Environmental tobacco smoke exposure and respiratory morbidity in children

Evaluation of hair cotinine and toxic metal levels in children who were exposed to tobacco smoke

Tobacco or tobacco products (TTP) are harmful because they contain nicotine and some heavy metals. In this study, it was aimed to evaluate whether the responses of parents to questionnaires were compatible with the hair cotinine levels of their children, and to investigate whether exposure to environmental tobacco smoke (ETS) and living conditions increased the levels of cotinine, lead (Pb), arsenic (As), and cadmium (Cd) in the hair samples of the children. Questionnaires were administered to the parents questioning household consumption of TTP and living conditions. Children were grouped as "exposed to ETS" (E-ETS) and "not exposed to ETS" (NE-ETS). This grouping was performed through a questionnaire-based evaluation, and a hair cotinine cut-off value-based evaluation. According to the questionnaire-based evaluation, there were no significant differences in hair Pb, As, and Cd levels between the groups (P-values: .337, .994, and .825, respectively). The hair cotinine of the E-ETS group was higher (0.24 ± 0.21 vs 0.22 ± 0.15 ng/mg), but the difference was not statistically significant (P = .317). According to the cotinine evaluation, cotinine, Pb, and As levels were statistically higher in the E-ETS group (P < .001, <.001, and .036, respectively), but there was no statistical difference between the groups in terms of Cd levels (P = .238). Our results showed that exposure to ETS increased the levels of cotinine, Pb, and As in the hair samples of children, and the questionnaire responses of the parents about their smoking habits might not be compatible with the hair cotinine levels of the children.

Exposure to environmental tobacco smoke by healthy children aged below five (Preliminary study)

AIM

Children are commonly affected by environmental tobacco smoke. The presence of exposure can be deduced from urinary urine kotinine/creatinine ratio and history. The aim of this study was to investigate passive smoking in healthy children between one-month and five year old, and to determine the adverse effects of passive smoking on child health.

MATERIAL AND METHODS

Children between one-month and five year old who were regularly monitored for health were included following informed consent given by their parents. The questionnaire method was used. Demographic variables, respiratory tract infections, recurrent infections were questioned. The levels of cotinine, creatinine were measured and the cotinine/creatinine ratios were calculated in urine specimens taken from the children. Growth status and infection frequency were determined using demographic data, cotinine/creatinine ratios in urine, exposure rate to second-hand tobacco smoke of the children.

RESULTS

The ratio of household smokers was 70.3%, the ratio of non-smokers was 29.7%. Fifty percent of the mothers were smokers. Urinary cotinine/creatinine ratios were found to be significantly higher in children of smokers compared with children of non-smokers (p=0.011). One third of the children was evaluated as passive smokers. The presence of a smoker at home and the increase in the number of cigarettes smoked during the day increased the frequency of acute respiratory infections (p=0.047).

CONCLUSION

In these regularly-monitored preschool children, we found frequent exposure to cigarette smoke. This study contributes to national data and will aid in increasing the awareness for the deleterious effects of passive smoking on child health.

Does raising awareness in families reduce environmental tobacco smoke exposure in wheezy children?

Introduction

Environmental tobacco smoke (ETS) is thought to increase the severity and number of attacks in wheezy children. Objective assessments are needed to change the behavior of families to reduce the exposure of wheezy children to ETS.

Aim

To determine whether informing families about their children’s urinary cotinine levels curtailed the exposure of children to ETS.

Material and methods

A survey was used to determine the ETS exposure level, and the urinary cotinine level of each patient was tested. Children with positive urinary cotinine levels were included in the second part of the study. The families were randomly divided into two groups: an intervention group that was advised about urinary cotinine levels by telephone and a non-intervention group that was not so advised. The groups were followed-up 2 months later, and urinary cotinine levels were measured once again.

Results

The intervention group contained 65 children of average age of 24.4 ±8.9 months, of whom 46 (70.8%) were male. The non-intervention group contained 69 children of average age of 25.3 ±9.8 months (p > 0.05), of whom 52 (75.4%) were male. The urinary cotinine levels at the time of the second interview were lower in both groups. The number of cigarettes that fathers smoked at home decreased in the intervention group (p = 0.037).

Conclusions

Presenting objective evidence on ETS exposure to families draws attention to their smoking habits. Measurement of cotinine levels is cheap, practical, and noninvasive. Combined with education, creating awareness by measuring cotinine levels may be beneficial.

Exposure to paternal tobacco smoking increased child hospitalization for lower respiratory infections but not for other diseases in Vietnam

Exposure to environmental tobacco smoke (ETS) is an important modifiable risk factor for child hospitalization, although its contribution is not well documented in countries where ETS due to maternal tobacco smoking is negligible. We conducted a birth cohort study of 1999 neonates between May 2009 and May 2010 in Nha Trang, Vietnam, to evaluate paternal tobacco smoking as a risk factor for infectious and non-infectious diseases. Hospitalizations during a 24-month observation period were identified using hospital records. The effect of paternal exposure during pregnancy and infancy on infectious disease incidence was evaluated using Poisson regression models. In total, 35.6% of 1624 children who attended follow-up visits required at least one hospitalization by 2 years of age, and the most common reason for hospitalization was lower respiratory tract infection (LRTI). Paternal tobacco smoking independently increased the risk of LRTI 1.76-fold (95% CI: 1.24-2.51) after adjusting for possible confounders but was not associated with any other cause of hospitalization. The population attributable fraction indicated that effective interventions to prevent paternal smoking in the presence of children would reduce LRTI-related hospitalizations by 14.8% in this epidemiological setting.

The role of secondhand smoke in sinusitis: a systematic review

BACKGROUND

The objective of this study was to systematically review existing literature on the association between sinusitis and secondhand smoke (SHS) exposure.

METHODS

We performed a literature search encompassing the last 25 years in PubMed, EMBASE, and Cochrane CENTRAL. Inclusion criteria included English language papers containing original human data with at least 7 subjects. Data was systematically collected on study design, patient demographics, clinical characteristics/outcomes, and level-of-evidence (Oxford Center for Evidence-Based Medicine). Quality assessment was performed using the Newcastle-Ottawa scale. Two investigators independently reviewed all manuscripts.

RESULTS

The initial search yielded 116 abstracts, of which 19 articles were included. Thirteen (68.4%) of the 19 articles showed a statistically significant association between sinusitis and SHS. Seven (36.8%) studies specifically evaluated chronic rhinosinusitis (CRS) with 5 (71.4%) CRS studies demonstrating a significant association between CRS and SHS. Seventeen articles were case-control studies (Level 3b). For characterizing sinusitis, 6 (31.6%) studies included computed tomography (CT) or endoscopy in the diagnostic criteria, with 5 of these studies following rhinosinusitis taskforce guidelines. For determining presence of SHS, all studies used questionnaires and 2 (10.5%) studies also reported serum or urine cotinine levels.

CONCLUSION

A majority of the studies (68.4%) included in this systematic review showed a significant association between sinusitis and SHS. Furthermore, 5 (83.3%) of the 6 studies with objective diagnostic criteria (CT, endoscopy) found a significant association between sinusitis and SHS. Further higher-quality studies with objective diagnosis of sinusitis and quantification of SHS exposure should be performed in the future to better evaluate the relationship between sinusitis and SHS.

Residential smoking restrictions are not associated with reduced child SHS exposure in a baseline sample of low-income, urban African Americans

Second hand smoke exposure (SHSe) relates to many chronic and acute illnesses. Low income African American (AA) maternal smokers and their children have disproportionately higher tobacco-use and child SHSe-related morbidity and mortality than other populations. While public health officials promote residential smoking restrictions to reduce SHSe and promote smoking cessation, little is known about the impact of restrictions in changing smoking behavior and SHSe in this population. Thus, the purpose of this study was to examine associations between residential smoking restrictions, maternal smoking, and young children's SHSe in the context of other factors known to influence low income AA mothers' smoking behavior. For this study, we used cross-sectional, baseline data from 307 AA maternal smokers' pre-treatment interviews completed as part of a subsequent behavioral counseling trial to reduce their young (< 4 years old) children's SHSe. Residential smoking restriction was dichotomized as 0 = no restrictions and 1 = some restrictions. Child urine cotinine provided a biomarker of SHSe. Mothers reported cigarettes/day smoked, cigarettes/day exposed to child, and intention to quit. Multivariate regressions modeled effects of restriction as the primary predictor of smoking and exposure outcomes. Maternal smoking patterns such as cigarettes per day (β = 0.52, p < 0.001) and years smoked (β = -0.11; p = 0.03) along with presence of additional smokers in the home (β = 0.10; p = 0.04), but not residential restriction (β = -0.09, p = 0.10), predicted reported SHSe. Restriction did not relate to baby cotinine or maternal intention to quit. Thus, residential smoking restrictions may contribute to efforts to reduce children's SHSe and promote maternal smoking change; but alone, may not constitute a sufficient intervention to protect children. Multi-level intervention approaches that include SHSe-reduction residential smoking policies plus support and cessation assistance for smokers may be a necessary approach to smoke-free home adoption and adherence.

Secondhand smoke exposure among women and children: evidence from 31 countries

OBJECTIVES

We sought to describe the range of exposure to secondhand smoke (SHS) among women and children living with smokers around the world and generate locally relevant data to motivate the development of tobacco control policies and interventions in developing countries.

METHODS

In 2006, we conducted a cross-sectional exposure survey to measure air nicotine concentrations in households and hair nicotine concentrations among nonsmoking women and children in convenience samples of 40 households in 31 countries.

RESULTS

Median air nicotine concentration was 17 times higher in households with smokers (0.18 mug/m(3)) compared with households without smokers (0.01 mug/m(3)). Air nicotine and hair nicotine concentrations in women and children increased with the number of smokers in the household. The dose-response relationship was steeper among children. Air nicotine concentrations increased an estimated 12.9 times (95% confidence interval=9.4, 17.6) in households allowing smoking inside compared with those prohibiting smoking inside.

CONCLUSIONS

Our results indicate that women and children living with smokers are at increased risk of premature death and disease from exposure to SHS. Interventions to protect women and children from household SHS need to be strengthened.