severe PWML; this outcome may be a direct effect of POE rather than being mediated by premature birth. POE was also associated with worse motor development. Continued follow-up to understand the long-term effects of POE is warranted.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH.
| | - Venkata Sita Priyanka Illapani
- Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stephanie L Merhar
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Beth Kline-Fath
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lili He
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nehal A Parikh
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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King CA, Brent D, Grupp-Phelan J, Page K, Czyz E, McGuire TC, Mahabee-Gittens EM, Block L, Casper TC. A Prospective Examination of the Interpersonal-Psychological Theory of Suicidal Behavior in Adolescents. J Clin Child Adolesc Psychol 2024:1-13. [PMID: 38547387 DOI: 10.1080/15374416.2024.2330068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Given the large and complex array of suicide risk factors, theoretical frameworks are critical to furthering our understanding of risk. This study prospectively examined several key constructs of the interpersonal-psychological theory of suicidal behavior (IPTS) in a large, geographically diverse sample of U.S. adolescents. METHOD Conducted in collaboration with the Pediatric Emergency Care Applied Research Network, adolescents, ages 12 to 17, were recruited from emergency departments. Baseline and 6-month follow-up samples were comprised of 6,448 (59% female sex) and 2,009 (64% female sex) adolescents, with self-identified race/ethnicity as follows (baseline/follow-up): White (52%/54%), Black (22%/23%), Multiracial (6%/6%), American Indian (3%/3%), other/unknown race (15%/14%), and Latinx (25%/23%). Youth and parents completed adolescent suicide risk surveys at baseline and 6-month follow-up (retention, 69%). Latent class analysis was used to identify classes of painful and provocative events (PPE), considered a precursor to acquired capability. RESULTS In keeping with IPTS tenets, thwarted belongingness (TB), perceived burdensomeness (PB), and the interaction between TB and PB were each significant predictors of suicidal ideation at baseline and follow-up. However, only PB and PPE were significant predictors of cross-sectional suicide attempts and only TB and PPE were significant predictors of prospective suicide attempts in models that adjusted for baseline suicidal ideation. The three-way interaction among PB, TB and PPE was nonsignificant. CONCLUSIONS Results from this large-scale prospective study suggest the importance of TB, PB, and PPE to our understanding of suicidal thoughts and suicide attempts among adolescents, pointing to promising prevention and intervention targets.
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Affiliation(s)
- Cheryl A King
- Department of Psychiatry, University of Michigan
- Injury Prevention Center, University of Michigan
| | - David Brent
- Department of Psychiatry, University of Pittsburgh
| | | | - Kent Page
- Department of Pediatrics, University of Utah
| | - Ewa Czyz
- Department of Psychiatry, University of Michigan
| | | | | | - Lucy Block
- Department of Psychiatry, University of Michigan
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Merianos AL, Stone TM, Mahabee-Gittens EM, Jandarov RA, Choi K. Tobacco Smoke Exposure and Sleep Duration among U.S. Adolescents. Behav Sleep Med 2024; 22:234-246. [PMID: 37417788 PMCID: PMC10772738 DOI: 10.1080/15402002.2023.2232498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
OBJECTIVES Tobacco smoke exposure (TSE) and poor sleep are public health problems with their own set of consequences. This study assessed whether TSE was associated with sleep duration among U.S. adolescents. METHOD We conducted a secondary analysis of 2013-2018 National Health and Nutrition Examination Survey data including 914 nontobacco-using adolescents ages 16-19 years. TSE measures included cotinine and self-reported home TSE groups including no home TSE, thirdhand smoke (THS) exposure, and secondhand smoke (SHS)+THS exposure. Sleep duration was assessed in hours and categorically as insufficient sleep (recommended hours). Weighted multiple linear regression and multinomial regression models were conducted. RESULTS Adolescents with higher log-cotinine levels had higher number of sleep hours (β = 0.31, 95%CI = 0.02,0.60) and were at increased odds of reporting excess sleep (AOR = 1.41, 95%CI = 1.40,1.42), but were at reduced odds of reporting insufficient sleep (AOR = 0.88, 95%CI = 0.87,0.89). Compared to adolescents with no home TSE, adolescents with home THS exposure and home SHS+THS exposure were at increased odds of reporting insufficient sleep (AOR = 2.27, 95%CI = 2.26,2.29; AOR = 2.75, 95%CI = 2.72,2.77, respectively) and excess sleep (AOR = 1.89, 95%CI = 1.87,1.90; AOR = 5.29, 95%CI = 5.23,5.34, respectively). CONCLUSIONS TSE may affect insufficient and excess sleep duration among adolescents. Eliminating TSE may promote adolescent respiratory and sleep health.
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Affiliation(s)
| | - Timothy M. Stone
- Division of Biostatistics and Bioinformatics, Department of
Environmental and Public Health Sciences, College of Medicine, University of
Cincinnati, 160 Panzeca Way, Cincinnati, OH, 45267, USA
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati
Children’s Hospital Medical Center, College of Medicine, University of
Cincinnati, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, USA
| | - Roman A. Jandarov
- Division of Biostatistics and Bioinformatics, Department of
Environmental and Public Health Sciences, College of Medicine, University of
Cincinnati, 160 Panzeca Way, Cincinnati, OH, 45267, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on
Minority Health and Health Disparities, Bethesda, Maryland, USA
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Mahabee-Gittens EM, Southworth H, Kranich C, Lorenz A, Arnold MW, Gittelman MA. Assessment of the Smoke Free Families Tobacco Screening, Counseling, and Referral Program in Pediatric Primary Care Practices. Acad Pediatr 2024; 24:277-283. [PMID: 37245665 PMCID: PMC10676440 DOI: 10.1016/j.acap.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The Smoke Free Families (SFF) program trained pediatric providers to use an SFF tool during well-child visits (WCVs) of infants ≤12 months to "Ask" caregivers about tobacco use, "Advise" smokers to quit, and "Refer" smokers to cessation services (AAR). The primary objectives were to assess the prevalence and changes in caregiver tobacco use after being screened and counseled by providers using the SFF tool. A secondary objective was to examine providers' AAR behavior facilitated by using the SFF tool. METHODS Pediatric practices participated in 1 of 3 6-9-month SFF program waves. Over the 3 waves, all initial SFF tools completed on caregivers during their infant's WCV were evaluated for the caregiver and household tobacco use and providers' AAR rates. An infant's first and next WCV was matched to determine changes in caregiver tobacco product use. RESULTS In total, the SFF tool was completed at 19,976 WCVs; 2081 (18.8%) infants were exposed to tobacco smoke. A total of 834 (74.1%) caregivers who smoked received counseling: 786 (69.9%) were advised to quit, 700 (62.2%) were given cessation resources, and 198 (17.6%) were referred to the Quitline. In total, 230 (27.6%) of caregivers who smoked had a second visit; 58 (25.2%) self-reported that they quit using tobacco. Among cigarette users (n = 183), 89 (48.6%) reported that they used fewer cigarettes or quit at their infants' second WCV. CONCLUSIONS Systematic use of the SFF AAR tool during infants' WCVs could improve the health of caregivers and children, resulting in decreases in tobacco-related morbidity.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine (EM Mahabee-Gittens and MA Gittelman), Cincinnati Children's Hospital Medical Center, Ohio; University of Cincinnati (EM Mahabee-Gittens and MA Gittelman), College of Medicine, Ohio.
| | - Hayley Southworth
- Ohio Chapter (H Southworth, MW Arnold, and MA Gittelman), American Academy of Pediatrics, Columbus
| | - Christiana Kranich
- Ohio Colleges of Medicine (C Kranich and A Lorenz), Government Resource Center, Columbus
| | - Allison Lorenz
- Ohio Colleges of Medicine (C Kranich and A Lorenz), Government Resource Center, Columbus
| | - Melissa Wervey Arnold
- Ohio Chapter (H Southworth, MW Arnold, and MA Gittelman), American Academy of Pediatrics, Columbus
| | - Michael A Gittelman
- Division of Emergency Medicine (EM Mahabee-Gittens and MA Gittelman), Cincinnati Children's Hospital Medical Center, Ohio; University of Cincinnati (EM Mahabee-Gittens and MA Gittelman), College of Medicine, Ohio; Ohio Chapter (H Southworth, MW Arnold, and MA Gittelman), American Academy of Pediatrics, Columbus
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Mahabee-Gittens EM, Harun N, Glover M, Folger AT, Parikh NA. Prenatal tobacco smoke exposure and risk for cognitive delays in infants born very premature. Sci Rep 2024; 14:1397. [PMID: 38228701 PMCID: PMC10791619 DOI: 10.1038/s41598-024-51263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
Prenatal tobacco smoke exposure (TSE) and prematurity are independent risk factors for abnormal neurodevelopment. The objectives were to compare differences in Bayley-III cognitive, language, and motor scores at 2 years corrected age (CA) in 395 infants born very preterm (≤ 32 weeks gestation) with and without prenatal TSE. We performed multivariable linear regression analyses to examine associations between prenatal TSE and neurodevelopmental outcomes and a mediation analysis to estimate direct effects of prenatal TSE on outcomes and indirect effects through preterm birth. In total, 50 (12.6%) infants had prenatal TSE. Infants with prenatal TSE had lower mean [95% CI] Cognitive score (82.8 [78.6, 87.1]) vs. nonexposed infants (91.7 [90.1, 93.4]). In children with and without prenatal TSE, there were significant differences in mean [95% CI] Language scores (81.7 [76.0, 87.4] vs. 92.4 [90.2, 94.6], respectively) and mean [95% CI] Motor scores (86.5 [82.2, 90.7] vs. 93.4 [91.8, 95.0], respectively); scores remained significant after controlling for confounders. Preterm birth indirectly mediated 9.0% of the total effect of prenatal TSE on Cognitive score (P = NS). However, 91% of the remaining total effect was significant and attributable to TSE's direct harmful effects on cognitive development (β = - 5.17 [95% CI - 9.97, - 0.38]). The significant association is largely due to TSE's direct effect on cognitive development and not primarily due to TSE's indirect effect on preterm birth.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meredith Glover
- Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alonzo T Folger
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nehal A Parikh
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Mahabee-Gittens EM, Matt GE, Mazzella MJ, Doucette JT, Ratnani P, Merianos AL. Inflammatory marker levels in children with tobacco smoke exposure. Cytokine 2024; 173:156448. [PMID: 37980882 PMCID: PMC10843711 DOI: 10.1016/j.cyto.2023.156448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Tobacco smoke exposure (TSE) has inflammatory and immunosuppressive effects which may be associated with altered levels of inflammatory markers and pediatric illnesses. OBJECTIVE The primary objective was to examine the associations of cotinine-confirmed and parent-reported child TSE patterns and discharge diagnoses with C-reactive protein (CRP), IL-8, and IL-10 in 0-11-year-old pediatric emergency department (PED) patients who lived with ≥ 1 smoker. METHODS Saliva samples were obtained from 115 children with a mean (SD) age of 3.5 (3.1) years during the PED visit (T0). Saliva was analyzed for cotinine, CRP, IL-8, and IL-10. Parents self-reported their children's TSE patterns; children's medical records were reviewed to identify and categorize discharge diagnoses. Linear regression models were utilized to find T0 associations of cotinine-confirmed and parent-reported child TSE patterns, and PED diagnoses with each inflammatory marker. All models were adjusted for child race/ethnicity, child sex, annual household income, and housing type. The TSE models also adjusted for child discharge diagnosis. RESULTS At T0, the geometric mean (GeoM) of cotinine was 4.1 ng/ml [95 %CI = 3.2-5.2]; the GeoMs of CRP, IL-8, and IL-10 were 3,326 pg/ml [95 %CI = 2,696-4,105], 474 pg/ml [95 %CI = 386-583], and 1.1 pg/ml [95 %CI = 0.9-1.3], respectively. Parent-reported child TSE patterns were positively associated with ln-transformed CRP levels, while adjusting for the covariates (β^ = 0.012 [95 %CI:0.004-0.020], p = 0.037). In the parent-reported child TSE pattern model, there were significant positive associations between the covariate of child age with CRP and IL-8 levels (p = 0.028 and p < 0.001, respectively). Children with a bacterial diagnosis had higher IL-8 levels (p = 0.002) compared to the other diagnosis groups. CONCLUSIONS Results indicate that parent-reported child TSE increases the expression of CRP in ill children and supports prior work demonstrating that IL-8 is higher in children with TSE who have bacterial infections. These findings should be examined in future research with ill children with and without TSE.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Matthew J Mazzella
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John T Doucette
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parita Ratnani
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Merianos AL, Matt GE, Stone TM, Jandarov RA, Hoh E, Dodder NG, Quintana PJE, Lopez-Galvez N, Stone L, Mahabee-Gittens EM. Contamination of surfaces in children's homes with nicotine and the potent carcinogenic tobacco-specific nitrosamine NNK. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00629-8. [PMID: 38104233 DOI: 10.1038/s41370-023-00629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Tobacco smoke exposure (TSE) through secondhand and thirdhand smoke is a modifiable risk factor that contributes to childhood morbidity. Limited research has assessed surface TSE pollution in children's environments as a potential source of thirdhand smoke exposure, and none have examined levels of the tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) on surfaces. OBJECTIVE This study measured surface NNK and nicotine in children's homes and associations with sociodemographics and parent-reported TSE behaviors. We assessed correlations of surface NNK and nicotine with dust NNK, dust nicotine, and child cotinine. METHODS Home surface wipe NNK and nicotine data from 84 children who lived with smokers were analyzed. Tobit and simple linear regression analyses were conducted to assess associations of surface NNK and nicotine with child characteristics. Spearman's (ρ) correlations assessed the strength of associations between environmental markers and child cotinine. RESULTS Nearly half (48.8%) of children's home surfaces had detectable NNK and 100% had detectable nicotine. The respective geometric means (GMs) of surface NNK and nicotine loadings were 14.0 ng/m2 and 16.4 µg/m2. Surface NNK positively correlated with surface nicotine (ρ = 0.54, p < 0.001) and dust NNK (ρ = 0.30, p = 0.020). Surface nicotine positively correlated with dust NNK (ρ = 0.42, p < 0.001) and dust nicotine (ρ = 0.24, p = 0.041). Children with household incomes ≤$15,000 had higher surface NNK levels (GM = 18.7 ng/m2, p = 0.017) compared to children with household incomes >$15,000 (GM = 7.1 ng/m2). Children with no home smoking bans had higher surface NNK (GM = 18.1 ng/m2, p = 0.020) and surface nicotine (GM = 17.7 µg/m2, p = 0.019) levels compared to children with smoking bans (GM = 7.5 ng/m2, 4.8 µg/m2, respectively). IMPACT Although nicotine on surfaces is an established marker of thirdhand smoke pollution, other thirdhand smoke contaminants have not been measured on surfaces in the homes of children living with smokers. We provide evidence that the potent carcinogenic tobacco-specific nitrosamine NNK was detectable on surfaces in nearly half of children's homes, and nicotine was detectable on all surfaces. Surface NNK was positively correlated with surface nicotine and dust NNK. Detectable surface NNK levels were found in homes with indoor smoking bans, indicating the role of NNK as a persistent thirdhand smoke pollutant accumulating on surfaces as well as in dust.
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Affiliation(s)
- Ashley L Merianos
- University of Cincinnati, School of Human Services, PO Box 210068, Cincinnati, OH, 45221-0068, USA.
| | - Georg E Matt
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4611, USA
| | - Timothy M Stone
- Department of Environmental and Public Health Sciences, Division of Biostatistics and Bioinformatics, University of Cincinnati, College of Medicine, 160 Panzeca Way, Cincinnati, OH, 45267-0056, USA
| | - Roman A Jandarov
- Department of Environmental and Public Health Sciences, Division of Biostatistics and Bioinformatics, University of Cincinnati, College of Medicine, 160 Panzeca Way, Cincinnati, OH, 45267-0056, USA
| | - Eunha Hoh
- San Diego State University, School of Public Health, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
| | - Nathan G Dodder
- San Diego State University, School of Public Health, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
| | - Penelope J E Quintana
- San Diego State University, School of Public Health, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
| | - Nicolas Lopez-Galvez
- San Diego State University, School of Public Health, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
| | - Lara Stone
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati, College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3026, USA
| | - E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati, College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3026, USA
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Micalizzi L, Mattingly DT, Hart JL, Jensen JK, Mahabee-Gittens EM, Garrison KA. Smartphone Apps Targeting Youth Tobacco Use Prevention and Cessation: An Assessment of Credibility and Quality. Curr Addict Rep 2023; 10:649-663. [PMID: 38680515 PMCID: PMC11052596 DOI: 10.1007/s40429-023-00524-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 05/01/2024]
Abstract
Purpose of Review The goals of this study were to identify smartphone apps targeting youth tobacco use prevention and/or cessation discussed in the academic literature and/or available in the Apple App Store and to review and rate the credibility of the apps. We took a multiphase approach in a non-systematic review that involved conducting parallel literature and App Store searches, screening the returned literature and apps for inclusion, characterizing the studies and apps, and evaluating app quality using a standardized rating scale. Recent Findings The negative consequences of youth tobacco use initiation are profound and far-reaching. Half of the youth who use nicotine want to quit, but quit rates are low. The integration of smartphone apps shows promise in complementing and enhancing evidence-based youth tobacco prevention and treatment methods. Summary Consistent with prior reviews, we identified a disconnect between apps that are readily accessible and those that have an evidence base, and many popular apps received low quality scores. Findings suggest a need for better integration between evidence-based and popular, available apps targeting youth tobacco use.
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Affiliation(s)
- Lauren Micalizzi
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
| | - Delvon T. Mattingly
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
- Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Joy L. Hart
- Department of Communication and Christina Lee Brown Environme Institute, University of Louisville, Louisville, KY 40292, USA
| | - Jessica King Jensen
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Health, New Brunswick, NJ 08901, USA
- Department of Family Medicine & Community Health, Johnson Medical School,, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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Matt GE, Merianos AL, Stone L, Wullenweber C, Quintana PJE, Hoh E, Dodder NG, Lopez Galvez N, Mahabee-Gittens EM. Changes and stability of hand nicotine levels in children of smokers: Associations with urinary biomarkers, reported child tobacco smoke exposure, and home smoking bans. Environ Int 2023; 181:108239. [PMID: 37852151 DOI: 10.1016/j.envint.2023.108239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Exposure to thirdhand smoke (THS) residue takes place through inhalation, ingestion, and dermal transfer. Hand nicotine levels have been proposed to measure THS pollution in the environment of children, but little is known about its variability and stability over time and correlates of change. OBJECTIVES The goal was to determine the stability of hand nicotine in comparison to urinary biomarkers and to explore factors that influence changes in hand nicotine. METHODS Data were collected from 0 to 11-year-old children (Mean age = 5.9) who lived with ≥1 tobacco smokers (N = 129). At a 6-week interval, we collected repeated measures of hand nicotine, four urinary biomarkers (cotinine, trans-3'-hydroxycotinine, nicotelline N-oxides, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), and parent-reported child tobacco smoke exposure (TSE). Dependent sample t-tests, correlations, and multivariable regression analyses were conducted to examine the changes in child TSE. RESULTS Hand nicotine levels (r = 0.63, p < 0.001) showed similar correlations between repeated measures to urinary biomarkers (r = 0.58-0.71; p < 0.001). Different from urinary biomarkers, mean hand nicotine levels increased over time (t(113) = 3.37, p < 0.001) being significantly higher in children from homes without smoking bans at Time 2 (p = 0.016) compared to Time 1 (p = 0.003). Changes in hand nicotine correlated with changes in cotinine and trans-3'-hydroxycotinine (r = 0.30 and r = 0.19, respectively, p < 0.05). Children with home smoking bans at Time 1 and 2 showed significantly lower hand nicotine levels compared to children without home smoking bans. DISCUSSION Findings indicate that hand nicotine levels provide additional insights into children's exposure to tobacco smoke pollutants than reported child TSE and urinary biomarkers. Changes in hand nicotine levels show that consistent home smoking bans in homes of children of smokers can lower THS exposure. Hand nicotine levels may be influenced by the environmental settings in which they are collected.
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Affiliation(s)
- Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA.
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, USA
| | - Chase Wullenweber
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, USA
| | | | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Nathan G Dodder
- School of Public Health, San Diego State University, San Diego, CA, USA; San Diego State University Research Foundation, San Diego, CA, USA
| | | | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Nidey N, Bowers K, Ding L, Ji H, Ammerman RT, Yolton K, Mahabee-Gittens EM, Folger AT. Neonatal AVPR1a Methylation and In-Utero Exposure to Maternal Smoking. Toxics 2023; 11:855. [PMID: 37888705 PMCID: PMC10611161 DOI: 10.3390/toxics11100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
(1) Introduction: Epigenetic changes have been proposed as a biologic link between in-utero exposure to maternal smoking and health outcomes. Therefore, we examined if in-utero exposure to maternal smoking was associated with infant DNA methylation (DNAm) of cytosine-phosphate-guanine dinucleotides (CpG sites) in the arginine vasopressin receptor 1A AVPR1a gene. The AVPR1a gene encodes a receptor that interacts with the arginine vasopressin hormone and may influence physiological stress regulation, blood pressure, and child development. (2) Methods: Fifty-two infants were included in this cohort study. Multivariable linear models were used to examine the effect of in-utero exposure to maternal smoking on the mean DNAm of CpG sites located at AVPR1a. (3) Results: After adjusting the model for substance use, infants with in-utero exposure to maternal smoking had a reduction in DNAm at AVPR1a CpG sites by -0.02 (95% CI -0.03, -0.01) at one month of age. In conclusion, in-utero exposure to tobacco smoke can lead to differential patterns of DNAm of AVPR1a among infants. Conclusions: Future studies are needed to identify how gene expression in response to early environmental exposures contributes to health outcomes.
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Affiliation(s)
- Nichole Nidey
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52242, USA;
| | - Katherine Bowers
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (K.B.); (L.D.)
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (K.B.); (L.D.)
| | - Hong Ji
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA;
| | - Robert T. Ammerman
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Kimberly Yolton
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Alonzo T. Folger
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (K.B.); (L.D.)
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Merianos AL, Mahabee-Gittens EM. Tobacco Smoke Exposure and Gastrointestinal Problems Among US Children. Clin Pediatr (Phila) 2023; 62:1229-1236. [PMID: 36789912 PMCID: PMC10425569 DOI: 10.1177/00099228231154135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This study examined the association between home tobacco smoke exposure (TSE) status and gastrointestinal problems in the past 12 months among US children. We conducted a secondary analysis of the 2018-2019 National Survey of Children's Health cross-sectional data including 20 149 children aged 4 to 10 years. Weighted logistic regression models unadjusted and adjusted for child and family covariates were fitted. Overall, 12.3% of children had home thirdhand smoke (THS) exposure only and 1.8% had home secondhand smoke (SHS) and THS exposure. Unadjusted (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.32-2.20) and adjusted (adjusted odds ratio [AOR] = 1.51, 95% CI = 1.14-1.99) logistic regression results indicated that relative to children with no home TSE, children with home THS exposure only were at increased odds of having frequent or chronic difficulty with gastrointestinal problems over the past 12 months. Interventions are critically needed to promote smoking cessation among household members who live with children in order to reduce levels of SHS and THS in their homes.
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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, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, USA
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13
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Merianos AL, Mahabee-Gittens EM, Hill MJ, Olaniyan AC, Smith ML, Choi K. Electronic cigarette use and cigarette smoking associated with inadequate sleep duration among U.S. young adults. Prev Med 2023; 175:107712. [PMID: 37758124 PMCID: PMC10591887 DOI: 10.1016/j.ypmed.2023.107712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Nicotine use can influence inadequate sleep, but less is known about the associations of exclusive and dual use of electronic cigarettes (e-cigarettes) with combustible cigarettes in U.S. young adults. This study assessed the associations between current exclusive e-cigarette use, exclusive cigarette smoking, and dual e-cigarette and combustible cigarette use and inadequate sleep duration among U.S. young adults. METHODS We performed a secondary analysis of 2020 Behavioral Risk Factor Surveillance System (BRFSS) data including 13,978 U.S. young adults ages 18-24 years. Inadequate sleep duration was assessed categorically using the National Sleep Foundation's age-specific recommendations that define <7 h as inadequate sleep. Weighted logistic regression models were performed while adjusting for participants' sex, race/ethnicity, education level, annual household income level, body mass index, current physical activity, mental health status, disability status, current alcohol use, and current smokeless tobacco use. RESULTS Concerning use patterns, 11.8% of young adults were exclusive e-cigarette users, 4.7% were exclusive cigarette smokers, and 3.8% were dual e-cigarette and combustible cigarette users. Exclusive e-cigarette users (adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.16-1.72), exclusive cigarette smokers (AOR = 1.63, 95%CI = 1.22-2.18), and dual product users (AOR = 2.03, 95%CI = 1.44-2.86) were at increased odds of having inadequate sleep duration compared to non-users, while adjusting for the covariates. Additionally, dual product users were at increased odds (AOR = 1.52, 95%CI = 1.06-2.19) of reporting inadequate sleep duration compared to exclusive e-cigarette users, while adjusting for the covariates. CONCLUSIONS Current e-cigarette and cigarette use may influence inadequate sleep among U.S. young adults. Tobacco cessation efforts may encourage increased sleep health.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH 45221, USA.
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Madelyn J Hill
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH 45221, USA.
| | - Afolakemi C Olaniyan
- School of Population and Health Sciences, Dillard Unversity, New Orleans, LA, USA.
| | - Matthew Lee Smith
- Department of Health Behavior, Texas A&M University, College Station, TX, USA.
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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Toraman Turk S, Merianos AL, Stone L, Schnadower D, Bouvay K, Mahabee-Gittens EM. "I Don't Want My Child to Be a Guinea Pig": Reasons for Non-Participation in a Parental Tobacco Cessation Trial in the Pediatric Emergency Department Setting. Toxics 2023; 11:655. [PMID: 37624161 PMCID: PMC10458252 DOI: 10.3390/toxics11080655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 08/26/2023]
Abstract
(1) Background: Pediatric emergency department (PED) settings are opportune venues in which to recruit parental smokers into tobacco cessation interventions. However, the barriers associated with parents' participation in PED-based cessation trials are unknown. The objective was to explore parents' reasons for non-participation in a PED-based tobacco cessation trial. (2) Methods: We employed the framework method and conducted a qualitative data analysis of parental smokers who were eligible to participate in a PED-based tobacco cessation trial and did not choose to participate (n = 371). (3) Results: Two main themes emerged about reasons for non-participation: (a) Not interested in participating in a research study, and (b) concerns specific to the study. Parents had various reasons for not participating in the cessation trial including not being interested in quitting, parents' health and well-being, parents' beliefs about research, and time required for the study and follow-up visits. (4) Conclusion: General disinterest and specific study-related concerns were touted as reasons for non-participation in a PED-based tobacco cessation trial. Given the potential reductions in tobacco-related morbidity to both parents and children that tobacco control interventions can facilitate, future tobacco interventions should consider alterations in study design and recruitment strategies to encourage all eligible parental smokers to participate.
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Affiliation(s)
- Sinem Toraman Turk
- Department of Health Policy and Management, Global Health Leadership Initiative, Yale University, 60 College Street, New Haven, CT 06520, 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, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH 45229, USA; (L.S.); (E.M.M.-G.)
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH 45229, USA; (L.S.); (E.M.M.-G.)
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Kamali Bouvay
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH 45229, USA; (L.S.); (E.M.M.-G.)
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH 45229, USA; (L.S.); (E.M.M.-G.)
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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Matt GE, Greiner L, Record RA, Wipfli H, Long J, Dodder NG, Hoh E, Lopez Galvez N, Novotny TE, Quintana PJE, Destaillats H, Tang X, Snijders AM, Mao JH, Hang B, Schick S, Jacob P, Talbot P, Mahabee-Gittens EM, Merianos AL, Northrup TF, Gundel L, Benowitz NL. Policy-relevant differences between secondhand and thirdhand smoke: strengthening protections from involuntary exposure to tobacco smoke pollutants. Tob Control 2023:tc-2023-057971. [PMID: 37263783 DOI: 10.1136/tc-2023-057971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
Starting in the 1970s, individuals, businesses and the public have increasingly benefited from policies prohibiting smoking indoors, saving thousands of lives and billions of dollars in healthcare expenditures. Smokefree policies to protect against secondhand smoke exposure, however, do not fully protect the public from the persistent and toxic chemical residues from tobacco smoke (also known as thirdhand smoke) that linger in indoor environments for years after smoking stops. Nor do these policies address the economic costs that individuals, businesses and the public bear in their attempts to remediate this toxic residue. We discuss policy-relevant differences between secondhand smoke and thirdhand smoke exposure: persistent pollutant reservoirs, pollutant transport, routes of exposure, the time gap between initial cause and effect, and remediation and disposal. We examine four policy considerations to better protect the public from involuntary exposure to tobacco smoke pollutants from all sources. We call for (a) redefining smokefree as free of tobacco smoke pollutants from secondhand and thirdhand smoke; (b) eliminating exemptions to comprehensive smoking bans; (c) identifying indoor environments with significant thirdhand smoke reservoirs; and (d) remediating thirdhand smoke. We use the case of California as an example of how secondhand smoke-protective laws may be strengthened to encompass thirdhand smoke protections. The health risks and economic costs of thirdhand smoke require that smokefree policies, environmental protections, real estate and rental disclosure policies, tenant protections, and consumer protection laws be strengthened to ensure that the public is fully protected from and informed about the risks of thirdhand smoke exposure.
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Affiliation(s)
- Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Lydia Greiner
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Rachael A Record
- School of Communication, San Diego State University, San Diego, CA, USA
| | - Heather Wipfli
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jamie Long
- Public Health Law Center, Mitchell Hamline School of Law, University of Minnesota, St Paul, MN, USA
| | - Nathan G Dodder
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - Thomas E Novotny
- School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - Hugo Destaillats
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Xiaochen Tang
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Antoine M Snijders
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Jian-Hua Mao
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Bo Hang
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Suzaynn Schick
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Peyton Jacob
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Prue Talbot
- Department of Molecular, Cell, and Systems Biology, University of California Riverside, Riverside, CA, USA
| | - E Melinda Mahabee-Gittens
- Department of Pediatrics, Division of Emergency Medicine Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Thomas F Northrup
- Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Lara Gundel
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Neal L Benowitz
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Merianos AL, Nabors LA, Odar Stough CC, Olaniyan AC, Smith ML, Mahabee-Gittens EM. Associations of household tobacco smoking status with childhood temperament among U.S. preschool-aged children. J Affect Disord 2023; 329:113-123. [PMID: 36841302 PMCID: PMC10042486 DOI: 10.1016/j.jad.2023.02.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/28/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND This study investigated the association between household tobacco smoking status and temperament among U.S. 3-5-year-olds. METHODS A secondary analysis of 2019-2020 National Survey of Children's Health data (N = 11,100) was conducted. Temperament dimensions of effortful control (characterized by attention focusing), negative affectivity (characterized by anger and soothability), and surgency (characterized by activity level and shyness) were assessed. Weighted ordinal regression models were conducted while adjusting for child and family covariates. RESULTS Approximately 13 % of children lived with smokers. Compared to children who did not live with smokers, children living with smokers displayed behaviors of poorer effortful control and were more likely to be easily distracted (AOR = 1.59, 95%CI = 1.24-2.04) and less likely to keep working on tasks until finished (AOR = 0.56, 95%CI = 0.44-0.71). Children living with smokers displayed behaviors of greater negative affectivity and were at increased odds of being angry or anxious when transitioning between activities (AOR = 1.50, 95%CI = 1.13-1.98) and losing their temper when things did not go their way (AOR = 1.53, 95%CI = 1.20-1.96), and were at decreased odds of calming down quickly when excited (AOR = 0.54, 95%CI = 0.42-0.70). Children living with smokers displayed behaviors of poorer surgency and were less likely to play well with others (AOR = 0.58, 95%CI = 0.45-0.76) and sit still compared to same-aged children (AOR = 0.56, 95%CI = 0.44-0.71). LIMITATIONS The NSCH uses a cross-sectional survey design; longitudinal associations and objective measures could not be assessed. However, the NSCH is nationally representative and results are generalizable to U.S. 3-5-year-olds. CONCLUSIONS Findings suggest household tobacco smoking influences temperament in early childhood. Results signify the need to promote household tobacco cessation.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA.
| | - Laura A Nabors
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Mahabee-Gittens EM, Matt GE, Jandarov RA, Merianos AL. The Associations of Trans-3'-Hydroxy Cotinine, Cotinine, and the Nicotine Metabolite Ratio in Pediatric Patients with Tobacco Smoke Exposure. Int J Environ Res Public Health 2023; 20:ijerph20095639. [PMID: 37174159 PMCID: PMC10177900 DOI: 10.3390/ijerph20095639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/09/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
(1) Background: Trans-3'-hydroxy cotinine (3HC) and cotinine (COT) are tobacco smoke exposure (TSE) biomarkers and the 3HC/COT ratio is a marker of CYP2A6 activity, an enzyme which metabolizes nicotine. The primary objective was to assess the associations of these TSE biomarkers with sociodemographics and TSE patterns in children who lived with ≥1 smoker. (2) Methods: A convenience sample of 288 children (mean age (SD) = 6.42 (4.8) years) was recruited. Multiple linear regression models were built to assess associations of sociodemographics and TSE patterns with urinary biomarker response variables: (1) 3HC, (2) COT, (3) 3HC+COT sum, and (4) 3HC/COT ratio. (3) Results: All children had detectable 3HC (Geometric Mean [GeoM] = 32.03 ng/mL, 95%CI = 26.97, 38.04) and COT (GeoM = 10.24 ng/mL, 95%CI = 8.82, 11.89). Children with higher cumulative TSE had higher 3HC and COT (β^ = 0.03, 95%CI = 0.01, 0.06, p = 0.015 and β^ = 0.03, 95%CI = 0.01, 0.05, p = 0.013, respectively). Highest 3HC+COT sum levels were in children who were Black (β^ = 0.60, 95%CI = 0.04, 1.17, p = 0.039) and who had higher cumulative TSE (β^ = 0.03, 95%CI = 0.01, 0.06, p = 0.015). Lowest 3HC/COT ratios were in children who were Black (β^ = -0.42, 95%CI = -0.78, -0.07, p = 0.021) and female (β^ = -0.32, 95%CI = -0.62, -0.01, p = 0.044). (4) Conclusion: Results indicate that there are racial and age-related differences in TSE, most likely due to slower nicotine metabolism in non-Hispanic Black children and in younger 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
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA 92123, USA
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA
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Merianos AL, Stone TM, Jandarov RA, Mahabee-Gittens EM, Choi K. Sources of Tobacco Smoke Exposure and Their Associations With Serum Cotinine Levels Among US Children and Adolescents. Nicotine Tob Res 2023; 25:1004-1013. [PMID: 36567673 PMCID: PMC10077940 DOI: 10.1093/ntr/ntac293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/11/2022] [Accepted: 12/25/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We assessed tobacco smoke exposure (TSE) levels based on private and public locations of TSE according to race and ethnicity among US school-aged children ages 6-11 years and adolescents ages 12-17 years. AIMS AND METHODS Data were from 5296 children and adolescents who participated in the National Health and Nutrition Examination Survey (NHANES) 2013-2018. Racial and ethnic groups were non-Hispanic white, black, other or multiracial, and Hispanic. NHANES assessed serum cotinine and the following TSE locations: homes and whether smokers did not smoke indoors (home thirdhand smoke [THS] exposure proxy) or smoked indoors (secondhand [SHS] and THS exposure proxy), cars, in other homes, restaurants, or any other indoor area. We used stratified weighted linear regression models by racial and ethnic groups and assessed the variance in cotinine levels explained by each location within each age group. RESULTS Among 6-11-year-olds, exposure to home THS only and home SHS + THS predicted higher log-cotinine among all racial and ethnic groups. Non-Hispanic white children exposed to car TSE had higher log-cotinine (β = 1.64, 95% confidence interval [CI] = 0.91% to 2.37%) compared to those unexposed. Non-Hispanic other/multiracial children exposed to restaurant TSE had higher log-cotinine (β = 1.13, 95% CI = 0.23% to 2.03%) compared to those unexposed. Among 12-17-year-olds, home SHS + THS exposure predicted higher log-cotinine among all racial and ethnic groups, except for non-Hispanic black adolescents. Car TSE predicted higher log-cotinine among all racial and ethnic groups. Non-Hispanic black adolescents with TSE in another indoor area had higher log-cotinine (β = 2.84, 95% CI = 0.85% to 4.83%) compared to those unexposed. CONCLUSIONS TSE location was uniquely associated with cotinine levels by race and ethnicity. Smoke-free home and car legislation are needed to reduce TSE among children and adolescents of all racial and ethnic backgrounds. IMPLICATIONS Racial and ethnic disparities in TSE trends have remained stable among US children and adolescents over time. This study's results indicate that TSE locations differentially contribute to biochemically measured TSE within racial and ethnic groups. Home TSE significantly contributed to cotinine levels among school-aged children 6-11 years old, and car TSE significantly contributed to cotinine levels among adolescents 12-17 years old. Racial and ethnic differences in locations of TSE were observed among each age group. Study findings provide unique insight into TSE sources, and indicate that home and car smoke-free legislation have great potential to reduce TSE among youth of all racial and ethnic backgrounds.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Timothy M Stone
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
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Mahabee-Gittens EM, Kline-Fath BM, Harun N, Folger AT, He L, Parikh NA. Prenatal tobacco smoke exposure and risk of brain abnormalities on magnetic resonance imaging at term in infants born very preterm. Am J Obstet Gynecol MFM 2023; 5:100856. [PMID: 36592820 PMCID: PMC9974884 DOI: 10.1016/j.ajogmf.2022.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prenatal tobacco smoke exposure and preterm birth are associated with abnormal brain and neurodevelopmental outcomes in infants. Studies that can disentangle indirect mediating effects from direct effects of prenatal tobacco smoke exposure on sensitive early brain magnetic resonance imaging biomarkers in very preterm infants are needed. OBJECTIVE This study aimed to determine whether prenatal tobacco smoke exposure in preterm infants posed any direct effects on magnetic resonance imaging-determined global brain abnormality score and secondary measures of brain abnormalities after removing any indirect mediating effects of preterm birth on neurostructural outcomes. STUDY DESIGN We examined brain magnetic resonance imaging findings collected at 39 to 44 weeks postmenstrual age from a prospective cohort of 395 infants born very preterm (gestational age of ≤32 weeks). The primary outcome was global brain abnormality score, and the secondary outcomes were global efficiency of structural connectome, diffuse white matter abnormality volume, total brain tissue volume, total gray and white matter volumes, and cerebellar volume. Maternal reports of smoking during pregnancy were obtained. We performed multivariable linear regression analyses to examine the association between prenatal tobacco smoke exposure and our magnetic resonance imaging outcomes, controlling for prospectively collected confounders. Moreover, we performed a mediation analysis to estimate the direct effects of prenatal tobacco smoke exposure on brain abnormalities and any indirect effects through preterm birth. RESULTS Overall, 12.6% of infants had prenatal tobacco smoke exposure. Infants with prenatal tobacco smoke exposure had a higher median global brain abnormality score than nonexposed infants (7 [interquartile range, 0-41] vs 5 [interquartile range, 0-34]; P≤.001); the findings remained significant (P<.001) after controlling for antenatal confounders. Global efficiency (P<.001), diffuse white matter volume (P=.037), and total brain tissue volume (P=.047) were significantly different between TSE groups in multivariable analyses. On mediation analysis, preterm birth mediated between 0% and 29% of the indirect effect of prenatal tobacco smoke exposure on several measures of brain abnormality outcomes. Thus, prenatal tobacco smoke exposure had a direct adverse effect between 71% and 100% on brain injury or abnormal development. CONCLUSION Our study has identified multiple adverse effects of prenatal tobacco smoke exposure on sensitive and objective measures of neonatal brain injury and abnormal development; most cases seemed to be a direct effect of prenatal tobacco smoke exposure on fetal brain development. The results underscored the significant adverse neurostructural effects of prenatal tobacco smoke exposure to tobacco smoke pollutants.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Mahabee-Gittens).
| | - Beth M Kline-Fath
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH (Drs Mahabee-Gittens, Kline-Fath, Folger, He, and Parikh)
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati OH (Dr Harun and Folger)
| | - Alonzo T Folger
- Departments of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Drs Kline-Fath and He)
| | - Lili He
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH (Drs Mahabee-Gittens, Kline-Fath, Folger, He, and Parikh)
| | - Nehal A Parikh
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Mahabee-Gittens); Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States (Drs He and Parikh)
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20
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Merianos AL, Mahabee-Gittens EM, Stone TM, Jandarov RA, Wang L, Bhandari D, Blount BC, Matt GE. Distinguishing Exposure to Secondhand and Thirdhand Tobacco Smoke among U.S. Children Using Machine Learning: NHANES 2013-2016. Environ Sci Technol 2023; 57:2042-2053. [PMID: 36705578 PMCID: PMC10230650 DOI: 10.1021/acs.est.2c08121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
While the thirdhand smoke (THS) residue from tobacco smoke has been recognized as a distinct public health hazard, there are currently no gold standard biomarkers to differentiate THS from secondhand smoke (SHS) exposure. This study used machine learning algorithms to assess which combinations of biomarkers and reported tobacco smoke exposure measures best differentiate children into three groups: no/minimal tobacco smoke exposure (NEG); predominant THS exposure (TEG); and mixed SHS and THS exposure (MEG). Participants were 4485 nonsmoking 3-17-year-olds from the National Health and Nutrition Examination Survey 2013-2016. We fitted and tested random forest models, and the majority (76%) of children were classified in NEG, 16% were classified in TEG, and 8% were classified in MEG. The final classification model based on reported exposure, biomarker, and biomarker ratio variables had a prediction accuracy of 95%. This final model had prediction accuracies of 100% for NEG, 88% for TEG, followed by 71% for MEG. The most important predictors were the reported number of household smokers, serum cotinine, serum hydroxycotinine, and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). In the absence of validated biomarkers specific to THS, comprehensive biomarker and questionnaire data for tobacco smoke exposure can distinguish children exposed to SHS and THS with high accuracy.
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Affiliation(s)
- Ashley L. Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati OH, 45221, USA
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, USA
| | - Timothy M. Stone
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Kettering Lab Building, 160 Panzeca Way, Cincinnati, OH, 45267-0056, USA
| | - Roman A. Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Kettering Lab Building, 160 Panzeca Way, Cincinnati, OH, 45267-0056, USA
| | - Lanqing Wang
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Deepak Bhandari
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Benjamin C. Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Georg E. Matt
- Department of Psychology, College of Sciences, San Diego State University, 9245 Sky Park Court, Suite 225, San Diego, CA, 92123, USA
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21
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Brent DA, Horowitz LM, Grupp-Phelan J, Bridge JA, Gibbons R, Chernick LS, Rea M, Cwik MF, Shenoi RP, Fein JA, Mahabee-Gittens EM, Patel SJ, Mistry RD, Duffy S, Melzer-Lange MD, Rogers A, Cohen DM, Keller A, Hickey RW, Page K, Casper TC, King CA. Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments. JAMA Netw Open 2023; 6:e2255986. [PMID: 36790810 PMCID: PMC9932829 DOI: 10.1001/jamanetworkopen.2022.55986] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
IMPORTANCE Screening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy for suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians in choosing a screening tool. OBJECTIVE To compare the Ask Suicide-Screening Questions (ASQ) instrument with the Computerized Adaptive Screen for Suicidal Youth (CASSY) instrument for the prediction of suicidal behavior among adolescents seen in EDs, across demographic and clinical strata. DESIGN, SETTING, AND PARTICIPANTS The Emergency Department Study for Teens at Risk for Suicide is a prospective, random-series, multicenter cohort study that recruited adolescents, oversampled for those with psychiatric symptoms, who presented to the ED from July 24, 2017, through October 29, 2018, with a 3-month follow-up to assess the occurrence of suicidal behavior. The study included 14 pediatric ED members of the Pediatric Emergency Care Applied Research Network and 1 Indian Health Service ED. Statistical analysis was performed from May 2021 through January 2023. MAIN OUTCOMES AND MEASURES This study used a prediction model to assess outcomes. The primary outcome was suicide attempt (SA), and the secondary outcome was suicide-related visits to the ED or hospital within 3 months of baseline; both were assessed by an interviewer blinded to baseline information. The ASQ is a 4-item questionnaire that surveys suicidal ideation and lifetime SAs. A positive response or nonresponse on any item indicates suicidal risk. The CASSY is a computerized adaptive screening tool that always includes 3 ASQ items and a mean of 8 additional items. The CASSY's continuous outcome is the predicted probability of an SA. RESULTS Of 6513 adolescents available, 4050 were enrolled, 3965 completed baseline assessments, and 2740 (1705 girls [62.2%]; mean [SD] age at enrollment, 15.0 [1.7] years; 469 Black participants [17.1%], 678 Hispanic participants [24.7%], and 1618 White participants [59.1%]) completed both screenings and follow-ups. The ASQ and the CASSY showed a similar sensitivity (0.951 [95% CI, 0.918-0.984] vs 0.945 [95% CI, 0.910-0.980]), specificity (0.588 [95% CI, 0.569-0.607] vs 0.643 [95% CI, 0.625-0.662]), positive predictive value (0.127 [95% CI, 0.109-0.146] vs 0.144 [95% CI, 0.123-0.165]), and negative predictive value (both 0.995 [95% CI, 0.991-0.998], respectively). Area under the receiver operating characteristic curve findings were similar among patients with physical symptoms (ASQ, 0.88 [95% CI, 0.81-0.95] vs CASSY, 0.94 [95% CI, 0.91-0.96]). Among patients with psychiatric symptoms, the CASSY performed better than the ASQ (0.72 [95% CI, 0.68-0.77] vs 0.57 [95% CI, 0.55-0.59], respectively). CONCLUSIONS AND RELEVANCE This study suggests that both the ASQ and the CASSY are appropriate for universal screening of patients in pediatric EDs. For the small subset of patients with psychiatric symptoms, the CASSY shows greater predictive validity.
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Affiliation(s)
- David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - Lisa M. Horowitz
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | | | - Jeffrey A. Bridge
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Robert Gibbons
- Department of Medicine, The University of Chicago, Chicago, Illinois
- Department of Public Health Sciences (Biostatistics), The University of Chicago, Chicago, Illinois
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
- Department of Comparative Human Development, The University of Chicago, Chicago, Illinois
| | - Lauren S. Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
| | - Margaret Rea
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Mary F. Cwik
- Department of International Health, Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rohit P. Shenoi
- Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Joel A. Fein
- Center for Violence Prevention, Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shilpa J. Patel
- Division of Pediatric Emergency Medicine, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Rakesh D. Mistry
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Susan Duffy
- Hasbro Children’s Hospital, Department of Pediatrics, Alpert Medical School at Brown University, Providence, Rhode Island
| | | | - Alexander Rogers
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Daniel M. Cohen
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Allison Keller
- Department of Pediatric Emergency Medicine, University of Utah and Primary Children’s Hospital, Salt Lake City
| | - Robert W. Hickey
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kent Page
- Department of Pediatrics, University of Utah, Salt Lake City
| | | | - Cheryl A. King
- Department of Psychiatry, Michigan Medicine, Ann Arbor
- Injury Prevention Center, The University of Michigan, Ann Arbor
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22
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Rafiee A, Hoseini M, Akbari S, Mahabee-Gittens EM. Exposure to Polycyclic Aromatic Hydrocarbons and adverse reproductive outcomes in women: current status and future perspectives. Rev Environ Health 2023; 0:reveh-2022-0182. [PMID: 36583940 PMCID: PMC10314966 DOI: 10.1515/reveh-2022-0182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Polycyclic Aromatic Hydrocarbons (PAHs) are ubiquitous, toxic environmental chemicals that can cause adverse reproductive health effects. The objectives of this mini-review are to highlight the adverse reproductive outcomes due to PAH exposure with the main focus on polycystic ovary syndrome (PCOS) and premature ovarian failure (POF) and to provide perspectives on future research needs. CONTENT We reviewed studies that have reported the adverse reproductive outcomes associated with PAHs exposures in women through a comprehensive search of bibliographic databases and gray literature sources. In addition, potentially modifiable sources of exposure to PAHs and associated reproductive outcomes were also investigated. SUMMARY A total of 232 papers were retrieved through a comprehensive search of bibliographic databases, out of which three studies met the eligibility criteria and were included in the review. Results showed that exposure to PAHs is associated with adverse reproductive outcomes defined as PCOS, POF, and reproductive hormone imbalance. Sources of PAH exposure associated with adverse reproductive outcomes include active and passive tobacco smoking, specific cooking methods, and pesticides. OUTLOOK Future studies are warranted to examine the mechanisms by which PAHs result in adverse reproductive endpoints in women. Further, environmental exposures that are potentially modifiable such as exposure to tobacco smoke, may contribute to PAH exposure, and these exposures should be targeted in future policies and interventions.
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Affiliation(s)
- Ata Rafiee
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mohammad Hoseini
- Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadaf Akbari
- Department of Internal Medicine, Division of Nephrology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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23
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. Carcinogenic and tobacco smoke-derived particulate matter biomarker uptake and associated healthcare patterns among children. Pediatr Res 2023; 93:143-153. [PMID: 35383260 PMCID: PMC9535039 DOI: 10.1038/s41390-022-02031-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective was to assess the associations of child tobacco smoke exposure (TSE) biomarkers (urinary cotinine, NNAL, and nicotelline N-oxides) and parent-reported smoking and child TSE patterns with total hospital visits, pediatric emergency department (PED) visits, urgent care (UC), revisits, and hospital admissions among 0-9-year-olds. METHODS A convenience sample of PED/UC patients (N = 242) who presented to a large, US children's hospital who had baseline urine samples assayed for the TSE biomarkers of interest were included. Biomarker levels were log-transformed, and linear and Poisson regression models were built. RESULTS The geometric means of child cotinine, creatinine-adjusted NNAL, and N-oxide levels were 11.2 ng/ml, 30.9 pg/mg creatinine, and 24.1 pg/ml, respectively. The mean (SD) number of daily cigarettes smoked by parents was 10.2 (6.1) cigarettes. Each one-unit increase in log-NNAL levels was associated with an increase in total UC visits (aRR = 1.68, 95% CI = 1.18-2.39) among 0-9-year-olds, while controlling for the covariates. Each one-unit increase in child log-NNAL/cotinine ratio (×103) values was associated with an increase in total hospital visits (aRR = 1.39, 95% CI = 1.10-1.75) and UC visits (aRR = 1.56, 95% CI = 1.14-2.13) over 6 months. CONCLUSION Systematic screening for child TSE should be conducted during all hospital visits. The comprehensive assessment of TSE biomarkers should be considered to objectively measure young children's exposure. IMPACT Higher levels of cotinine, a widely used tobacco smoke exposure biomarker, have been associated with higher healthcare utilization patterns among children. Less is known on the associations of carcinogenic and tobacco smoke-derived particulate matter biomarker uptake with child healthcare utilization patterns. This study assessed the associations of several biomarkers with healthcare utilization patterns among pediatric emergency department patients ages 0-9 years who lived with tobacco smokers. Higher urinary NNAL biomarker levels, in individual and ratio form with cotinine, increased children's risk for urgent care visits over 6 months. Higher parent-reported cumulative child tobacco smoke exposure increased children's risk for hospital admissions.
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Affiliation(s)
- Ashley L Merianos
- University of Cincinnati, School of Human Services, Cincinnati, OH, USA.
| | - Roman A Jandarov
- University of Cincinnati, College of Medicine, Department of Environmental and Public Health Sciences, Division of Biostatistics and Bioinformatics, Cincinnati, OH, USA
| | - E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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Mendy A, Burcham S, Merianos AL, Mersha TB, Mahabee-Gittens EM, Chen A, Yolton K. Urinary volatile organic compound metabolites and reduced lung function in U.S. adults. Respir Med 2022; 205:107053. [PMID: 36399896 PMCID: PMC9869342 DOI: 10.1016/j.rmed.2022.107053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Volatile organic compounds (VOCs) are associated with adverse respiratory outcomes at high occupational exposures. However, whether exposure levels found in the general population have similar effects is unknown. METHODS We analyzed data on 1342 adult participants in the 2011-2012 National Health and Nutrition Examination Survey aged ≥18 years old who had urinary VOC metabolites and spirometry measurements available. Linear regression models adjusting for covariates were fitted to estimate the associations of VOC exposures levels and spirometry outcomes, while accounting for survey design and sampling weights to generate nationally representative estimates. RESULTS The urinary metabolites for xylene, acrylamide, acrolein, 1,3-butadiene, cyanide, toluene, 1-bromopropane, acrylonitrile, propylene oxide, styrene, ethylbenzene, and crotonaldehyde in our analysis were all detected in >75% of participants. Forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio % was lower with urinary metabolites of acrylamide (β: -2.65, 95% CI: -4.32, -0.98), acrylonitrile (β: -1.02, 95% CI: -2.01, -0.03), and styrene (β: -3.13, 95% CI: -5.35, -0.90). FEV1% predicted was lower with the urinary metabolites of acrolein (β: -7.77, 95% CI: -13.29, -2.25), acrylonitrile (β: -2.05, 95% CI: -3.77, -0.34), propylene oxide (β: -2.90, 95% CI: -5.50, -0.32), and styrene (β: -4.41, 95% CI: -6.97, -1.85). CONCLUSIONS This is the first study of a representative sample of the U.S. adult population to reveal associations of acrylonitrile, propylene oxide, and styrene urinary metabolites with reduced lung function at non-occupational exposures. Results also support previous evidence of acrylamide and acrolein's association with adverse respiratory outcomes.
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Affiliation(s)
- Angelico Mendy
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Sara Burcham
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Tesfaye B Mersha
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aimin Chen
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberley Yolton
- General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Zamor RL, Vaughn LM, McCann E, Sanchez L, Page EM, Mahabee-Gittens EM. Perceptions and experiences of Latinx parents with language barriers in a pediatric emergency department: a qualitative study. BMC Health Serv Res 2022; 22:1463. [PMID: 36457015 PMCID: PMC9717444 DOI: 10.1186/s12913-022-08839-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Prior research has shown disparities exist among Latinx children who require treatment for respiratory illnesses within the pediatric emergency department (PED). Limited data exist regarding Latinx families' experiences on the care they received at PEDs within non-traditional destination areas (NDA). Their experiences can identify areas of improvement to potentially reduce healthcare disparities among pediatric patients within this population. The purpose of this qualitative study was to explore the lived experiences of Latinx families with low English proficiency in the PED with a NDA. The broader purpose was to identify areas of improvement for reducing health care disparities among Latinx families. METHODS We used qualitative methods to analyze semi-structured interviews among Latinx families who presented to the PED with their 0-2 year-old child for a respiratory illness from May 2019 through January 2020. All participants had low English proficiency and requested a Spanish interpreter during registration. All interviews were transcribed and reviewed using thematic analysis based on a phenomenology framework. RESULTS Interviews were conducted with 16 Latinx parents. Thematic analysis revealed four major themes: (1) Uncertainty - Families expressed uncertainty regarding how to care for a child with distressing symptoms, (2) Communication - Families favored in-person interpreters which enhanced communication and allowed families to feel more informed, (3) System Burden - Families reported that the unfamiliarity with the US health system and lack of resources are additional burdens, and (4) Emotional Support - The emergency department visits garnered confidence and reassurance for families. CONCLUSIONS Our study identified four major themes among Latinx families within a PED of a NDA. Potential areas of interventions should focus on supporting access to an interpreter, improving information delivery, and enhancing education on community resources for families with low English proficiency.
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Affiliation(s)
- Ronine L. Zamor
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA ,grid.189967.80000 0001 0941 6502Present Address: Division of Emergency Medicine, Children’s Healthcare of Atlanta, Emory University, 1547 Clifton Road, NE 2nd Floor, Atlanta, GA 30322 USA
| | - Lisa M. Vaughn
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA
| | - Erin McCann
- grid.239573.90000 0000 9025 8099Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - Luisanna Sanchez
- grid.239573.90000 0000 9025 8099Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - Erica M. Page
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - E. Melinda Mahabee-Gittens
- grid.239573.90000 0000 9025 8099Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267 USA
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Mahabee-Gittens EM, Merianos AL, Stone L, Wullenweber CA, Quintana PJE, Hoh E, Dodder NG, Lopez-Galvez N, Matt GE. Hand nicotine as an independent marker of thirdhand smoke pollution in children's environments. Sci Total Environ 2022; 849:157914. [PMID: 35952873 PMCID: PMC10199779 DOI: 10.1016/j.scitotenv.2022.157914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/22/2022] [Accepted: 08/04/2022] [Indexed: 05/23/2023]
Abstract
BACKGROUND Hand nicotine (HN) levels measure children's exposure to tobacco smoke pollutants from thirdhand and secondhand smoke. HN is associated with urinary and salivary cotinine, but the associations of HN with other tobacco smoke exposure (TSE) markers remain unknown. OBJECTIVES We compared levels of HN and four urinary TSE biomarkers: cotinine, trans-3'-hydroxycotinine (3HC), nicotelline N-oxides, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and children's sociodemographic and TSE patterns. We also examined if HN is a plausible pathway for children's exposure to active smoking. METHODS Data were collected from 175 non-smoking patients (Mean (SD) age = 5.4 (3.4) years) who lived with ≥1 cigarette smoker(s). HN and TSE biomarker levels were determined using LC-MS/MS. Multivariate and multivariable regression analyses were conducted to examine associations between TSE markers and parent-reported measures, controlling for sociodemographics. RESULTS Of the five markers of TSE, cotinine (R2 = 0.221; p = 0.003) and HN (R2 = 0.247; p = 0.001) showed the strongest overall associations. Of the five markers, only cotinine showed significantly higher levels among Black children (β^=0.307,p<0.05) independent of age, reported exposure, and home smoking bans. Cotinine (β^=0.010,p<0.05), NNAL (β^=0.012,p<0.05), and HN (β^=0.011,p<0.05) showed significant positive associations with reported exposure independent of race, age, and home smoking bans. NNAL (β^=-0.285,p<0.05) and HN (β^=-0.336,p<0.05), but not cotinine, 3HC, and N-oxides, showed significantly lower levels among children who lived in homes with smoking bans. Child age, hand surface area, home smoking ban, and reported exposure independently accounted for 21 % of the variance in HN levels (p = 0.002). HN accounted for 30 % of the variance in cotinine independent of child race and child age. DISCUSSION HN levels were associated with modifiable tobacco-related behaviors and shows promise as a marker of sources of THS pollution in a child's environment not captured by measurement of urinary cotinine alone. HN levels provide additional information about TSE, complementing other biomarkers when assessing children's overall TSE.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chase A Wullenweber
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Nathan G Dodder
- School of Public Health, San Diego State University, San Diego, CA, USA; San Diego State University Research Foundation, San Diego, CA, USA
| | - Nicolas Lopez-Galvez
- School of Public Health, San Diego State University, San Diego, CA, USA; San Diego State University Research Foundation, San Diego, CA, USA
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Mendy A, Merianos AL, Mersha TB, Mahabee-Gittens EM. Blood volatile organic compounds associated with non-reversible and reversible airflow obstruction in US adults. Eur Respir J 2022; 60:2201185. [PMID: 36202413 PMCID: PMC10191183 DOI: 10.1183/13993003.01185-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/25/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Angelico Mendy
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Tesfaye B Mersha
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Mahabee-Gittens EM, Han G, Merianos AL. Child Tobacco Smoke Exposure, Indoor Home Characteristics, and Housing Stability among a National Sample of U.S. Children. Toxics 2022; 10:639. [PMID: 36355931 PMCID: PMC9695748 DOI: 10.3390/toxics10110639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
(1) Objectives: To examine the associations of child tobacco smoke exposure (TSE) with home quality and housing instability. (2) Methods. A secondary analysis of 32,066 U.S. 0-11-year-old children from the 2018-2019 National Survey of Children's Health was conducted. Child home TSE status was defined as: no TSE: child lived with no smokers; thirdhand smoke (THS) exposure only: child lived with a smoker(s) who did not smoke indoors; and secondhand smoke (SHS) and THS exposure: child lived with a smoker(s) who smoked indoors. Home quality was assessed by the presence of mold or pesticide use and housing instability was assessed by home ownership, frequency of moves, and number of household members. We conducted weighted multivariable logistic regression and linear regression models while adjusting for important child covariates. (3) Results: In total, 12.3% had home THS exposure only and 1.6% had home SHS and THS exposure. Compared to children with no home TSE, children with home SHS and THS exposure were 2.60 times more likely (95%CI = 1.73, 3.92) to have mold inside their homes; 1.57 times more likely (95%CI = 1.09, 2.26) to live in homes where pesticides were used ≥1 time during the past 12-months; and more likely to have more frequent moves (β = 1.06, 95%CI = 0.62, 1.50). (4) Conclusions: Children with home TSE have higher rates of mold, pesticide use, frequent moves, and household members compared to children with no home TSE. Children with TSE should also be screened for home quality and housing instability and provided with appropriate interventions and resources.
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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, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH 45229, USA
| | - Gang Han
- Department of Epidemiology and Biostatistics, Texas A&M University School of Public Health, College Station, TX 77843, USA
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH 45221, USA
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Gittelman M, Southworth H, Carle AC, Anzeljc S, Qian X, Wervey Arnold M, Mahabee-Gittens EM. Types of Tobacco Products Used by Caregivers of Newborns in the Primary Care Setting. Clin Pediatr (Phila) 2022; 61:535-541. [PMID: 35484841 PMCID: PMC10134048 DOI: 10.1177/00099228221091030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study determined the types of tobacco products used by caregivers who presented to infant well-child visits (WCVs), tobacco product use by other household members, and caregivers' readiness to quit. The Ohio Chapter of the American Academy of Pediatrics conducted a 10-month quality improvement collaborative to improve providers' tobacco screening and cessation counseling practices. A sub-analysis of the initial screenings was performed to determine types of tobacco products used and caregivers' readiness to quit. Fourteen practices (60 providers) participated, and 3972 initial screens were analyzed; 320 (8.1%) caregivers and 490 (12.4%) household members used tobacco products. Most smoking caregivers and household members exclusively used cigarettes (79% and 72%, respectively). There was no difference in caregiver intention to quit by tobacco type, yet 53% of smoking caregivers were ready to quit. Providers should provide screening and cessation counseling to caregivers of infants at WCVs since many are ready to quit.
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Affiliation(s)
- Michael Gittelman
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Ohio Chapter of the American Academy of Pediatrics, Columbus, OH, USA
| | - Hayley Southworth
- Ohio Chapter of the American Academy of Pediatrics, Columbus, OH, USA
| | - Adam C Carle
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Samantha Anzeljc
- Ohio Chapter of the American Academy of Pediatrics, Columbus, OH, USA
| | - Xiaokun Qian
- Ohio Colleges of Medicine, Government Resource Center, Columbus, OH, USA
| | | | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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30
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Mahabee-Gittens EM, Matt GE, Merianos AL. High Levels of the Carcinogenic Tobacco-Specific Nitrosamine NNAL and Associated Findings in Children of Smokers: A Case Series. Biomark Insights 2022; 17:11772719221118868. [PMID: 35982916 PMCID: PMC9379955 DOI: 10.1177/11772719221118868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
High levels of NNAL, the tobacco smoke exposure (TSE) biomarker of the carcinogen
4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), indicate future cancer
risk. A prior study of smokers’ children revealed NNAL levels as high as active
smokers. Therefore, we conducted a case series to examine the sociodemographics,
TSE and clinical patterns, and other TSE biomarker levels in 9 children with
extreme NNAL levels of >200 pg/ml to generate hypotheses and explore
potential causes and implications. We identified 0 to 4-year-olds who presented
to an emergency setting and lived with ⩾1 smoker who were part of a parental
tobacco cessation trial (n = 461). Of these children, 52 had urinary NNAL,
cotinine, and N-oxides results (n = 52). Nine children (17.3%) had NNAL levels
>200 pg/ml, ranging from 206.4 to 1399.0 pg/ml (Median (Mdn) = 489.2 pg/ml;
Interquartile Range (IQR) = 222.7-1289.3 pg/ml). The cotinine Mdn (IQR) was 38.5
(10.3-102.2) ng/ml and the N-oxides Mdn (IQR) = 93.8 (24.7-109.6) pg/ml. While
all biomarker levels were alarmingly high, these young children would not have
been flagged for very high cancer risk based on urinary cotinine levels alone.
This underscores the critical role of comprehensive TSE biomarker measurement in
capturing different TSE exposure patterns and assessing children’s future risk
for cancer and other TSE-related morbidities.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati OH, USA
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Berardi V, Collins BN, Glynn LM, Lepore SJ, Mahabee-Gittens EM, Wilson KM, Hovell MF. Real-time feedback of air quality in children’s bedrooms reduces exposure to secondhand smoke. Tob Prev Cessat 2022; 8:23. [PMID: 35811785 PMCID: PMC9214655 DOI: 10.18332/tpc/149908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/28/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) exposure creates health risks for non-smokers and is especially detrimental to children. This study evaluated whether immediate feedback in response to poor indoor air quality in children’s bedrooms can reduce the potential for SHS exposure, as measured by adherence to a World Health Organization (WHO) indoor air standard. METHODS Homes that contained children and an adult who regularly smoked inside (n=298) had an air particle monitor installed in the child’s bedroom. These devices measured the concentration of particulate matter (PM2.5) for approximately three months and, for half of the participants, immediately provided aversive feedback in response to elevated PM2.5. Hierarchical linear models were fit to the data to assess whether the intervention increased the probability that: 1) a given day was below the WHO guideline for daily exposure, and 2) a household established and maintained a smoke-free home (SFH), operationalized as achieving 30 consecutive days below the WHO guideline. The intervention’s impact was calculated as group-by-time effects. RESULTS The likelihood that a child’s bedroom met the WHO indoor air quality standard on a given day increased such that the baseline versus post-baseline odds ratio (OR) of maintaining indoor PM2.5 levels below the WHO guideline was 2.38 times larger for participants who received the intervention. Similarly, the baseline versus post-baseline OR associated with achieving an SFH was 3.49 times larger for participants in the intervention group. CONCLUSIONS The real-time intervention successfully drove clinically meaningful changes in smoking behavior that mitigated indoor PM2.5 levels in children’s bedrooms and thereby reduced SHS exposure. These results demonstrate the effectiveness of targeting sensitive microenvironments by giving caregivers actionable information about children’s SHS risks. Future extensions should examine additional microenvironments and focus on identifying the potential for SHS exposure before it occurs.
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Affiliation(s)
- Vincent Berardi
- Department of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, United States
| | - Bradley N. Collins
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, United States
| | - Laura M. Glynn
- Department of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, United States
| | - Stephen J. Lepore
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, United States
| | - E. Melinda Mahabee-Gittens
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Karen M. Wilson
- University of Rochester Medical Center, Rochester, United States
| | - Melbourne F. Hovell
- San Diego State University Graduate School of Public Health, San Diego, United States
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Mahabee-Gittens EM, Vidourek RA, King KA, Merianos AL. Home Tobacco Smoke Exposure and Neighborhood Support and Safety among U.S. School-aged Children. Health Behav Res 2022; 5:6. [PMID: 38107160 PMCID: PMC10722861 DOI: 10.4148/2572-1836.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Children who are socioeconomically disadvantaged face a myriad of environmental hardships in the neighborhoods in which they live. This study examined the associations between home tobacco smoke exposure (TSE) and neighborhood support, neighborhood safety, and school safety among U.S. school-aged children. Children ages 6-11 years were included in this secondary analysis of 2018-2019 National Survey of Children's Health data (N = 17,300). Children's home TSE status was categorized into three levels: (1) no TSE: Child did not live with a smoker; (2) Outside TSE only: Child lived with a smoker who did not smoke inside the home; and (3) Inside TSE: Child lived with a smoker who smoked inside the home. Parent-reported measures of perceived neighborhood support, and neighborhood and school safety were examined; covariates included the child's age, sex, and race/ethnicity; the parent's education; the family's household structure, and federal poverty level. Weighted logistic and ordinal regression models were built adjusting for the covariates. In total, 13.2% of children had outside TSE and 1.7% of children had inside TSE. Multivariable logistic regression model results indicated that children with outside TSE were at decreased odds (AOR = 0.79, 95%CI = 0.65-0.96) of living in a supportive neighborhood compared to children with no TSE. Ordinal regression model results indicated that children with outside TSE (AOR = 0.77, 95%CI = 0.61-0.97) and children with inside TSE were at decreased odds (AOR = 0.62, 95%CI = 0.39-0.99) of going to a school that was perceived as safe. Community-level programs, policies, and funding are needed to improve neighborhood characteristics among children with TSE to improve their future health outcomes.
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Merianos AL, Russell AM, Mahabee-Gittens EM, Barry AE, Yang M, Lin HC. Concurrent use of e-cigarettes and cannabis and associated COVID-19 symptoms, testing, and diagnosis among student e-cigarette users at four U.S. Universities. Addict Behav 2022; 126:107170. [PMID: 34776303 PMCID: PMC8570844 DOI: 10.1016/j.addbeh.2021.107170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 12/27/2022]
Abstract
Introduction This investigation assessed whether current (past 30-day) electronic cigarette (e-cigarette) and cannabis use was associated with coronavirus disease 2019 (COVID-19) symptomatology, testing, and diagnosis among college student e-cigarette users. Methods Participants were 18–26-year-old college student e-cigarette users attending four geographically diverse, large U.S. public universities during October-December 2020 (N = 800). Multivariable logistic regression models explored associations between exclusive e-cigarette use and concurrent e-cigarette and cannabis use and COVID-19 symptoms, testing, and diagnosis. Models controlled for demographics, university site, and current use of combustible cigarettes, cigars, and smokeless tobacco. Results Over half of student e-cigarette users (52.0%) concurrently used cannabis. Compared to exclusive e-cigarette users, concurrent e-cigarette and cannabis users were 3.53 times more likely (95%CI = 1.96–6.36) to report COVID-19 symptoms, after adjusting for the covariates. Compared to infrequent exclusive e-cigarette users, infrequent concurrent users (AOR = 4.72, 95%CI = 1.31–17.00), intermediate concurrent users (AOR = 5.10, 95%CI = 1.37–18.97), and frequent concurrent users (AOR = 7.44, 95%CI = 2.06–26.84) were at increased odds of reporting COVID-19 symptoms. Compared to exclusive e-cigarette users, concurrent e-cigarette and cannabis users were 1.85 times more likely (95%CI = 1.15–2.98) to report a COVID-19 diagnosis. Intermediate concurrent users (AOR = 2.88, 95%CI = 1.13–7.35) and frequent concurrent users (AOR = 3.22, 95%CI = 1.32–7.87) were at increased odds of reporting a COVID-19 diagnosis, compared to infrequent exclusive e-cigarette users. Conclusions Concurrent use of e-cigarettes and cannabis may be an underlying risk factor of COVID-19 symptomatology and diagnosis, with more pronounced odds found among intermediate and frequent users. Results highlight the need to educate students about the impacts of e-cigarette and cannabis use on respiratory, immune, and overall health.
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Abstract
This cross-sectional study examines the prevalence of and income-related disparities associated with exposure to thirdhand smoke among children.
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Affiliation(s)
- Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, California
| | | | | | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, California
| | - Nathan G. Dodder
- School of Public Health, San Diego State University, San Diego, California
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Merianos AL, Fiser KA, Mahabee-Gittens EM, Lyons MS, Gordon JS. Barriers to implementation of pediatric emergency department interventions for parental tobacco use and dependence: a qualitative study using the theoretical domains framework. Implement Sci Commun 2022; 3:3. [PMID: 35022066 PMCID: PMC8754362 DOI: 10.1186/s43058-021-00251-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pediatric emergency department (PED) and urgent care (UC) professionals can play a key role in delivering evidence-based guidelines to address parental tobacco use and child tobacco smoke exposure (TSE). Understanding PED/UC professionals’ perceptions regarding these guidelines is the first step in developing and implementing a TSE screening and counseling intervention in these settings. This study aimed to use the theoretical domains framework (TDF) to identify current screening and counseling behaviors of PED/UC professionals related to parental tobacco use and child TSE, and determine barriers and enablers that influence these behaviors. Methods Semi-structured, focused interviews were conducted with 29 actively practicing PED/UC clinical staff who worked at one large, Midwestern children’s hospital. The interview guide was informed by the TDF and included open-ended questions. Content analysis of interview transcripts was guided by the TDF. Nurses, physicians, and healthcare administrators were assessed overall and by group membership to ensure each group was represented based on their varying PED/UC roles. Results Fifty-one percent were nurses, 38% were physicians, and 11% were healthcare administrators. Most PED/UC professionals did not currently follow the guidelines, but perceived addressing parental tobacco use as part of their role. All 14 TDF domains were identified by nurses, physicians, and administrators in relation to counseling for parental tobacco use and child TSE. Domains with the most sub-themes were (1) knowledge: lack of knowledge about tobacco counseling, including implementing counseling, cessation resources/referrals, and thirdhand smoke; (2) beliefs about capabilities: not comfortable counseling parents, easier to discuss with parents who are receptive and to ask and advise when patients have a TSE-related complaint, and more likely to discuss if there were resources/referrals; and (3) environmental context and resources: barriers include lack of time, training, and resources and referral information to give to parents, and an enabler is using TSE-related complaints as a context to offer counseling. Conclusions Study findings provide a strong foundation for developing and implementing clinical practice guidelines regarding parental tobacco use and child TSE in the PED/UC setting. Future intervention development will address all TDF domains and test the implementation of the intervention in the PED/UC setting.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH, 45221-0068, USA. .,Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Kayleigh A Fiser
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH, 45221-0068, USA
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, College of Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Michael S Lyons
- Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Department of Emergency Medicine, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0769, USA
| | - Judith S Gordon
- College of Nursing, The University of Arizona, 1305 N Martin Avenue, PO Box 210203, Tucson, AZ, 85721-0203, USA
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Mahabee-Gittens EM, Quintana PJE, Hoh E, Merianos AL, Stone L, Lopez-Galvez N, Matt GE. Collecting Hand Wipe Samples to Assess Thirdhand Smoke Exposure. Front Public Health 2021; 9:770505. [PMID: 34988051 PMCID: PMC8720752 DOI: 10.3389/fpubh.2021.770505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- *Correspondence: E. Melinda Mahabee-Gittens
| | | | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, United States
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nicolas Lopez-Galvez
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, CA, United States
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Merianos AL, Fiser K, Mahabee-Gittens EM, Lyons MS, Stone L, Gordon JS. Clinical decision support for tobacco screening and counseling parents of pediatric patients: A qualitative analysis of pediatric emergency department and urgent care professionals. Drug Alcohol Depend Rep 2021; 2:100019. [PMID: 36845898 PMCID: PMC9948809 DOI: 10.1016/j.dadr.2021.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
Background Clinical Decision Support Systems (CDSS) embedded into electronic medical records is a best practices approach. However, information is needed on how to incorporate a CDSS to facilitate parental tobacco cessation counseling and reduce child tobacco smoke exposure (TSE) in Pediatric Emergency Department (PED) and Urgent Care (UC) settings. The objective was to explore the barriers and enablers of CDSS use to facilitate child TSE screening and parental tobacco cessation counseling by PED/UC nurses and physicians. Methods We conducted 29 semi-structured, focused interviews with nurses (n = 17) and physicians (n = 12) at a children's hospital PED/UC. The interview guide included a brief presentation about the design and components of a prior CDSS tobacco intervention. Participants were asked their opinions about CDSS components and recommendations for adapting and implementing the CDSS tobacco intervention in the PED/UC setting. A thematic framework analysis method was used to code and analyze qualitative data. Results Participant mean (± SD) age was 42 (± 10.1) years; the majority were female (82.8%), non-Hispanic white (93.1%), and never tobacco users (86.2%); all were never electronic cigarette users. Four themes emerged: (1) explore optimal timing to complete CDSS screening and counseling during visits; (2) CDSS additional information and feedback needs; (3) perceived enablers to CDSS use, such as the systematic approach; and (4) perceived barriers to CDSS use, such as lack of time and staff. Conclusions The CDSS intervention for child TSE screening and parental tobacco cessation during PED/UC visits received endorsements and suggestions for optimal implementation from nurses and physicians.
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Affiliation(s)
- Ashley L. Merianos
- University of Cincinnati, School of Human Services, PO Box 210068, Cincinnati, OH, 45221-0068, United States
- University of Cincinnati, College of Medicine, Center for Addiction Research, Cincinnati, OH, United States
- Corresponding author at: PO Box 210068, Cincinnati, OH, 45221-0068, United States
| | - Kayleigh Fiser
- University of Cincinnati, School of Human Services, PO Box 210068, Cincinnati, OH, 45221-0068, United States
| | - E. Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati, College of Medicine, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, United States
| | - Michael S. Lyons
- University of Cincinnati, College of Medicine, Center for Addiction Research, Cincinnati, OH, United States
- University of Cincinnati, College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way, ML 0769, Cincinnati, OH, 45267-0769, United States
| | - Lara Stone
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, United States
| | - Judith S. Gordon
- The University of Arizona, College of Nursing, 1305 N Martin Avenue, PO Box 210203, Tucson, AZ, 85721-0203, United States
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Merianos AL, Russell AM, Mahabee-Gittens EM, Barry AE, Yang M, Lin HC. Assessment of Exclusive, Dual, and Polytobacco E-Cigarette Use and COVID-19 Outcomes Among College Students. Am J Health Promot 2021; 36:421-428. [PMID: 34865520 PMCID: PMC8851046 DOI: 10.1177/08901171211055904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose This study examined current (past 30-day) dual- and polytobacco use patterns and COVID-19 symptomatology, testing, and diagnosis status among college student electronic cigarette (e-cigarette) users. Design Cross-sectional online questionnaire administered during October–December 2020. Setting Four large, U.S. public universities in geographically diverse locations. Sample College students (N=756) ages 18–24 who reported current e-cigarette use. Measures Current use of e-cigarettes, combustible cigarettes, and cigars, and self-reported COVID-19 symptomatology, testing, and diagnosis status were measured. Analysis Multivariable logistic regression models accounting for students’ demographics, university site, fraternity/sorority membership, and current residence. Results Over half (53.6%) of students were exclusive e-cigarette users, 20.4% were dual e-cigarette and combustible cigarette users, 4.6% were dual e-cigarette and cigar users, and 21.4% were poly users of e-cigarettes, combustible cigarettes, and cigars. Compared to exclusive e-cigarette users, dual users of e-cigarettes and combustible cigarettes (AOR=2.12, 95%CI=1.05–4.27) and poly users of e-cigarettes, combustible cigarettes, and cigars (AOR=3.70, 95%CI=1.78–7.70) had increased odds of COVID-19 symptomatology, even when accounting for covariates. While current tobacco use groups did not differ based on COVID-19 testing, polytobacco users had significantly increased odds (AOR=2.16, 95%CI=1.11–4.20) of having received a positive COVID-19 diagnosis. Conclusion Given use of two or more tobacco products increased COVID-19-related risks, results underscore the need to prevent dual- and polytobacco use behaviors in college student e-cigarette users.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, 2514University of Cincinnati, Cincinnati, OH, USA
| | - Alex M Russell
- Department of Health, Human Performance, and Recreation, 3341University of Arkansas Fayetteville, Fayetteville, AR, USA
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, 2518University of Cincinnati, Cincinnati, OH, USA
| | - Adam E Barry
- Department of Health and Kinesiology, 14736Texas A&M University, College Station, TX, USA
| | - Meng Yang
- Department of Applied Health Science, 1771Indiana University School of Public Health - Bloomington, Bloomington, IN, USA
| | - Hsien-Chang Lin
- Department of Applied Health Science, 1771Indiana University School of Public Health - Bloomington, Bloomington, IN, USA
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Kelley ST, Liu W, Quintana PJ, Hoh E, Dodder NG, Mahabee-Gittens EM, Padilla S, Ogden S, Frenzel S, Sisk-Hackworth L, Matt GE. Altered microbiomes in thirdhand smoke-exposed children and their home environments. Pediatr Res 2021; 90:1153-1160. [PMID: 33654287 PMCID: PMC8410873 DOI: 10.1038/s41390-021-01400-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Tobacco smoke contains numerous toxic chemicals that accumulate in indoor environments creating thirdhand smoke (THS). We investigated if THS-polluted homes differed in children's human and built-environment microbiomes as compared to THS-free homes. METHODS Participants were n = 19 THS-exposed children and n = 10 unexposed children (≤5 years) and their caregivers. Environmental and biological samples were analyzed for THS pollutants and exposure. Swab samples were collected from the built-environment (floor, table, armrest, bed frame) and child (finger, nose, mouth, and ear canal), and 16S ribosomal RNA genes were analyzed for bacterial taxa using high-throughput DNA sequencing. RESULTS Phylogenetic α-diversity was significantly higher for the built-environment microbiomes in THS-polluted homes compared to THS-free homes (p < 0.014). Log2-fold comparison found differences between THS-polluted and THS-free homes for specific genera in samples from the built-environment (e.g., Acinetobacter, Bradyrhizobium, Corynebacterium, Gemella, Neisseria, Staphylococcus, Streptococcus, and Veillonella) and in samples from children (esp. Corynebacterium, Gemella, Lautropia, Neisseria, Rothia, Staphylococcus, and Veillonella). CONCLUSION When exposed to THS, indoor and children microbiomes are altered in an environment-specific manner. Changes are similar to those reported in previous studies for smokers and secondhand smoke-exposed persons. THS-induced changes in child and built-environmental microbiomes may play a role in clinical outcomes in children. IMPACT Despite smoking bans, children can be exposed to tobacco smoke residue (i.e., thirdhand smoke) that lingers on surfaces and in settled house dust. Thirdhand smoke exposure is associated with changes in the microbiomes of the home environment and of the children living in these homes. Thirdhand smoke is associated with increased phylogenetic diversity of the home environment and changes in the abundances of several genera of the child microbiome known to be affected by active smoking and secondhand smoke (e.g., Corynebacterium, Staphylococcus, Streptococcus). Thirdhand smoke exposure by itself may induce alterations in the microbiome that play a role in childhood pathologies.
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Affiliation(s)
| | - William Liu
- San Diego State University, San Diego CA, USA
| | | | - Eunha Hoh
- San Diego State University, San Diego CA, USA
| | | | - E. Melinda Mahabee-Gittens
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, U.S.A
| | | | - Shawn Ogden
- San Diego State University, San Diego CA, USA
| | - Sia Frenzel
- San Diego State University, San Diego CA, USA
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Merianos AL, Jandarov RA, Cataletto M, Mahabee-Gittens EM. Tobacco smoke exposure and fractional exhaled nitric oxide levels among U.S. adolescents. Nitric Oxide 2021; 117:53-59. [PMID: 34688860 DOI: 10.1016/j.niox.2021.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/14/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) can objectively guide clinical practice in the assessment, diagnosis, and treatment of eosinophilic airway inflammation. FeNO values may be affected by current smoking, but the role of tobacco smoke exposure (TSE) is understudied. OBJECTIVE This study investigated the associations between biochemically validated and self-reported TSE and FeNO levels among U.S. nonsmoking adolescents without asthma. METHODS National Health and Nutrition Examination Survey 2007-2012 data were used. TSE was assessed via serum cotinine and self-reported measures. We assessed FeNO continuously and using cutpoints of >35 ppb and >50 ppb to indicate likely eosinophilic inflammation in children and adults, respectively. We conducted linear and logistic regression adjusting for potential covariates. RESULTS Overall, 34.0% of adolescents had low cotinine (0.05-2.99 ng/ml), 6.2% had high cotinine (≥3.00 ng/ml), and 11.9% had home TSE. Compared to adolescents with no/minimal cotinine, adolescents with high cotinine were at reduced odds to have FeNO >35 ppb (adjusted odds ratio [aOR] = 0.54, 95%CI = 0.43,0.69). Adolescents with low cotinine had lower FeNO values (β = -2.05, 95%CI = -3.61,-0.49), and were also at decreased odds to have FeNO >35 ppb (aOR = 0.74, 95%CI = 0.66,0.83) and FeNO >50 ppb (aOR = 0.62, 95%CI = 0.53,0.72). Adolescents with home TSE were at reduced odds to have FeNO >50 ppb (aOR = 0.72, 95%CI = 0.57,0.91) than adolescents without home TSE. Adolescents with a higher number of cigarettes/day smoked inside their home were at reduced odds to have FeNO >35 ppb (OR = 0.98, 95%CI = 0.97,0.99) and FeNO >50 ppb (OR = 0.98, 95%CI = 0.96,0.99). CONCLUSIONS TSE was associated with decreased FeNO levels. The addition of TSE may be clinically important when interpreting thresholds for FeNO.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA.
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, 162 Kettering Lab Building, 160 Panzeca Way, Cincinnati, OH, 45267-0056, USA.
| | - Mary Cataletto
- Department of Pediatrics, NYU Long Island School of Medicine, 222 Station Plaza North, Mineola, NY, 11501, USA.
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, USA.
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mahabee-Gittens EM, Merianos AL, Jandarov RA, Quintana PJE, Hoh E, Matt GE. Differential associations of hand nicotine and urinary cotinine with children's exposure to tobacco smoke and clinical outcomes. Environ Res 2021; 202:111722. [PMID: 34297932 PMCID: PMC8578289 DOI: 10.1016/j.envres.2021.111722] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Children's overall tobacco smoke exposure (TSE) consists of both inhalation of secondhand smoke (SHS) and ingestion, dermal uptake, and inhalation of thirdhand smoke (THS) residue from dust and surfaces in their environments. OBJECTIVES Our objective was to compare the different roles of urinary cotinine as a biomarker of recent overall TSE and hand nicotine as a marker of children's contact with nicotine pollution in their environments. We explored the differential associations of these markers with sociodemographics, parental smoking, child TSE, and clinical diagnoses. METHODS Data were collected from 276 pediatric emergency department patients (Median age = 4.0 years) who lived with a cigarette smoker. Children's hand nicotine and urinary cotinine levels were determined using LC-MS/MS. Parents reported tobacco use and child TSE. Medical records were reviewed to assess discharge diagnoses. RESULTS All children had detectable hand nicotine (GeoM = 89.7ng/wipe; 95 % CI = [78.9; 102.0]) and detectable urinary cotinine (GeoM = 10.4 ng/ml; 95%CI = [8.5; 12.6]). Although hand nicotine and urinary cotinine were highly correlated (r = 0.62, p < 0.001), urinary cotinine geometric means differed between racial groups and were higher for children with lower family income (p < 0.05), unlike hand nicotine. Independent of urinary cotinine, age, race, and ethnicity, children with higher hand nicotine levels were at increased risk to have discharge diagnoses of viral/other infectious illness (aOR = 7.49; 95%CI = [2.06; 27.24], p = 0.002), pulmonary illness (aOR = 6.56; 95%CI = [1.76; 24.43], p = 0.005), and bacterial infection (aOR = 5.45; 95%CI = [1.50; 19.85], p = 0.03). In contrast, urinary cotinine levels showed no associations with diagnosis independent of child hand nicotine levels and demographics. DISCUSSION The distinct associations of hand nicotine and urinary cotinine suggest the two markers reflect different exposure profiles that contribute differentially to pediatric illness. Because THS in a child's environment directly contributes to hand nicotine, additional studies of children of smokers and nonsmokers are warranted to determine the role of hand nicotine as a marker of THS exposure and its potential role in the development of tobacco-related pediatric illnesses.
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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, Cincinnati, OH, USA.
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Roman A Jandarov
- Department of Environmental Health, Division of Biostatistics and Bioinformatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Merianos AL, Mahabee-Gittens EM, Choi K. Tobacco smoke exposure and inadequate sleep among U.S. school-aged children. Sleep Med 2021; 86:99-105. [PMID: 34479053 DOI: 10.1016/j.sleep.2021.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE/BACKGROUND Inadequate sleep and tobacco smoke exposure (TSE) have been separately linked to adverse childhood health consequences. Our objective was to assess the association between home TSE status and inadequate sleep among U.S. school-aged children. METHODS We analyzed 2018-2019 National Survey of Children's Health data, and included 17,851 children ages 6-11 years. Children were classified into three parent-report TSE groups: (1) did not live with a smoker (no TSE at home); (2) lived with a smoker who did not smoke inside the home (thirdhand smoke (THS) exposure only); and (3) lived with a smoker who smoked inside the home (secondhand smoke (SHS) and THS exposure). Parent-report of inadequate sleep on most weeknights was defined as <9 h, following age-specific national guidelines. We fitted a weighted multivariable logistic model to assess the association between TSE groups and inadequate sleep, adjusting for child covariates (sociodemographics, overweight status, health status, physical activity, and screen time). RESULTS About 13% and 1% of school-aged children were exposed to home THS only and home SHS and THS, respectively; approximately 36% overall had inadequate sleep. Compared to children with no TSE at home, children who were exposed to home THS only had higher odds of inadequate sleep (AOR = 1.44, 95%CI = 1.20-1.73); those exposed to home SHS and THS had higher odds of inadequate sleep (AOR = 1.83, 95%CI = 1.20-2.78). CONCLUSIONS TSE is associated with school-aged children having inadequate sleep, even when smokers did not smoke inside the home. Promoting parental smoking cessation is essential to fully protect children from related risks.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA.
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mahabee-Gittens EM, Mendy A, Merianos AL. Assessment of Severe COVID-19 Outcomes Using Measures of Smoking Status and Smoking Intensity. Int J Environ Res Public Health 2021; 18:ijerph18178939. [PMID: 34501529 PMCID: PMC8431679 DOI: 10.3390/ijerph18178939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
Objective: Smoking status does not indicate the amount or length of tobacco use, and thus, it is an imperfect measure to assess the association between cigarette smoking and severe coronavirus disease 2019 (COVID-19) outcomes. This investigation assessed whether cigarette smoking status, intensity of smoking (i.e., average daily packs of cigarettes smoked), duration of smoking, and pack-years of smoking are associated with severe outcomes among adults diagnosed with COVID-19. Methods: We conducted a retrospective, cross-sectional study in which we identified consecutive patients diagnosed with COVID-19 at the University of Cincinnati healthcare system between 13 March 2020 and 30 September 2020 who had complete information on smoking status, severe COVID-19 outcomes, and covariates (i.e., demographics and comorbidities). We used logistic regression to evaluate the associations of smoking status and intensity of smoking with COVID-19 severity, defined as hospitalization, admission to intensive care unit (ICU), or death, adjusting for sociodemographics and comorbidities. Results: Among the 4611 COVID-19 patients included in the analysis, 18.2% were current smokers and 20.7% were former smokers. The prevalence of COVID-19 outcomes was 28.9% for hospitalization, 9.8% for ICU admission, and 1.4% for death. In the adjusted analysis, current smoking (AOR: 1.23, 95% CI: 1.02–1.49), former smoking (AOR: 1.28, 95% CI: 1.07–1.54), and pack-years of smoking (AOR: 1.09, 95% CI: 1.02–1.17) were associated with a higher prevalence of hospitalization. Average daily packs of cigarettes smoked was associated with a higher prevalence of hospitalization (AOR: 1.30, 95% CI: 1.10–1.53) and ICU admission (AOR: 1.23, 95% CI: 1.04–1.44). Conclusions: Smoking status, pack-years, and intensity of smoking were associated with hospitalizations in patients with COVID-19 and intensity of smoking was associated with ICU admission. The findings underscore the need for detailed information beyond smoking status when evaluating smokers with COVID-19 so that the potential for adverse sequelae may be optimally managed in at-risk patients.
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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
| | - Angelico Mendy
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA;
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Merianos AL, Mahabee-Gittens EM, Jacobs W, Oloruntoba O, Barry AE, Smith ML. Self-Perceptions, Normative Beliefs, and Substance Use Associated With High School Girls Comparing Themselves to Peers. J Sch Health 2021; 91:482-489. [PMID: 33786816 PMCID: PMC8218720 DOI: 10.1111/josh.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/11/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND We assessed whether self-descriptions, self-perceptions, perceived substance use of friends, and actual substance use were associated with high school girls' frequency of making social comparisons to peers. METHODS We analyzed data from the Adolescent Health Risk Behavior Survey data for 357 high school girls using multinomial logistic regression. RESULTS Compared to those who "never/rarely" made social comparisons, participants who self-described as fearing something constantly (p = .014) and forced to imitate the people they like (p = .009) were more likely to "usually" compare themselves to peers. Participants who described themselves as feeling forced to imitate the people they like (p = .022), were not the person they would like to be (p = .005), and did not remain calm under pressure (p = .010), were more likely to "often/always" make social comparisons. Participants who perceived themselves as unattractive (p = .034) and self-centered (p = .016) were more likely to "often/always" make social comparisons. Participants who perceived a larger proportion of friends use illicit drugs were less likely to "usually" make social comparisons (p = .027). Participants who perceived a larger proportion of friends drink alcohol were more likely to "often/always" make social comparisons (p = .018). CONCLUSIONS Girls who perceive and describe themselves more negatively are at increased odds of making social comparisons to peers.
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Affiliation(s)
- Ashley L Merianos
- University of Cincinnati, PO Box 210068, Cincinnati, OH, 45221-0068, USA
| | - E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati, College of Medicine, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, USA
| | - Wura Jacobs
- Department of Kinesiology, California State University Stanislaus, One University Circle, Turlock, CA, 95382, USA
| | - Oluyomi Oloruntoba
- School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX, 77843, USA
| | - Adam E Barry
- Department of Health and Kinesiology, Texas A&M University, 332C Blocker Building, College Station, TX, 77843, USA
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX, 77843, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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King CA, Brent D, Grupp-Phelan J, Casper TC, Dean JM, Chernick LS, Fein JA, Mahabee-Gittens EM, Patel SJ, Mistry RD, Duffy S, Melzer-Lange M, Rogers A, Cohen DM, Keller A, Shenoi R, Hickey RW, Rea M, Cwik M, Page K, McGuire TC, Wang J, Gibbons R. Prospective Development and Validation of the Computerized Adaptive Screen for Suicidal Youth. JAMA Psychiatry 2021; 78:540-549. [PMID: 33533908 PMCID: PMC7859874 DOI: 10.1001/jamapsychiatry.2020.4576] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The rate of suicide among adolescents is rising in the US, yet many adolescents at risk are unidentified and receive no mental health services. OBJECTIVE To develop and independently validate a novel computerized adaptive screen for suicidal youth (CASSY) for use as a universal screen for suicide risk in medical emergency departments (EDs). DESIGN, SETTING, AND PARTICIPANTS Study 1 of this prognostic study prospectively enrolled adolescent patients at 13 geographically diverse US EDs in the Pediatric Emergency Care Applied Research Network. They completed a baseline suicide risk survey and participated in 3-month telephone follow-ups. Using 3 fixed Ask Suicide-Screening Questions items as anchors and additional items that varied in number and content across individuals, we derived algorithms for the CASSY. In study 2, data were collected from patients at 14 Pediatric Emergency Care Applied Research Network EDs and 1 Indian Health Service hospital. Algorithms were independently validated in a prospective cohort of adolescent patients who also participated in 3-month telephone follow-ups. Adolescents aged 12 to 17 years were consecutively approached during randomly assigned shifts. EXPOSURES Presentation at an ED. MAIN OUTCOME AND MEASURE A suicide attempt between ED visit and 3-month follow-up, measured via patient and/or parent report. RESULTS The study 1 CASSY derivation sample included 2075 adolescents (1307 female adolescents [63.0%]; mean [SD] age, 15.1 [1.61] years) with 3-month follow-ups (72.9% retention [2075 adolescents]). The study 2 validation sample included 2754 adolescents (1711 female adolescents [62.1%]; mean [SD] age, 15.0 [1.65] years), with 3-month follow-ups (69.5% retention [2754 adolescents]). The CASSY algorithms had excellent predictive accuracy for suicide attempt (area under the curve, 0.89 [95% CI, 0.85-0.91]) in study 1. The mean number of adaptively administered items was 11 (range, 5-21). At a specificity of 80%, the CASSY had a sensitivity of 83%. It also demonstrated excellent accuracy in the study 2 validation sample (area under the curve, 0.87 [95% CI, 0.85-0.89]). In this study, the CASSY had a sensitivity of 82.4% for prediction of a suicide attempt at the 80% specificity cutoff established in study 1. CONCLUSIONS AND RELEVANCE In this study, the adaptive and personalized CASSY demonstrated excellent suicide attempt risk recognition, which has the potential to facilitate linkage to services.
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Affiliation(s)
- Cheryl A. King
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Lauren S. Chernick
- Department of Emergency Medicine and Pediatrics, Columbia University Medical Center, New York, New York
| | - Joel A. Fein
- Center for Violence Prevention, Children’s Hospital of Philadelphia, Division of Emergency Medicine, University of Pennsylvania, Philadelphia
| | | | - Shilpa J. Patel
- Division of Emergency Medicine, Children’s National Hospital, Washington, DC
| | - Rakesh D. Mistry
- Department of Pediatrics–Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Susan Duffy
- Department of Emergency Medicine, Alpert Medical School at Brown University, Providence, Rhode Island,Department of Pediatrics, Alpert Medical School at Brown University, Providence, Rhode Island
| | | | - Alexander Rogers
- Department of Emergency Medicine, University of Michigan, Ann Arbor,Department of Pediatrics, University of Michigan, Ann Arbor
| | - Daniel M. Cohen
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Allison Keller
- Department of Pediatric Emergency Medicine, The University of Utah, Salt Lake City
| | - Rohit Shenoi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Robert W. Hickey
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Margaret Rea
- Medical Center at the University of California School of Medicine, Davis, Sacramento
| | - Mary Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kent Page
- The University of Utah School of Medicine, Salt Lake City
| | | | - Jiebiao Wang
- Department of Statistics and Data Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Robert Gibbons
- Department of Medicine, The University of Chicago, Chicago, Illinois,Department of Public Health Sciences (Biostatistics), The University of Chicago, Chicago, Illinois,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois,Department of Comparative Human Development, The University of Chicago, Chicago, Illinois
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mahabee-Gittens EM, Merianos AL, Matt GE. Comment regarding categorization of Third-hand smoke exposure in "Third-hand Exposure at Homes: Assessment Using Salivary Cotinine". Environ Res 2021; 195:110595. [PMID: 33556354 PMCID: PMC8195292 DOI: 10.1016/j.envres.2020.110595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Affiliation(s)
- E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati, College of Medicine, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229-3039, USA.
| | - Ashley L Merianos
- University of Cincinnati, School of Human Services, PO Box 210068, Cincinnati, OH, 45221-0068, USA.
| | - Georg E Matt
- San Diego State University, College of Sciences, Department of Psychology, MC4611, San Diego, CA, 92182-4611, USA.
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