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O’Sharkey K, Xu Y, Cabison J, Rosales M, Chavez T, Johnson M, Yang T, Cho SH, Chartier R, Lerner D, Lurvey N, Toledo Corral CM, Cockburn M, Franklin M, Farzan SF, Bastain TM, Breton CV, Habre R. A Comparison of Measured Airborne and Self-Reported Secondhand Smoke Exposure in the MADRES Pregnancy Cohort Study. Nicotine Tob Res 2024; 26:669-677. [PMID: 37846518 PMCID: PMC11109487 DOI: 10.1093/ntr/ntad202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/26/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Secondhand smoke (SHS) exposure during pregnancy is linked to adverse birth outcomes, such as low birth weight and preterm birth. While questionnaires are commonly used to assess SHS exposure, their ability to capture true exposure can vary, making it difficult for researchers to harmonize SHS measures. This study aimed to compare self-reported SHS exposure with measurements of airborne SHS in personal samples of pregnant women. METHODS SHS was measured on 48-hour integrated personal PM2.5 Teflon filters collected from 204 pregnant women, and self-reported SHS exposure measures were obtained via questionnaires. Descriptive statistics were calculated for airborne SHS measures, and analysis of variance tests assessed group differences in airborne SHS concentrations by self-reported SHS exposure. RESULTS Participants were 81% Hispanic, with a mean (standard deviation [SD]) age of 28.2 (6.0) years. Geometric mean (SD) personal airborne SHS concentrations were 0.14 (9.41) µg/m3. Participants reporting lower education have significantly higher airborne SHS exposure (p = .015). Mean airborne SHS concentrations were greater in those reporting longer duration with windows open in the home. There was no association between airborne SHS and self-reported SHS exposure; however, asking about the number of smokers nearby in the 48-hour monitoring period was most correlated with measured airborne SHS (Two + smokers: 0.30 µg/m3 vs. One: 0.12 µg/m3 and Zero: 0.15 µg/m3; p = .230). CONCLUSIONS Self-reported SHS exposure was not associated with measured airborne SHS in personal PM2.5 samples. This suggests exposure misclassification using SHS questionnaires and the need for harmonized and validated questions to characterize this exposure in health studies. IMPLICATIONS This study adds to the growing body of evidence that measurement error is a major concern in pregnancy research, particularly in studies that rely on self-report questionnaires to measure SHS exposure. The study introduces an alternative method of SHS exposure assessment using objective optical measurements, which can help improve the accuracy of exposure assessment. The findings emphasize the importance of using harmonized and validated SHS questionnaires in pregnancy health research to avoid biased effect estimates. This study can inform future research, practice, and policy development to reduce SHS exposure and its adverse health effects.
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Affiliation(s)
- Karl O’Sharkey
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Yan Xu
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Jane Cabison
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Marisela Rosales
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Thomas Chavez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Mark Johnson
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Tingyu Yang
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Seung-Hyun Cho
- Research Triangle Institute, Research Triangle Park, NC, USA
| | - Ryan Chartier
- Research Triangle Institute, Research Triangle Park, NC, USA
| | | | | | - Claudia M Toledo Corral
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Department of Health Sciences, California State University Northridge, Northridge, CA, USA
| | - Myles Cockburn
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Meredith Franklin
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Department of Statistical Sciences, School of the Environment, University of Toronto, Toronto, Ontario, Canada
| | - Shohreh F Farzan
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Carrie V Breton
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Rima Habre
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
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Wan Z, Zhang X, He H, Zhang Y, Chen GC, Qin LQ, Zhang N, Li FR. Secondhand Smoke Exposure and Risk of Dementia in Nonsmokers: A Population-Based Cohort Study. Neuroepidemiology 2024; 58:166-173. [PMID: 38417408 DOI: 10.1159/000535828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/06/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Large population-based prospective studies are necessary to provide clarification on the associations of panoramic secondhand smoking burden, including prenatal and postnatal secondhand smoke (SHS) exposure, with the risk of developing dementia. METHODS Our study comprised a sample of 353,756 dementia-free individuals from the UK Biobank who were nonsmokers had data on the exposure of maternal smoking as well as SHS exposure in daily life, which was quantified in terms of hours per week (h/week) and whether they lived with household smokers. Multivariable Cox regression models were utilized to analyze the independent and joint associations of maternal smoking and daily life SHS exposure with dementia risk. RESULTS During a median follow-up of 11.8 years, 4,113 participants developed dementia. Compared with those who lived in the environment without smokers, multivariable-adjusted hazard ratios (HRs) (95% CIs) were 1.11 (1.02, 1.20) and 1.31 (1.13, 1.52) for those who exposed to SHS for >0 but ≤4 h/week and >4 h/week, respectively, and was 1.25 (1.13, 1.39) for those who lived with smokers in the household. A positive history of maternal smoking was associated with a modestly higher risk of dementia (HR = 1.07; 95% CI: 1.01, 1.15). Furthermore, compared with participants with neither history of maternal smoking nor exposure to SHS, a particularly higher risk of dementia was observed among those with both exposures (HR = 1.48; 95% CI: 1.18, 1.86). Additionally, the HR (95% CI) was 1.32 (1.10, 1.59) when comparing participants with a history of maternal smoking who lived with smokers in their households with those who had neither exposures. CONCLUSIONS Having a history of maternal smoking, longer exposure to SHS, and living with smokers in the household were each associated with an increased risk of developing dementia. Individuals who were simultaneously exposed to maternal smoking and SHS or lived with household smokers had a particularly higher dementia risk.
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Affiliation(s)
- Zhongxiao Wan
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Xiaohui Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Huanying He
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Yebing Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Na Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fu-Rong Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
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Glenn AL, Ragno LK, Liu J. Association between postnatal environmental tobacco smoke exposure controlling for prenatal exposure and conduct problems in children: A systematic review. Neurotoxicology 2023; 97:53-64. [PMID: 37211157 PMCID: PMC10527764 DOI: 10.1016/j.neuro.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
Prenatal exposure to environmental tobacco smoke (ETS) is commonly associated with conduct problems in children. However, there is limited research on the effects of postnatal ETS exposure on the development of conduct problems, and many studies focusing on the postnatal period fail to control for the effects of prenatal ETS. This systematic review explores the association between postnatal ETS exposure and child conduct problems in studies that control for prenatal ETS exposure. Of the thirteen studies identified, nine reported a significant positive association of postnatal ETS exposure and child conduct-related behavior problems when controlling for prenatal ETS exposure. Results from tests of dose-response relationships were mixed. These findings highlight the significance of postnatal ETS exposure in conferring risk for conduct problems over and above prenatal ETS, and thus provide important information for guiding public health recommendations.
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Affiliation(s)
- Andrea L Glenn
- University of Alabama, Center for Youth Development and Intervention, Department of Psychology, Tuscaloosa, AL, USA
| | - Leah K Ragno
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Jianghong Liu
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
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Kalloo G, Wellenius GA, McCandless L, Calafat AM, Sjodin A, Sullivan AJ, Romano ME, Karagas MR, Chen A, Yolton K, Lanphear BP, Braun JM. Chemical mixture exposures during pregnancy and cognitive abilities in school-aged children. ENVIRONMENTAL RESEARCH 2021; 197:111027. [PMID: 33744271 PMCID: PMC9022783 DOI: 10.1016/j.envres.2021.111027] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Gestational exposure to chemical mixtures, which is prevalent among pregnant women, may be associated with adverse childhood neurodevelopment. However, few studies have examined relations between gestational chemical mixture exposure and children's cognitive abilities. METHODS In a cohort of 253 pregnant women and their children from Cincinnati, OH (enrolled 2003-2006), we quantified biomarker concentrations of 43 metals, phthalates, phenols, polybrominated diphenyl ethers, organophosphate and organochlorine pesticides, polychlorinated biphenyls, perfluoroalkyl substances, and environmental tobacco smoke in blood or urine. Using k-means clustering and principal component (PC) analysis, we characterized chemical mixtures among pregnant women. We assessed children's cognitive abilities using the Wechsler Preschool and Primary Scale of Intelligence-III and Wechsler Intelligence Scale for Children-IV at ages 5 and 8 years, respectively. We estimated covariate-adjusted differences in children's cognitive ability scores ]=cross clusters, and with increasing PC scores and individual biomarker concentrations. RESULTS Geometric mean biomarker concentrations were generally highest, intermediate, and lowest among women in clusters 1, 2, and 3, respectively. Children born to women in clusters 1 and 2 had 5.1 (95% CI: 9.4,-0.8) and 2.0 (95% CI: 5.5, 1,4) lower performance IQ scores compared to children in cluster 3, respectively. PC scores and individual chemical biomarker concentrations were not associated with cognitive abilities. CONCLUSIONS In this cohort, combined prenatal exposure to phenols, certain phthalates, pesticides, and perfluoroalkyl substances was inversely associated with children's cognition, but some individual chemical biomarker concentrations were not. Additional studies should determine if the aggregate impact of these chemicals on cognition is different from their individual effects.
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Affiliation(s)
- Geetika Kalloo
- Department of Epidemiology, Brown University, Providence, RI, USA.
| | | | | | | | - Andreas Sjodin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam J Sullivan
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Megan E Romano
- Department of Epidemiology, Dartmouth College, Hanover, NH, USA
| | | | - Aimin Chen
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; Child and Family Research Institute, BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
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Chen X, Huang L, Li Q, Wu M, Lin L, Hong M, Wang H, Yang X, Hao L, Yang N. Exposure to environmental tobacco smoke during pregnancy and infancy increased the risk of upper respiratory tract infections in infants: A birth cohort study in Wuhan, China. INDOOR AIR 2021; 31:673-681. [PMID: 33090568 DOI: 10.1111/ina.12761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/02/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
We aimed to evaluate the association of the exposure to environmental tobacco smoke (ETS) during pregnancy and infancy with the risk of upper respiratory tract infections (URTI) in infants based on a Chinese birth cohort study. Among 4178 infants who constituted the final study population, 46.8% experienced URTI in their first year of life. The hazard ratios (HR) and 95% confidence intervals (CI) for the risk of URTI were assessed using Cox regression models. Compared with no ETS during pregnancy, continued ETS during pregnancy was independently associated with a higher risk of URTI (HR: 1.36, 95% CI: 1.13, 1.63) after adjustment for potential confounders and also associated with earlier occurrence of URTI (log-rank P = .002). The association remained consistent across the strata defined according to maternal age, number of siblings, sex, and breastfeeding. Exposure to ETS during infancy was associated with URTI only among infants who were breastfed for less than 12 months (P for interaction < 0.05).Furthermore, infants exposed to ETS during both pregnancy and infancy showed the highest HR of 1.46 (95% CI: 1.16, 1.85) for URTI. Efforts should be made to protect pregnant women and infants from the adverse effects of indoor and outdoor ETS.
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Affiliation(s)
- Xi Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Huang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meng Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lixia Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Miao Hong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huanzhuo Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Nianhong Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Yusuf KK, Wilson R, Mbah A, Sappenfield W, King LM, Salihu HM. Maternal Cotinine Levels and Red Blood Cell Folate Concentrations in the Periconceptual Period. South Med J 2020; 113:156-163. [PMID: 32239227 DOI: 10.14423/smj.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Studies have examined the association between tobacco use and folate levels in pregnancy, yet few have assessed this relation using objective and accurate measures of both smoking and folate. In this study, we evaluated the association between maternal cotinine levels and periconceptional red blood cell (RBC) folic acid reserves in a cohort of low-income pregnant mothers. METHODS Smoking information, based on salivary cotinine, a highly sensitive and specific tobacco smoke exposure biomarker, was used. Furthermore, folate was assessed using RBC folate, an indicator of long-term folate storage. Participants were early to mid-trimester pregnant women who received antenatal care between 2011 and 2015 at the Genesis Clinic of Tampa (Florida). A total of 496 women were enrolled in the study. Associations between smoking status/maternal salivary cotinine concentrations, sociodemographic factors, and folate concentrations were investigated using Tobit regression analyses. RESULTS The mean folate level of the participants was 718.3 ± 183.2 ng/mL, and only 2 (0.4%) participants were deficient in folate. We observed no significant difference in folate levels by smoking status. In contrast, salivary cotinine levels were significantly associated with decreased RBC folate concentrations (β -11.43, standard error 5.45, P = 0.032). Prepregnancy maternal body mass index, gestational age, stress, and depression also were associated with folate levels. CONCLUSIONS Low RBC folate is associated with perinatal factors, including high maternal cotinine levels, body mass index, stress, and depression. The effect of low folate levels among smokers cannot be overemphasized, considering that tobacco products not only reduce folate levels but also decrease the bioutilization of folate.
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Affiliation(s)
- Korede K Yusuf
- From the College of Nursing and Public Health, Adelphi University, Garden City, New York, the College of Public Health, University of South Florida, Tampa, the Department of Health Services Research, Management and Policy, University of Florida, Gainesville, and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Roneé Wilson
- From the College of Nursing and Public Health, Adelphi University, Garden City, New York, the College of Public Health, University of South Florida, Tampa, the Department of Health Services Research, Management and Policy, University of Florida, Gainesville, and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Alfred Mbah
- From the College of Nursing and Public Health, Adelphi University, Garden City, New York, the College of Public Health, University of South Florida, Tampa, the Department of Health Services Research, Management and Policy, University of Florida, Gainesville, and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - William Sappenfield
- From the College of Nursing and Public Health, Adelphi University, Garden City, New York, the College of Public Health, University of South Florida, Tampa, the Department of Health Services Research, Management and Policy, University of Florida, Gainesville, and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Lindsey M King
- From the College of Nursing and Public Health, Adelphi University, Garden City, New York, the College of Public Health, University of South Florida, Tampa, the Department of Health Services Research, Management and Policy, University of Florida, Gainesville, and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Hamisu M Salihu
- From the College of Nursing and Public Health, Adelphi University, Garden City, New York, the College of Public Health, University of South Florida, Tampa, the Department of Health Services Research, Management and Policy, University of Florida, Gainesville, and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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He F, Li T, Lin J, Li F, Zhai Y, Zhang T, Gu X, Zhao G. Passive Smoking Exposure in Living Environments Reduces Cognitive Function: A Prospective Cohort Study in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041402. [PMID: 32098188 PMCID: PMC7068506 DOI: 10.3390/ijerph17041402] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 01/29/2023]
Abstract
There is currently no consensus regarding the effects of passive smoking exposure on cognitive function in older adults. We evaluated 7000 permanent residents from six regions within Zhejiang Province, China, aged ≥60 years, without cognitive impairment at baseline and during follow-up examinations for two years. The Chinese version of the Mini-Mental State Examination was used to assess the participants’ cognitive function. Multivariate regression analyses were carried out to calculate the adjusted relative risks (RRs) as measures of the association between passive smoking exposure and cognitive impairment after adjusting for potential confounders. The results showed an association between passive smoking exposure in the living environment and increased risk of cognitive impairment (RR: 1.16; 95% confidence interval (CI): 1.01–1.35). No dose–response relationship between the cumulative dose of passive smoking exposure (days) and cognitive impairment was observed. The results of stratified analyses suggested a harmful effect of passive smoking exposure on cognitive function in non-smokers (RR: 1.24; 95% CI: 1.06–1.46), but not in smokers (RR: 1.11; 95% CI: 0.71–1.92). Therefore, passive smoking exposure increased the risk of cognitive impairment in older adults, especially non-smokers. More effective measures to restrict smoking in the living environment should be developed and implemented.
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Affiliation(s)
- Fan He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China;
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (J.L.); (F.L.); (Y.Z.); (T.Z.); (X.G.)
| | - Tian Li
- Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA;
| | - Junfen Lin
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (J.L.); (F.L.); (Y.Z.); (T.Z.); (X.G.)
| | - Fudong Li
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (J.L.); (F.L.); (Y.Z.); (T.Z.); (X.G.)
| | - Yujia Zhai
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (J.L.); (F.L.); (Y.Z.); (T.Z.); (X.G.)
| | - Tao Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (J.L.); (F.L.); (Y.Z.); (T.Z.); (X.G.)
| | - Xue Gu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China; (J.L.); (F.L.); (Y.Z.); (T.Z.); (X.G.)
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China;
- Correspondence: ; Tel.: +86-021-54237334
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Kalloo G, Wellenius GA, McCandless L, Calafat AM, Sjodin A, Romano ME, Karagas MR, Chen A, Yolton K, Lanphear BP, Braun JM. Exposures to chemical mixtures during pregnancy and neonatal outcomes: The HOME study. ENVIRONMENT INTERNATIONAL 2020; 134:105219. [PMID: 31726361 DOI: 10.1016/j.envint.2019.105219] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Exposure to mixtures of environmental chemicals are prevalent among pregnant women and may be associated with altered fetal growth and gestational age. To date, most research regarding environmental chemicals and neonatal outcomes has focused on the effect of individual agents. METHODS In a prospective cohort of 380 pregnant women from Cincinnati, OH (enrolled 2003-2006), we used biomarkers to estimate exposure to 43 phenols, phthalates, metals, organophosphate/pyrethroid/organochlorine pesticides, polychlorinated biphenyls, polybrominated diphenyl ethers, perfluoroalkyl substances (PFAS), and environmental tobacco smoke. Using three approaches, we estimated covariate-adjusted associations of chemical mixtures or individual chemicals with gestational-age-specific birth weight z-scores, birth length, head circumference, and gestational age: k-means clustering, principal components (PC), and one-chemical-at-a-time regression. RESULTS We identified three chemical mixture profiles using k-means clustering. Women in cluster 1 had higher concentrations of most phenols, three phthalate metabolites, several metals, organophosphate/organochlorine pesticides, polychlorinated biphenyls, and several PFAS than women in clusters 2 and 3. On average, infants born to women in clusters 1 (-1.2 cm; 95% CI: -1.9, -0.5) and 2 (-0.5 cm; 95% CI: -1.1, 0.1) had lower birth length than infants in cluster 3. Six PCs explained 50% of the variance in biomarker concentrations and biomarkers with similar chemical structures or from shared commercial/industrial settings loaded onto commons PCs. Each standard deviation increase in PC 1 (organochlorine pesticides, some phenols) and PC 6 (cadmium, bisphenol A) was associated with 0.2 cm (95% CI: -0.4, 0.0) and 0.1 cm (95% CI: -0.4, 0.1) lower birth length, respectively. Organochlorine compounds, parabens, and cadmium were inversely associated with birth length in the one-chemical-at-a-time analysis. Cluster membership, PC scores, and individual chemicals were not associated with other birth outcomes. CONCLUSION All three methods of characterizing multiple chemical exposures in this cohort identified inverse associations of select organochlorine compounds, phenols, and cadmium with birth length, but not other neonatal outcomes.
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Affiliation(s)
- Geetika Kalloo
- Department of Epidemiology, Brown University, Providence, RI, USA.
| | | | | | | | - Andreas Sjodin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Megan E Romano
- Department of Epidemiology, Dartmouth College, Hanover, NH, USA
| | | | - Aimin Chen
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; Child and Family Research Institute, BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
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Lee M, Ha M, Hong YC, Park H, Kim Y, Kim EJ, Kim Y, Ha E. Exposure to prenatal secondhand smoke and early neurodevelopment: Mothers and Children's Environmental Health (MOCEH) study. Environ Health 2019; 18:22. [PMID: 30894196 PMCID: PMC6425627 DOI: 10.1186/s12940-019-0463-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/05/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND The association between exposure to secondhand smoke (SHS) during pregnancy and a child's neurodevelopment has not been established yet. We explored the association between prenatal exposure to SHS and neurodevelopment at 24 months of age considering genetic polymorphism and breastfeeding in 720 mothers and their offspring enrolled in the Korean multicenter birth cohort study (Mothers and Children Environmental Health, MOCEH). METHODS We quantified urine cotinine concentrations in mothers once from 12th to 20th gestational weeks and excluded those whose urine cotinine levels exceeded 42.7 ng/ml to represent SHS exposure in early pregnancy. Mental developmental index (MDI) and psychomotor developmental index (PDI) values were measured using the Korean version of the Bayley Scales of Infant Development II (K-BSID-II) at 24 months of age. A general linear model was used to assess the relationship between maternal urinary cotinine level and neurodevelopment. RESULTS MDI scores were inversely associated with cotinine [β = - 2.73; 95% confidence interval (CI): - 5.32 to - 0.15] in children whose mothers had early pregnancy urinary cotinine levels >1.90 ng/ml. No association was evident in children whose mothers had cotinine levels ≤1.90 ng/ml. This negative association was more pronounced in children whose mothers had both Glutathione S-transferases mu 1 (GSTM1) and theta 1 (GSTT1) null type [β = - 5.78; 95% CI: -10.69 to - 0.87], but not in children whose mothers had any present type of GSTM1/GSTT1 [β = - 1.64; 95% CI: -4.79 to 1.52]. The association was no longer significant when children received breast milk exclusively for up to 6 months [β = - 0.24; 95% CI: -4.69 to 4.20] compared to others [β = - 3.75; 95% CI: -7.51 to 0.00]. No significant association was found for PDI. CONCLUSIONS Maternal exposure to SHS during pregnancy may result in delayed MDI in early childhood. This effect might be modified by genetic polymorphism and breastfeeding behavior.
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Affiliation(s)
- Myeongjee Lee
- Department of Occupational and Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Mina Ha
- Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Yun-Chul Hong
- Institute of Environmental Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Hyesook Park
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eui-Jung Kim
- Department of Psychiatry, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Yeni Kim
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Eunhee Ha
- Department of Occupational and Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
- Ewha Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
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10
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Differences in Prenatal Tobacco Exposure Patterns among 13 Race/Ethnic Groups in California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030458. [PMID: 30764487 PMCID: PMC6388267 DOI: 10.3390/ijerph16030458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
Prenatal tobacco exposure is a significant, preventable cause of childhood morbidity, yet little is known about exposure risks for many race/ethnic subpopulations. We studied active smoking and environmental tobacco smoke (ETS) exposure in a population-based cohort of 13 racially/ethnically diverse pregnant women: white, African American, Hispanic, Native American, including nine Asian/Pacific Islander subgroups: Chinese, Japanese, Korean, Filipino, Cambodian, Vietnamese, Laotian, Samoan, and Asian Indians (N = 3329). Using the major nicotine metabolite, cotinine, as an objective biomarker, we analyzed mid-pregnancy serum from prenatal screening banked in 1999–2002 from Southern California in an effort to understand differences in tobacco exposure patterns by race/ethnicity, as well as provide a baseline for future work to assess secular changes and longer-term health outcomes. Prevalence of active smoking (based on age- and race-specific cotinine cutpoints) was highest among African American, Samoan, Native Americans and whites (6.8–14.1%); and lowest among Filipinos, Chinese, Vietnamese and Asian Indians (0.3–1.0%). ETS exposure among non-smokers was highest among African Americans and Samoans, followed by Cambodians, Native Americans, Vietnamese and Koreans, and lowest among Filipinos, Japanese, whites, and Chinese. At least 75% of women had detectable cotinine. While for most groups, levels of active smoking corresponded with levels of ETS, divergent patterns were also found. For example, smoking prevalence among white women was among the highest, but the group’s ETS exposure was low among non-smokers; while Vietnamese women were unlikely to be active smokers, they experienced relatively high ETS exposure. Knowledge of race/ethnic differences may be useful in assessing disparities in health outcomes and creating successful tobacco interventions.
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11
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Hoyt AT, Canfield MA, Romitti PA, Botto LD, Anderka MT, Krikov SV, Feldkamp ML. Does Maternal Exposure to Secondhand Tobacco Smoke During Pregnancy Increase the Risk for Preterm or Small-for-Gestational Age Birth? Matern Child Health J 2018; 22:1418-1429. [PMID: 29574536 DOI: 10.1007/s10995-018-2522-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction While associations between active smoking and various adverse birth outcomes (ABOs) have been reported in the literature, less is known about the impact of secondhand smoke (SHS) on many pregnancy outcomes. Methods We examined the relationship between maternal exposure to SHS during pregnancy and preterm (< 37 weeks gestation) and small-for-gestational age (SGA; assessed using sex-, race/ethnic-, and parity-specific growth curves) singleton births using non-smoking controls from the National Birth Defects Prevention Study (1997-2011). Multivariable logistic regression models for household, workplace/school, and combined SHS exposure-controlled for maternal education, race/ethnicity, pre-pregnancy body mass index, and high blood pressure-were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Interaction was assessed for maternal folic acid supplementation, alcohol use, age at delivery, and infant sex. Results Infants of 8855 mothers were examined in the preterm birth analysis with 666 (7.5%) categorized as preterm, 574 moderately preterm (32-36 weeks), and 92 very preterm (< 32 weeks). For the SGA analysis, infants of 8684 mothers were examined with 670 (7.7%) categorized as SGA. The aORs for mothers reporting both household and workplace/school SHS were elevated for preterm (aOR 1.99; 95% CI 1.13-3.50) and moderately preterm birth (32-36 weeks) (aOR 2.17; 95% CI 1.22-3.88). No results for the SGA analysis achieved significance, nor was evidence of interaction evident. Conclusion The findings suggest an association between SHS from multiple exposure sources and preterm birth, but no evidence for association with SGA births. Continued study of SHS and ABOs is needed to best inform public health prevention programs.
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Affiliation(s)
- Adrienne T Hoyt
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th St., Austin, TX, 78714-9347, USA.
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th St., Austin, TX, 78714-9347, USA
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marlene T Anderka
- Massachusetts Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA, USA
| | - Sergey V Krikov
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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12
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Kalloo G, Wellenius GA, McCandless L, Calafat AM, Sjodin A, Karagas M, Chen A, Yolton K, Lanphear BP, Braun JM. Profiles and Predictors of Environmental Chemical Mixture Exposure among Pregnant Women: The Health Outcomes and Measures of the Environment Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:10104-10113. [PMID: 30088764 PMCID: PMC10105973 DOI: 10.1021/acs.est.8b02946] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Pregnant women are exposed to numerous environmental chemicals, but there is limited understanding of chemical mixture exposure profiles and predictors. In a prospective cohort of 389 pregnant women from Cincinnati, OH, we used biomarkers to estimate exposure to 41 phenols, phthalates, metals, organophosphate/pyrethroid/organochlorine pesticides, polychlorinated biphenyls, polybrominated diphenyl ethers, perfluoroalkyl substances, and environmental tobacco smoke. Using pairwise correlations, k-means clustering, and principal component analysis (PCA), we identified several profiles of chemical exposure. Chemicals within structurally, commercially, or industrially related chemical classes (e.g., phthalates) were moderate to strongly correlated compared to unrelated chemicals (e.g., pyrethroid pesticides and environmental tobacco smoke). Using k-means clustering and PCA, we identified 3 clusters of women ( N = 106, 158, and 125) and 6 PC scores, respectively, that characterized profiles of cumulative chemical exposure. The first two PC scores significantly varied by cluster, indicating that some of these profiles could be identified using both methods. Cluster membership and PCA scores were associated with race, marital status, consumption of fresh fruits and vegetables, and parity. Future work could use clusters and PCA scores to characterize environmental chemical mixture exposures in other cohorts of pregnant women and predict potential health effects of environmental chemical mixture exposure.
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Affiliation(s)
- Geetika Kalloo
- Department of Epidemiology, Brown University, Providence, Rhode Island 02912, United States
- Corresponding Author: Geetika Kalloo. Tel: +1 (401) 863-5397;
| | - Gregory A. Wellenius
- Department of Epidemiology, Brown University, Providence, Rhode Island 02912, United States
| | - Lawrence McCandless
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - Antonia M. Calafat
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, United States
| | - Andreas Sjodin
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, United States
| | - Margaret Karagas
- Department of Epidemiology, Dartmouth College, Hanover, New Hampshire 03755, United States
| | - Aimin Chen
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio 45267, United States
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio 45229, United States
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
- Child and Family Research Institute, BC Children’s and Women’s Hospital, Vancouver, BC, Canada Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia V5Z 4H4, Canada
| | - Joseph M. Braun
- Department of Epidemiology, Brown University, Providence, Rhode Island 02912, United States
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13
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Schechter JC, Fuemmeler BF, Hoyo C, Murphy SK, Zhang JJ, Kollins SH. Impact of Smoking Ban on Passive Smoke Exposure in Pregnant Non-Smokers in the Southeastern United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010083. [PMID: 29316617 PMCID: PMC5800182 DOI: 10.3390/ijerph15010083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
Abstract
Prenatal passive smoke exposure raises risk for negative birth outcomes. Legislation regulating public smoking has been shown to impact exposure levels, though fewer studies involving pregnant women have been conducted within the U.S. where bans are inconsistent across regions. This study examined the effect of a ban enacted in the southeastern U.S. on pregnant women's cotinine levels. Additional analyses compared self-reported exposure to cotinine and identified characteristics associated with passive exposure. Pregnant women (N = 851) were recruited prospectively between 2005 and 2011 in North Carolina. Sociodemographic and health data were collected via surveys; maternal blood samples were assayed for cotinine. Among non-active smokers who provided self-report data regarding passive exposure (N = 503), 20% were inconsistent with corresponding cotinine. Among all non-smokers (N = 668), being unmarried, African American, and less educated were each associated with greater passive exposure. Controlling for covariates, mean cotinine was higher prior to the ban compared to after, F(1, 640) = 24.65, p < 0.001. Results suggest that banning smoking in public spaces may reduce passive smoke exposure for non-smoking pregnant women. These data are some of the first to examine the impact of legislation on passive smoke exposure in pregnant women within the U.S. using a biomarker and can inform policy in regions lacking comprehensive smoke-free legislation.
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Affiliation(s)
- Julia C Schechter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road, Durham, NC 27705, USA.
| | - Bernard F Fuemmeler
- Health Behavior and Policy, Virginia Commonwealth University, PO Box 980430, Richmond, VA 23298, USA.
| | - Cathrine Hoyo
- Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Campus Box 7633, Raleigh, NC 27695, USA.
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Box 91012, Durham, NC 27708, USA.
| | - Junfeng Jim Zhang
- Nicholas School of the Environment & Duke Global Health Institute, 308 Research Drive, Durham, NC 27701, USA.
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road, Durham, NC 27705, USA.
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14
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Lee W, Lee S, Roh J, Won JU, Yoon JH. The Association between Involuntary Smoking Exposure with Urine Cotinine Level and Blood Cadmium Level in General Non-Smoking Populations. J Korean Med Sci 2017; 32:568-575. [PMID: 28244280 PMCID: PMC5334152 DOI: 10.3346/jkms.2017.32.4.568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/11/2016] [Indexed: 01/31/2023] Open
Abstract
Unintentional environmental exposure to toxicants is associated with an aggravated health status of the general population. Involuntary smoking (IS) exposure is one of the main routes to involuntary toxicants exposure. However, few studies have attempted to understand the environmental cadmium exposure by IS exposure in the general, non-smoking population. The purpose of the current study was to examine the relationship between blood cadmium level and IS level according to gender and age. We used the Korea National Health and Nutrition Examination Survey (KNHANES) IV-VI data that included heavy metal and urine cotinine sampling with IS exposure history. The final analysis comprised 3,493 adults (1,231 males and 2,262 females) and 395 adolescents (210 males and 185 females). Linear regression was performed to estimate the association between self-reported IS exposure with urine cotinine level and blood cadmium level in non-smokers with gender and age group stratification. In final regression model, the effect values (B) (standard errors [SE]) between blood cadmium and urine cotinine level in men was 0.0004 (0.0001) and 0.0006 (0.0002) in adults and adolescents, the B (SE) in women was 0.0006 (0.0002) and 0.0016 (0.0006) in adults and adolescents. Our study revealed, for the first time, a significant association between blood cadmium and IS exposure in non-smokers. Greater efforts are needed to improve environmental justices of the general population from IS, considering the severe harmful effects of involuntary exposure to even a low level of cadmium.
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Affiliation(s)
- Wanhyung Lee
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
- Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea
- Incheon Worker's Health Center, Incheon, Korea
| | - Seunghyun Lee
- Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Jaehoon Roh
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
- Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea
- Incheon Worker's Health Center, Incheon, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Uk Won
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
- Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea
- Incheon Worker's Health Center, Incheon, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Ha Yoon
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
- Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea
- Incheon Worker's Health Center, Incheon, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
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15
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Kim S. Overview of Cotinine Cutoff Values for Smoking Status Classification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121236. [PMID: 27983665 PMCID: PMC5201377 DOI: 10.3390/ijerph13121236] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Abstract
While cotinine is commonly used as a biomarker to validate self-reported smoking status, the selection of an optimal cotinine cutoff value for distinguishing true smokers from true nonsmokers shows a lack of standardization among studies. This review describes how the cutoff values have been derived, and explains the issues involved in the generalization of a cutoff value. In this study, we conducted an English-language literature search in PubMed using the keywords “cotinine” and “cutoff” or “self-reported” and “smoking status” and “validation” for the years 1985–2014. We obtained 104 articles, 32 of which provided (1) sensitivity and specificity of a cutoff value and (2) determination methods for the given cutoff value. We found that the saliva cotinine cutoff value range of 10–25 ng/mL, serum and urine cotinine cutoff of 10–20 ng/mL and 50–200 ng/mL, respectively, have been commonly used to validate self-reported smoking status using a 2 × 2 table or a receiver operating characteristics (ROC) curve. We also found that recent large population-based studies in the U.S. and UK reported lower cutoff values for cotinine in serum (3 ng/mL) and saliva (12 ng/mL), compared to the traditionally accepted ones (15 and 14 ng/mg, respectively).
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Affiliation(s)
- Sungroul Kim
- Department of Environmental Health Sciences, Soonchunhyang University, Asan 31538, Korea.
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16
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Associations between maternal periconceptional exposure to secondhand tobacco smoke and major birth defects. Am J Obstet Gynecol 2016; 215:613.e1-613.e11. [PMID: 27443814 DOI: 10.1016/j.ajog.2016.07.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/01/2016] [Accepted: 07/07/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND While associations between secondhand smoke and a few birth defects (namely, oral clefts and neural tube defects) have been noted in the scientific literature, to our knowledge, there is no single or comprehensive source of population-based information on its associations with a range of birth defects among nonsmoking mothers. OBJECTIVE We utilized data from the National Birth Defects Prevention Study, a large population-based multisite case-control study, to examine associations between maternal reports of periconceptional exposure to secondhand smoke in the household or workplace/school and major birth defects. STUDY DESIGN The multisite National Birth Defects Prevention Study is the largest case-control study of birth defects to date in the United States. We selected cases from birth defect groups having >100 total cases, as well as all nonmalformed controls (10,200), from delivery years 1997 through 2009; 44 birth defects were examined. After excluding cases and controls from multiple births and whose mothers reported active smoking or pregestational diabetes, we analyzed data on periconceptional secondhand smoke exposure-encompassing the period 1 month prior to conception through the first trimester. For the birth defect craniosynostosis, we additionally examined the effect of exposure in the second and third trimesters as well due to the potential sensitivity to teratogens for this defect throughout pregnancy. Covariates included in all final models of birth defects with ≥5 exposed mothers were study site, previous live births, time between estimated date of delivery and interview date, maternal age at estimated date of delivery, race/ethnicity, education, body mass index, nativity, household income divided by number of people supported by this income, periconceptional alcohol consumption, and folic acid supplementation. For each birth defect examined, we used logistic regression analyses to estimate both crude and adjusted odds ratios and 95% confidence intervals for both isolated and total case groups for various sources of exposure (household only; workplace/school only; household and workplace/school; household or workplace/school). RESULTS The prevalence of secondhand smoke exposure only across all sources ranged from 12.9-27.8% for cases and 14.5-15.8% for controls. The adjusted odds ratios for any vs no secondhand smoke exposure in the household or workplace/school and isolated birth defects were significantly elevated for neural tube defects (anencephaly: adjusted odds ratio, 1.66; 95% confidence interval, 1.22-2.25; and spina bifida: adjusted odds ratio, 1.49; 95% confidence interval, 1.20-1.86); orofacial clefts (cleft lip without cleft palate: adjusted odds ratio, 1.41; 95% confidence interval, 1.10-1.81; cleft lip with or without cleft palate: adjusted odds ratio, 1.24; 95% confidence interval, 1.05-1.46; cleft palate alone: adjusted odds ratio, 1.31; 95% confidence interval, 1.06-1.63); bilateral renal agenesis (adjusted odds ratio, 1.99; 95% confidence interval, 1.05-3.75); amniotic band syndrome-limb body wall complex (adjusted odds ratio, 1.66; 95% confidence interval, 1.10-2.51); and atrial septal defects, secundum (adjusted odds ratio, 1.37; 95% confidence interval, 1.09-1.72). There were no significant inverse associations observed. CONCLUSION Additional studies replicating the findings are needed to better understand the moderate positive associations observed between periconceptional secondhand smoke and several birth defects in this analysis. Increased odds ratios resulting from chance (eg, multiple comparisons) or recall bias cannot be ruled out.
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17
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Weng SC, Huang JP, Huang YL, Lee TSH, Chen YH. Effects of tobacco exposure on perinatal suicidal ideation, depression, and anxiety. BMC Public Health 2016; 16:623. [PMID: 27448804 PMCID: PMC4957348 DOI: 10.1186/s12889-016-3254-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/30/2016] [Indexed: 12/16/2022] Open
Abstract
Background Previous studies have stressed the importance of tobacco exposure for the mood disorders of depression and anxiety. Although a few studies have focused on perinatal women, none have specifically considered the effects of smoking and secondhand smoke exposure on perinatal suicidal ideation. Thus, this study aimed to investigate the relationships of smoking/secondhand smoke exposure status with suicidal ideation, depression, and anxiety from the first trimester to the first month post partum. Methods This cross-sectional study based on self-reported data was conducted at five hospitals in Taipei, Taiwan from July 2011 to June 2014. The questionnaire inquired about women’s pregnancy history, sociodemographic information, and pre-pregnancy smoking and secondhand smoke exposure status, and assessed their suicidal ideation, depression, and anxiety symptoms. Logistic regression models were used for analysis. Results In the 3867 women in the study, secondhand smoke exposure was positively associated with perinatal depression and suicidal ideation. Compared with women without perinatal secondhand smoke exposure, women exposed to secondhand smoke independently exhibited higher risks for suicidal ideation during the second trimester (odds ratio (OR) = 7.63; 95 % confidence interval (CI) = 3.25–17.93) and third trimester (OR = 4.03; 95 % CI = 1.76–9.23). Women exposed to secondhand smoke had an increased risk of depression, especially those aged 26–35 years (OR = 1.71; 95 % CI = 1.27–2.29). Conclusions Secondhand smoke exposure also considerably contributes to adverse mental health for women in perinatal periods, especially for the severe outcome of suicidal ideation. Our results strongly support the importance of propagating smoke-free environments to protect the health of perinatal women. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3254-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shu-Chuan Weng
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.,Mackay Memorial Hospital, New Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ya-Li Huang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Education, National Taiwan Normal University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
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18
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Cui H, Gong TT, Liu CX, Wu QJ. Associations between Passive Maternal Smoking during Pregnancy and Preterm Birth: Evidence from a Meta-Analysis of Observational Studies. PLoS One 2016; 11:e0147848. [PMID: 26808045 PMCID: PMC4726502 DOI: 10.1371/journal.pone.0147848] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/08/2016] [Indexed: 11/18/2022] Open
Abstract
Previous studies investigating the relationship between passive maternal smoking and preterm birth reveal inconsistent results. We conducted the current meta-analysis of observational studies to evaluate the relationship between passive maternal smoking and preterm birth. We identified relevant studies by searching PubMed, EMBASE, and ISI Web of Science databases. We used random-effects models to estimate summary odds ratios (SORs) and 95% confidence intervals (CIs) for aforementioned association. For the analysis, we included 24 studies that involved a total of 5607 women who experienced preterm birth. Overall, the SORs of preterm birth for women who were ever exposed to passive smoking versus women who had never been exposed to passive smoking at any place and at home were 1.20 (95%CI = 1.07-1.34,I(2) = 36.1%) and 1.16 (95%CI = 1.04-1.30,I(2) = 4.4%), respectively. When we conducted a stratified analysis according to study design, the risk estimate was slightly weaker in cohort studies (SOR = 1.10, 95%CI = 1.00-1.21,n = 16) than in cross-sectional studies (SOR = 1.47, 95%CI = 1.23-1.74,n = 5). Additionally, the associations between passive maternal smoking and preterm birth were statistically significant for studies conducted in Asia (SOR = 1.26, 95%CI = 1.05-1.52), for studies including more than 100 cases of preterm birth (SOR = 1.22, 95%CI = 1.05-1.41), and for studies adjusted for maternal age (SOR = 1.27,95%CI = 1.09-1.47), socioeconomic status and/or education (SOR = 1.28, 95%CI = 1.10-1.49), body mass index (SOR = 1.33, 95%CI = 1.04-1.71), and parity (SOR = 1.27, 95%CI = 1.13-1.43). Our findings demonstrate that passive maternal smoking is associated with an increased risk of preterm birth. Future prospective cohort studies are warranted to provide more detailed results stratified by passive maternal smoking during different trimesters of pregnancy and by different types and causes of preterm birth.
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Affiliation(s)
- Hong Cui
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Cai-Xia Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- * E-mail:
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Snodgrass AM, Tan PT, Soh SE, Goh A, Shek LP, van Bever HP, Gluckman PD, Godfrey KM, Chong YS, Saw SM, Kwek K, Teoh OH. Tobacco smoke exposure and respiratory morbidity in young children. Tob Control 2015; 25:e75-e82. [DOI: 10.1136/tobaccocontrol-2015-052383] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/07/2015] [Indexed: 11/04/2022]
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Modification of the association between maternal smoke exposure and congenital heart defects by polymorphisms in glutathione S-transferase genes. Sci Rep 2015; 5:14915. [PMID: 26456689 PMCID: PMC4601072 DOI: 10.1038/srep14915] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 09/07/2015] [Indexed: 12/31/2022] Open
Abstract
Congenital heart defects (CHDs) arise through various combinations of genetic and environmental factors. Our study explores how polymorphisms in the glutathione S-transferase (GST) genes affect the association between cigarette smoke exposure and CHDs. We analysed 299 mothers of children with CHDs and 284 mothers of children without any abnormalities who were recruited from six hospitals. The hair nicotine concentration (HNC) was used to quantify maternal smoke exposure, and the maternal GSTT1, and GSTM1 and GSTP1 genes were sequenced. We found a trend of higher adjusted odds ratios with higher maternal HNC levels, suggesting a dose-response relationship between maternal smoke exposure and CHDs. The lowest HNC range associated with an increased risk of CHDs was 0.213–0.319 ng/mg among the mothers with functional deletions of GSTM1 or GSTT1and 0.319–0.573 ng/mg among the mothers with normal copies of GSTM1 and GSTT1. In addition, the adjusted odds ratio for an HNC of >0.573 ng/mg was 38.53 among the mothers with the GSTP1 AG or GG genotype, which was 7.76 (χ2 = 6.702, p = 0.010) times greater than the AOR in the mothers with GSTP1 AA genotype. Our study suggests that polymorphisms of maternal GST genes may modify the association of maternal smoke exposure with CHDs.
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Evlampidou I, Bagkeris M, Vardavas C, Koutra K, Patelarou E, Koutis A, Chatzi L, Kogevinas M. Prenatal Second-Hand Smoke Exposure Measured with Urine Cotinine May Reduce Gross Motor Development at 18 Months of Age. J Pediatr 2015; 167:246-52.e2. [PMID: 25863662 DOI: 10.1016/j.jpeds.2015.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 02/02/2015] [Accepted: 03/03/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the association of second-hand smoke exposure of pregnant mothers using urine cotinine with the neurodevelopment of their children at 18 months of age in the mother-child cohort in Crete (Rhea Study). STUDY DESIGN Selected participants were Greek mothers with singleton pregnancies, had never smoked, and had available urine cotinine measurements in pregnancy, and their children for whom a neurodevelopmental assessment was completed. We performed face-to-face interviews twice during pregnancy and postnatally, and assessed children's neurodevelopment at 18 months of age using the Bayley Scales of Infant and Toddler Development, Third Edition. We used linear regression and generalized additive models. RESULTS Of 599 mothers, 175 (29%) met the inclusion criteria. Maternal urine cotinine levels were low (mean: 10.3 ng/mL, SD: 11.7 ng/mL). Reported passive smoking from different sources was strongly associated with urine cotinine levels. A negative association was observed between cotinine levels in pregnancy and child's gross motor function (beta = -3.22 per 10 ng/mL, 95% CI -5.09 to -1.34) after adjusting for factors potentially associated with neurodevelopment; results were similar in both sexes. A negative association was also observed for cognitive and receptive communication scales but the effect was small and not statistically significant. CONCLUSIONS Maternal exposure during pregnancy to second-hand smoke measured through urine cotinine was associated with a decrease in gross motor function among 18-month-old children, even at low levels of exposure.
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Affiliation(s)
- Iro Evlampidou
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Manolis Bagkeris
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece; University College London, Institute of Child Health, London, United Kingdom
| | - Constantine Vardavas
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece; Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA
| | - Katerina Koutra
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Evridiki Patelarou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece; Florence Nightingale School of Nursing and Midwifery, King's College, London, United Kingdom
| | - Antonis Koutis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain; National School of Public Health, Athens, Greece.
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Slotkin TA, Skavicus S, Card J, Levin ED, Seidler FJ. Amelioration strategies fail to prevent tobacco smoke effects on neurodifferentiation: Nicotinic receptor blockade, antioxidants, methyl donors. Toxicology 2015; 333:63-75. [PMID: 25891525 DOI: 10.1016/j.tox.2015.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/12/2015] [Accepted: 04/14/2015] [Indexed: 12/12/2022]
Abstract
Tobacco smoke exposure is associated with neurodevelopmental disorders. We used neuronotypic PC12 cells to evaluate the mechanisms by which tobacco smoke extract (TSE) affects neurodifferentiation. In undifferentiated cells, TSE impaired DNA synthesis and cell numbers to a much greater extent than nicotine alone; TSE also impaired cell viability to a small extent. In differentiating cells, TSE enhanced cell growth at the expense of cell numbers and promoted emergence of the dopaminergic phenotype. Nicotinic receptor blockade with mecamylamine was ineffective in preventing the adverse effects of TSE and actually enhanced the effect of TSE on the dopamine phenotype. A mixture of antioxidants (vitamin C, vitamin E, N-acetyl-l-cysteine) provided partial protection against cell loss but also promoted loss of the cholinergic phenotype in response to TSE. Notably, the antioxidants themselves altered neurodifferentiation, reducing cell numbers and promoting the cholinergic phenotype at the expense of the dopaminergic phenotype, an effect that was most prominent for N-acetyl-l-cysteine. Treatment with methyl donors (vitamin B12, folic acid, choline) had no protectant effect and actually enhanced the cell loss evoked by TSE; they did have a minor, synergistic interaction with antioxidants protecting against TSE effects on growth. Thus, components of tobacco smoke perturb neurodifferentiation through mechanisms that cannot be attributed to the individual effects of nicotine, oxidative stress or interference with one-carbon metabolism. Consequently, attempted amelioration strategies may be partially effective at best, or, as seen here, can actually aggravate injury by interfering with normal developmental signals and/or by sensitizing cells to TSE effects on neurodifferentiation.
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Affiliation(s)
- Theodore A Slotkin
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA.
| | - Samantha Skavicus
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Jennifer Card
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Edward D Levin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Frederic J Seidler
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
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Xie C, Wen X, Niu Z, Ding P, Liu T, He Y, Lin J, Yuan S, Guo X, Jia D, Chen W. Comparison of secondhand smoke exposure measures during pregnancy in the development of a clinical prediction model for small-for-gestational-age among non-smoking Chinese pregnant women. Tob Control 2014; 24:e179-87. [PMID: 25052864 DOI: 10.1136/tobaccocontrol-2014-051569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/25/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare predictive values of small-for-gestational-age (SGA) by different measures for secondhand smoke (SHS) exposure during pregnancy and to develop and validate a prediction model for SGA using SHS exposure along with sociodemographic and pregnancy factors. METHODS We compared the predictability of different measures of SHS exposure during pregnancy for SGA among 545 Chinese pregnant women, and then used the optimal SHS measure along with other clinically available factors to develop and validate a prediction model for SGA. We fit logistic regression models to predict SGA by single measures of SHS exposure (self-report, serum cotinine and CYP2A6*4) and different combinations (self-report+cotinine, cotinine+CYP2A6*4, self-report+CYP2A6*4 and self-report+cotinine+CYP2A6*4). RESULTS We found that self-reported SHS exposure alone predicted SGA (area under the receiver operating characteristic curve or area under the receiver operating curve (AUROC), 0.578) better than the other two single measures (cotinine, 0.547; CYP2A6*4, 0.529) or as accurately as combined SHS measures (0.545-0.584). The final prediction model that contained self-reported SHS exposure, prepregnancy body mass index, gestational weight gain velocity during the second and third trimesters, gestational diabetes, gestational hypertension and the third-trimester biparietal diameter Z-score could predict SGA fairly accurately (AUROC, 0.698). CONCLUSIONS Self-reported SHS exposure at peribirth performs better in predicting SGA than a single measure of serum cotinine at the same time, although repeated biochemical cotinine assessments throughout pregnancy may be optimal. Our simple prediction model is fairly accurate and can be potentially used in routine prenatal care.
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Affiliation(s)
- Chuanbo Xie
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiaozhong Wen
- Division of Behavioural Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Zhongzheng Niu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Peng Ding
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yanhui He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jianmiao Lin
- Shenzhen Women and Children's Hospital, Shenzhen, China
| | - Shixin Yuan
- Shenzhen Women and Children's Hospital, Shenzhen, China
| | - Xiaoling Guo
- Foshan Women and Children's Hospital, Foshan, China
| | - Deqin Jia
- Foshan Women and Children's Hospital, Foshan, China
| | - Weiqing Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
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Qiu J, He X, Cui H, Zhang C, Zhang H, Dang Y, Han X, Chen Y, Tang Z, Zhang H, Bai H, Xu R, Zhu D, Lin X, Lv L, Xu X, Lin R, Yao T, Su J, Liu X, Wang W, Wang Y, Ma B, Liu S, Huang H, Lerro C, Zhao N, Liang J, Ma S, Ehrenkranz RA, Liu Q, Zhang Y. Passive smoking and preterm birth in urban China. Am J Epidemiol 2014; 180:94-102. [PMID: 24838804 DOI: 10.1093/aje/kwu092] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Studies investigating the relationship between maternal passive smoking and the risk of preterm birth have reached inconsistent conclusions. A birth cohort study that included 10,095 nonsmoking women who delivered a singleton live birth was carried out in Lanzhou, China, between 2010 and 2012. Exposure to passive smoking during pregnancy was associated with an increased risk of very preterm birth (<32 completed weeks of gestation; odds ratio = 1.98, 95% confidence interval: 1.41, 2.76) but not moderate preterm birth (32-36 completed weeks of gestation; odds ratio = 0.98, 95% confidence interval: 0.81, 1.19). Risk of very preterm birth increased with the duration of exposure (P for trend = 0.0014). There was no variability in exposures by trimester. The associations were consistent for both medically indicated and spontaneous preterm births. Overall, our findings support a positive association between passive smoking and the risk of very preterm birth.
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Prasodjo A, Pfeiffer CM, Fazili Z, Xu Y, Liddy S, Yolton K, Savitz DA, Lanphear BP, Braun JM. Serum cotinine and whole blood folate concentrations in pregnancy. Ann Epidemiol 2014; 24:498-503.e1. [PMID: 24854185 DOI: 10.1016/j.annepidem.2014.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/04/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Prenatal tobacco smoke exposure may be associated with low maternal folate levels that increase the risk of adverse infant and child health outcomes by reducing folate availability during fetal development. METHODS Using data from the Health Outcomes and Measures of the Environment Study, we examined the relationship between secondhand or active tobacco smoke exposure and whole blood folate concentrations in pregnant women from Cincinnati, Ohio (n = 362) at approximately 16-week gestation. We used multivariable linear regression to examine the association between continuous or categorical serum cotinine levels and whole blood folate levels, adjusting for sociodemographic, dietary, and perinatal variables. RESULTS After adjustment for potential confounders, an interquartile range increases in serum cotinine concentration (0.012-0.224 ng/mL) was suggestively associated with decreased whole blood folate levels (β, -23 nmol/L; 95% confidence interval (CI), -49, 3; P value = .08). Compared with unexposed women, reductions in mean whole blood folate were observed among active smokers (β, -94, 95% CI, 195, 6 nmol/L; P value = .40); smaller reductions were observed among women with secondhand exposure (β, 26; CI, 84, 32 nmol/L; P value = .07). CONCLUSIONS Consistent with prior studies, active smoking was associated with reduced whole blood folate levels among these pregnant women. Secondhand tobacco smoke exposures were associated with small and imprecise reductions in whole blood folate levels.
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Affiliation(s)
- Adila Prasodjo
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Christine M Pfeiffer
- Division of Laboratory Sciences, National Center for Environmental Health, Nutritional Biomarkers Branch, Centers for Disease Control and Prevention, Atlanta, GA
| | - Zia Fazili
- Division of Laboratory Sciences, National Center for Environmental Health, Nutritional Biomarkers Branch, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stacey Liddy
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Bruce P Lanphear
- Faculty of Health and Sciences, Simon Fraser University, Burnaby, Canada; Child and Family Research Institute, BC Children's and Women's Hospital, Vancouver, Canada
| | - Joseph M Braun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI.
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Abstract
OBJECTIVE To compare illicit drug and smoking use in pregnancies with and without stillbirth. METHODS The Stillbirth Collaborative Research Network conducted a case-control study from March 2006 to September 2008, covering more than 90% of deliveries to residents of five a priori-defined geographically diverse regions. The study attempted to include all stillbirths and representative liveborn controls. Umbilical cord samples from cases and controls were collected and frozen for subsequent batch analysis. Maternal serum was collected at delivery and batch analyzed for cotinine. RESULTS For 663 stillbirth deliveries, 418 (63%) had cord homogenate and 579 (87%) had maternal cotinine assays performed. For 1,932 live birth deliveries, 1,050 (54%) had cord homogenate toxicology and 1,545 (80%) had maternal cotinine assays performed. A positive cord homogenate test for any illicit drug was associated with stillbirth (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.16-3.27). The most common individual drug was cannabis (OR 2.34 95% CI 1.13-4.81), although the effect was partially confounded by smoking. Both maternal self-reported smoking history and maternal serum cotinine levels were associated in a dose-response relationship with stillbirth. Positive serum cotinine less than 3 ng/mL and no reported history of smoking (proxy for passive smoke exposure) also were associated with stillbirth (OR 2.06, 95% CI 1.24-3.41). CONCLUSION Cannabis use, smoking, illicit drug use, and apparent exposure to second-hand smoke, separately or in combination, during pregnancy were associated with an increased risk of stillbirth. Because cannabis use may be increasing with increased legalization, the relevance of these findings may increase as well. LEVEL OF EVIDENCE II.
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27
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Hawkins SS, Dacey C, Gennaro S, Keshinover T, Gross S, Gibeau A, Lulloff A, Aldous KM. Secondhand smoke exposure among nonsmoking pregnant women in New York City. Nicotine Tob Res 2014; 16:1079-84. [PMID: 24642590 DOI: 10.1093/ntr/ntu034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Although secondhand smoke (SHS) exposure during pregnancy has detrimental effects on fetal health, little is known about levels of SHS in nonsmoking pregnant women. We examined disparities in SHS exposure among nonsmoking, ethnic minority pregnant women in New York City. METHODS We used self-reported smoking and serum cotinine collected from 244 pregnant women from the Bronx who self-identified as African American, Caribbean American, or Black Hispanic to examine smoking prevalence (>3 ng/ml) and, in an adjusted logistic regression model, risk factors for SHS (≥ 0.05 ng/ml and ≤ 3 ng/ml). RESULTS Although only 4.1% of women self-reported they were smokers, 10.7% had serum cotinine levels indicating they were smokers. Among the 218 nonsmokers, 46.8% had serum cotinine levels indicating SHS exposure. Women at highest risk included those with less than a high school degree (66.7%) and those who were U.S.-born Black Hispanic (63.2%) or African American (63.0%). Women with more than 12 years of education were less likely to have detectable SHS exposure than women with fewer than 12 years (adjusted odds ratio 0.39, 95% CI = 0.17, 0.91). Compared with African American U.S.-born women, those who were African American foreign-born or Caribbean American and either U.S.-born or foreign-born were less likely to have detectable SHS exposure (all p ≤ .05). CONCLUSIONS Nearly half of nonsmoking pregnant women in New York City had elevated cotinine levels despite living in a city with comprehensive tobacco control policies. Health professionals need to assess sources of SHS exposure during pregnancy and promote smoke-free environments to improve maternal and fetal health.
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Affiliation(s)
- Summer S Hawkins
- Boston College, Graduate School of Social Work, Chestnut Hill, MA;
| | - Caitlin Dacey
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA
| | - Susan Gennaro
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA
| | | | - Susan Gross
- Albert Einstein College of Medicine, Bronx, NY
| | | | - Amanda Lulloff
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA
| | - Kenneth M Aldous
- New York State Department of Health, Wadsworth Center, Albany, NY
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Slotkin TA, Card J, Stadler A, Levin ED, Seidler FJ. Effects of tobacco smoke on PC12 cell neurodifferentiation are distinct from those of nicotine or benzo[a]pyrene. Neurotoxicol Teratol 2014; 43:19-24. [PMID: 24642111 DOI: 10.1016/j.ntt.2014.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 02/28/2014] [Accepted: 03/01/2014] [Indexed: 01/31/2023]
Abstract
Although nicotine accounts for a great deal of the neurodevelopmental damage associated with maternal smoking or second-hand exposure, tobacco smoke contains thousands of potentially neurotoxic compounds. We used PC12 cells, a standard in vitro model of neurodifferentiation, to compare tobacco smoke extract (TSE) to nicotine, matching TSE exposure (with its inherent nicotine content) to parallel concentrations of nicotine, or to benzo[a]pyrene, a tobacco combustion product. TSE promoted the transition from cell replication to differentiation, resulting in fewer, but larger cells with greater neurite extension. TSE also biased differentiation into the dopaminergic versus the cholinergic phenotype, evidenced by an increase in tyrosine hydroxylase activity but not choline acetyltransferase. Nicotine likewise promoted differentiation at the expense of cell numbers, but its effect on growth and neurite extension was smaller than that of TSE; furthermore, nicotine did not promote the dopaminergic phenotype. Benzo[a]pyrene had effects opposite to those of TSE, retarding neurodifferentiation, which resulted in higher cell numbers, smaller cells, reduced neurite information, and impaired emergence of both dopaminergic and cholinergic phenotypes. Our studies show that the complex mixture of compounds in tobacco smoke exerts direct effects on neural cell replication and differentiation that resemble those of nicotine in some ways but not others, and most importantly, that are greater in magnitude than can be accounted for from just the nicotine content of TSE. Thus, fetal tobacco smoke exposure, including lower levels associated with second-hand smoke, could be more injurious than would be anticipated from measured levels of nicotine or its metabolites.
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Affiliation(s)
- Theodore A Slotkin
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA.
| | - Jennifer Card
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Ashley Stadler
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Edward D Levin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Frederic J Seidler
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
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Chen R, Hu Z, Orton S, Chen RL, Wei L. Association of passive smoking with cognitive impairment in nonsmoking older adults: a systematic literature review and a new study of Chinese cohort. J Geriatr Psychiatry Neurol 2013; 26:199-208. [PMID: 23877565 DOI: 10.1177/0891988713496165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Association of passive smoking with cognitive impairment in older adults is unclear. We carried out a systematic literature review and a new study to determine the association. There were 3 cross-sectional studies published, showing a significant association of passive smoking with cognitive impairment (a relative risk (RR) of about 1.30-1.90). In the new cohort study, we interviewed 1081 never-smoking participants aged ≥ 65 years in China using a standard method of the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy and found a significant association with dose response; multivariate adjusted RR was 1.02 (95% confidence interval 0.67-1.55) in > 0 to 49 exposure level years of passive smoking, 1.57 (1.00-2.47) in 50 to 99, and 2.12 (1.24-3.63) in ≥ 100, trend P = .008. The relationship seems not to be a reverse causality of the effect. Passive smoking could be considered an important risk factor for cognitive impairment in older adults. Avoiding exposure to passive smoking would help to preserve cognitive decline in later life.
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Affiliation(s)
- Ruoling Chen
- Division of Health and Social Care Research, King's College London, London, UK
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30
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Is exposure to secondhand smoke associated with cognitive parameters of children and adolescents?--a systematic literature review. Ann Epidemiol 2013; 23:652-61. [PMID: 23969303 DOI: 10.1016/j.annepidem.2013.07.001] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 06/17/2013] [Accepted: 07/01/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE Despite the known association of second hand smoke (SHS) with increased risk of ill health and mortality, the effects of SHS exposure on cognitive functioning in children and adolescents are unclear. Through a critical review of the literature we sought to determine whether a relationship exists between these variables. METHODS The authors systematically reviewed articles (dated 1989-2012) that investigated the association between SHS exposure (including in utero due to SHS exposure by pregnant women) and performance on neurocognitive and academic tests. Eligible studies were identified from searches of Web of Knowledge, MEDLINE, Science Direct, Google Scholar, CINAHL, EMBASE, Zetoc, and Clinicaltrials.gov. RESULTS Fifteen articles were identified, of which 12 showed inverse relationships between SHS and cognitive parameters. Prenatal SHS exposure was inversely associated with neurodevelopmental outcomes in young children, whereas postnatal SHS exposure was associated with poor academic achievement and neurocognitive performance in older children and adolescents. Furthermore, SHS exposure was associated with an increased risk of neurodevelopmental delay. CONCLUSIONS Recommendations should be made to the public to avoid sources of SHS and future research should investigate interactions between SHS exposure and other risk factors for delayed neurodevelopment and poor cognitive performance.
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Kim S, Jung A. Optimum cutoff value of urinary cotinine distinguishing South Korean adult smokers from nonsmokers using data from the KNHANES (2008-2010). Nicotine Tob Res 2013; 15:1608-16. [PMID: 23509092 DOI: 10.1093/ntr/ntt027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Cutoff values for distinguishing smokers from nonsmokers have generally been derived from studies in White populations. Even though recent population-based studies have demonstrated that cutoff values can differ by race and ethnicity, few studies have explored cutoff values among Asian populations. We established the cutoff values for urinary cotinine and cotinine:creatinine ratio (CCR) using a nationally representative South Korean adult population sample. METHODS Data were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2010 with pooled sampling weights. Adult participants (n = 11,629) aged ≥19 were included. Optimal cutoff values were determined by performing receiver operating characteristic curve analysis. RESULTS The optimum cutoff values for urinary cotinine and CCR for Korean adults were found to be 164ng/mL and 1122ng/mg, respectively. The application of these urinary cotinine and CCR cutoff values for the female subpopulations aged 19-34, 35-54, and ≥55 years provided sensitivities ranging from 87.1% to 93.8% and from 82.9% to 94.9%, respectively, while maintaining specificity of ≥92%. For the 3 male age-based subpopulations, we obtained sensitivities and specificities for cotinine ranging from 93.1% to 94.5% and from 92.8% to 97.0%, respectively, and for CCR ranging from 90.0% to 96.9% and from 92.2% to 96.8%, respectively. CONCLUSIONS Our cutoff values should allow researchers conducting environmental epidemiological or clinical studies in South Korea to distinguish adult smokers from nonsmokers effectively. However, different values may be applicable for subpopulations with different smoking prevalence rates or higher exposure levels to secondhand smoke.
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Affiliation(s)
- Sungroul Kim
- Department of Environmental Health Sciences, Soonchunhyang University, Asan, South Korea.
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Kusel J, Timm B, Lockhart I. The impact of smoking in the home on the health outcomes of non-smoker occupants in the UK. Tob Induc Dis 2013; 11:3. [PMID: 23360643 PMCID: PMC3568010 DOI: 10.1186/1617-9625-11-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/16/2013] [Indexed: 11/10/2022] Open
Abstract
Smoking in the home remains a key source of exposure to secondhand smoke for non-smokers, particularly since the UK public smoking ban in 2007. A systematic literature review was conducted to identify all UK evidence on the impact of secondhand smoke exposure in the home on health and behavioural outcomes in non-smoker occupants. MEDLINE, EMBASE and the Cochrane Library were searched to identify all relevant UK empirical studies from 2000 to June 2011. A qualitative overview of the evidence is presented. Exposure to secondhand smoke in UK homes was found to be associated with serious negative health effects in non-smokers, including significantly increased risk of meningococcal carriage (p < 0.001) and disease (p = 0.05) in children and adolescents, cognitive impairment (p < 0.001) in adults, a higher rate of medically attended accidents in children with smoking mothers (p < 0.01), and for non-smoking women, a significant decrease in infant birth weight (p = 0.007). Living in a smoking household significantly increased the risk of future regular smoking in children (p < 0.001). In conclusion, this systematic review has identified strong evidence of an association between secondhand smoke exposure in the home and several serious health conditions. This finding highlights the importance of educating current smokers on the consequences of non-smoker exposure to smoking in the home.
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Affiliation(s)
- Jeanette Kusel
- Costello Medical Consulting Ltd, St John's Innovation Centre, Cowley Road, Cambridge, CB4 0WS, UK.
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Chen R, Wilson K, Chen Y, Zhang D, Qin X, He M, Hu Z, Ma Y, Copeland JR. Association between environmental tobacco smoke exposure and dementia syndromes. Occup Environ Med 2012; 70:63-9. [PMID: 23104731 PMCID: PMC3534257 DOI: 10.1136/oemed-2012-100785] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Environmental tobacco smoke (ETS) has a range of adverse health effects, but its association with dementia remains unclear and with dementia syndromes unknown. We examined the dose-response relationship between ETS exposure and dementia syndromes. METHODS Using a standard method of GMS, we interviewed 5921 people aged ≥60 years in five provinces in China in 2007-2009 and characterised their ETS exposure. Five levels of dementia syndrome were diagnosed using the Automated Geriatric Examination for Computer Assisted Taxonomy instrument. The relative risk (RR) of moderate (levels 1-2) and severe (levels 3-5) dementia syndromes among participants exposed to ETS was calculated in multivariate adjusted regression models. RESULTS 626 participants (10.6%) had severe dementia syndromes and 869 (14.7%) moderate syndromes. Participants exposed to ETS had a significantly increased risk of severe syndromes (adjusted RR 1.29, 95% CI 1.05 to 1.59). This was dose-dependently related to exposure level and duration. The cumulative exposure dose data showed an adjusted RR of 0.99 (95% CI 0.76 to 1.28) for >0-24 level years of exposure, 1.15 (95% CI 0.93 to 1.42) for 25-49 level years, 1.18 (95% CI 0.87 to 1.59) for 59-74 level years, 1.39 (95% CI 1.03 to 1.84) for 75-99 level years and 1.95 (95% CI 1.34 to 2.83) for ≥100 level years. Significant associations with severe syndromes were found in never smokers and in former/current smokers. There were no positive associations between ETS and moderate dementia syndromes. CONCLUSIONS ETS should be considered an important risk factor for severe dementia syndromes. Avoidance of ETS may reduce the rates of severe dementia syndromes worldwide.
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Affiliation(s)
- Ruoling Chen
- School of Health Administration, Anhui Medical University, Hefei, China.
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Rauch SA, Braun JM, Barr DB, Calafat AM, Khoury J, Montesano AM, Yolton K, Lanphear BP. Associations of prenatal exposure to organophosphate pesticide metabolites with gestational age and birth weight. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1055-60. [PMID: 22476135 PMCID: PMC3404666 DOI: 10.1289/ehp.1104615] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 03/20/2012] [Indexed: 05/17/2023]
Abstract
BACKGROUND Prenatal exposure to organophosphate (OP) insecticides, a widely used class of pesticides, may be associated with decreased gestational age and lower birth weight. Single nucleotide polymorphisms in paroxanase (PON1) enzyme genotypes may modify the relationships between OP exposure and perinatal outcomes. OBJECTIVE We examined the relationship of prenatal OP insecticide exposure, measured using urinary dialkyl phosphate (DAP) metabolite concentrations, with gestational age and birth weight. METHODS We measured the concentrations of six nonspecific DAP metabolites of OP insecticides in two maternal spot urine samples collected in a prospective birth cohort. We performed multivariable regression to examine associations between the sum of six DAP concentrations (ΣDAP) with gestational age and birth weight. We also examined whether these associations differed according to infant PON1(192) and PON1(-108) genotypes. RESULTS Among 306 mother-infant dyads, a 10-fold increase in ΣDAP concentrations was associated with a decrease in covariate-adjusted gestational age [-0.5 weeks; 95% confidence interval (CI): -0.8, -0.1] and birth weight (-151 g; CI: -287, -16); the decrements in birth weight were attenuated after adjusting for gestational age. The relationship between ΣDAP concentrations and gestational age was stronger for white (-0.7 weeks; CI: -1.1, -0.3) than for black (-0.1 weeks; 95% CI: -0.9, 0.6) newborns. In contrast, there was a greater decrease in birth weight with increasing urinary ΣDAP concentrations for black (-188 g; CI: -395, 19) than for white (-118 g; CI: -296, 60) newborns. Decrements in birth weight and gestational age associated with ΣDAP concentrations were greatest among infants with PON1(192QR) and PON(-108CT) genotypes. CONCLUSIONS Prenatal urinary ΣDAP concentrations were associated with shortened gestation and reduced birth weight in this cohort, but the effects differed by race/ethnicity and PON1(192/108) genotypes.
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Affiliation(s)
- Stephen A Rauch
- Child & Family Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
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Partner cigarette smoking and risk of neural tube defects among infants of non-smoking women in northern China. Tob Control 2012; 22:401-5. [DOI: 10.1136/tobaccocontrol-2011-050384] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chen R. Association of environmental tobacco smoke with dementia and Alzheimer's disease among never smokers. Alzheimers Dement 2011; 8:590-5. [DOI: 10.1016/j.jalz.2011.09.231] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 09/12/2011] [Accepted: 09/19/2011] [Indexed: 02/07/2023]
Affiliation(s)
- Ruoling Chen
- Division of Health and Social Care ResearchKing's College LondonLondonUnited Kingdom
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Sasaki S, Braimoh TS, Yila TA, Yoshioka E, Kishi R. Self-reported tobacco smoke exposure and plasma cotinine levels during pregnancy--a validation study in Northern Japan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2011; 412-413:114-118. [PMID: 22078365 DOI: 10.1016/j.scitotenv.2011.10.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 05/31/2023]
Abstract
Maternal smoking is a critical public health concern requiring the establishment of its prevalence rate and clinical impact. Maternal self-reported information of tobacco smoke exposure requires validation using accurate biochemical analysis. This study examined the association between self-reported exposure to tobacco smoke and plasma cotinine level in Japanese pregnant women. We collected information about smoking and secondhand smoke (SHS) exposure during pregnancy from 5128 pregnant women in a prospective cohort design, and analyzed biochemically maternal blood samples using the enzyme-linked immunosorbent assay (ELISA) technique. Based on self-reports, the subjects were classified into three groups: 650 smokers, 728 ex-smokers and 3750 non-smokers. Using the receiver operating characteristic (ROC) curve, plasma cotinine cut-off value of 11.48 ng/mL was established for separating smokers from non-smokers, resulting in a smoking prevalence of 14%. A cotinine cut-off value of 0.21 ng/mL for discriminating exposed and unexposed nonsmokers resulted in a 63% prevalence of exposure to tobacco smoke among nonsmokers. Cotinine biomarker analysis proved accurate in validating self-reported smoking information in the subjects. Lower validity of SHS exposure suggests a need to confirm questionnaire information with biochemical analysis.
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Affiliation(s)
- Seiko Sasaki
- Department of Public Health, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo 060-8638, Japan
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Khader YS, Al-Akour N, Alzubi IM, Lataifeh I. The association between second hand smoke and low birth weight and preterm delivery. Matern Child Health J 2011; 15:453-9. [PMID: 20364365 DOI: 10.1007/s10995-010-0599-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To determine the association between maternal exposure to SHS and low birth weight and preterm delivery. This cross-sectional study was carried out in the four main governmental hospitals dealing with deliveries in the north of Jordan. A consecutive 8,490 women who delivered in these hospitals between April 2007 and September 2007 were included in the study after excluding those who reported active smoking during the current pregnancy. Pre-structured questionnaire and review of hospital records were used to collect data about maternal background, obstetric history, medical history, and data related to second hand smoke exposure. Overall, 13.8% of women gave birth to a preterm baby and 10.0% gave birth to a low birth weight baby. About 12.6% of women who were exposed to SHS delivered low birth weight babies compared to 7.7% for non exposed women. The rate of preterm delivery among the exposed group was significantly higher than that among the non-exposed group (17.2 vs. 10.6%). In the multivariate analysis, exposure to SHS during pregnancy was significantly associated with increased odds of low birth weight (OR = 1.56 (95% CI 1.31, 1.89)) and preterm delivery (OR = 1.61 (95% CI: 1.30, 1.99)). Exposure of women to SHS during pregnancy is associated with increased odds of low birth weight and preterm delivery. Health care professionals should carry out educational programs to increase awareness and understanding of pregnant women and their husbands about the harmful effects of second hand smoke on birth outcomes.
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Affiliation(s)
- Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology (JUST), P.O. Box (3030), Irbid, 22110, Jordan.
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Rosa MJ, Jung KH, Perzanowski MS, Kelvin EA, Darling KW, Camann DE, Chillrud SN, Whyatt RM, Kinney PL, Perera FP, Miller RL. Prenatal exposure to polycyclic aromatic hydrocarbons, environmental tobacco smoke and asthma. Respir Med 2011; 105:869-76. [PMID: 21163637 PMCID: PMC3081952 DOI: 10.1016/j.rmed.2010.11.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/17/2010] [Accepted: 11/19/2010] [Indexed: 01/25/2023]
Abstract
BACKGROUND Previously, we reported that prenatal exposures to polycyclic aromatic hydrocarbons (PAH) and postnatal environmental tobacco smoke (ETS) in combination were associated with respiratory symptoms at ages 1 and 2 years. Here, we hypothesized that children exposed to both prenatal PAH and ETS may be at greater risk of asthma and seroatopy at ages 5-6 years, after controlling for current pollution exposure. METHODS Prenatal PAH exposure was measured by personal air monitoring over 48 h. ETS exposure, respiratory symptoms and asthma at ages 5-6 years were assessed through questionnaire. Immunoglobulin (Ig) E was measured by Immunocap. RESULTS A significant interaction between prenatal PAH and prenatal (but not postnatal) ETS exposure on asthma (p < 0.05), but not IgE, was detected. Among children exposed to prenatal ETS, a positive nonsignificant association was found between prenatal PAH exposure and asthma (OR 1.96, 95% CI [0.95-4.05]). Among children without exposure to prenatal ETS, a negative nonsignificant association was found between prenatal PAH exposure and asthma (OR 0.65, 95% CI [0.41-1.01]). Prenatal PAH exposure was not associated with asthma or IgE at age 5-6 years. CONCLUSIONS Combined prenatal exposure to PAH and ETS appears to be associated with asthma but not seroatopy at age 5-6. Exposure to PAH alone does not appear associated with either asthma or seroatopy at age 5-6 years. Discerning the differential effects between ETS exposed and ETS nonexposed children requires further study.
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Affiliation(s)
- Maria José Rosa
- Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, NY 10032, USA.
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Suarez L, Ramadhani T, Felkner M, Canfield MA, Brender JD, Romitti PA, Sun L. Maternal smoking, passive tobacco smoke, and neural tube defects. ACTA ACUST UNITED AC 2010; 91:29-33. [PMID: 21254356 DOI: 10.1002/bdra.20743] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 08/13/2010] [Accepted: 08/18/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although cigarette smoke is a well-established toxin and harmful to the developing embryo, the evidence for an independent effect on the occurrence of neural tube defects (NTDs) is mixed. In this study, we examined the relation between NTDs and maternal exposures to cigarette smoke, including passive smoke exposure. METHODS We used cases and controls from the large, multistate, population-based National Birth Defects Prevention Study. A total of 1041 NTD cases and 5862 live birth controls, delivered during 1997 to 2004, were available for analyses. Mothers were interviewed by telephone between 6 weeks and 24 months after delivery. Participation rates were 71% for NTD case mothers and 69% for control mothers. RESULTS Compared with nonsmokers (and also not exposed to passive cigarette smoke), mothers exposed only to passive smoke had an increased NTD odds ratio (OR, 1.7; 95% confidence interval [CI], 1.4-2.0), adjusted for race-ethnicity, and study center. There was no increased OR for mothers who actively smoked 24 or fewer cigarettes per day. Mothers who smoked 25 or more cigarettes per day had an elevated OR (OR, 1.6; 95% CI, 0.9-3.0), but the OR adjusted for race-ethnicity, and center was compatible with the null. CONCLUSION Results suggest that maternal exposure to passive smoke is associated with NTDs. Women who plan on becoming pregnant should minimize their exposure to passive smoke and refrain from smoking.
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Affiliation(s)
- Lucina Suarez
- Texas Center for Birth Defects Research and Prevention, Texas Department of State Health Services, Austin, TX 78714, USA.
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Braun JM, Daniels JL, Poole C, Olshan AF, Hornung R, Bernert JT, Khoury J, Needham LL, Barr DB, Lanphear BP. Prenatal environmental tobacco smoke exposure and early childhood body mass index. Paediatr Perinat Epidemiol 2010; 24:524-34. [PMID: 20955230 PMCID: PMC3509191 DOI: 10.1111/j.1365-3016.2010.01146.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Maternal smoking during pregnancy is associated with increased risk of childhood overweight body mass index (BMI). Less is known about the association between prenatal secondhand tobacco smoke (SHS) exposure and childhood BMI. We followed 292 mother-child dyads from early pregnancy to 3 years of age. Prenatal tobacco smoke exposure during pregnancy was quantified using self-report and serum cotinine biomarkers. We used linear mixed models to estimate the association between tobacco smoke exposure and BMI at birth, 4 weeks, and 1, 2 and 3 years. During pregnancy, 15% of women reported SHS exposure and 12% reported active smoking, but 51% of women had cotinine levels consistent with SHS exposure and 10% had cotinine concentrations indicative of active smoking. After adjustment for confounders, children born to active smokers (self-report or serum cotinine) had higher BMI at 2 and 3 years of age, compared with unexposed children. Children born to women with prenatal serum cotinine concentrations indicative of SHS exposure had higher BMI at 2 (mean difference [MD] 0.3 [95% confidence interval -0.1, 0.7]) and 3 (MD 0.4 [0, 0.8]) years compared with unexposed children. Using self-reported prenatal exposure resulted in non-differential exposure misclassification of SHS exposures that attenuated the association between SHS exposure and BMI compared with serum cotinine concentrations. These findings suggest active and secondhand prenatal tobacco smoke exposure may be related to an important public health problem in childhood and later life. In addition, accurate quantification of prenatal secondhand tobacco smoke exposures is essential to obtaining valid estimates.
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Affiliation(s)
- Joe M. Braun
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599-7435
| | - Julie L. Daniels
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599-7435
| | - Charles Poole
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599-7435
| | - Andrew F. Olshan
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599-7435
| | - Richard Hornung
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229
| | - John T. Bernert
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Jane Khoury
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229
| | - Larry L. Needham
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Dana Boyd Barr
- Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Bruce P. Lanphear
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229,Child & Family Research Institute, BC Children’s Hospital and the Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia
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Ashford KB, Hahn E, Hall L, Rayens MK, Noland M, Ferguson JE. The effects of prenatal secondhand smoke exposure on preterm birth and neonatal outcomes. J Obstet Gynecol Neonatal Nurs 2010; 39:525-35. [PMID: 20919999 PMCID: PMC2951268 DOI: 10.1111/j.1552-6909.2010.01169.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the relationship between prenatal secondhand smoke (SHS) exposure, preterm birth and immediate neonatal outcomes by measuring maternal hair nicotine. DESIGN Cross-sectional, observational design. SETTING A metropolitan Kentucky birthing center. PARTICIPANTS Two hundred and ten (210) mother-baby couplets. METHODS Nicotine in maternal hair was used as the biomarker for prenatal SHS exposure collected within 48 hours of birth. Smoking status was confirmed by urine cotinine analysis. RESULTS Smoking status (nonsmoking, passive smoking, and smoking) strongly correlated with low, medium, and high hair nicotine tertiles (ρ=.74; p<.001). Women exposed to prenatal SHS were more at risk for preterm birth (odds ratio [OR]=2.3; 95% Confidence Interval [CI] [.96, 5.96]), and their infants were more likely to have immediate newborn complications (OR=2.4; 95% CI [1.09, 5.33]) than nonexposed women. Infants of passive smoking mothers were at increased risk for respiratory distress syndrome (RDS) (OR=4.9; 95% CI [1.45, 10.5]) and admission to a Neonatal Intensive Care Unit (NICU) (OR=6.5; CI [1.29, 9.7]) when compared to infants of smoking mothers (OR=3.9; 95% CI [1.61, 14.9]; OR=3.5; 95% CI [2.09, 20.4], respectively). Passive smokers and/or women with hair nicotine levels greater than .35 ng/ml were more likely to deliver earlier (1 week), give birth to infants weighing less (decrease of 200-300 g), and deliver shorter infants (decrease of 1.1-1.7 cm). CONCLUSIONS Prenatal SHS exposure places women at greater risk for preterm birth, and their newborns are more likely to have RDS, NICU admissions, and immediate newborn complications.
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Affiliation(s)
- Kristin B Ashford
- College of Nursing, University of Kentucky, Lexington, KY 40536-0232, USA.
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Braun JM, Daniels JL, Poole C, Olshan AF, Hornung R, Bernert JT, Xia Y, Bearer C, Barr DB, Lanphear BP. A prospective cohort study of biomarkers of prenatal tobacco smoke exposure: the correlation between serum and meconium and their association with infant birth weight. Environ Health 2010; 9:53. [PMID: 20799929 PMCID: PMC2944243 DOI: 10.1186/1476-069x-9-53] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 08/27/2010] [Indexed: 05/18/2023]
Abstract
BACKGROUND The evaluation of infant meconium as a cumulative matrix of prenatal toxicant exposure requires comparison to established biomarkers of prenatal exposure. METHODS We calculated the frequency of detection and concentration of tobacco smoke metabolites measured in meconium (nicotine, cotinine, and trans-3'-hydroxycotinine concentrations) and three serial serum cotinine concentrations taken during the latter two-thirds of pregnancy among 337 mother-infant dyads. We estimated the duration and intensity of prenatal tobacco smoke exposure using serial serum cotinine concentrations and calculated geometric mean meconium tobacco smoke metabolite concentrations according to prenatal exposure. We also compared the estimated associations between these prenatal biomarkers and infant birth weight using linear regression. RESULTS We detected nicotine (80%), cotinine (69%), and trans-3'-hydroxycotinine (57%) in most meconium samples. Meconium tobacco smoke metabolite concentrations were positively associated with serum cotinine concentrations and increased with the number of serum cotinine measurements consistent with secondhand or active tobacco smoke exposure. Like serum cotinine, meconium tobacco smoke metabolites were inversely associated with birth weight. CONCLUSIONS Meconium is a useful biological matrix for measuring prenatal tobacco smoke exposure and could be used in epidemiological studies that enroll women and infants at birth. Meconium holds promise as a biological matrix for measuring the intensity and duration of environmental toxicant exposure and future studies should validate the utility of meconium using other environmental toxicants.
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Affiliation(s)
- Joe M Braun
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599-7435, USA
| | - Julie L Daniels
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599-7435, USA
| | - Charles Poole
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599-7435, USA
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599-7435, USA
| | - Richard Hornung
- Department of Pediatrics, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - John T Bernert
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Yang Xia
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Cynthia Bearer
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Dana Boyd Barr
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Bruce P Lanphear
- Department of Pediatrics, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
- Child & Family Research Institute, British Columbia Children's Hospital and the Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, CA
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Mijal RS, Holzman CB. Blood cadmium levels in women of childbearing age vary by race/ethnicity. ENVIRONMENTAL RESEARCH 2010; 110:505-12. [PMID: 20400068 PMCID: PMC2922033 DOI: 10.1016/j.envres.2010.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 02/12/2010] [Accepted: 02/22/2010] [Indexed: 05/20/2023]
Abstract
The heavy metal cadmium (Cd) is long-lived in the body and low-level cumulative exposure, even among non-smokers, has been associated with changes in renal function and bone metabolism. Women are more susceptible to the adverse effects of Cd and have higher body burdens. Due to increased dietary absorption of Cd in menstruating women and the long half-life of the metal, reproductive age exposures are likely important contributors to overall body burden and disease risk. We examined blood Cd levels in women of reproductive age in the US and assessed variation by race/ethnicity. Blood Cd concentrations were compared among female NHANES participants aged 20-44, who were neither pregnant nor breastfeeding. Sample size varied primarily based on inclusion/exclusion of smokers (n=1734-3121). Mean Cd concentrations, distributions and odds ratios were calculated using SUDAAN. For logistic regression Cd was modeled as high (the upper 10% of the distribution) vs. the remainder. Overall, Mexican Americans had lower Cd levels than other groups due to a lower smoking prevalence, smoking being an important source of exposure. Among never-smokers, Mexican Americans had 1.77 (95% CI: 1.06-2.96) times the odds of high Cd as compared to non-Hispanic Whites after controlling for age and low iron (ferritin). For non-Hispanic Blacks, the odds were 2.96 (CI: 1.96-4.47) times those of non-Hispanic Whites in adjusted models. Adjustment for relevant reproductive factors or exposure to environmental tobacco smoke had no effect. In this nationally representative sample, non-smoking Mexican American and non-Hispanic Black women were more likely to have high Cd than non-Hispanic White women. Additional research is required to determine the underlying causes of these differences.
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Affiliation(s)
- Renée S Mijal
- Department of Epidemiology, Michigan State University, B601 W. Fee Hall, East Lansing, MI 48824, USA.
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Ashford KB, Hahn E, Hall L, Rayens MK, Noland M, Collins R. Measuring prenatal secondhand smoke exposure in mother-baby couplets. Nicotine Tob Res 2009; 12:127-35. [PMID: 20038509 DOI: 10.1093/ntr/ntp185] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Pregnant women often underreport their smoking status and extent of secondhand smoke (SHS) exposure. Biomarker confirmation is the recommended method to assess smoking behaviors and SHS exposure in both mothers and infants. OBJECTIVES The primary aims are to (a) examine the relationship between smoking behaviors and SHS exposure in mother-baby couplets using maternal and infant hair nicotine and maternal urine cotinine analyses and (b) determine whether there is an association between maternal and infant hair nicotine samples obtained shortly after birth. DISCUSSION A cross-sectional study with a multiethnic sample of 210 mother-baby couplets assessing SHS exposure. RESULTS The level of maternal hair nicotine (MHN) was significantly different among three groups: nonsmoking, nonsmoking/passive exposed, and smoking (p < .0001), with nonsmoking and nonexposed women having the lowest level. Urine cotinine was strongly associated with self-reported smoking status (rho = .88; p < .0001). Maternal and infant hair nicotine were correlated, although MHN correlated more strongly with smoking status (rho = .46, p < .0001) than infant hair nicotine (rho = .39, p < .0001). CONCLUSIONS MHN was a more precise biomarker of prenatal SHS exposure than infant hair nicotine; mothers' urine cotinine was strongly correlated with self-reported smoking status.
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Affiliation(s)
- Kristin B Ashford
- University of Kentucky College of Nursing, Lexington, KY 40536-0232, USA.
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Ashford KB, Hahn E, Hall L, Rayens MK, Noland M. Postpartum smoking relapse and secondhand smoke. Public Health Rep 2009; 124:515-26. [PMID: 19618788 DOI: 10.1177/003335490912400408] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE There has been an abundance of research evaluating prenatal and postnatal smoking abstinence programs. However, few researchers have tested postpartum relapse interventions that address secondhand smoke (SHS) exposure. Pregnant women exposed to SHS are more likely to relapse. This article explores the similarities and differences among postpartum interventions that incorporate SHS education. Generating knowledge about the components of postpartum relapse prevention interventions that do and do not achieve prolongation of abstinence is integral to the development of effective SHS interventions that help women achieve lifelong abstinence. METHODS We used a methodological review of 11 randomized, controlled trials testing the efficacy of relapse prevention interventions that address SHS exposure. We compared intervention strength, biomarker validation of home smoking and SHS, as well as abstinence and relapse rates. We examined three predictors of postpartum relapse: (1) partner smoking in the home, (2) adoption of home smoking restrictions, and (3) motivation/confidence to remain abstinent. RESULTS Findings revealed a need for more comprehensive SHS interventions and a clear delineation of abstinence/relapse terminology. Biomarker validation of home smoking and SHS was primarily measured by self-report, passive nicotine monitors, and hair nicotine levels. Furthermore, studies using nurse- and pediatrician-led interventions resulted in the lowest relapse rates. CONCLUSION A comprehensive intervention that specifically prioritizes parental education on the health effects of SHS on the family, empowerment of the mother and family members to remain abstinent and adopt a smoke-free home smoking policy, and partner influence on smoking could result in a significant reduction in postpartum relapse rates.
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Affiliation(s)
- Kristin B Ashford
- University of Kentucky College of Nursing, Lexington, KY 40536-0232, USA.
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Fantuzzi G, Vaccaro V, Aggazzotti G, Righi E, Kanitz S, Barbone F, Sansebastiano G, Battaglia MA, Leoni V, Fabiani L, Triassi M, Sciacca S, Facchinetti F. Exposure to active and passive smoking during pregnancy and severe small for gestational age at term. J Matern Fetal Neonatal Med 2009; 21:643-7. [PMID: 18828056 DOI: 10.1080/14767050802203744] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Paek YJ, Kang JB, Myung SK, Lee DH, Seong MW, Seo HG, Cho JJ, Song HJ, Park KH, Kim CH, Ko JA. Self-reported exposure to second-hand smoke and positive urinary cotinine in pregnant nonsmokers. Yonsei Med J 2009; 50:345-51. [PMID: 19568595 PMCID: PMC2703756 DOI: 10.3349/ymj.2009.50.3.345] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 11/08/2008] [Accepted: 11/08/2008] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This cross-sectional study aimed to examine the association between self-reported exposure status to second-hand smoke and urinary cotinine level in pregnant nonsmokers. MATERIALS AND METHODS We recruited pregnant nonsmokers from the prenatal care clinics of a university hospital and two community health centers, and their urinary cotinine concentrations were measured. RESULTS Among a total of 412 pregnant nonsmokers, the proportions of self-reported exposure to second-hand smoke and positive urinary cotinine level were 60.4% and 3.4%, respectively. Among those, 4.8% of the participants who reported exposure to second-hand smoke had cotinine levels of 40 ng/mL (the kappa value = 0.029, p = 0.049). Among those who reported living with smokers (n = 170), "smoking currently permitted in the whole house" (vs. not permitted at home) was associated with positive urinary cotinine in the univariable analysis. Furthermore, this variable showed a significant association with positive urinary cotinine in the stepwise multiple logistic regression analysis [Odds ratio (OR), 15.6; 95% Confidence interval (CI) = 2.1-115.4]. CONCLUSION In the current study, the association between self-reported exposure status to second-hand smoke and positive urinary cotinine in pregnant nonsmokers was poor. "Smoking currently permitted in the whole house" was a significant factor of positive urinary cotinine in pregnant nonsmokers. Furthermore, we suggest that a complete smoking ban at home should be considered to avoid potential adverse effects on pregnancy outcomes due to second-hand smoke.
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Affiliation(s)
- Yu Jin Paek
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jeong Bae Kang
- Department of Obstetrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seung-Kwon Myung
- Smoking Cessation Clinic, Center for Cancer Prevention and Detection, Korea
| | - Do-Hoon Lee
- Department of Laboratory Medicine, National Cancer Center, Goyang, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, National Cancer Center, Goyang, Korea
| | - Hong Gwan Seo
- Smoking Cessation Clinic, Center for Cancer Prevention and Detection, Korea
| | - Jung Jin Cho
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hong Ji Song
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chan Ho Kim
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jeong Ah Ko
- Department of Family Medicine, Seoul National University Hospital; Preventive Medicine, Graduate School of Seoul National University, Seoul, Korea
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GILLIGAN CONOR, SANSON-FISHER ROBERT, EADES SANDRA, WENITONG MARK, PANARETTO KATHRYN, D'ESTE CATHERINE. Assessing the accuracy of self-reported smoking status and impact of passive smoke exposure among pregnant Aboriginal and Torres Strait Islander women using cotinine biochemical validation. Drug Alcohol Rev 2009; 29:35-40. [DOI: 10.1111/j.1465-3362.2009.00078.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Blake SM, Murray KD, El-Khorazaty MN, Gantz MG, Kiely M, Best D, Joseph JG, El-Mohandes AAE. Environmental tobacco smoke avoidance among pregnant African-American nonsmokers. Am J Prev Med 2009; 36:225-34. [PMID: 19215848 PMCID: PMC2711691 DOI: 10.1016/j.amepre.2008.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 09/16/2008] [Accepted: 10/31/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Environmental tobacco smoke (ETS) exposure during pregnancy contributes to adverse infant health outcomes. Limited previous research has focused on identifying correlates of ETS avoidance. This study sought to identify proximal and more distal correlates of ETS avoidance early in pregnancy among African-American women. METHODS From a sample of low-income, black women (n=1044) recruited in six urban, prenatal care clinics (July 2001-October 2003), cotinine-confirmed nonsmokers with partners, household/family members, or friends who smoked (n=450) were identified and divided into two groups: any past-7-day ETS exposure and cotinine-confirmed ETS avoidance. Bivariate and multivariate logistic regression analyses identified factors associated with ETS avoidance. Data were initially analyzed in 2004. Final models were reviewed and revised in 2007 and 2008. RESULTS Twenty-seven percent of pregnant nonsmokers were confirmed as ETS avoiders. In multivariate logistic regression analysis, the odds of ETS avoidance were increased among women who reported household smoking bans (OR=2.96; 95% CI=1.83, 4.77; p<0.0001), that the father wanted the baby (OR=2.70; CI=1.26, 5.76; p=0.01), and that no/few family members/friends smoked (OR=3.15; 95% CI=1.58, 6.29; p<0.001). The odds were decreased among women who had a current partner (OR=0.42; 95% CI=0.23, 0.76; p<0.01), reported any intimate partner violence during pregnancy (OR=0.43; 95% CI=0.19, 0.95; p<0.05), and reported little social support to prevent ETS exposure (OR=0.50; 95% CI=0.30, 0.85; p=0.01). Parity, emotional coping strategies, substance use during pregnancy, partner/household member smoking status, and self-confidence in avoiding ETS were significant in bivariate, but not multivariate analyses. CONCLUSIONS Social contextual factors were the strongest determinants of ETS avoidance during pregnancy. Results highlight the importance of prenatal screening to identify pregnant nonsmokers at risk, encouraging household smoking bans, gaining support from significant others, and fully understanding the interpersonal context of a woman's pregnancy before providing behavioral counseling and advice to prevent ETS exposure.
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Affiliation(s)
- Susan M Blake
- Department of Prevention and Community Health, School of Public Health and Health Services, The George Washington University Medical Center, Washington, DC 20037, USA.
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