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Huai Y, Guan X, Liu S, Uyeki TM, Jiang H, Klena J, Huang J, Chen M, Peng Y, Yang H, Luo J, Zheng J, Peng Z, Huo X, Xiao L, Chen H, Zhang Y, Xing X, Feng L, Hu DJ, Yu H, Zhan F, Varma JK. Clinical characteristics and factors associated with severe acute respiratory infection and influenza among children in Jingzhou, China. Influenza Other Respir Viruses 2016; 11:148-156. [PMID: 27465959 PMCID: PMC5304575 DOI: 10.1111/irv.12419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Influenza is an important cause of respiratory illness in children, but data are limited on hospitalized children with laboratory-confirmed influenza in China. METHODS We conducted active surveillance for severe acute respiratory infection (SARI; fever and at least one sign or symptom of acute respiratory illness) among hospitalized pediatric patients in Jingzhou, Hubei Province, from April 2010 to April 2012. Data were collected from enrolled SARI patients on demographics, underlying health conditions, clinical course of illness, and outcomes. Nasal swabs were collected and tested for influenza viruses by reverse transcription polymerase chain reaction. We described the clinical and epidemiological characteristics of children with influenza and analyzed the association between potential risk factors and SARI patients with influenza. RESULTS During the study period, 15 354 children aged <15 years with signs and symptoms of SARI were enrolled at hospital admission. severe acute respiratory infection patients aged 5-15 years with confirmed influenza (H3N2) infection were more likely than children without influenza to have radiographic diagnosis of pneumonia (11/31, 36% vs 15/105, 14%. P<.05). Only 16% (1116/7145) of enrolled patients had received seasonal trivalent influenza vaccination within 12 months of hospital admission. Non-vaccinated influenza cases were more likely than vaccinated influenza cases to have pneumonia (31/133, 23% vs 37/256, 15%, P<.05). severe acute respiratory infection cases aged 5-15 years diagnosed with influenza were also more likely to have a household member who smoked cigarettes compared with SARI cases without a smoking household member (54/208, 26% vs 158/960, 16%, P<.05). CONCLUSIONS Influenza A (H3N2) virus infection was an important contributor to pneumonia requiring hospitalization. Our results highlight the importance of surveillance in identifying factors for influenza hospitalization, monitoring adherence to influenza prevention and treatment strategies, and evaluating the disease burden among hospitalized pediatric SARI patients. Influenza vaccination promotion should target children.
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Affiliation(s)
- Yang Huai
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China
| | - Xuhua Guan
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Shali Liu
- Jingzhou Central Hospital, Jingzhou, China
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Hui Jiang
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - John Klena
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China.,Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Maoyi Chen
- Jingzhou Center for Disease Control and Prevention, Jingzhou, China
| | - Youxing Peng
- Jingzhou First People's Hospital, Jingzhou, China
| | - Hui Yang
- Jingzhou Second People's Hospital, Jingzhou, China
| | - Jun Luo
- Jingzhou Maternal and Children's Hospital, Jingzhou, China
| | - Jiandong Zheng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhibin Peng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xixiang Huo
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Lin Xiao
- Jingzhou Central Hospital, Jingzhou, China
| | - Hui Chen
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Yuzhi Zhang
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China
| | - Xuesen Xing
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Luzhao Feng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dale J Hu
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China.,Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Vaccine Clinical Research Branch Vaccine Research Program, Division of AIDS, NIAID/NIH, Bethesda, MD, USA
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Faxian Zhan
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Jay K Varma
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China.,Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Cohen G, Vardavas C, Patelarou E, Kogevinas M, Katz-Salamon M. Adverse circulatory effects of passive smoking during infancy: surprisingly strong, manifest early, easily avoided. Acta Paediatr 2014; 103:386-92. [PMID: 24330403 DOI: 10.1111/apa.12538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 11/24/2013] [Accepted: 12/09/2013] [Indexed: 11/30/2022]
Abstract
AIM To compare blood pressure reactions (BPR) of infants to mild stress for evidence of adverse cardiovascular effects of passive exposure to tobacco smoke during pregnancy and early infancy. METHODS An observational field study conducted in Crete. We compared 4- to 6-month olds of lifelong nonsmokers minimally (controls, n = 9) or frequently exposed to tobacco smoke (passive smokers; n = 10) with those born to habitual smokers (n = 6). Smoke exposure was verified biochemically (urine cotinine each trimester and at study). We recorded beat-to-beat blood pressure (BP) during brief repositioning manoeuvres performed during a daytime nap and analysed BPR (% change in BP during head-up tilt) for associations with maternal and infant cotinine. RESULTS We observed a 20-fold difference between BPR of infants of controls versus passive smokers - exceptional given number of infants (α error/confidence level <10% i.e. power >90%). The BPR declined linearly as the infant's (but not mother's) cotinine level rose (p = 0.04), indicating abnormal BPR was caused mainly by postnatal smoke exposure. Infants of active smokers differed from those of passive smokers. CONCLUSION Cardiovascular effects of passive smoking by a newborn infant manifest early on and are exceptionally strong. They can be largely avoided by keeping the home smoke rigorously free.
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Affiliation(s)
- G Cohen
- Department of Women's and Children's Health; Karolinska Institute; Stockholm Sweden
| | - C Vardavas
- Department of Social Medicine; University of Crete; Heraklion Greece
- Center for Global Tobacco Control; Harvard School of Public Health; Boston MA USA
| | - E Patelarou
- Department of Social Medicine; University of Crete; Heraklion Greece
- Florence Nightingale School of Nursing and Midwifery; King's College; London UK
| | - M Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- National School of Public Health; Athens Greece
| | - M Katz-Salamon
- Department of Women's and Children's Health; Karolinska Institute; Stockholm Sweden
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Chen X, Abdulhamid I, Woodcroft K. Maternal smoking during pregnancy, polymorphic CYP1A1 and GSTM1, and lung-function measures in urban family children. ENVIRONMENTAL RESEARCH 2011; 111:1215-1221. [PMID: 21872227 DOI: 10.1016/j.envres.2011.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 07/29/2011] [Accepted: 08/02/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE Understanding the interplay between genes and in-utero tobacco exposure in affecting child lung development is of great significance. In this study, we tested the hypothesis that tobacco-related lung-function reduction in children differs by maternal polymorphic genes Cytochrome P450 1A1 (CYP1A1) and Glutathione S-transferase Mu 1 (GSTM1). MATERIALS AND METHODS Data were collected among 370 children (6-10 years old, 81.6% African-Americans) and their biological mothers visiting a large children's hospital. Study hypotheses were tested using multiple regression method. RESULTS Among the study sample, 143 mothers smoked throughout pregnancy and 72 smoked on a daily basis. Spirometric measures (mean±SD) included were: forced vital capacity (FVC)=1635±431 mL, forced expiratory volume in the first 1s (FEV1)=1440 ±360 mL, percent FEV1/FVC ratio=89±12, and forced expiratory flow between the 25% and 75% of FVC (FEF25-75)=1745±603 mL. In addition to a tobacco effect on FVC (-131 mL, 95% CI: -245, -17) and FEV1/FVC ratio (42, 95% CI: 1, 83), regression analysis controlling for covariates indicated that for the subsample of children whose mothers were CYP1A1⁎2A homozygous, maternal daily smoking was associated with -734 mL (95% CI: -1206, -262) reductions in FEV1 and -825 mL (95% CI: -909, -795) reductions in FVC; reduced smoking was still associated with -590 mL (95% CI: -629, -551) reductions in FVC. For children of mothers with GSTM1 deletion, persistent daily smoking was associated with -176 mL (95% CI: -305, -47) reductions in FVC. DISCUSSION AND CONCLUSIONS Maternal smoking during pregnancy was significantly associated with lung-function reduction in children, particularly for those whose mothers possessed the polymorphic CYP1A1*2A and GSTM1 deletion.
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Affiliation(s)
- Xinguang Chen
- The Adams Ann Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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Arrandale VH, Brauer M, Brook JR, Brunekreef B, Gold DR, London SJ, Miller JD, Özkaynak H, Ries NM, Sears MR, Silverman FS, Takaro TK. Exposure assessment in cohort studies of childhood asthma. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:591-597. [PMID: 21081299 PMCID: PMC3094407 DOI: 10.1289/ehp.1002267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 11/16/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND The environment is suspected to play an important role in the development of childhood asthma. Cohort studies are a powerful observational design for studying exposure-response relationships, but their power depends in part upon the accuracy of the exposure assessment. OBJECTIVE The purpose of this paper is to summarize and discuss issues that make accurate exposure assessment a challenge and to suggest strategies for improving exposure assessment in longitudinal cohort studies of childhood asthma and allergies. DATA SYNTHESIS Exposures of interest need to be prioritized, because a single study cannot measure all potentially relevant exposures. Hypotheses need to be based on proposed mechanisms, critical time windows for effects, prior knowledge of physical, physiologic, and immunologic development, as well as genetic pathways potentially influenced by the exposures. Modifiable exposures are most important from the public health perspective. Given the interest in evaluating gene-environment interactions, large cohort sizes are required, and planning for data pooling across independent studies is critical. Collection of additional samples, possibly through subject participation, will permit secondary analyses. Models combining air quality, environmental, and dose data provide exposure estimates across large cohorts but can still be improved. CONCLUSIONS Exposure is best characterized through a combination of information sources. Improving exposure assessment is critical for reducing measurement error and increasing power, which increase confidence in characterization of children at risk, leading to improved health outcomes.
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Affiliation(s)
- Victoria H. Arrandale
- Dalla Lana School of Public Health, Gage Occupational and Environmental Health Unit, University of Toronto, Toronto, Ontario, Canada
| | - Michael Brauer
- School of Environmental Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R. Brook
- Dalla Lana School of Public Health, Gage Occupational and Environmental Health Unit, University of Toronto, Toronto, Ontario, Canada
- Environment Canada, Air Quality Research Division, Toronto, Ontario, Canada
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
| | - Diane R. Gold
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Stephanie J. London
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - J. David Miller
- College of Natural Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Halûk Özkaynak
- U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Nola M. Ries
- Health Law Institute, University of Alberta, Edmonton, Alberta, Canada, Faculty of Law and School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Malcolm R. Sears
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Frances S. Silverman
- Dalla Lana School of Public Health, Gage Occupational and Environmental Health Unit, University of Toronto, Toronto, Ontario, Canada
| | - Tim K. Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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5
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Kalkbrenner AE, Hornung RW, Bernert JT, Hammond SK, Braun JM, Lanphear BP. Determinants of serum cotinine and hair cotinine as biomarkers of childhood secondhand smoke exposure. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2010; 20:615-624. [PMID: 20237497 PMCID: PMC2972673 DOI: 10.1038/jes.2010.7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 02/02/2010] [Indexed: 05/27/2023]
Abstract
Understanding the determinants of childhood secondhand smoke (SHS) exposure is important in measuring and preventing exposure to this widespread environmental contaminant. We evaluated the ability of a broad set of factors to explain variability in serum cotinine, reflecting recent exposure, and hair cotinine, reflecting longer-term exposure. We included repeated measures from 223 elementary-school-age asthmatic children residing with a smoker. We used a manual model-building approach and likelihood ratio tests to select a model predicting each biomarker, and also compared the predictive ability of determinants using Akaike Information Criteria. Potential determinants included a comprehensive parent questionnaire, household nicotine, home ventilation characteristics, exposure in vehicles and others' homes, child demographics, and family social class. Variables in each of these categories remained in the final model for both serum (R(2) of 0.61) and hair cotinine (R(2) of 0.45). A comprehensive set of factors was required to best predict cotinine. Studies should use biomarkers for the best quantitative assessment of SHS exposure. Hair cotinine may be a problematic measure because it was highly influenced by racial differences that were unexplained by SHS exposure. When biospecimen collection is not possible, a household nicotine measurement is warranted. If only questionnaires are available, multiple questions are required to best characterize exposure, such as number of cigarettes, hours spent in a room with concurrent smoking, maternal smoking, and approximate home size.
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Affiliation(s)
- Amy E Kalkbrenner
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
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Kehl D, Thyrian JR, Lüdemann J, Nauck M, John U. A descriptive analysis of relations between parents' self-reported smoking behavior and infants' daily exposure to environmental tobacco smoke. BMC Public Health 2010; 10:424. [PMID: 20642817 PMCID: PMC2914780 DOI: 10.1186/1471-2458-10-424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 07/19/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of the present study were to examine relations between parents' self-reported smoking behavior and infants' daily exposure to environmental tobacco smoke, as assessed by urinary cotinine-to-creatinine ratio (CCR), and to describe the CCR over seven days among infants at home. METHODS A convenience sample of 27 households was drawn. Each household had to have at least one daily tobacco smoker and one child up to three years of age. Over a seven-day period, urine samples were obtained from the child daily. To examine relations between parents' self-reported smoking and infants' daily CCR, generalized estimating equation (GEE) analysis was used. RESULTS The data revealed that infants from households with indoor smoking had higher CCRs than infants in households with outdoor smoking. CCRs were higher in girls than in boys. Older infants had lower CCRs than younger infants. Smoking outside the home versus inside the home, infant's gender, and infants' age accounted for 68% of the variance in CCR in a GEE data analysis model. No increase or decrease of CCR over time was found. CONCLUSION The findings suggest that parents' self-reported smoking indoors at home versus outdoors is predictive of CCR among infants three and younger. Higher CCR concentrations in girls' urine need further examination. Furthermore, significant fluctuations in daily CCR were not apparent in infants over a seven-day time period.
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Affiliation(s)
- Doris Kehl
- Ernst-Moritz-Arndt-University Greifswald, Institute of Psychology, Department Health and Prevention, Greifswald, Germany.
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7
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Biological matrices for the evaluation of exposure to environmental tobacco smoke during prenatal life and childhood. Anal Bioanal Chem 2009; 396:379-99. [DOI: 10.1007/s00216-009-2831-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 04/26/2009] [Accepted: 04/30/2009] [Indexed: 10/20/2022]
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Lee HR, Kim HK, Yoo JS, Kim KN, Lee SY, Yoo SM, Kim HB, Kim BS, Hong SJ, Kim JH, Lee SY, Seong MW, Lee DH. Urine Cotinine and Environmental Tobacco Exposure in Korean Adolescents. Korean J Fam Med 2009. [DOI: 10.4082/kjfm.2009.30.1.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Hae Reung Lee
- Department of Family Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Hyeon-Keun Kim
- Department of Family Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jang Suk Yoo
- Department of Family Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Kyu Nam Kim
- Department of Family Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seon Yeong Lee
- Department of Family Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sun Mi Yoo
- Department of Family Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Bong Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Soo Jong Hong
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ja Hyeung Kim
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - So Yeon Lee
- Department of Pediatrics, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Moon Woo Seong
- Center for Clinical Services, National Cancer Center, Goyang, Korea
| | - Do Hoon Lee
- Center for Clinical Services, National Cancer Center, Goyang, Korea
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9
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Mak YW, Loke AY, Abdullah AS, Lam TH. Household smoking practices of parents with young children, and predictors of poor household smoking practices. Public Health 2008; 122:1199-209. [DOI: 10.1016/j.puhe.2008.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 03/05/2008] [Accepted: 04/04/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Y W Mak
- Department of Nursing Studies, The University of Hong Kong, 4/F William MW Mong Block, LKS Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Al-Delaimy WK, Willett WC. Measurement of tobacco smoke exposure: comparison of toenail nicotine biomarkers and self-reports. Cancer Epidemiol Biomarkers Prev 2008; 17:1255-61. [PMID: 18483348 DOI: 10.1158/1055-9965.epi-07-2695] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Accurate measurement tools of exposure for use in large epidemiologic studies are lacking. Biomarkers of tobacco exposure provide additional advantages to self-reports and there is a need to further develop and validate them. The objective is to compare toenail nicotine levels, a novel biomarker of tobacco exposure, with self-reports of tobacco exposure from a large cohort study. METHODS In this cross-sectional analysis, toenail samples were collected from 2,485 women participating in the Nurses' Health Study in 1982. Detailed self-reports of smoking habits and reported exposure to secondhand smoke (SHS) were collected from these women near the time of toenail collection. The toenail samples were analyzed by a high-performance liquid chromatography method for measuring nicotine. RESULTS The 5 to 95 percentile range of toenail nicotine was from 0.06 to 4.06 ng/mg toenail and the median level was 0.21 ng/mg. There was a significant difference in toenail nicotine levels according to reported smoking status (the median level for nonsmokers with no SHS was 0.10 ng/mg, the median level for nonsmokers with SHS was 0.14 ng/mg, and the median level for active smokers was 1.77 ng/mg). However there was considerable overlap in nicotine levels according to reported smoking status. Toenail nicotine level was strongly associated with reported smoking level (Spearman r = 0.63), but there was no complete concordance, suggesting that the two methods are measuring different aspects of the same exposure. CONCLUSION Our findings show that toenail nicotine levels capture the overall burden of tobacco smoke exposure and provide additional information on exposure not captured by reported history.
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Affiliation(s)
- Wael K Al-Delaimy
- Moores UCSD Cancer Center, Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA 92093, USA.
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Jedrychowski W, Perera F, Mroz E, Edwards S, Flak E, Bernert JT, Mrozek-Budzyn D, Sowa A, Musiał A. Fetal exposure to secondhand tobacco smoke assessed by maternal self-reports and cord blood cotinine: prospective cohort study in Krakow. Matern Child Health J 2008; 13:415-23. [PMID: 18437300 DOI: 10.1007/s10995-008-0350-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 04/15/2008] [Indexed: 01/08/2023]
Abstract
OBJECTIVES While the validity of self-reported smoking habits is generally judged as satisfactory, objective markers of secondhand smoke (SHS) exposure may be more useful in validating the causal links between prenatal SHS and health effects. The cohort study in Krakow provided an opportunity for comparative assessment of fetal exposure to SHS based upon questionnaires and cord blood cotinine measurements. METHODS The study sample included 467 newborns born to women recruited in the first and second trimester of pregnancy. To compare the validity of self-reported SHS and cord blood cotinine levels in assessing the association between fetal passive smoking and health effects of newborns, we separately examined the regression coefficients of birthweight on self-reported number of cigarettes smoked by other household members during the entire pregnancy and cord blood cotinine levels. RESULTS In the non-exposed newborns the geometric mean of cord blood cotinine was 0.077 ng/ml and was significantly lower than in newborns with a maternal report of SHS. Cord cotinine levels were more highly correlated with a self-reported number of cigarettes smoked daily at home in the third trimester of pregnancy. The two measures of SHS (number of cigarettes and number of hours of daily exposure) were equally well correlated with cord blood cotinine levels. Using cotinine as the exposure variable, overall the association was not significant; but among the subgroup with cord cotinine levels above the median (> or =0.083 ng/ml), the association with birthweight was significant (beta coefficient = -113.65, P = 0.041). CONCLUSION The study provides evidence that the assessment of fetal SHS exposure based on cord blood cotinine produced better estimates of the association between exposure and birth outcomes.
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Affiliation(s)
- Wieslaw Jedrychowski
- Department of Epidemiology and Preventive Medicine, College of Medicine, Jagiellonian University, 7, Kopernika street, Krakow, Poland.
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Anuntaseree W, Mo-Suwan L, Ovatlarnporn C, Tantana C, Ma-a-Lee A. Exposure to environmental tobacco smoke among infants in southern Thailand: a study of urinary cotinine. BULLETIN OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2008; 80:34-37. [PMID: 17989910 DOI: 10.1007/s00128-007-9303-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 10/19/2007] [Indexed: 05/25/2023]
Abstract
We performed a survey to assess the exposure to environmental tobacco smoke (ETS) in 1-year-old infants in Thailand. Of the 725 infants, it was reported that 73.3% had household smoking and 40.7% had detectable urinary cotinine. Twenty-five infants (3.4%) had urinary cotinine in the range of adult heavy smokers. The prevalence of ETS exposure was significantly higher in infants with a father whose education was < or = grade 6 than in those with father's education >6 years (44.0% vs. 36.0%, p = 0.039). Data on the exposure to ETS among infants will provide prevalence information and identify population subgroups at increased risk for exposure.
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Affiliation(s)
- Wanaporn Anuntaseree
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Valente P, Forastiere F, Bacosi A, Cattani G, Di Carlo S, Ferri M, Figà-Talamanca I, Marconi A, Paoletti L, Perucci C, Zuccaro P. Exposure to fine and ultrafine particles from secondhand smoke in public places before and after the smoking ban, Italy 2005. Tob Control 2007; 16:312-7. [PMID: 17897989 PMCID: PMC2598558 DOI: 10.1136/tc.2006.019646] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 05/04/2007] [Indexed: 11/04/2022]
Abstract
BACKGROUND A smoking ban in all indoor public places was enforced in Italy on 10 January 2005. METHODS We compared indoor air quality before and after the smoking ban by monitoring the indoor concentrations of fine (<2.5 microm diameter, PM2.5) and ultrafine particulate matter (<0.1 microm diameter, UFP). PM2.5 and ultrafine particles were measured in 40 public places (14 bars, six fast food restaurants, eight restaurants, six game rooms, six pubs) in Rome, before and after the introduction of the law banning smoking (after 3 and 12 months). Measurements were taken using real time particle monitors (DustTRAK Mod. 8520 TSI; Ultra-fine Particles Counter-TRAK Model 8525 TSI). The PM2.5 data were scaled using a correction equation derived from a comparison with the reference method (gravimetric measurement). The study was completed by measuring urinary cotinine, and pre-law and post-law enforcement among non-smoking employees at these establishments RESULTS In the post-law period, PM2.5 decreased significantly from a mean concentration of 119.3 microg/m3 to 38.2 microg/m3 after 3 months (p<0.005), and then to 43.3 microg/m3 a year later (p<0.01). The UFP concentrations also decreased significantly from 76,956 particles/cm3 to 38,079 particles/cm3 (p<0.0001) and then to 51,692 particles/cm3 (p<0.01). Similarly, the concentration of urinary cotinine among non-smoking workers decreased from 17.8 ng/ml to 5.5 ng/ml (p<0.0001) and then to 3.7 ng/ml (p<0.0001). CONCLUSION The application of the smoking ban led to a considerable reduction in the exposure to indoor fine and ultrafine particles in hospitality venues, confirmed by a contemporaneous reduction of urinary cotinine.
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Affiliation(s)
- Pasquale Valente
- University of Rome La Sapienza, 5 Ple Aldo Moro, 00185 Rome, Italy.
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Hecht SS, Carmella SG, Le KA, Murphy SE, Boettcher AJ, Le C, Koopmeiners J, An L, Hennrikus DJ. 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides in the urine of infants exposed to environmental tobacco smoke. Cancer Epidemiol Biomarkers Prev 2006; 15:988-92. [PMID: 16702381 DOI: 10.1158/1055-9965.epi-05-0596] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Biomarkers of carcinogen uptake could provide important information pertinent to the question of exposure to environmental tobacco smoke (ETS) in childhood and cancer development later in life. Previous studies have focused on exposures before birth and during childhood, but carcinogen uptake from ETS in infants has not been reported. Exposures in infants could be higher than in children or adults because of their proximity to parents who smoke. Therefore, we quantified 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides (total NNAL) in the urine of 144 infants, ages 3 to 12 months, who lived in homes with parents who smoked. Total NNAL is an accepted biomarker of uptake of the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone. Cotinine and its glucuronide (total cotinine) and nicotine and its glucuronide (total nicotine) were also quantified. Total NNAL was detectable in 67 of 144 infants (46.5%). Mean levels of total NNAL in the 144 infants were 0.083 +/- 0.200 pmol/mL, whereas those of total cotinine and total nicotine were 0.133 +/- 0.190 and 0.069 +/- 0.102 nmol/mL, respectively. The number of cigarettes smoked per week in the home or car by any family member when the infant was present was significantly higher (P < 0.0001) when NNAL was detected than when it was not (76.0 +/- 88.1 versus 27.1 +/- 38.2). The mean level of NNAL detected in the urine of these infants was higher than in most other field studies of ETS exposure. The results of this study show substantial uptake of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone in infants exposed to ETS and support the concept that persistent ETS exposure in childhood could be related to cancer later in life.
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Affiliation(s)
- Stephen S Hecht
- The Cancer Center, University of Minnesota, Mayo Mail Code 806, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
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15
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Gehring U, Leaderer BP, Heinrich J, Oldenwening M, Giovannangelo MECA, Nordling E, Merkel G, Hoek G, Bellander T, Brunekreef B. Comparison of parental reports of smoking and residential air nicotine concentrations in children. Occup Environ Med 2006; 63:766-72. [PMID: 16912089 PMCID: PMC2077986 DOI: 10.1136/oem.2006.027151] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Using questionnaires to assess children's residential exposure to environmental tobacco smoke (ETS) may result in misclassification from recall and response bias. Questionnaire data have frequently been validated against urinary cotinine measurements, but rarely against actual measurements of residential air nicotine. OBJECTIVE To compare questionnaire reported smoking with air nicotine concentrations in a large population of children and with urinary cotinine levels in a subpopulation; and to assess the potential impact of the symptom status of the children on the agreement between different measures of exposure. METHODS The authors assessed residential exposure to ETS in 347 German, 335 Dutch, and 354 Swedish preschool and schoolchildren by questionnaire and air nicotine measurements, and in a subset of 307 German children by urinary cotinine measurements. They then compared the different measures of ETS exposure. RESULTS In all countries, air nicotine concentrations increased with increasing questionnaire reported smoking in a dose-response fashion. Specificity and negative predictive values of questionnaire reports for nicotine concentrations were excellent. Sensitivity and positive predictive values were moderate to good. Excluding occasional smokers, the overall percentage of homes misclassified was 6.9%, 6.7%, and 5.1% in Germany, the Netherlands, and Sweden, respectively. Similar results were found for the agreement of urinary cotinine concentrations with questionnaire reports and air nicotine levels. There was no indication of underreporting by parents of symptomatic children. CONCLUSION Despite some misclassification, questionnaire reports are an inexpensive and valid estimate of residential ETS exposure among preschool and school children.
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Affiliation(s)
- U Gehring
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.
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16
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Stepanov I, Hecht SS, Duca G, Mardari I. Uptake of the tobacco-specific lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone by Moldovan children. Cancer Epidemiol Biomarkers Prev 2006; 15:7-11. [PMID: 16434579 DOI: 10.1158/1055-9965.epi-05-0293] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The evidence of an association between childhood exposure to environmental tobacco smoke (ETS) and an increased risk of lung cancer is inconsistent. However, taking into account the existing association between lung cancer and adulthood ETS exposure, it is plausible that children exposed to ETS also would be at risk of developing lung cancer later in life. In this study, we investigated the uptake by Moldovan children of the tobacco-specific lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) by measuring total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), the sum of the NNK metabolites, NNAL, and its O-glucuronide and N-glucuronide (NNAL-Glucs) in urine. We also measured urinary cotinine and its glucuronide (total cotinine). Total NNAL was detected in 69 of 80 samples, including those that were low in cotinine (<5 ng/mL). The mean+/- SD level of total NNAL (0.09+/- 0.077 pmol/mL) was comparable with those observed in previous studies of children and adults exposed to ETS. Total NNAL correlated with total cotinine (r=0.8, P<0.0001). The mean+/- SD levels of total NNAL and total cotinine were higher in children who were exposed to ETS (0.1+/- 0.08 and 109+/- 126 pmol/mL, respectively) than in those who were classified as unexposed to ETS based on questionnaire data (0.049+/- 0.016 pmol/mL and 0.043+/- 0.040 nmol/mL). The results of this study for the first time show widespread and considerable uptake of nicotine and the tobacco-specific lung carcinogen NNK in Moldovan children. These results should be useful in heightening the awareness of the dangers of smoking and ETS exposure in this eastern European country.
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Affiliation(s)
- Irina Stepanov
- The Cancer Center, University of Minnesota, Mayo Mail Code 806, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA
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17
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Abstract
INTRODUCTION Young children are vulnerable to the health effects of environmental tobacco smoke (ETS) exposure in their own homes. Characteristics of households and the use of smoking bans (i.e., no smoking allowed) as an indicator of smoke exposure need to be understood before interventions can be developed to eliminate ETS exposure in homes where young children live. METHODS This cross-sectional, descriptive study investigated demographic characteristics, knowledge, attitudes/beliefs, health of children, smoking practices, and the presence of smoking bans in households. A survey questionnaire was administered to a convenience sample of 226 English- and Spanish-speaking subjects, 18 to 50 years of age, including both smokers and nonsmokers. Cotinine levels of urine samples from children measured actual smoke exposure to confirm reports of home smoking policies. RESULTS Ethnicity of households (P < .001) and negative attitudes toward smoke exposure (P < .001) predicted the presence of smoking bans. The number of households with no or partial smoking bans correlated significantly with urine cotinine levels (r = .486); the presence of no or partial smoking bans predicted smoke exposure in households. DISCUSSION Because the use of smoking bans in predicting household smoke exposure has not been previously demonstrated, further study is needed to determine how smoking bans can be utilized to eliminate or reduce smoke exposure in homes where children live.
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Affiliation(s)
- Yvonne K Yousey
- University of North Carolina, Charlotte, Department of Family and Community Nursing, 9201 University City Blvd, Charlotte, NC 28223, USA.
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Spencer N, Blackburn C, Bonas S, Coe C, Dolan A. Parent reported home smoking bans and toddler (18-30 month) smoke exposure: a cross-sectional survey. Arch Dis Child 2005; 90:670-4. [PMID: 15970606 PMCID: PMC1720498 DOI: 10.1136/adc.2004.054684] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To study the relation between the use of parent reported home smoking bans and smoke exposure among children aged 18-30 months. METHODS A total of 309 smoking households with children aged 18-30 months, who were part of the Coventry Cohort study, consented to participate in this cross-sectional survey. RESULTS Although parents in almost 88% of smoking households reported using harm reduction strategies to protect their toddlers from smoke exposure, only 13.9% reported smoking bans in the house. Mean log urinary cotinine:creatinine ratio was significantly lower for those children whose parents reported no smoking in the house (1.11, 95% CI 0.64 to 1.49) compared with none/less strict strategies (1.87, 95% CI 1.64 to 2.10). In linear regression models fitted on log cotinine:creatinine ratio, no smoking in the house was independently associated with a significant reduction in cotinine:creatinine ratio (B = -0.55, 95% CI -0.89 to -0.20) after adjusting for mother's and partner's average daily cigarette consumption, housing tenure, and overcrowding. The final model accounted for 44.3% of the variance. CONCLUSIONS Not smoking in the house was associated with a reduction in mean urinary cotinine:creatinine ratio in children aged 18-30 months; the relation persisted after adjustment for levels of mother's and partner's daily cigarette consumption and sociodemographic factors. Results suggest that home smoking bans in this age group have a small but significant effect on smoke exposure independent of levels of parental tobacco consumption.
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Affiliation(s)
- N Spencer
- School of Health and Social Studies, University of Warwick, UK.
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19
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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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20
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Gaffney KF, Molloy SB, Maradiegue AH. Questionnaires for the Measurement of Infant Environmental Tobacco Smoke Exposure: A Systematic Review. J Nurs Meas 2003; 11:225-39. [PMID: 15633778 DOI: 10.1891/jnum.11.3.225.61275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A necessary prerequisite for reducing infant morbidity associated with passive smoking is effective measurement of this health risk factor. The purpose of this review was to evaluate questionnaires currently used in research to measure infant environmental tobacco smoke (ETS) exposure. Systematic searches were conducted using MEDLINE and CINAHL databases to identify current studies of infant ETS exposure. Sixty research reports published between 1996 and 2002 met the selection criteria. All of these investigations used brief investigator-developed, parental self-reports; no two studies used the same questionnaire. Reliability testing for questionnaires was lacking. Preliminary support for concurrent and construct validity is presented. Nursing studies are needed that lead to the development of ETS exposure questionnaires with established reliability and validity that measure both risk and protective mechanisms that occur in the infant environment.
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Affiliation(s)
- Kathleen F Gaffney
- College of Nursing and Health Science, George Mason University, Fairfax, VA 22030-4444, USA.
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21
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Blackburn C, Spencer N, Bonas S, Coe C, Dolan A, Moy R. Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home: cross sectional survey. BMJ 2003; 327:257. [PMID: 12896936 PMCID: PMC167160 DOI: 10.1136/bmj.327.7409.257] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine parents' reported knowledge and use of harm reduction strategies to protect their infants from exposure to tobacco smoke in the home, and the relation between reported use of strategies and urinary cotinine to creatinine ratios in the infants. DESIGN Cross sectional survey. SETTINGS Coventry and Birmingham. MAIN OUTCOME MEASURES Parents' reported knowledge and use of harm reduction strategies and urinary cotinine to creatinine ratios in their infants. PARTICIPANTS 314 smoking households with infants. RESULTS 86% of parents (264/307) believed that environmental tobacco smoke is harmful, 90% (281/314) believed that infants can be protected from it in the home, and 10% (32/314) were either unaware of measures or reported using none. 65% of parents (205/314) reported using two or more measures, but only 18% (58/314) reported not allowing smoking in the home. No difference was found in mean log e transformed urinary cotinine to creatinine ratio in infants from households that used no measures compared with households that used less strict measures. Mean log cotinine to creatinine ratios were significantly different in households banning smoking in the home compared with those using less strict or no measures. Banning smoking in the home was independently associated with a significant reduction in urinary cotinine to creatinine ratio by a factor of 2.6 (1.6 to 4.2) after adjustment for average household cigarette consumption, tenure, and overcrowding. CONCLUSIONS Less than a fifth of parents in smoking households ban smoking in the home. Banning smoking was associated with a small but significant reduction in urinary cotinine to creatinine ratio in infants, whereas less strict measures compared with no measures had no effect on the infants' exposure to environmental tobacco smoke.
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Affiliation(s)
- Clare Blackburn
- School of Health and Social Studies, University of Warwick, Coventry CV4 7AL.
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22
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Wong GC, Berman BA, Hoang T, Bernaards C, Jones C, Bernert JT. Children's exposure to environmental tobacco smoke in the home: comparison of urine cotinine and parental reports. ARCHIVES OF ENVIRONMENTAL HEALTH 2002; 57:584-90. [PMID: 12696657 DOI: 10.1080/00039890209602092] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors examined the relationship between parent-reported estimates of children's exposure to environmental tobacco smoke (ETS) in the home and children's urinary cotinine levels. Data were collected from a largely ethnic minority, low-income, urban sample of households in which a child had asthma and at least 1 household member smoked. Information about level of household smoking restriction, parental smoking status, and number of cigarettes smoked per day accounted for approximately 45% of the variance in cotinine concentration. Detailed information about the duration of household smoking or children's ETS exposure added no additional significant information. Questionnaires eliciting detailed information about smoking habits and children's ETS exposure may be no better at predicting children's urinary cotinine levels than simpler surveys that inquire about smoking restrictions in the home, parental smoking status, and number of cigarettes smoked at home per day.
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Affiliation(s)
- Glenn C Wong
- Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California 90095-6900, USA
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23
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Abstract
This article provides an overview of the hair nicotine biomarker for assessment of exposure to tobacco smoke, with emphasis on environmental tobacco smoke (ETS). Measurement of nicotine in hair can be an informative tool for research looking at ETS and related illnesses. There are still unresolved issues in relation to this biomarker such as influence of hair treatment, hair colour, and growth rate on nicotine levels in hair, which need to be addressed in order to further refine this biomarker for exposure assessment. Nevertheless, hair nicotine promises to be a valid and reliable measure of longer term exposure that can be readily applied in epidemiological studies of exposure to tobacco smoke, and more specifically ETS, and its risk to health.
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Affiliation(s)
- W K Al-Delaimy
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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Seifert JA, Ross CA, Norris JM. Validation of a five-question survey to assess a child's exposure to environmental tobacco smoke. Ann Epidemiol 2002; 12:273-7. [PMID: 11988416 DOI: 10.1016/s1047-2797(01)00264-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the potentially adverse health effects of environmental tobacco smoke (ETS) exposure in young children, a short five-question survey was developed to identify routine exposure to ETS in a large epidemiological study. METHODS The survey is administered to parents of a healthy cohort of children starting at age 3 months. To validate the survey, urinary cotinine levels were measured on 50 children from this cohort who were selected based on ETS exposure as reported in the survey: 24 with no exposure and 26 with exposure. Cotinine was adjusted for creatinine. RESULTS Overall, children with some form of reported ETS exposure had urinary cotinine levels 7.5 times higher than those who were not exposed. Analysis of variance shows that mean levels of log transformed cotinine in children whose parent(s) smoke in the home, parent(s) who smoke but not in the home, and non-smoking parents are 137.13, 75.60, and 43.28 respectively (p = 0.0009), indicating decreasing levels of cotinine as reported exposure decreases. Using a cut-point of 30 ng/mg of cotinine to differentiate unexposed and exposed to ETS, we found 80% agreement with our survey. A Spearman's ranked correlation coefficient of 0.62 indicates a direct relationship between cotinine and an ETS exposure intensity score (p < 0.0001). CONCLUSIONS These results suggest that the 5-question survey reflects the child's exposure to passive smoke and that the survey is sensitive to varying levels of exposure.
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Affiliation(s)
- Jennifer A Seifert
- University of Colorado Health Sciences Center, Department of Preventive Medicine and Biometrics, Denver, CO 80262, USA
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25
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Al-Delaimy WK, Crane J, Woodward A. Is the hair nicotine level a more accurate biomarker of environmental tobacco smoke exposure than urine cotinine? J Epidemiol Community Health 2002; 56:66-71. [PMID: 11801622 PMCID: PMC1732006 DOI: 10.1136/jech.56.1.66] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to compare the two biomarkers of exposure to environmental tobacco smoke (ETS); urine cotinine and hair nicotine, using questionnaires as the standard. DESIGN A cross sectional study of children consecutively admitted to hospital for lower respiratory illnesses during the period of the study. SETTINGS Three regional hospitals in the larger Wellington area, New Zealand. PARTICIPANTS Children aged 3-27 months and admitted to the above hospitals during August 1997 to October 1998. A total of 322 children provided 297 hair samples and 158 urine samples. MAIN RESULTS Hair nicotine levels were better able to discriminate the groups of children according to their household's smoking habits at home (no smokers, smoke only outside the home, smoke inside the house) than urine cotinine (Kruskall-Wallis; chi(2)=142.14, and chi(2)=49.5, respectively (p<0.0001)). Furthermore, hair nicotine levels were more strongly correlated with number of smokers in the house, and the number of cigarettes smoked by parents and other members of the child's households. Hair nicotine was better related to the questionnaire variables of smoking in a multivariate regression model (r(2)=0.55) than urine cotinine (r(2)=0.31). CONCLUSIONS In this group of young children, hair nicotine was a more precise biomarker of exposure to ETS than urine cotinine levels, using questionnaire reports as the reference. Both biomarkers indicate that smoking outside the house limits ETS exposure of children but does not eliminate it.
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Affiliation(s)
- W K Al-Delaimy
- Department of Public Health, Wellington School of Medicine, Wellington, New Zealand.
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SANTOS UBIRATANP, GANNAM SILMAR, ABE JULIEM, ESTEVES PATRICIAB, FREITAS FILHO MARCO, WAKASSA THAISB, ISSA JAQUELINES, TERRA-FILHO MARIO, STELMACH RAFAEL, CUKIER ALBERTO. Emprego da determinação de monóxido de carbono no ar exalado para a detecção do consumo de tabaco. ACTA ACUST UNITED AC 2001. [DOI: 10.1590/s0102-35862001000500001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introdução: O tabagismo é o principal fator de risco prevenível de morbidade e mortalidade em países desenvolvidos e está em ascensão nos países em desenvolvimento. Apesar deste fato, e do maior conhecimento sobre seus efeitos, a prevalência de tabagistas continua elevada. Com o objetivo de comparar o valor de monóxido de carbono no ar exalado (COex) entre indivíduos fumantes e não fumantes, avaliar fatores que influenciam estes valores entre os que fumam e também avaliar a possível influência do tabagismo passivo, foram medidos níveis de COex em funcionários e pacientes do Instituto do Coração HC-FMUSP. Materiais e métodos: Este estudo transversal incluiu 256 voluntários que responderam a um questionário e foram submetidos à mensuração de COex em aparelho micromedidor de CO. Resultados: Dos entrevistados, 106 eram do sexo masculino e 150 do feminino e a idade média foi de 43,4 anos (Vmin-max: 15-83). 107 informaram ser tabagistas, 118 não fumantes e 31 fumantes passivos. A média de COex dos fumantes foi de 14,01ppm (Vmin-max: 1-44), dos fumantes passivos 2,03ppm (Vmin-max: 0-5) e, dos não fumantes, 2,50ppm (Vmin-max: 0-9). Houve diferença estatisticamente significante ente o grupo de fumantes e os demais (p < 0,001), mas não entre os fumantes passivos e os não fumantes. Foi encontrada correlação positiva entre número de cigarros fumados por dia e valores de COex e negativa entre o intervalo após ter fumado o último cigarro e o valor de COex. Para um valor de corte de COex igual a 6ppm, foram encontradas sensibilidade de 77% e especificidade de 96%. Conclusão: A mensuração de COex constitui-se um indicador de fácil emprego, baixo custo, não invasivo e que permite a obtenção de resultado imediato, com o valor de corte de COex de 6ppm apresentando boa especificidade para aferir o hábito tabágico.
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Daly JB, Wiggers JH, Considine RJ. Infant exposure to environmental tobacco smoke: a prevalence study in Australia. Aust N Z J Public Health 2001; 25:132-7. [PMID: 11357908 DOI: 10.1111/j.1753-6405.2001.tb01834.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine: the prevalence of exposure to environmental tobacco smoke among infants aged 0-12 months in two child health care settings; the accuracy of parent report indicators of exposure; and the factors associated with exposure to environmental tobacco smoke. METHOD Samples of consecutive parents of infants 12 months of age or younger who attended Hunter Region public child health and immunisation clinics were approached to complete a questionnaire and to allow a urine sample to be obtained from their infant during December and January 1998/99. Infant urine samples were analysed for cotinine and information obtained regarding the smoking status of household members, infant exposure to environmental tobacco smoke during the previous three days, and parent and infant characteristics and demographics. RESULTS 85 (47%) [95% CI 40-54] infants in the combined sample had detectable levels of cotinine. Sensitivity of reported infant exposure of 86% was achieved through the combined measure of parent report of exposure and smoking status of households. The odds of exposure for infants of smoking parents were 14 times that of infants of nonsmokers [CI 5.26-50.0]. CONCLUSIONS Almost half of the infants in this study had detectable levels of cotinine in their urine. Future interventions targeting infant exposure to environmental tobacco smoke should incorporate quit smoking strategies for both parents and other household members, as well as strategies for changing the pattern of smoking behaviour around infants. IMPLICATIONS These findings suggest that existing community education strategies and passive smoking public policies are failing to protect this vulnerable population group.
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Affiliation(s)
- J B Daly
- Hunter Centre for Health Advancement, Wallsend, New South Wales.
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28
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Al-Delaimy WK, Crane J, Woodward A. Passive smoking in children: effect of avoidance strategies, at home as measured by hair nicotine levels. ARCHIVES OF ENVIRONMENTAL HEALTH 2001; 56:117-22. [PMID: 11339674 DOI: 10.1080/00039890109604062] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hair nicotine levels were studied among children, relative to their caregivers' reported exposure to environmental tobacco smoke. A total of 117 children, aged 3 months to 10 years, were recruited consecutively from hospital inpatients, and their respective parents or caregivers were interviewed. Degree of exposure to environmental tobacco smoke was assessed via questionnaire. Scalp hair samples were collected from children and were assayed for nicotine. Levels of nicotine in hair among children reportedly exposed to smokers were higher than levels among unexposed children (chi2 = 26.46, p < .0001). In addition, hair nicotine levels were higher among children with mothers who smoked, compared with those whose mothers did not smoke. Whether household members smoked outside or inside the house had no significant effect on hair nicotine levels of children. Hair nicotine levels differed between children who were reportedly unexposed to environmental tobacco smoke at home and those who were exposed. Smoking outside the home, as reported by parents, did not cause a reduction in nicotine levels in the hair of children.
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Affiliation(s)
- W K Al-Delaimy
- Department of Public Health, Wellington School of Medicine, New Zealand
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Daly KA, Brown JE, Lindgren BR, Meland MH, Le CT, Giebink GS. Epidemiology of otitis media onset by six months of age. Pediatrics 1999; 103:1158-66. [PMID: 10353923 DOI: 10.1542/peds.103.6.1158] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Although early otitis media (OM) onset predicts later recurrent and chronic OM, little research has been directed at illuminating the role of prenatal exposures in early OM. This prospective study examined prenatal, innate, and early environmental exposures associated with acute otitis media (AOM) onset and recurrent OM (ROM) by age 6 months. DESIGN AND METHODS Prospective study of 596 infants from a health maintenance organization followed from birth to 6 months. Mothers completed monthly forms on prenatal exposures (diet, medications, and illnesses) and infant risk factors (eg, smoke exposure and child care) during pregnancy and until infants were 6 months old. Urine samples were collected when infants were 2 months of age and analyzed for cotinine and creatinine. Physicians and nurse practitioners examined infants at each clinic visit and completed standard ear examination forms. RESULTS Thirty-nine percent had an episode of AOM and 20% had ROM by age 6 months. Using Cox's regression models to control for confounding, respiratory tract infection (relative risk [RR] 7.5), day care (RR 1. 7), >1 sibling (RR 1.4), maternal, paternal, and sibling OM history (RR 1.6, 1.5, and 1.7, respectively) were significantly related to early OM onset. ROM was related to respiratory tract infection (RR 9. 5), day care (RR 1.9), conjunctivitis (RR 2.0), maternal OM history (RR 1.9), and birth in the fall (RR 2.6). Among prenatal exposures, only high prenatal dietary vitamin C intake was significantly inversely related to early AOM with univariate but not multivariate analysis. CONCLUSION Prenatal factors were not linked to early AOM onset with multivariate analysis, but environmental and innate factors play an important role in early AOM onset. Strategies to reduce exposure to environmental variables could reduce rates of early AOM, which could potentially result in declining rates of ROM and chronic OME.
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Affiliation(s)
- K A Daly
- Otitis Media Research Center, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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Affiliation(s)
- F Carrión Valero
- Servicio de Neumología, Hospital Clínico Universitario, Valencia
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