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Gavarkovs AG, Risica PM, Parker DR, Jennings E, Mello J, Phipps M. Self-Reported Environmental Tobacco Smoke Exposure and Avoidance Compared with Cotinine Confirmed Tobacco Smoke Exposure among Pregnant Women and Their Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E871. [PMID: 29702552 PMCID: PMC5981910 DOI: 10.3390/ijerph15050871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Exposure to environmental tobacco smoke (ETS) presents substantial health risks for pregnant women and newborn infants. Measurements of ETS include invasive and expensive biochemical tests, as well as less invasive and lower-cost, self-reported exposure and avoidance measures. Better understanding of self-report measures will help to select ETS assessments for evaluation. METHODS This analysis was conducted within the context of a tailored video intervention to reduce tobacco smoking and ETS exposure during pregnancy and after delivery in the control group sample of 147 nonsmoking women. Measurements of salivary cotinine concentration, self-reported ETS exposure, and avoidance behaviors were captured at 32 weeks’ gestation and 6 months postpartum. RESULTS Salivary cotinine concentration was significantly related to ETS avoidance among pregnant nonsmokers at 32 weeks’ gestation, but not ETS exposure. At 6 months postpartum, both the reported ETS exposure of the infant and maternal avoidance behaviors to reduce her infant’s exposure were associated with the infant’s salivary cotinine concentration. At 32 weeks’ gestation and 6 months postpartum, avoidance behaviors decreased as exposure increased. DISCUSSION This study suggests that for nonsmoking women during pregnancy, reports of tobacco smoke avoidance are more valid than reports of exposure. After delivery, self-reported ETS exposure or avoidance are associated with each other and the biochemical measurement of salivary cotinine. These results provide researchers and clinicians with evidence to support the inclusion of avoidance behaviors in the selection of ETS measures.
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Affiliation(s)
- Adam Gregory Gavarkovs
- Department of Behavioral and Social Sciences, Brown School of Public Health, Brown University, Providence, RI 02912, USA.
| | - Patricia Markham Risica
- Department of Behavioral and Social Sciences, Brown School of Public Health, Brown University, Providence, RI 02912, USA.
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI 02912, USA.
- Center for Health Equity Research, Brown School of Public Health, Brown University, Providence, RI 02912, USA.
| | - Donna R Parker
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI 02912, USA.
- Memorial Hospital of RI, Center of Primary Care and Prevention, Pawtucket, RI 02904, USA.
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
| | - Ernestine Jennings
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02906, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
| | - Jennifer Mello
- Center for Health Equity Research, Brown School of Public Health, Brown University, Providence, RI 02912, USA.
| | - Maureen Phipps
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI 02912, USA.
- Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
- Women & Infants Hospital of Rhode Island, Providence, RI 02905, USA.
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Ulbricht S, Unger F, Groß S, Nauck M, Meyer C, John U. Factors associated with secondhand smoke exposure prevalence and secondhand smoke level of children living with parental smokers: a cross sectional study. J Community Health 2016; 40:501-7. [PMID: 25352414 DOI: 10.1007/s10900-014-9963-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Factors that might account for the probability of children being exposed to secondhand smoke compared to those who are unexposed and characteristics associated with the urinary cotinine level (UCL) of those who are exposed were investigated. All households in a German region with a child aged 3 years or younger (n = 3,570) were invited to participate in a study that tested the efficacy of an intervention for reducing secondhand smoke exposure. In 1,282 households, at least one parent reported daily smoking. Among these, 915 (71.3%) participated in the study. For data analyses, we used a two-part model. Characteristics of the households associated with SHSE of the youngest child were analyzed, as well as characteristics associated with UCL among those exposed. Exposure to secondhand smoke was defined using a UCL ≥ 10 ng/ml. Secondhand smoke exposure was detected in 57.1% of the samples. Nursery attendance was associated with secondhand smoke exposure, in addition to the number of smokers living in the household, extent of home smoking ban and parental education. Among children exposed, nursery attendance, season of urine collection and age of the child were associated with UCL. Consideration of seasonal smoking behavior and a child's age at the time of intervention may increase attention to the adverse health effects of secondhand smoke exposure.
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Affiliation(s)
- Sabina Ulbricht
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany,
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Martinez S, Garcia-Meric P, Millet V, Aymeric-Ponsonnet M, Alagha K, Dubus JC. Tobacco smoke in infants with bronchopulmonary dysplasia. Eur J Pediatr 2015; 174:943-8. [PMID: 25633581 DOI: 10.1007/s00431-015-2491-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/06/2015] [Accepted: 01/13/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED Exposure to tobacco smoke has been not evaluated in children with bronchopulmonary dysplasia (BPD). We evaluate the association of in utero smoking (IUS) and environmental tobacco smoke (ETS) with the respiratory events of BPD and non-BPD children. Two hundred sixty-two children born before 35 weeks of gestational age (GA) and regularly followed up in our regional network for preterms were enrolled. They were paired according to their BPD status, their gestational age and birth weight (131 children with BPD and 131 without BPD, 28 mean weeks GA; mean weight 1000 g). Respiratory data were obtained prospectively during their first 2 years of life. A complementary questionnaire was completed by the parents about their child's respiratory health at the age of 2, their home environment, and tobacco status. IUS concerned 12.6 %; ETS, 48.8 % (67 % in BPD children treated with oxygen at home). No further influence on respiratory outcome could be found by exposure to intrauterine smoke or extrauterine tobacco smoke in this patient sample. CONCLUSION IUS and ETS exposures are as high in preterm children as in a general pediatric population. The highest exposure occurs among BPD infants treated with oxygen at home. WHAT IS KNOWN • Environmental tobacco smoke (ETS) and in utero smoking (IUS) are responsible for many morphological, functional, and clinical changes in children. • Children with bronchopulmonary dysplasia (BPD) have more respiratory events in their first years of life than preterm children without BPB, maybe triggered by ETS and IUS. What is New: • The exposition to ETS and IUS is high in preterm children with and without BDP, as high as in a general. • Pedaitric population, particularly in children with BPD and treated with oxygen at home. • No further influence on respiratory outcome could be found by exposure to ETS or IUS in our studied population.
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Affiliation(s)
- Stéphanie Martinez
- Unité de pneumologie infantile, CHU Timone-Enfants, 264 rue Saint Pierre, 13385, Marseille CEDEX 5, France,
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Misailidi M, Tzatzarakis MN, Kavvalakis MP, Koutedakis Y, Tsatsakis AM, Flouris AD. Instruments to assess secondhand smoke exposure in large cohorts of never smokers: the smoke scales. PLoS One 2014; 9:e85809. [PMID: 24465719 PMCID: PMC3897519 DOI: 10.1371/journal.pone.0085809] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 12/03/2013] [Indexed: 11/19/2022] Open
Abstract
The objectives of this study were to: (i) to develop questionnaires that can identify never-smoking children and adults experiencing increased exposure to secondhand smoke (SHS+), (ii) to determine their validity against hair nicotine, and (iii) assess their reliability. A sample of 191 children (85 males; 106 females; 7–18 years) and 95 adult (23 males; 72 females; 18–62 years) never-smokers consented to hair nicotine analysis and answered a large number of questions assessing all sources of SHS. A randomly-selected 30% answered the questions again after 20–30 days. Prevalence of SHS+ in children and adults was 0.52±0.07 and 0.67±0.10, respectively (p<0.05). The Smoke Scale for Children (SS-C) and the Smoke Scale for Adults (SS-A) were developed via factor analysis and included nine questions each. Positivity criteria for SS-C and SS-A via receiver operating characteristics curve analysis were identified at >16.5 and >16, respectively. Significant Kappa agreement (p<0.05) was confirmed when comparing the SS-C and SS-A to hair nicotine concentration. Reliability analyses demonstrated that the SS-C and SS-A scores obtained on two different days are highly correlated (p<0.001) and not significantly different (p>0.05). Area under the curve and McNemar's Chi-square showed no pair-wise differences in sensitivity and specificity at the cutoff point between the two different days for SS-C and SS-A (p>0.05). We conclude that the SS-C and the SS-A represent valid, reliable, practical, and inexpensive instruments to identify children and adult never-smokers exposed to increased SHS. Future research should aim to further increase the validity of the two questionnaires.
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Affiliation(s)
- Maria Misailidi
- FAME Laboratory, Centre for Research and Technology Hellas, Trikala, Greece
- Department of Exercise Sciences, University of Thessaly, Trikala, Greece
- Regional Directorate of Primary and Secondary Education of Western Greece, Patras, Greece
| | - Manolis N. Tzatzarakis
- Centre of Toxicology Science and Research, Medical School, University of Crete, Iraklio, Greece
| | - Mathaios P. Kavvalakis
- Centre of Toxicology Science and Research, Medical School, University of Crete, Iraklio, Greece
| | - Yiannis Koutedakis
- Department of Exercise Sciences, University of Thessaly, Trikala, Greece
- School of Sports, Performing Arts and Leisure, University of Wolverhampton, Walsall, United Kingdom
| | - Aristidis M. Tsatsakis
- Centre of Toxicology Science and Research, Medical School, University of Crete, Iraklio, Greece
| | - Andreas D. Flouris
- FAME Laboratory, Centre for Research and Technology Hellas, Trikala, Greece
- * E-mail:
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Schvartsman C, Farhat SCL, Schvartsman S, Saldiva PHN. Parental smoking patterns and their association with wheezing in children. Clinics (Sao Paulo) 2013; 68:934-9. [PMID: 23917656 PMCID: PMC3714778 DOI: 10.6061/clinics/2013(07)08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/10/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate parental smoking patterns and their association with wheezing in children. METHODS We performed a case-control study that included 105 children between 6 and 23 months of age who were divided into two groups: cases (children with 3 previous episodes of wheezing) and controls (healthy children without wheezing). The children's exposure to cigarette smoking was estimated using a questionnaire completed by the mothers and by the children's urinary cotinine levels. RESULTS Based on both the questionnaire results and cotinine levels, exposure to cigarette smoking was higher in the households of cases in which the incidence of maternal smoking was significantly higher than that of paternal smoking. Children in this group were more affected by maternal smoking and by the total number of cigarettes smoked inside the house. Additionally, the questionnaire results indicated that the risk of wheezing was dose dependent. The presence of allergic components, such as atopic dermatitis and siblings with allergic rhinitis and asthma, greatly increased the odds ratio when wheezing was associated with cotinine levels. CONCLUSION Children exposed to tobacco smoke have an increased risk of developing wheezing syndrome. This risk increases in association with the number of cigarettes smoked inside the house and the presence of other allergic components in the family.
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Affiliation(s)
- Claudio Schvartsman
- Universidade de São Paulo, Hospital das Clínicas, Instituto da Criança, Faculdade de Medicina, São Paulo, SP, Brazil.
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Avila-Tang E, Elf JL, Cummings KM, Fong GT, Hovell MF, Klein JD, McMillen R, Winickoff JP, Samet JM. Assessing secondhand smoke exposure with reported measures. Tob Control 2012; 22:156-63. [PMID: 22949496 PMCID: PMC3639349 DOI: 10.1136/tobaccocontrol-2011-050296] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Non-smokers are exposed to tobacco smoke from the burning cigarette and the exhaled smoke from smokers. In spite of decades of development of approaches to assess secondhand smoke exposure (SHSe), there are still unresolved methodological issues. This manuscript summarises the scientific evidence on the use of SHSe reported measures and their methods, objectives, strengths and limitations; and discusses best practices for assessing behaviour leading to SHSe for lifetime and immediate or current SHSe. Recommendations for advancing measurement science of SHSe are provided. Behavioural measures of SHSe commonly rely on self-reports from children and adults. Most commonly, the methodology includes self, proxy and interview-based reporting styles using retrospective recall or diary-style reporting formats. The reporting method used will vary based upon the subject of interest, assessment objectives and cultural context. Appropriately implemented, reported measures of SHSe provide an accurate, timely and cost-effective method for assessing exposure time, location and quantity in a wide variety of populations.
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Affiliation(s)
- Erika Avila-Tang
- Department of Epidemiology, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 4th floor, Baltimore, Maryland 21205, USA.
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7
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El Idrissi-Raja L, Draïss G, Bourrous M, Amine M, Bouskraoui M. [Survey on passive smoking in children in Agadir]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:289-297. [PMID: 22017948 DOI: 10.1016/j.pneumo.2010.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 10/20/2010] [Accepted: 11/01/2010] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The aim of the study was to assess children's exposure to tobacco smoke at home, at school and in public places, to study its risks and to educate parents about the dangers of passive smoking. METHODS This is a survey conducted in October 2007 among children enrolled in pre-school and primary school in the city of Agadir, Morocco. The data was gathered by a written questionnaire completed by parents at home. RESULTS The survey covered 776 children. The response rate to the questionnaires was 88%. The father was a smoker in 28.9% of cases, against 0.7% for the mother. The prevalence of childhood exposure to tobacco was 34.1% at home, 36.4% in public places and 30.1% in schools. Concerning pregnant women, passive smoking and/or active was associated with a significantly increased risk of respiratory distress in newborn babies and hospitalisations in the neonatology department. In infant and child, involuntary inhalation of tobacco smoke involved an increased risk of sudden infant death syndrome and recurrent respiratory symptoms. However, its noxious effects were not found in the case of child asthma and tumour. CONCLUSION Passive smoking is a real public health problem and smoking is a dangerous but also a preventable source of pollution.
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Affiliation(s)
- L El Idrissi-Raja
- Service de pédiatrie A, hôpital Ar-Razi Mère-Enfant, CHU Mohammed VI, avenue Ibn-Sina Ammerchich, Marrakech, Morocco.
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Winickoff JP, Tanski SE, McMillen RC, Ross KM, Lipstein EA, Hipple BJ, Friebely J, Klein JD. Acceptability of testing children for tobacco-smoke exposure: a national parent survey. Pediatrics 2011; 127:628-34. [PMID: 21422089 PMCID: PMC3387887 DOI: 10.1542/peds.2010-2462] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tests are available to measure children's exposure to tobacco smoke. One potential barrier to testing children for tobacco-smoke exposure is the belief that parents who smoke would not want their child tested. No previous surveys have assessed whether testing children for exposure to tobacco smoke in the context of their child's primary care visit is acceptable to parents. OBJECTIVE To assess whether testing children for tobacco-smoke exposure is acceptable to parents. DESIGN AND METHODS We conducted a national random-digit-dial telephone survey of households from September to November 2006. The sample was weighted by race and gender, based on the 2005 US Census, to be representative of the US population. RESULTS Of 2070 eligible respondents contacted, 1803 (87.1%) completed the surveys. Among 477 parents in the sample, 60.1% thought that children should be tested for tobacco-smoke exposure at their child's doctor visit. Among the parental smokers sampled, 62.0% thought that children should be tested for tobacco-smoke exposure at the child's doctor visit. In bivariate analysis, lower parental education level, allowing smoking in the home, nonwhite race, and female gender were each associated (P < .05) with wanting the child tested for tobacco-smoke exposure. CONCLUSIONS The majority of nonsmoking and smoking parents want their children tested for tobacco-smoke exposure during the child's health care visit.
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Affiliation(s)
- Jonathan P. Winickoff
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts; ,American Academy of Pediatrics Tobacco Consortium and Julius B Richmond Center of Excellence, Elk Grove Village, Illinois
| | - Susanne E. Tanski
- American Academy of Pediatrics Tobacco Consortium and Julius B Richmond Center of Excellence, Elk Grove Village, Illinois; ,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Robert C. McMillen
- American Academy of Pediatrics Tobacco Consortium and Julius B Richmond Center of Excellence, Elk Grove Village, Illinois; ,Social Science Research Center, Mississippi State University, Starkville, Mississippi
| | - Kaile M. Ross
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Ellen A. Lipstein
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts; ,Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Bethany J. Hipple
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Joan Friebely
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Jonathan D. Klein
- American Academy of Pediatrics Tobacco Consortium and Julius B Richmond Center of Excellence, Elk Grove Village, Illinois; ,Department of Pediatrics, University of Rochester, Rochester, New York
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[Influence of environmental tobacco smoke on characteristics of childhood asthma]. SRP ARK CELOK LEK 2009; 137:152-9. [PMID: 19459561 DOI: 10.2298/sarh0904152r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION We compared characteristics of asthma in children from smoking and non-smoking families. OBJECTIVE To examine if there was any difference in asthma in children exposed and not exposed to environmental tobacco smoke (ETS). METHODS We examined 231 asthmatic children and their parents. According to the questionnaire and carbon monoxide (CO) values in exhaled air measured by Smokerlyzer, we divided the children in two groups: children from smoking and children from non-smoking families. We compared birth weight, birth length, the occurrence of the first broncho-obstruction, the number of respiratory infections and exacerbations per year, asthma severity, the number of hospitalizations, total IgE, Skin prick test and allergic manifestations. We examined the influence of parental educational level on smoking behaviour and how much money a smoking family spent on cigarettes. RESULTS The children's average age was 10.6 years, there were 49% of boys and 51% of girls. We had 77% of smoking families, 45.9% of active smoking mothers and 51% of active smoking fathers. Smoking was more common among lower educated parents. A smoking family spent 7.3% of the family budget on cigarettes. The children from smoking families had more allergic manifestations. The children of smoking mothers had more respiratory infections (without a statistic difference in the second and third year) and more asthmatic exacerbations with a statistic difference after the third year. With parents who smoked, children had more severe asthma. There was no statistical difference in the following: birth weight, birth length, Skin prick test, total IgE, the first wheezing episode and the number of hospitalizations. However, in the group of 26 children with exhaled CO values higher than 6 ppm, birth weight was lower (3250 g vs. 3550 g), the first wheezing episode occurred earlier (2 years vs. 3.7 years) and total IgE was higher (702 IU/ml vs. 563 IU/ml) by more than two normal ranges (60 IU/ml). CONCLUSION It is necessary to protect children with asthma from ETS because it has a negative impact on their illness.
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Florescu A, Ferrence R, Einarson T, Selby P, Soldin O, Koren G. Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: focus on developmental toxicology. Ther Drug Monit 2009; 31:14-30. [PMID: 19125149 PMCID: PMC3644554 DOI: 10.1097/ftd.0b013e3181957a3b] [Citation(s) in RCA: 248] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Active and passive smoking have been associated with an array of adverse effects on health. The development of valid and accurate scales of measurement for exposures associated with health risks constitutes an active area of research. Tobacco smoke exposure still lacks an ideal method of measurement. A valid estimation of the risks associated with tobacco exposure depends on accurate measurement. However, some groups of people are more reluctant than others to disclose their smoking status and exposure to tobacco. This is particularly true for pregnant women and parents of young children, whose smoking is often regarded as socially unacceptable. For others, recall of tobacco exposure may also prove difficult. Because relying on self-report and the various biases it introduces may lead to inaccurate measures of nicotine exposure, more objective solutions have been suggested. Biomarkers constitute the most commonly used objective method of ascertaining nicotine exposure. Of those available, cotinine has gained supremacy as the biomarker of choice. Traditionally, cotinine has been measured in blood, saliva, and urine. Cotinine collection and analysis from these sources has posed some difficulties, which have motivated the search for a more consistent and reliable source of this biomarker. Hair analysis is a novel, noninvasive technique used to detect the presence of drugs and metabolites in the hair shaft. Because cotinine accumulates in hair during hair growth, it is a unique measure of long-term, cumulative exposure to tobacco smoke. Although hair analysis of cotinine holds great promise, a detailed evaluation of its potential as a biomarker of nicotine exposure, is needed. No studies have been published that address this issue. Because the levels of cotinine in the body are dependent on nicotine metabolism, which in turn is affected by factors such as age and pregnancy, the characterization of hair cotinine should be population specific. This review aims at defining the sensitivity, specificity, and clinical utilization of different methods used to estimate exposure to cigarette smoking and environmental tobacco smoke.
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Affiliation(s)
- Ana Florescu
- Department of Research, The CAMH Center, University of Toronto
- Department of Epidemiology, The CAMH Center, University of Toronto
| | - Roberta Ferrence
- Department of Research, The CAMH Center, University of Toronto
- Department of Epidemiology, The CAMH Center, University of Toronto
| | - Tom Einarson
- Department of Pharmaceutical Sciences, The CAMH Center, University of Toronto
- The Motherisk Program, Hospital for Sick Children
| | - Peter Selby
- Department of Research, The CAMH Center, University of Toronto
| | - Offie Soldin
- Departments of Oncology, Medicine & Physiology, Georgetown University Medical Center, Washington, D.C
| | - Gideon Koren
- The Motherisk Program, Hospital for Sick Children
- Department of Pediatrics, Pharmacology and Medical Genetics, University of Toronto, Toronto, Ontario, Canada
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Okoli CTC, Hall LA, Rayens MK, Hahn EJ. Measuring tobacco smoke exposure among smoking and nonsmoking bar and restaurant workers. Biol Res Nurs 2007; 9:81-9. [PMID: 17601859 DOI: 10.1177/1099800407300852] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study assesses the validity of hair nicotine as a biomarker for secondhand smoke (SHS) exposure. Although most biomarkers of tobacco-smoke exposure have a relatively short half-life, hair nicotine can measure several months of cumulative SHS exposure. DESIGN A cross-sectional study of hospitality-industry workers. METHOD Hair samples were obtained from 207 bar and restaurant workers and analyzed by the reversed-phase high-performance liquid chromatography with electrochemical detection (HPLC-ECD) method. Self-reported tobacco use and sources of SHS exposure were assessed. FINDINGS Higher hair-nicotine levels were associated with more cigarettes smoked per day among smokers and a greater number of SHS-exposure sources among nonsmokers. Number of SHS exposure sources, gender, number of cigarettes smoked per day, and type of establishment predicted hair-nicotine levels. DISCUSSION Hair nicotine is a valid measure of SHS exposure. It may be used as an alternative biomarker to measure longer term SHS exposure.
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Boyaci H, Etiler N, Duman C, Basyigit I, Pala A. Environmental tobacco smoke exposure in school children: parent report and urine cotinine measures. Pediatr Int 2006; 48:382-9. [PMID: 16911083 DOI: 10.1111/j.1442-200x.2006.02225.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Environmental tobacco smoke (ETS) in the home continues to be a major health risk for children around the world. Measuring ETS is a central feature of clinical and epidemiological studies, with children's exposure often assessed through parental estimates. The authors examined the relationship between parent-reported estimates of children's exposure to ETS and children's urinary cotinine levels and evaluated the ETS exposure and its effect on respiratory health in children. METHODS A total of 188 school children were included in the study. Parents were asked to complete a questionnaire about their smoking habits, their children's respiratory morbidity status and housing conditions. Urinary cotinine levels were measured in children. RESULTS According to the responses, 72.3% of the children came from households with smokers, and 34.6% had daily exposure to ETS. When urine cotinine levels of >10 ng/mL were used as the yardstick of exposure, 76% of the children were identified as ETS exposed. No relation was detected between the symptoms of respiratory tract diseases and ETS exposure. To determine the amount of ETS exposure, the contribution of parental reports was low. CONCLUSION To evaluate the level of ETS exposure of children, the parents' reports were not reliable. The addition of a biological measure results in a more informative estimate of ETS exposure in children.
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Affiliation(s)
- Hasim Boyaci
- Department of Chest Diseases, Kocaeli University School of Medicine, Kocaeli, Turkey.
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Ino T, Shibuya T, Saito K, Ohshima J, Okada R. A passive smoking screening program for children. Prev Med 2006; 42:427-9. [PMID: 16530257 DOI: 10.1016/j.ypmed.2006.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 01/15/2006] [Accepted: 01/19/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND There has been no report to date on mass screening of passive smoking in children using biomarkers. METHOD To identify children exposed to actual environmental tobacco smoke (ETS), 261 children were divided into the following 3 groups: (A) both parents smoke; (B) one parent smokes; and (C) no parent smokes. Child urinary cotinine measurement and a parent questionnaire were obtained. RESULTS Urinary cotinine was positive (>10 ng/ml) in 92 (35.2%) of the 261 children. Of the 92 children, 29 were classified into group A, 47 into group B, and 16 into group C. The percentages of children who tested positive for urinary cotinine in groups A, B, and C were 56.9%, 31.1%, and 27.1%, respectively. However, in group B, the percentage of children who tested positive for urinary cotinine was significantly higher if only the mother smoked (47.1%) than if only the father smoked (29.1%) (P<0.05). The mean+SD urinary cotinine level in group A was 12.9+/-6.5 ng/ml, and that in group B was 10.4+/-3.8 ng/ml if the mother smoked and 5.4+/-2.6 ng/ml if the father smoked. CONCLUSIONS This smoking screening program may be useful in identifying children with actual ETS exposure and motivating their parents to either quit smoking or modify their smoking behavior around children.
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Affiliation(s)
- Toshihiro Ino
- Ino Clinic, 1-12-24 Hakoda, Kumagaya, Saitama 360-0014, Japan.
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Lee DJ, Arheart KL, Trapido E, Soza-Vento R, Rodriguez R. Accuracy of parental and youth reporting of secondhand smoke exposure: the Florida youth cohort study. Addict Behav 2005; 30:1555-62. [PMID: 16122616 DOI: 10.1016/j.addbeh.2005.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Revised: 02/11/2005] [Accepted: 02/11/2005] [Indexed: 10/25/2022]
Abstract
The accuracy of adolescent and parental reports of youth secondhand smoke exposure has received limited attention in the research literature. Florida Youth Cohort Study participants provided saliva samples during the fifth round of interviews for determination of cotinine levels. After exclusion of admitted or likely youth smokers with cotinine levels>14.7 ng/ml, there were 341 youth ages 13-17 who completed a telephone interview; 304 parents of these participants completed a similar secondhand smoke exposure interview. Adolescents with cotinine levels above the threshold of detection (> 0.10 ng/ml) were considered exposed. Specificity ranged from 87.1-97.8. Positive predictive value, negative predictive value, sensitivity, and kappa values varied considerably by the reporting source (e.g., youth, parent, or a combination of responses), and the age and gender of the youth respondent. Agreement between youth and parent that at least one parent smoked inside the home yielded the best combination of sensitivity (85.0) and specificity (89.8) and was least affected by the age and gender of the youth respondent.
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Affiliation(s)
- David J Lee
- University of Miami Tobacco Research and Evaluation Coordinating Center, Sylvester Comprehensive Cancer Center, Miami, Florida 33101, United States.
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Jurado D, Muñoz C, Luna JDD, Fernández-Crehuet M. Environmental tobacco smoke exposure in children: parental perception of smokiness at home and other factors associated with urinary cotinine in preschool children. JOURNAL OF EXPOSURE ANALYSIS AND ENVIRONMENTAL EPIDEMIOLOGY 2004; 14:330-6. [PMID: 15254480 DOI: 10.1038/sj.jea.7500329] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Parental smoking behavior at home and sociodemographic variables may influence exposure to environmental tobacco smoke (ETS) in children. A sample of 115 preschool children aged 3-6 years was enrolled in this study. ETS exposure was evaluated through a questionnaire about parents' smoking behavior and determinations of urinary cotinine -- a biomarker of exposure -- in children. Bivariate and multiple regression analyses were used to evaluate the association between the smoking behavior of each parent at home, sociodemographic factors and cotinine levels in children. The parental perception of smokiness in the home was significantly associated with urinary cotinine in children (r-partial coefficient=0.324; P<0.002). The father's education, mother's smoking status, and day of the week when urine was sampled (Tuesday) were also independently associated with levels of cotinine. These four variables explained 26.4% of the variance in the cotinine levels of children. In designing educational programs to reduce passive smoking among children, it is necessary to take into account those factors related with cotinine levels in children. Our results support the influence of the mothers' smoking status, the fathers' educational level, and the day of the week of sampling on cotinine in children. The perception of parents (smokers and nonsmokers) about the smokiness in the home could also be a useful indicator of the cotinine in children exposed to environmental tobacco smoke in the household.
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Affiliation(s)
- Dolores Jurado
- Department of Preventive Medicine and Public Health, University of Granada, Spain.
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Fossum B, Arborelius E, Bremberg S. Evaluation of a counseling method for the prevention of child exposure to tobacco smoke: an example of client-centered communication. Prev Med 2004; 38:295-301. [PMID: 14766111 DOI: 10.1016/j.ypmed.2003.10.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Environmental tobacco smoke (ETS) is an important risk factor. The aim of this study is to evaluate effects of the counseling method "Smoke-free children" that focuses on protection of infants. METHODS The counseling method, "Smoke-free children", has been developed and implemented at Swedish child health centers. The counseling method's point of departure is based upon a client-centered approach. Saliva cotinine samples from the mothers were collected when the child was 1-4 weeks and 3 months of age. Interviews regarding mothers' smoking habits and self-reported maternal smoking were also carried out. RESULTS Forty-one mothers participated in the study, 26 in the intervention group and 15 in the control group. Cotinine was collected from 22 subjects in the intervention and 8 in the control group. Before the intervention, the mean cotinine level was 185 ng/mL in the intervention group and 245 ng/mL in the control group. After the intervention, cotinine levels were reduced in the intervention group (165 ng/mL) and increased in the control group (346 ng/mL). Yet, after the intervention, the mothers themselves reported more smoking in the intervention group than in the control group. Only weak correlations were found between self-reported smoking and cotinine. CONCLUSIONS The statistical analysis supports the view that a client-centered intervention, aimed at increasing self-efficacy, exerts a positive effect on maternal smoking in the prevention of infant exposure to ETS, when applied in a routine clinical setting.
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Affiliation(s)
- B Fossum
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Karolinska Hospital, Norrbacka, SE-171 76 Stockholm, Sweden.
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