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Sadhasivam B, Manyanga J, Ganapathy V, Acharya P, Bouharati C, Chinnaiyan M, Mehta T, Mathews B, Castles S, Rubenstein DA, Tackett AP, Zhao YD, Ramachandran I, Queimado L. Exposure to Secondhand Smoke Extract Increases Cisplatin Resistance in Head and Neck Cancer Cells. Int J Mol Sci 2024; 25:1032. [PMID: 38256106 PMCID: PMC10816441 DOI: 10.3390/ijms25021032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Chemotherapy and radiotherapy resistance are major obstacles in the long-term efficacy of head and neck squamous cell carcinoma (HNSCC) treatment. Secondhand smoke (SHS) exposure is common and has been proposed as an independent predictor of HNSCC recurrence and disease-free survival. However, the underlying mechanisms responsible for these negative patient outcomes are unknown. To assess the effects of SHS exposure on cisplatin efficacy in cancer cells, three distinct HNSCC cell lines were exposed to sidestream (SS) smoke, the main component of SHS, at concentrations mimicking the nicotine level seen in passive smokers' saliva and treated with cisplatin (0.01-100 µM) for 48 h. Compared to cisplatin treatment alone, cancer cells exposed to both cisplatin and SS smoke extract showed significantly lower cisplatin-induced cell death and higher cell viability, IC50, and indefinite survival capacity. However, SS smoke extract exposure alone did not change cancer cell viability, cell death, or cell proliferation compared to unexposed control cancer cells. Mechanistically, exposure to SS smoke extract significantly reduced the expression of cisplatin influx transporter CTR1, and increased the expression of multidrug-resistant proteins ABCG2 and ATP7A. Our study is the first to document that exposure to SHS can increase cisplatin resistance by altering the expression of several proteins involved in multidrug resistance, thus increasing the cells' capability to evade cisplatin-induced cell death. These findings emphasize the urgent need for clinicians to consider the potential role of SHS on treatment outcomes and to advise cancer patients and caregivers on the potential benefits of avoiding SHS exposure.
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Affiliation(s)
- Balaji Sadhasivam
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
- Department of Occupational and Environmental Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Jimmy Manyanga
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
- Department of Cell Biology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Vengatesh Ganapathy
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - Pawan Acharya
- Department of Biostatistics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (P.A.); (Y.D.Z.)
| | - Célia Bouharati
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - Mayilvanan Chinnaiyan
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - Toral Mehta
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - Basil Mathews
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - Samuel Castles
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - David A. Rubenstein
- Department of Biomedical Engineering, Stony Brook University, New York City, NY 11794, USA;
| | - Alayna P. Tackett
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
- Division of Medical Oncology, The Ohio State University, Columbus, OH 43210, USA
| | - Yan D. Zhao
- Department of Biostatistics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (P.A.); (Y.D.Z.)
| | - Ilangovan Ramachandran
- Department of Endocrinology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai, TN 600113, India;
| | - Lurdes Queimado
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
- Department of Cell Biology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
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López-Ojeda W, Hurley RA. Vaping and the Brain: Effects of Electronic Cigarettes and E-Liquid Substances. J Neuropsychiatry Clin Neurosci 2024; 36:A41-5. [PMID: 38226910 DOI: 10.1176/appi.neuropsych.20230184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- Wilfredo López-Ojeda
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) and Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (López-Ojeda, Hurley); Department of Psychiatry and Behavioral Medicine (López-Ojeda, Hurley) and Department of Radiology (Hurley), Wake Forest University School of Medicine, Winston-Salem, N.C.; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley)
| | - Robin A Hurley
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) and Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (López-Ojeda, Hurley); Department of Psychiatry and Behavioral Medicine (López-Ojeda, Hurley) and Department of Radiology (Hurley), Wake Forest University School of Medicine, Winston-Salem, N.C.; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley)
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Thorpe AE, Donovan C, Kim RY, Vindin HJ, Zakarya R, Miyai H, Chan YL, van Reyk D, Chen H, Oliver BG. Third-Hand Exposure to E-Cigarette Vapour Induces Pulmonary Effects in Mice. TOXICS 2023; 11:749. [PMID: 37755759 PMCID: PMC10536515 DOI: 10.3390/toxics11090749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/18/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023]
Abstract
In the last decade, e-cigarette usage has increased, with an estimated 82 million e-cigarette users globally. This is, in part, due to the common opinion that they are "healthier" than tobacco cigarettes or simply "water vapour". Third-hand e-vapour exposure is the chemical residue left behind from e-cigarette aerosols, which is of concern due to its invisible nature, especially among young children. However, there is limited information surrounding third-hand e-vapour exposure. This study aimed to investigate the pulmonary effects of sub-chronic third-hand e-vapour exposure in a murine model. BALB/c mice (4 weeks of age) were exposed to a towel containing nicotine free (0 mg) e-vapour, nicotine (18 mg) e-vapour, or no e-vapour (sham) and replaced daily for 4 weeks. At the endpoint, lung function was assessed, and bronchoalveolar lavage fluid and lungs were collected to measure inflammation and fibrosis. Mice exposed to third-hand e-vapour without nicotine had alveolar enlargement compared to sham exposed controls. Mice exposed to third-hand e-vapour with nicotine had reduced bronchial responsiveness to provocation, increased epithelial thickening in large airways, increased epithelial layers in small airways, alveolar enlargement, and increased small airway collagen deposition, compared to sham exposed controls. In conclusion, our study shows that third-hand e-vapour exposure, particularly in the presence of nicotine, negatively affects the lung health of mice and highlights the need for greater public awareness surrounding the dangers of third-hand exposure to e-cigarette vapour.
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Affiliation(s)
- Andrew E. Thorpe
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia (Y.L.C.); (H.C.)
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia
| | - Chantal Donovan
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia (Y.L.C.); (H.C.)
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2000, Australia
| | - Richard Y. Kim
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia (Y.L.C.); (H.C.)
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia
- Immune Health Program, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2000, Australia
| | - Howard J. Vindin
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia
- School of Life and Environmental Sciences, Faculty of Science, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Razia Zakarya
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia (Y.L.C.); (H.C.)
- Epigenetics of Chronic Disease, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia
| | - Hanna Miyai
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia (Y.L.C.); (H.C.)
| | - Yik L. Chan
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia (Y.L.C.); (H.C.)
| | - David van Reyk
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia (Y.L.C.); (H.C.)
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia (Y.L.C.); (H.C.)
| | - Brian G. Oliver
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia (Y.L.C.); (H.C.)
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia
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Mourino N, Pérez-Ríos M, Yolton K, Lanphear BP, Chen A, Buckley JP, Kalkwarf HJ, Cecil KM, Braun JM. Pre- and postnatal exposure to secondhand tobacco smoke and cardiometabolic risk at 12 years: Periods of susceptibility. ENVIRONMENTAL RESEARCH 2023; 224:115572. [PMID: 36841524 PMCID: PMC10726317 DOI: 10.1016/j.envres.2023.115572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND To identify periods of heightened susceptibility to the association of secondhand tobacco smoke (SHS) exposure with cardiometabolic (CM) risk at age 12 years. METHODS We used data from 212 adolescents from the HOME Study, a prospective pregnancy and birth cohort in Cincinnati, OH. Using multiple informant models, we estimated associations of maternal serum cotinine (mean of concentrations at 16 and 26 weeks of pregnancy) and children's serum cotinine concentrations (mean of concentrations at ages 1, 2, 3, and 4 years) with a CM risk summary score constructed of five risk components measured at age 12 years. We determined if these associations differed for pre- and postnatal exposure periods, and adolescent's sex. RESULTS We found some evidence that the cotinine-outcome associations differed by exposure period and sex. Postnatal, but not prenatal, cotinine was associated with higher CM risk scores and individual CM risk component values (interaction p-values = 0.04 to 0.35). Each 10-fold increase in postnatal cotinine was associated with 0.57 (95% CI: 0.32, 1.45), 0.09 (95% CI: 0.13, 0.31), 0.14 (-0.08, 0.35), 0.07 (95% CI: 0.34, 0.48), and 0.11 (95% CI: 0.04, 0.27) higher CM risk, HOMA-IR, TG to HDL-C ratio, leptin to adiponectin ratio, and visceral fat area. Postnatal cotinine was associated with higher visceral fat area among females but not males (sex × period × cotinine interaction p-value = 0.01). CONCLUSIONS Serum cotinine concentrations during the postnatal period had greater influence on adolescent's CM risk compared to the prenatal period, and these associations may be sex-specific. This study reinforces the need for ongoing public health interventions to minimize children's exposure to SHS.
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Affiliation(s)
- Nerea Mourino
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public health (CIBERESP), Madrid, Spain.
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessie P Buckley
- Department of Environmental Health and Engineering, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim M Cecil
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
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Merianos AL, Mahabee-Gittens EM, Stone TM, Jandarov RA, Wang L, Bhandari D, Blount BC, Matt GE. Distinguishing Exposure to Secondhand and Thirdhand Tobacco Smoke among U.S. Children Using Machine Learning: NHANES 2013-2016. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:2042-2053. [PMID: 36705578 PMCID: PMC10230650 DOI: 10.1021/acs.est.2c08121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
While the thirdhand smoke (THS) residue from tobacco smoke has been recognized as a distinct public health hazard, there are currently no gold standard biomarkers to differentiate THS from secondhand smoke (SHS) exposure. This study used machine learning algorithms to assess which combinations of biomarkers and reported tobacco smoke exposure measures best differentiate children into three groups: no/minimal tobacco smoke exposure (NEG); predominant THS exposure (TEG); and mixed SHS and THS exposure (MEG). Participants were 4485 nonsmoking 3-17-year-olds from the National Health and Nutrition Examination Survey 2013-2016. We fitted and tested random forest models, and the majority (76%) of children were classified in NEG, 16% were classified in TEG, and 8% were classified in MEG. The final classification model based on reported exposure, biomarker, and biomarker ratio variables had a prediction accuracy of 95%. This final model had prediction accuracies of 100% for NEG, 88% for TEG, followed by 71% for MEG. The most important predictors were the reported number of household smokers, serum cotinine, serum hydroxycotinine, and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). In the absence of validated biomarkers specific to THS, comprehensive biomarker and questionnaire data for tobacco smoke exposure can distinguish children exposed to SHS and THS with high accuracy.
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Affiliation(s)
- Ashley L. Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati OH, 45221, USA
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, USA
| | - Timothy M. Stone
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Kettering Lab Building, 160 Panzeca Way, Cincinnati, OH, 45267-0056, USA
| | - Roman A. Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Kettering Lab Building, 160 Panzeca Way, Cincinnati, OH, 45267-0056, USA
| | - Lanqing Wang
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Deepak Bhandari
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Benjamin C. Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Georg E. Matt
- Department of Psychology, College of Sciences, San Diego State University, 9245 Sky Park Court, Suite 225, San Diego, CA, 92123, USA
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Mahabee-Gittens EM, Merianos AL, Stone L, Wullenweber CA, Quintana PJE, Hoh E, Dodder NG, Lopez-Galvez N, Matt GE. Hand nicotine as an independent marker of thirdhand smoke pollution in children's environments. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 849:157914. [PMID: 35952873 PMCID: PMC10199779 DOI: 10.1016/j.scitotenv.2022.157914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/22/2022] [Accepted: 08/04/2022] [Indexed: 05/23/2023]
Abstract
BACKGROUND Hand nicotine (HN) levels measure children's exposure to tobacco smoke pollutants from thirdhand and secondhand smoke. HN is associated with urinary and salivary cotinine, but the associations of HN with other tobacco smoke exposure (TSE) markers remain unknown. OBJECTIVES We compared levels of HN and four urinary TSE biomarkers: cotinine, trans-3'-hydroxycotinine (3HC), nicotelline N-oxides, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and children's sociodemographic and TSE patterns. We also examined if HN is a plausible pathway for children's exposure to active smoking. METHODS Data were collected from 175 non-smoking patients (Mean (SD) age = 5.4 (3.4) years) who lived with ≥1 cigarette smoker(s). HN and TSE biomarker levels were determined using LC-MS/MS. Multivariate and multivariable regression analyses were conducted to examine associations between TSE markers and parent-reported measures, controlling for sociodemographics. RESULTS Of the five markers of TSE, cotinine (R2 = 0.221; p = 0.003) and HN (R2 = 0.247; p = 0.001) showed the strongest overall associations. Of the five markers, only cotinine showed significantly higher levels among Black children (β^=0.307,p<0.05) independent of age, reported exposure, and home smoking bans. Cotinine (β^=0.010,p<0.05), NNAL (β^=0.012,p<0.05), and HN (β^=0.011,p<0.05) showed significant positive associations with reported exposure independent of race, age, and home smoking bans. NNAL (β^=-0.285,p<0.05) and HN (β^=-0.336,p<0.05), but not cotinine, 3HC, and N-oxides, showed significantly lower levels among children who lived in homes with smoking bans. Child age, hand surface area, home smoking ban, and reported exposure independently accounted for 21 % of the variance in HN levels (p = 0.002). HN accounted for 30 % of the variance in cotinine independent of child race and child age. DISCUSSION HN levels were associated with modifiable tobacco-related behaviors and shows promise as a marker of sources of THS pollution in a child's environment not captured by measurement of urinary cotinine alone. HN levels provide additional information about TSE, complementing other biomarkers when assessing children's overall TSE.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chase A Wullenweber
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Nathan G Dodder
- School of Public Health, San Diego State University, San Diego, CA, USA; San Diego State University Research Foundation, San Diego, CA, USA
| | - Nicolas Lopez-Galvez
- School of Public Health, San Diego State University, San Diego, CA, USA; San Diego State University Research Foundation, San Diego, CA, USA
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Northrup TF, Stotts AL, Suchting R, Khan AM, Klawans MR, Green C, Hoh E, Hovell MF, Matt GE, Quintana PJE. Handwashing Results in Incomplete Nicotine Removal from Fingers of Individuals who Smoke: A Randomized Controlled Experiment. Am J Perinatol 2022; 39:1634-1642. [PMID: 34634832 DOI: 10.1055/s-0041-1736287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Tobacco residue, also known as third-hand smoke (THS), contains toxicants and lingers in dust and on surfaces and clothes. THS also remains on hands of individuals who smoke, with potential transfer to infants during visitation while infants are hospitalized in neonatal intensive care units (NICUs), raising concerns (e.g., hindered respiratory development) for vulnerable infants. Previously unexplored, this study tested handwashing (HW) and sanitization efficacy for finger-nicotine removal in a sample of adults who smoked and were visiting infants in an NICU. STUDY DESIGN A cross-sectional sample was recruited to complete an interview, carbon monoxide breath samples, and three nicotine wipes of separate fingers (thumb, index, and middle). Eligible participants (n = 14) reported current smoking (verified with breath samples) and were randomly assigned to 30 seconds of HW (n = 7) or alcohol-based sanitization (n = 7), with the order of finger wipes both counterbalanced and randomly assigned. After randomization, the first finger was wiped for nicotine. Participants then washed or sanitized their hands and finger two was wiped 5 minutes later. An interview assessing tobacco/nicotine use and exposure was then administered, followed by a second breath sample and the final finger wipe (40-60 minutes after washing/sanitizing). RESULTS Generalized linear mixed models found that HW was more effective than sanitizer for nicotine removal but failed to completely remove nicotine. CONCLUSIONS Without proper protections (e.g., wearing gloves and gowns), NICU visitors who smoke may inadvertently expose infants to THS. Research on cleaning protocols are needed to protect vulnerable medical populations from THS and associated risks. KEY POINTS · NICU infants may be exposed to THS via visitors.. · THS is not eliminated by HW or sanitizing.. · THS removal protections for NICU infants are needed..
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Affiliation(s)
- Thomas F Northrup
- Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas
| | - Angela L Stotts
- Department of Family and Community Medicine, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, UTHealth, McGovern Medical School, Houston, Texas
| | - Amir M Khan
- Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas
| | - Michelle R Klawans
- Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas
| | - Charles Green
- Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas
| | - Eunha Hoh
- Division of Environmental Health, School of Public Health, San Diego State University, San Diego, California
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, California
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, California
| | - Penelope J E Quintana
- Division of Environmental Health, School of Public Health, San Diego State University, San Diego, California
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Merianos AL, Fiser KA, Mahabee-Gittens EM, Lyons MS, Gordon JS. Barriers to implementation of pediatric emergency department interventions for parental tobacco use and dependence: a qualitative study using the theoretical domains framework. Implement Sci Commun 2022; 3:3. [PMID: 35022066 PMCID: PMC8754362 DOI: 10.1186/s43058-021-00251-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pediatric emergency department (PED) and urgent care (UC) professionals can play a key role in delivering evidence-based guidelines to address parental tobacco use and child tobacco smoke exposure (TSE). Understanding PED/UC professionals’ perceptions regarding these guidelines is the first step in developing and implementing a TSE screening and counseling intervention in these settings. This study aimed to use the theoretical domains framework (TDF) to identify current screening and counseling behaviors of PED/UC professionals related to parental tobacco use and child TSE, and determine barriers and enablers that influence these behaviors. Methods Semi-structured, focused interviews were conducted with 29 actively practicing PED/UC clinical staff who worked at one large, Midwestern children’s hospital. The interview guide was informed by the TDF and included open-ended questions. Content analysis of interview transcripts was guided by the TDF. Nurses, physicians, and healthcare administrators were assessed overall and by group membership to ensure each group was represented based on their varying PED/UC roles. Results Fifty-one percent were nurses, 38% were physicians, and 11% were healthcare administrators. Most PED/UC professionals did not currently follow the guidelines, but perceived addressing parental tobacco use as part of their role. All 14 TDF domains were identified by nurses, physicians, and administrators in relation to counseling for parental tobacco use and child TSE. Domains with the most sub-themes were (1) knowledge: lack of knowledge about tobacco counseling, including implementing counseling, cessation resources/referrals, and thirdhand smoke; (2) beliefs about capabilities: not comfortable counseling parents, easier to discuss with parents who are receptive and to ask and advise when patients have a TSE-related complaint, and more likely to discuss if there were resources/referrals; and (3) environmental context and resources: barriers include lack of time, training, and resources and referral information to give to parents, and an enabler is using TSE-related complaints as a context to offer counseling. Conclusions Study findings provide a strong foundation for developing and implementing clinical practice guidelines regarding parental tobacco use and child TSE in the PED/UC setting. Future intervention development will address all TDF domains and test the implementation of the intervention in the PED/UC setting.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH, 45221-0068, USA. .,Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Kayleigh A Fiser
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH, 45221-0068, USA
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, College of Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Michael S Lyons
- Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Department of Emergency Medicine, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0769, USA
| | - Judith S Gordon
- College of Nursing, The University of Arizona, 1305 N Martin Avenue, PO Box 210203, Tucson, AZ, 85721-0203, USA
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Mahabee-Gittens EM, Quintana PJE, Hoh E, Merianos AL, Stone L, Lopez-Galvez N, Matt GE. Collecting Hand Wipe Samples to Assess Thirdhand Smoke Exposure. Front Public Health 2021; 9:770505. [PMID: 34988051 PMCID: PMC8720752 DOI: 10.3389/fpubh.2021.770505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- *Correspondence: E. Melinda Mahabee-Gittens
| | | | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, United States
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nicolas Lopez-Galvez
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, CA, United States
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Kelley ST, Liu W, Quintana PJ, Hoh E, Dodder NG, Mahabee-Gittens EM, Padilla S, Ogden S, Frenzel S, Sisk-Hackworth L, Matt GE. Altered microbiomes in thirdhand smoke-exposed children and their home environments. Pediatr Res 2021; 90:1153-1160. [PMID: 33654287 PMCID: PMC8410873 DOI: 10.1038/s41390-021-01400-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Tobacco smoke contains numerous toxic chemicals that accumulate in indoor environments creating thirdhand smoke (THS). We investigated if THS-polluted homes differed in children's human and built-environment microbiomes as compared to THS-free homes. METHODS Participants were n = 19 THS-exposed children and n = 10 unexposed children (≤5 years) and their caregivers. Environmental and biological samples were analyzed for THS pollutants and exposure. Swab samples were collected from the built-environment (floor, table, armrest, bed frame) and child (finger, nose, mouth, and ear canal), and 16S ribosomal RNA genes were analyzed for bacterial taxa using high-throughput DNA sequencing. RESULTS Phylogenetic α-diversity was significantly higher for the built-environment microbiomes in THS-polluted homes compared to THS-free homes (p < 0.014). Log2-fold comparison found differences between THS-polluted and THS-free homes for specific genera in samples from the built-environment (e.g., Acinetobacter, Bradyrhizobium, Corynebacterium, Gemella, Neisseria, Staphylococcus, Streptococcus, and Veillonella) and in samples from children (esp. Corynebacterium, Gemella, Lautropia, Neisseria, Rothia, Staphylococcus, and Veillonella). CONCLUSION When exposed to THS, indoor and children microbiomes are altered in an environment-specific manner. Changes are similar to those reported in previous studies for smokers and secondhand smoke-exposed persons. THS-induced changes in child and built-environmental microbiomes may play a role in clinical outcomes in children. IMPACT Despite smoking bans, children can be exposed to tobacco smoke residue (i.e., thirdhand smoke) that lingers on surfaces and in settled house dust. Thirdhand smoke exposure is associated with changes in the microbiomes of the home environment and of the children living in these homes. Thirdhand smoke is associated with increased phylogenetic diversity of the home environment and changes in the abundances of several genera of the child microbiome known to be affected by active smoking and secondhand smoke (e.g., Corynebacterium, Staphylococcus, Streptococcus). Thirdhand smoke exposure by itself may induce alterations in the microbiome that play a role in childhood pathologies.
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Affiliation(s)
| | - William Liu
- San Diego State University, San Diego CA, USA
| | | | - Eunha Hoh
- San Diego State University, San Diego CA, USA
| | | | - E. Melinda Mahabee-Gittens
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, U.S.A
| | | | - Shawn Ogden
- San Diego State University, San Diego CA, USA
| | - Sia Frenzel
- San Diego State University, San Diego CA, USA
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Mahabee-Gittens EM, Merianos AL, Jandarov RA, Quintana PJE, Hoh E, Matt GE. Differential associations of hand nicotine and urinary cotinine with children's exposure to tobacco smoke and clinical outcomes. ENVIRONMENTAL RESEARCH 2021; 202:111722. [PMID: 34297932 PMCID: PMC8578289 DOI: 10.1016/j.envres.2021.111722] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Children's overall tobacco smoke exposure (TSE) consists of both inhalation of secondhand smoke (SHS) and ingestion, dermal uptake, and inhalation of thirdhand smoke (THS) residue from dust and surfaces in their environments. OBJECTIVES Our objective was to compare the different roles of urinary cotinine as a biomarker of recent overall TSE and hand nicotine as a marker of children's contact with nicotine pollution in their environments. We explored the differential associations of these markers with sociodemographics, parental smoking, child TSE, and clinical diagnoses. METHODS Data were collected from 276 pediatric emergency department patients (Median age = 4.0 years) who lived with a cigarette smoker. Children's hand nicotine and urinary cotinine levels were determined using LC-MS/MS. Parents reported tobacco use and child TSE. Medical records were reviewed to assess discharge diagnoses. RESULTS All children had detectable hand nicotine (GeoM = 89.7ng/wipe; 95 % CI = [78.9; 102.0]) and detectable urinary cotinine (GeoM = 10.4 ng/ml; 95%CI = [8.5; 12.6]). Although hand nicotine and urinary cotinine were highly correlated (r = 0.62, p < 0.001), urinary cotinine geometric means differed between racial groups and were higher for children with lower family income (p < 0.05), unlike hand nicotine. Independent of urinary cotinine, age, race, and ethnicity, children with higher hand nicotine levels were at increased risk to have discharge diagnoses of viral/other infectious illness (aOR = 7.49; 95%CI = [2.06; 27.24], p = 0.002), pulmonary illness (aOR = 6.56; 95%CI = [1.76; 24.43], p = 0.005), and bacterial infection (aOR = 5.45; 95%CI = [1.50; 19.85], p = 0.03). In contrast, urinary cotinine levels showed no associations with diagnosis independent of child hand nicotine levels and demographics. DISCUSSION The distinct associations of hand nicotine and urinary cotinine suggest the two markers reflect different exposure profiles that contribute differentially to pediatric illness. Because THS in a child's environment directly contributes to hand nicotine, additional studies of children of smokers and nonsmokers are warranted to determine the role of hand nicotine as a marker of THS exposure and its potential role in the development of tobacco-related pediatric illnesses.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Roman A Jandarov
- Department of Environmental Health, Division of Biostatistics and Bioinformatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Liu H, Chen H. The effects of thirdhand smoke on reproductive health. J Appl Toxicol 2021; 42:172-179. [PMID: 34462936 DOI: 10.1002/jat.4227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/20/2022]
Abstract
Tobacco smoke is an environmental pollutant that can cause follicle destruction and oocyte dysfunction. Thirdhand smoke (THS) is residual tobacco smoke existing in the environment long after cigarettes have been extinguished, which can react with other environmental compounds to produce secondary pollutants. THS contains a variety of toxic and harmful chemicals, such as nicotine and 1-(N-methyl-N-nitrosamino)-1-(3-pyridinyl)-4-butanal (NNA), a logical biomarker of THS exposure. The health hazards of THS exposure and its components have been researched in recent years. In this review, we have summarized research progress on the effects of THS exposure on organs in mice and humans especially on the reproductive system. This review may help evaluate the health risks of THS, in particular reproduction and offspring health. We hope this review will guide public health education on the dangers of THS exposure and promotion of healthy living habits.
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Affiliation(s)
- Huage Liu
- Institute of Reproductive Medicine, Nantong University, Nantong, China
| | - Hao Chen
- Institute of Reproductive Medicine, Nantong University, Nantong, China
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Abstract
Objectives Past research has not examined secondhand and thirdhand smoke (THS) exposure in children of cigar smokers. We examined hand nicotine and cotinine levels in children of cigar smokers to explore the contribution of cigar smoke to tobacco smoke exposure (TSE). Methods Participants were children (N = 24; mean (SD) age = 6.5 (3.6) years) whose parents smoked cigars only or poly-used cigars and/or cigarettes. Primary outcomes were hand nicotine and urinary cotinine levels. Results All children had detectable hand nicotine (range: 7.6-312.5ng/wipe) and cotinine (range: 0.3-100.3ng/ml). Positive correlations were found between hand nicotine and cotinine (r = 0.693, p = .001), hand nicotine and parents who also smoked cigarettes (r = 0.407, p = .048), and hand nicotine and number of smokers around the child (r = 0.436, p = .03). Hand nicotine (r = -0.464, p = .02), but not cotinine (r = -0.266, p = .26), was negatively correlated with child age. Multiple regression results indicated a positive association between hand nicotine and cotinine (p = .002; semi-partial r2 = 0.415), irrespective of child age. Conclusions The significant association of hand nicotine with urinary cotinine suggests that THS pollution should be assessed in evaluating children's overall TSE to cigars and other tobacco products, and hand nicotine may be a proxy for overall TSE. Younger children may have increased THS pollutant uptake.
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Mahabee-Gittens EM, Merianos AL, Matt GE. Comment regarding categorization of Third-hand smoke exposure in "Third-hand Exposure at Homes: Assessment Using Salivary Cotinine". ENVIRONMENTAL RESEARCH 2021; 195:110595. [PMID: 33556354 PMCID: PMC8195292 DOI: 10.1016/j.envres.2020.110595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Affiliation(s)
- E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati, College of Medicine, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229-3039, USA.
| | - Ashley L Merianos
- University of Cincinnati, School of Human Services, PO Box 210068, Cincinnati, OH, 45221-0068, USA.
| | - Georg E Matt
- San Diego State University, College of Sciences, Department of Psychology, MC4611, San Diego, CA, 92182-4611, USA.
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Child tobacco smoke exposure and healthcare resource utilization patterns. Pediatr Res 2020; 88:571-579. [PMID: 32505125 PMCID: PMC7529841 DOI: 10.1038/s41390-020-0997-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/08/2020] [Accepted: 05/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The objective was to examine the relationship between healthcare resource utilization patterns in tobacco smoke-exposed children (TSE group) compared with unexposed children (non-TSE group). METHODS We matched 380 children in the TSE group with 1140 children in the non-TSE group based on child age, sex, race, and ethnicity using propensity scores. Healthcare resource utilization variables included respiratory-related procedures, diagnostic testing, disposition, and medications. Logistic and linear regression models were built. RESULTS Child mean age was 4.9 (SD = 0.1) years, 50.5% were female, 55.5% black, and 73.2% had public insurance/self-pay. Compared to the non-TSE group, the TSE group was at increased odds to have the following performed/obtained: nasal bulb suctioning, infectious diagnostic tests, laboratory tests, and radiologic tests. The TSE group was more likely to be admitted to the hospital, and more likely to receive steroids and intravenous fluids during their visit. Among asthmatics, the TSE group was more likely to receive steroids, albuterol, or ipratropium alone, or a combination of all three medications during their visit, and be prescribed albuterol alone or steroids and albuterol. CONCLUSION Tobacco smoke-exposed children are more likely to have higher resource utilization patterns, highlighting the importance of screening and providing TSE prevention and remediation interventions. IMPACT Tobacco smoke exposure may affect the healthcare resource utilization patterns of children. Evidence is lacking concerning these associations among the highly vulnerable pediatric emergency department patient population. This study examined the association between tobacco smoke exposure and healthcare resource utilization patterns among pediatric emergency department patients. Tobacco smoke exposure increased the risk of pediatric patients having respiratory-related procedures, respiratory-related and non-respiratory-related testing, medications administered during the pediatric emergency department visit, and medications prescribed for home administration. Tobacco smoke-exposed patients were more likely to be admitted to the hospital compared to unexposed patients.
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Mahabee-Gittens EM, Merianos AL, Matt GE. Letter to the Editor Regarding: "An Imperative Need for Research on the Role of Environmental Factors in Transmission of Novel Coronavirus (COVID-19)" -Secondhand and Thirdhand Smoke As Potential Sources of COVID-19. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:5309-5310. [PMID: 32319756 PMCID: PMC7179740 DOI: 10.1021/acs.est.0c02041] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 05/23/2023]
Affiliation(s)
- E. Melinda Mahabee-Gittens
- Cincinnati Children’s Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati, College of Medicine, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229
| | - Ashley L. Merianos
- University of Cincinnati, School of Human Services, PO Box 210068, Cincinnati, OH, 45221-0068
| | - Georg E. Matt
- Department of Psychology, College of Sciences, San Diego State University, MC4611, San Diego, CA, 92182-4611
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Mahabee-Gittens EM, Merianos AL, Gordon JS, Stone L, Semenova O, Matt GE. Electronic Health Record Classification of Tobacco Smoke Exposure and Cotinine Levels in Hospitalized Pediatric Patients. Hosp Pediatr 2020; 9:659-664. [PMID: 31451583 DOI: 10.1542/hpeds.2018-0247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Documentation of children's tobacco smoke exposure (TSE) in the electronic health record (EHR) can have important implications for clinical care. However, it may not be accurate if it is not based on biochemical assessment, the most reliable method of verifying TSE. Our objectives were to compare the accuracy of EHR classification of TSE with cotinine verification and to explore parent and child variables associated with biochemically verified TSE. METHODS Participants were 171 hospitalized pediatric patients (ages 0-17 years; mean age 5.1 [SD 3.7] years) who had EHR documentation of TSE and measured salivary cotinine. Children with cotinine levels >1 ng/mL were classified as having biochemical verification of TSE. Parents reported sociodemographic characteristics, and children's EHRs were abstracted for TSE status, past medical history, and diagnoses. We conducted χ2 tests to assess the agreement between EHR classification of TSE status and cotinine levels. Then, we assessed the relationship between sociodemographic and clinical variables and cotinine using crude and adjusted logistic regression models. RESULTS Overall, 71% (121 of 171) of EHR classifications were correct on the basis of cotinine levels. Specificity analyses showed that 77% (53 of 69) were correctly identified as exposed to tobacco smoke. Sensitivity analyses showed that 67% (68 of 102) were correctly identified as unexposed. The negative predictive value was 0.61 (53 of 87); 39% (34 of 87) were misclassified as unexposed. The positive predictive value was 0.81 (68 of 84); 19% (16 of 84) were misclassified as exposed. CONCLUSIONS Almost 40% of children were misclassified in the EHR as unexposed to tobacco smoke. Biochemical verification should be used as part of universal TSE screening during pediatric hospitalizations.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; .,College of Medicine and
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, Ohio
| | - Judith S Gordon
- College of Nursing, The University of Arizona, Tucson, Arizona; and
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Olga Semenova
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, California
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Matt GE, Quintana PJE, Hoh E, Zakarian JM, Dodder NG, Record RA, Hovell MF, Mahabee-Gittens EM, Padilla S, Markman L, Watanabe K, Novotny TE. Persistent tobacco smoke residue in multiunit housing: Legacy of permissive indoor smoking policies and challenges in the implementation of smoking bans. Prev Med Rep 2020; 18:101088. [PMID: 32368436 PMCID: PMC7186560 DOI: 10.1016/j.pmedr.2020.101088] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/13/2020] [Accepted: 03/29/2020] [Indexed: 01/04/2023] Open
Abstract
Secondhand smoke (SHS) is a common indoor pollutant in multiunit housing (MUH). It is also the precursor of thirdhand smoke (THS), the toxic mixture of tobacco smoke residue that accumulates in indoor environments where tobacco has been used. This study examined the levels, distribution, and factors associated with THS pollution in low-income MUH. Interviews were conducted 2016-2018 in a cross-sectional study of N = 220 MUH homes in San Diego, California. Two surface wipe samples were collected per home and analyzed for nicotine, a THS marker, using liquid chromatography-triple quadrupole mass spectrometry. Nicotine was detected in all homes of nonsmokers with indoor smoking bans (Geo Mean = 1.67 µg/m2; 95% CI = [1.23;2.30]) and smokers regardless of an indoor ban (Geo Mean = 4.80 µg/m2; 95% CI = [1.89;12.19]). Approximately 10% of nonsmokers' homes with smoking bans showed nicotine levels higher than the average level in homes of smokers without smoking bans from previous studies (≥30 µg/m2). Housing for seniors, smoking bans on balconies, indoor tobacco use, difficult to reach surfaces, and self-reported African-American race/ethnicity were independently associated with higher THS levels. Individual cases demonstrated that high levels of surface nicotine may persist in nonsmoker homes for years after tobacco use even in the presence of indoor smoking bans. To achieve MUH free of tobacco smoke pollutants, attention must be given to identifying and remediating highly polluted units and to implementing smoking policies that prevent new accumulation of THS. As THS is a form of toxic tobacco product waste, responsibility for preventing and mitigating harmful impacts should include manufacturers, suppliers, and retailers.
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Affiliation(s)
- Georg E Matt
- San Diego State University Department of Psychology, San Diego, CA, USA
| | | | - Eunha Hoh
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Joy M Zakarian
- San Diego State University Research Foundation, San Diego, CA, USA
| | - Nathan G Dodder
- San Diego State University Research Foundation, San Diego, CA, USA
| | - Rachael A Record
- San Diego State University School of Communication, San Diego, CA, USA
| | | | - E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Samuel Padilla
- San Diego State University Research Foundation, San Diego, CA, USA
| | - Laura Markman
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Kayo Watanabe
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Thomas E Novotny
- San Diego State University School of Public Health, San Diego, CA, USA
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Gunay F, Cullas Ilarslan NE, Bakar-Ates F, Deniz K, Kadioglu YK, Kiran S, Bakirarar B, Cobanoglu N. Evaluation of hair cotinine and toxic metal levels in children who were exposed to tobacco smoke. Pediatr Pulmonol 2020; 55:1012-1019. [PMID: 32068966 DOI: 10.1002/ppul.24692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/03/2020] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Fatih Gunay
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | | | - Filiz Bakar-Ates
- Department of Biochemistry, Ankara University Faculty of Pharmacy, Ankara, Turkey
| | - Kiymet Deniz
- Department of Geological Engineering, Ankara University Faculty of Engineering, Ankara, Turkey
| | - Yusuf Kagan Kadioglu
- Department of Geological Engineering, Ankara University Faculty of Engineering, Ankara, Turkey
| | - Sibel Kiran
- Institute of Public Health, Hacettepe University, Ankara, Turkey
| | - Batuhan Bakirarar
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Nazan Cobanoglu
- Division of Pediatric Pulmonology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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Comparison of Liquid Chromatography Mass Spectrometry and Enzyme-Linked Immunosorbent Assay Methods to Measure Salivary Cotinine Levels in Ill Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041157. [PMID: 32059566 PMCID: PMC7068296 DOI: 10.3390/ijerph17041157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/26/2022]
Abstract
Objective: Cotinine is the preferred biomarker to validate levels of tobacco smoke exposure (TSE) in children. Compared to enzyme-linked immunosorbent assay methods (ELISA) for quantifying cotinine in saliva, the use of liquid chromatography tandem mass spectrometry (LC-MS/MS) has higher sensitivity and specificity to measure very low levels of TSE. We sought to compare LC-MS/MS and ELISA measures of cotinine in saliva samples from children overall and the associations of these measures with demographics and TSE patterns. Method: Participants were nonsmoking children (N = 218; age mean (SD) = 6.1 (5.1) years) presenting to a pediatric emergency department. Saliva samples were analyzed for cotinine using both LC-MS/MS and ELISA. Limit of quantitation (LOQ) for LC-MS/MS and ELISA was 0.1 ng/ml and 0.15 ng/ml, respectively. Results: Intraclass correlations (ICC) across methods = 0.884 and was consistent in sex and age subgroups. The geometric mean (GeoM) of LC-MS/MS = 4.1 (range: < LOQ - 382 ng/mL; 3% < LOQ) which was lower (p < 0.0001) than the ELISA GeoM = 5.7 (range: < LOQ - 364 ng/mL; 5% < LOQ). Similar associations of cotinine concentrations with age ( < -0.10, p < 0.0001), demographic characteristics (e.g., income), and number of cigarettes smoked by caregiver ( > 0.07, p < 0.0001) were found regardless of cotinine detection method; however, cotinine associations with sex and race/ethnicity were only found to be significant in models using LC-MS/MS-derived cotinine. Conclusions: Utilizing LC-MS/MS-based cotinine, associations of cotinine with sex and race/ethnicity of child were revealed that were not detectable using ELISA-based cotinine, demonstrating the benefits of utilizing the more sensitive LC-MS/MS assay for cotinine measurement when detecting low levels of TSE in children.
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Sempio C, Lindley E, Klawitter J, Christians U, Bowler RP, Adgate JL, Allshouse W, Awdziejczyk L, Fischer S, Bainbridge J, Vandyke M, Netsanet R, Crume T, Kinney GL. Surface Detection of THC Attributable to Vaporizer Use in the Indoor Environment. Sci Rep 2019; 9:18587. [PMID: 31819131 PMCID: PMC6901575 DOI: 10.1038/s41598-019-55151-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/20/2019] [Indexed: 11/09/2022] Open
Abstract
The number of cannabis users increased up to 188 million users worldwide in 2017. Smoking and vaping are the most common consumption routes with formation of side-stream smoke/vapor and secondhand exposure to cannabinoids has been described in the literature. External contamination of hair by cannabis smoke has been studied but there are no studies on third-hand cannabis exposure due to deposition of smoke or vapor on surfaces. We tested whether cannabinoids could be detected on surfaces and objects in a room where cannabis is vaporized. Surface samples were collected using isopropanol imbued non-woven wipes from hard surfaces and objects. Each surface was swabbed three times with standardized swabbing protocol including three different patterns. Samples were analyzed using LC-ESI-MS/MS in combination with online extraction. THC was detected on 6 samples out of the 15 collected in the study room at quantifiable levels ranging 348-4882 ng/m2. Negative control samples collected from areas outside the study room were all negative. We demonstrated that surfaces exposed to side-stream cannabis vapor are positive for THC at quantifiable levels. This study represents a first step in understanding how side-stream cannabis vapor deposits in the environment and potentially results in a tertiary exposure for users and non-users.
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Affiliation(s)
- Cristina Sempio
- iC42 Integrated Solutions in Systems Biology for Clinical Research & Development, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Emily Lindley
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jost Klawitter
- iC42 Integrated Solutions in Systems Biology for Clinical Research & Development, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Uwe Christians
- iC42 Integrated Solutions in Systems Biology for Clinical Research & Development, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Russell P Bowler
- National Jewish Health and University of Colorado Denver, Denver, CO, USA
| | - John L Adgate
- National Jewish Health and University of Colorado Denver, Denver, CO, USA.,Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William Allshouse
- National Jewish Health and University of Colorado Denver, Denver, CO, USA.,Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren Awdziejczyk
- iC42 Integrated Solutions in Systems Biology for Clinical Research & Development, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah Fischer
- Skaggs School of Pharmacy and Pharmaceutical Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacquelyn Bainbridge
- Skaggs School of Pharmacy and Pharmaceutical Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mike Vandyke
- Colorado Department of Public Health and the Environment, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rahwa Netsanet
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tessa Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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22
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Mahabee-Gittens EM, Merianos AL, Fulkerson PC, Stone L, Matt GE. The Association of Environmental Tobacco Smoke Exposure and Inflammatory Markers in Hospitalized Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234625. [PMID: 31766400 PMCID: PMC6926853 DOI: 10.3390/ijerph16234625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/07/2019] [Accepted: 11/16/2019] [Indexed: 12/13/2022]
Abstract
Background: Environmental tobacco smoke (ETS) exposure is associated with altered cytokine levels in children. We sought to examine ETS exposure prevalence and the relationship between ETS exposure and cytokine levels in a sample of hospitalized children. (2) Methods: Inflammatory markers (IL-8, IL-1β, IL-10, and TNF-α) and cotinine were measured in saliva of hospitalized, nonsmoking children (N = 112). To assess the association between ETS exposure and immune system response, we built a multivariate regression model including the four inflammatory markers as the response variables and cotinine, age, sex, and discharge diagnosis as explanatory variables while assessing possible interaction effects. (3) Results: Mean age (SD) was 5.8(5.0) years; Geometric Mean (GeoM) cotinine = 1.8 [95% CI = 1.4–2.2]. Children with non-inflammatory other diagnoses had lower IL-10 (p = 0.003) and TNF-α (p = 0.009) levels than children with inflammatory other diagnoses. Children with asthma (p = 0.01) and bacterial illnesses and/or pneumonia (p = 0.002) had higher IL-8 levels. Independent of diagnosis, there was a significant curvilinear association between cotinine and IL-1β (p = 0.002) reflecting no association for cotinine levels <5 ng/mL and a positive association for >5 ng/mL. (4) Conclusions: Children with higher ETS exposure levels have higher IL-1β levels regardless of age, sex, and diagnosis. ETS exposure may increase pro-inflammatory immune responses in children and may interfere with native immune responses and the ability to heal and fight infection.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center; University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
- Correspondence: ; Tel.: +1-513-636-7966
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Patricia C. Fulkerson
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati; College of Medicine, Cincinnati, OH 45229, USA;
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center; University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, CA 92123, USA;
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23
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Critselis E, Panagiotakos DB, Georgousopoulou EN, Katsaounou P, Chrysohoou C, Pitsavos C. Exposure to second hand smoke and 10-year (2002-2012) incidence of cardiovascular disease in never smokers: The ATTICA cohort study. Int J Cardiol 2019; 295:29-35. [PMID: 31375335 DOI: 10.1016/j.ijcard.2019.07.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite WHO Framework Convention of Tobacco Control (FCTC) adoption, effective implementation of national smoking bans remains pending in several countries. This study quantified the association of second hand smoke (SHS) exposure and 10-year cardiovascular disease (CVD) among never smokers in such settings. METHODS In 2001-2002, a sample of 1514 males and 1528 females (range: 18-89 years old) were randomly selected in Greece. Frequency and duration of SHS exposure (i.e. exposure extending >30 min/day) within the home and/or workplace were assessed by interview. Following a 10-year follow-up period (2002-2012), incidence of non-fatal and fatal CVD (ICD-10) was evaluated among n = 2020 participants. The analytic study sample consisted of all never smokers (n = 910). RESULTS Despite national smoking ban implementation (2009), 44.6% (n = 406) of never smokers reported SHS exposure. While SHS exposed never smokers exhibited a more favorable profile of CVD-related risk factors at baseline, they subsequently developed similar 10-year CVD incidence rates, at a younger mean age (p = 0.001), than their non-exposed counterparts. Following adjustment for several lifestyle and clinical factors, SHS exposed never smokers exhibited a two-fold elevated 10-year CVD risk (adj. HR: 2.04, 95% CI: 1.43-2.92), particularly among women (adj. HR: 2.45, 95% CI: 1.45-4.06). SHS exposure accounted for 32% excess Population Attributable Risk (PAR) for 10-year CVD events in never smokers, with highest rates (PAR: 52%) being among those exposed in the workplace. CONCLUSION The prevention of SHS associated CVD and related healthcare costs mandates additional strategies for securing the effective implementation of comprehensive WHO FCTC based national smoking bans.
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Affiliation(s)
- Elena Critselis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; University of Canberra, Faculty of Health, Canberra, Australia; University of La Trobe, College of Science, Health & Engineering, Melbourne, Australia.
| | - Ekavi N Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; University of Canberra, Faculty of Health, Canberra, Australia; University of Notre Dame Australia, Medical School, Sydney, Australia
| | - Paraskevi Katsaounou
- Pulmonary and Critical Care Department, First ICU, School of Medicine, University of Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
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24
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Mahabee-Gittens EM, Merianos AL, Stone L, Tabangin ME, Khoury JC, Gordon JS. Tobacco Use Behaviors and Perceptions of Parental Smokers in the Emergency Department Setting. Tob Use Insights 2019; 12:1179173X19841392. [PMID: 31258335 PMCID: PMC6585244 DOI: 10.1177/1179173x19841392] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/10/2019] [Indexed: 11/15/2022] Open
Abstract
Background More information is needed about modifiable child tobacco smoke exposure (TSE) patterns in racially diverse parental smokers to tailor interventions designed to help parents quit smoking and reduce their child's TSE. Our objectives were to determine whether there were differences in smoking and TSE patterns based on parental race and child age and whether these patterns differed based on child age within black and white parental smokers. Secondary objectives were to assess the relationship between parental perceptions about the effects of smoking and the benefits of quitting on their child based on child age, race, and reported TSE patterns and to examine biochemically verified TSE levels by child age, race, and parent-reported TSE patterns. Methods Participants (N = 415) were non-Hispanic black and non-Hispanic white parental smokers, mean age (standard deviation [SD]) = 31.2 (7.2) years, who visited the Pediatric Emergency Department (PED) or Urgent Care (UC) with their child, mean age (SD) = 4.7 (4.6) years. Parents reported sociodemographics, smoking, and child TSE patterns. We conducted chi-square tests, independent t-tests, and general linear regression models to answer our primary objectives and linear regression models to answer our secondary objectives. Results Parents were 56.1% non-Hispanic black; 87.5% women; mean (SD) number of cigarettes smoked/day was 10.5(6.8). A higher proportion of parents with younger children <3 years old reported smoking bans compared with parents with older children ⩾3 to <18 years old (41.3% vs 19.7%, P < .0001). Subsequent analyses revealed this pattern for both black and white parents. A total of 212 (51%) of children had biochemical assessment of TSE; 89.6% had detectable TSE. Younger children had significantly higher cotinine levels than older children independent of their race (P < .001). Conclusions Children of parental smokers who visit the PED/UC were highly tobacco smoke exposed. Both black and white parental smokers with younger children were more likely to enforce smoking bans, but younger children had higher TSE levels than older children. Interventions that target this group of parental smokers with younger children may be more effective than interventions geared to all parental smokers.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jane C Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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25
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Mahabee-Gittens EM, Matt GE, Hoh E, Quintana PJE, Stone L, Geraci MA, Wullenweber CA, Koutsounadis GN, Ruwe AG, Meyers GT, Zakrajsek MA, Witry JK, Merianos AL. Contribution of thirdhand smoke to overall tobacco smoke exposure in pediatric patients: study protocol. BMC Public Health 2019; 19:491. [PMID: 31046729 PMCID: PMC6498613 DOI: 10.1186/s12889-019-6829-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thirdhand smoke (THS) is the persistent residue resulting from secondhand smoke (SHS) that accumulates in dust, objects, and on surfaces in homes where tobacco has been used, and is reemitted into air. Very little is known about the extent to which THS contributes to children's overall tobacco smoke exposure (OTS) levels, defined as their combined THS and SHS exposure. Even less is known about the effect of OTS and THS on children's health. This project will examine how different home smoking behaviors contribute to THS and OTS and if levels of THS are associated with respiratory illnesses in nonsmoking children. METHODS This project leverages the experimental design from an ongoing pediatric emergency department-based tobacco cessation trial of caregivers who smoke and their children (NIHR01HD083354). At baseline and follow-up, we will collect urine and handwipe samples from children and samples of dust and air from the homes of smokers who smoke indoors, have smoking bans or who have quit smoking. These samples will be analyzed to examine to what extent THS pollution at home contributes to OTS exposure over and above SHS and to what extent THS continues to persist and contribute to OTS in homes of smokers who have quit or have smoking bans. Targeted and nontargeted chemical analyses of home dust samples will explore which types of THS pollutants are present in homes. Electronic medical record review will examine if THS and OTS levels are associated with child respiratory illness. Additionally, a repository of child and environmental samples will be created. DISCUSSION The results of this study will be crucial to help close gaps in our understanding of the types, quantity, and clinical effects of OTS, THS exposure, and THS pollutants in a unique sample of tobacco smoke-exposed ill children and their homes. The potential impact of these findings is substantial, as currently the level of risk in OTS attributable to THS is unknown. This research has the potential to change how we protect children from OTS, by recognizing that SHS and THS exposure needs to be addressed separately and jointly as sources of pollution and exposure. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02531594 . Date of registration: August 24, 2015.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Divison of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2008, Cincinnati, Ohio, 45229-3039, USA. .,University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870 3230 Eden Avenue, Cincinnati, Ohio, 45267, USA.
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Eunha Hoh
- San Diego State University Graduate School of Public Health, San Diego, CA, USA
| | | | - Lara Stone
- Divison of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2008, Cincinnati, Ohio, 45229-3039, USA
| | - Maegan A Geraci
- Divison of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2008, Cincinnati, Ohio, 45229-3039, USA
| | - Chase A Wullenweber
- Divison of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2008, Cincinnati, Ohio, 45229-3039, USA
| | - Gena N Koutsounadis
- Divison of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2008, Cincinnati, Ohio, 45229-3039, USA
| | - Abigail G Ruwe
- Divison of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2008, Cincinnati, Ohio, 45229-3039, USA
| | - Gabriel T Meyers
- Divison of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2008, Cincinnati, Ohio, 45229-3039, USA
| | - Mark A Zakrajsek
- Divison of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2008, Cincinnati, Ohio, 45229-3039, USA
| | - John K Witry
- Divison of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2008, Cincinnati, Ohio, 45229-3039, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, PO Box 210002, Cincinnati, Ohio, 45221, USA
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26
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Northrup TF, Stotts AL, Suchting R, Khan AM, Green C, Quintana PJE, Hoh E, Hovell MF, Matt GE. Medical staff contributions to thirdhand smoke contamination in a neonatal intensive care unit. Tob Induc Dis 2019; 17:37. [PMID: 31516480 PMCID: PMC6662774 DOI: 10.18332/tid/106116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Non-smoking policies are strictly enforced in neonatal intensive care units (NICUs), which may still become contaminated by thirdhand smoke (THS), posing potential health risks to medically fragile infants. Study aims were to explore contamination routes by characterizing nicotine levels (THS proxy) found on the fingers of NICU medical staff and to assess finger-nicotine correlates. METHODS NICU medical staff were surveyed regarding smoking and electronic nicotine devices (ENDS) use/exposure, and household characteristics. Approximately 35% of staff were randomly selected for a finger-nicotine wipe. Three separate quantile regressions modeled percentiles associated with: presence of any finger nicotine, finger-nicotine levels above the median field blank level (i.e. 0.377 ng/wipe), and finger-nicotine levels two times the median blank. RESULTS The final sample size was 246 (n=260 approached; n=14 refusals). Over three-quarters (78.5%) reported some exposure to tobacco smoke or ENDS vapor/aerosols. After field-blank adjustments, the median nicotine level (ng/finger wipe) was 0.232 (IQR: 0.021–0.681) and 78.3% of medical staff had measurable finger-nicotine levels. Both being near smoking in friends’/family members’ homes and finger-surface area were related to elevated finger-nicotine levels (p<0.05) in the median blank model. CONCLUSIONS Almost four in five NICU staff had measurable finger nicotine, with finger surface area and frequency of reported exposure to tobacco smoke in friends’/family members’ homes emerging as important correlates. Future research will determine the impact of THS on NICU infants. Medical personnel working in a NICU should be cognizant of secondhand smoke and THS, particularly inside friends’/family members’ homes, to reduce potential NICU contamination and infant exposures.
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Affiliation(s)
- Thomas F Northrup
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
| | - Angela L Stotts
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States.,Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
| | - Amir M Khan
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
| | - Charles Green
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States.,Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
| | - Penelope J E Quintana
- Division of Environmental Health, School of Public Health, San Diego State University, San Diego, United States
| | - Eunha Hoh
- Division of Environmental Health, School of Public Health, San Diego State University, San Diego, United States
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, School of Public Health, San Diego State University, San Diego, United States
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, United States
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27
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Murrison LB, Brandt EB, Myers JB, Hershey GKK. Environmental exposures and mechanisms in allergy and asthma development. J Clin Invest 2019; 129:1504-1515. [PMID: 30741719 DOI: 10.1172/jci124612] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Environmental exposures interplay with human host factors to promote the development and progression of allergic diseases. The worldwide prevalence of allergic disease is rising as a result of complex gene-environment interactions that shape the immune system and host response. Research shows an association between the rise of allergic diseases and increasingly modern Westernized lifestyles, which are characterized by increased urbanization, time spent indoors, and antibiotic usage. These environmental changes result in increased exposure to air and traffic pollution, fungi, infectious agents, tobacco smoke, and other early-life and lifelong risk factors for the development and exacerbation of asthma and allergic diseases. It is increasingly recognized that the timing, load, and route of allergen exposure affect allergic disease phenotypes and development. Still, our ability to prevent allergic diseases is hindered by gaps in understanding of the underlying mechanisms and interaction of environmental, viral, and allergen exposures with immune pathways that impact disease development. This Review highlights epidemiologic and mechanistic evidence linking environmental exposures to the development and exacerbation of allergic airway responses.
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Affiliation(s)
- Liza Bronner Murrison
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eric B Brandt
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Jocelyn Biagini Myers
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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28
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Mahabee-Gittens EM, Merianos AL, Hoh E, Quintana PJ, Matt GE. Nicotine on Children's Hands: Limited Protection of Smoking Bans and Initial Clinical Findings. Tob Use Insights 2019; 12:1179173X18823493. [PMID: 30728727 PMCID: PMC6351963 DOI: 10.1177/1179173x18823493] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/14/2018] [Indexed: 02/03/2023] Open
Abstract
Background: Thirdhand smoke (THS) pollutants, such as nicotine, accumulate on the hands of children who live in homes with smokers and are exposed to secondhand smoke. Our objective was to examine whether levels of hand nicotine in exposed children are associated with demographics, environmental factors, and clinical findings. Methods: Participants were caregivers who smoke and children (mean age (SD) = 2.6 (3.7) years) who were part of an ongoing 2-group, randomized controlled trial of an emergency department–based tobacco cessation intervention (N = 104). The primary outcome measure was nicotine on the child’s hand. Caregivers reported demographics and smoking patterns; children’s medical records were abstracted for chief complaint, medical history, and diagnoses. Results: All children had detectable hand nicotine (geometric mean [GeoM] = 86.2 ng/wipe; range = 3.5-2, 190.4 ng/wipe). Children in the age group of 2 to 4 years old (GeoM = 185.6 ng/wipe) had higher levels than the children in the age groups of 0 to 1 (GeoM = 68.9 ng/wipe, P < .001), 5 to 9 (GeoM = 77.9 ng/wipe, P = .04), and 10 to 15 years old (GeoM = 74.2 ng/wipe, P = .048). Children whose caregivers smoked 6 to 14 (GeoM = 97.2 ng/wipe, P = .047) and 15 to 40 cigarettes/day (GeoM = 124.0 ng/wipe, P = .01) had higher levels than children whose caregivers smoked 1 to 5 cigarettes/day (GeoM = 59.7 ng/wipe). Children with 6 to 14 cigarettes/day (GeoM = 163.11 ng/wipe, P = .007) and 15 to 40 cigarettes/day (GeoM = 186.1, P = .003) smoked inside the home by all smokers had significantly higher levels than homes with 0 cigarettes (GeoM = 81.3 ng/wipe). Similar differences in hand nicotine levels were found for smoking frequency of all household members in any location. Children with complaints of cough/congestion (GeoM = 97.7 ng/wipe) had higher levels than those without cough/congestion (GeoM = 59.0 ng/wipe, P = .01). Conclusions: The high hand nicotine levels in children whose caregivers do not necessarily smoke indoor demonstrate that indoor smoking bans do not safeguard against THS exposure and the associations with increased home smoking activity indicate that hand wipes may be a noninvasive way to characterize children’s exposure. The findings of associated cough and congestion with higher THS levels need to be examined further.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
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29
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Houghton F, Duncan B, Houghton S, O'Doherty D, McInerney D. Responding to health inequities in New Zealand: the potential of dissuasive cigarettes. J Prim Health Care 2019. [DOI: 10.1071/hc19013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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30
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Torres S, Merino C, Paton B, Correig X, Ramírez N. Biomarkers of Exposure to Secondhand and Thirdhand Tobacco Smoke: Recent Advances and Future Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2693. [PMID: 30501044 PMCID: PMC6313747 DOI: 10.3390/ijerph15122693] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 12/22/2022]
Abstract
Smoking is the leading preventable disease worldwide and passive smoking is estimated to be the cause of about 1.0% of worldwide mortality. The determination of tobacco smoke biomarkers in human biological matrices is key to assess the health effects related to the exposure to environmental tobacco smoke. The biomonitoring of cotinine, the main nicotine metabolite, in human biofluids-including urine, serum or saliva-has been extensively used to assess this exposure. However, the simultaneous determination of cotinine together with other tobacco biomarkers and the selection of alternative biological matrices, such as hair, skin or exhaled breath, would enable a better characterization of the kind and extent of tobacco exposure. This review aims to perform a critical analysis of the up-to-date literature focused on the simultaneous determination of multiple tobacco smoke biomarkers studied in different biological matrices, due to the exposure to secondhand smoke (SHS) and thirdhand smoke (THS). Target biomarkers included both tobacco-specific biomarkers-nicotine and tobacco specific nitrosamine biomarkers-and tobacco-related biomarkers, such as those from polycyclic aromatic hydrocarbons, volatile organic compounds, metals and carbon monoxide. To conclude, we discuss the suitability of determining multiple biomarkers through several relevant examples of SHS and THS exposure.
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Affiliation(s)
- Sònia Torres
- Department of Electronic Engineering, Universitat Rovira i Virgili, Països Catalans 26, 43007 Tarragona, Spain.
| | - Carla Merino
- Department of Electronic Engineering, Universitat Rovira i Virgili, Països Catalans 26, 43007 Tarragona, Spain.
| | - Beatrix Paton
- Department of Electronic Engineering, Universitat Rovira i Virgili, Països Catalans 26, 43007 Tarragona, Spain.
| | - Xavier Correig
- Department of Electronic Engineering, Universitat Rovira i Virgili, Països Catalans 26, 43007 Tarragona, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Escorxador s/n, 43003 Tarragona, Spain.
- CIBERDEM, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Carlos III Health Institute, Monforte de Lemos 3-5, 28029 Madrid, Spain.
| | - Noelia Ramírez
- Department of Electronic Engineering, Universitat Rovira i Virgili, Països Catalans 26, 43007 Tarragona, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Escorxador s/n, 43003 Tarragona, Spain.
- CIBERDEM, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Carlos III Health Institute, Monforte de Lemos 3-5, 28029 Madrid, Spain.
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31
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Houghton F, Houghton S, Doherty DO, McInerney D, Duncan B. 'Greenwashing' tobacco products through ecological and social/equity labelling: A potential threat to tobacco control. Tob Prev Cessat 2018; 4:37. [PMID: 32411863 PMCID: PMC7205140 DOI: 10.18332/tpc/99674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/30/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
There has been significant growth in ecological/environmental labelling of products and services internationally in recent years. Such efforts have become an integral element of the marketing strategies used by many firms. Concerns have been raised, however, that for some companies, this is little more than 'greenwashing', i.e. a cynical attempt to boost sales without any meaningful underlying sensitivity or change, in practice. Given the extremely negative track record of the global tobacco industry (Big Tobacco), it is essential that health policy makers and anti-smoking campaigners closely monitor this industry's attempts to exploit both growing environmental concerns among consumers and gaps in legislation. Although there is relatively strong legislation in some countries, to prohibit suggestions that cigarettes may be environment friendly, a further tightening of legislation is required.
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Affiliation(s)
- Frank Houghton
- Department of Applied Social Sciences, Limerick Institute of Technology, Moylish, Limerick, Ireland
| | | | - Diane O’ Doherty
- Department of Applied Social Sciences, Limerick Institute of Technology, Moylish, Limerick, Ireland
| | - Derek McInerney
- Department of Applied Social Sciences, Limerick Institute of Technology, Moylish, Limerick, Ireland
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Díez-Izquierdo A, Cassanello-Peñarroya P, Lidón-Moyano C, Matilla-Santander N, Balaguer A, Martínez-Sánchez JM. Update on thirdhand smoke: A comprehensive systematic review. ENVIRONMENTAL RESEARCH 2018; 167:341-371. [PMID: 30096604 DOI: 10.1016/j.envres.2018.07.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The objective of this study is to perform a comprehensive review of the literature about thirdhand smoke (THS). METHODS Systematic review of all aspects of THS. Standard methodological procedures were used to search the following databases through April 2018: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science (WOS) in Indo-European languages. To identify published grey literature, the first 200 hits from Google Scholar™ were evaluated. Clinical trial databases, conference proceedings, and reference lists from the identified articles were also searched. Two unblinded review authors independently assessed trials for inclusion in the review. These same reviewers also extracted study data in accordance with PRISMA guidelines. The study protocol was registered with PROSPERO (CRD42018083619). RESULTS Sixty-eight articles were included in this systematic review. Of these, 28 analyzed the concentration of nicotine as a component of THS (the most commonly-used method to measure THS in those studies was chromatography, followed by the mass spectrometry), 21 evaluated the exposure and impact of THS on health (11 studies analyzed the effect of THS in cells [human and animal], 4 in animals, 1 in adults, and 5 in children), 16 investigated the beliefs, behaviours, and policies related to THS, and 3 evaluated other aspects such as THS in e-cigarettes or hookahs. In these 68 studies, THS was determined by measuring the following components: nicotine (30 studies), nitrosamines (17 studies) and cotinine (15 studies). The findings from most of these studies suggest a potential health impact of THS exposure (i.e.: cytotoxicity, metabolic alterations in metabolism, in glycemia; or cell structure; alterations in liver, lung, skin and behaviour in mice), and low awareness about the risks of THS among the general population. CONCLUSIONS Numerous specific biomarkers of THS were evaluated, with the most common being nicotine, nitrosamines, and cotinine. The most common method of preparing THS dust samples were cotton wipes, while chromatography, used alone or coupled with mass spectrometry, was the most common analytical technique. We have tried to establish common bases after reviewing all the current literature of the THS although, there is great heterogeneity between the studies and we have not always succeeded. The studies in this review demonstrate the harmful effects of THS on health in cells, in animal models, and in people including children. However, in people, the long-term effects remain unknown and more research is needed. These studies show that knowledge about THS and its potential harmful effects are poorly understood among the general population. For this reason, THS should receive greater emphasis in education and awareness policies.
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Affiliation(s)
- Ana Díez-Izquierdo
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Paediatrics Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Spain
| | - Pia Cassanello-Peñarroya
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Paediatrics Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Spain
| | - Cristina Lidón-Moyano
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Group of Evaluation of Health Determinants and Health Policies, Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Nuria Matilla-Santander
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Group of Evaluation of Health Determinants and Health Policies, Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Albert Balaguer
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Paediatrics Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Spain
| | - Jose M Martínez-Sánchez
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Group of Evaluation of Health Determinants and Health Policies, Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
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Díez-Izquierdo A, Cassanello P, Cartanyà A, Matilla-Santander N, Balaguer Santamaria A, Martinez-Sanchez JM. Knowledge and attitudes toward thirdhand smoke among parents with children under 3 years in Spain. Pediatr Res 2018; 84:645-649. [PMID: 30194415 DOI: 10.1038/s41390-018-0153-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/31/2018] [Accepted: 08/08/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The knowledge and beliefs about what is thirdhand smoke (THS) are limited. Our objective is to characterize the knowledge and beliefs about THS in parents of children under 3 years old in Spain. METHODS A cross-sectional study (n = 1406 parents) was conducted online in 2017. We collected information about the knowledge of THS given later, written information with the definition of THS, and asking about beliefs of the effects of THS on children's health. RESULTS A total of 27% of the respondents had heard about THS. We only found significant differences among smoking status, being the smokers who declare higher knowledge about THS. A total of 86% of the respondents believed that THS is harmful to their children with statistically significant differences according to educational level, higher among parents with a university degree (ORa = 2.6), and according to the previous knowledge on THS (ORa = 2.1). CONCLUSIONS This is the first study in Europe to describe the knowledge and belief of THS. Around 3 out of 10 parents have heard about THS and more than 8 out of 10 parents believed that THS is harmful to their children. Currently, they were not aware of THS but after providing brief information about it, most of them agreed that THS exposure is harmful to their children.
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Affiliation(s)
- Ana Díez-Izquierdo
- Pediatrics Department, Hospital Universitari General de Catalunya (HUGC), Sant Cugat del Vallès, Spain
| | - Pia Cassanello
- Pediatrics Department, Hospital Universitari General de Catalunya (HUGC), Sant Cugat del Vallès, Spain
| | - Aurea Cartanyà
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya (UIC-Barcelona), Sant Cugat del Vallès, Spain
| | - Núria Matilla-Santander
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya (UIC-Barcelona), Sant Cugat del Vallès, Spain
| | - Albert Balaguer Santamaria
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya (UIC-Barcelona), Sant Cugat del Vallès, Spain
| | - Jose M Martinez-Sanchez
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya (UIC-Barcelona), Sant Cugat del Vallès, Spain.
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Frazer K, Kelleher C. Reducing tobacco smoke exposure for vulnerable groups: hospital settings and teachable moments. Perspect Public Health 2018; 138:142-144. [PMID: 29635989 DOI: 10.1177/1757913918763444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kate Frazer
- UCD School of Nursing, Midwifery and Health Systems
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Lai FY, Lympousi K, Been F, Benaglia L, Udrisard R, Delémont O, Esseiva P, Thomaidis NS, Covaci A, van Nuijs ALN. Levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in raw wastewater as an innovative perspective for investigating population-wide exposure to third-hand smoke. Sci Rep 2018; 8:13254. [PMID: 30185880 PMCID: PMC6125383 DOI: 10.1038/s41598-018-31324-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022] Open
Abstract
Tobacco smoking is the major cause of many chronic diseases, especially lung cancer. Knowledge about population-wide tobacco use and exposure is essential to characterise its burden on public health and evaluate policy efficacy. Obtaining such knowledge remains challenging with current methods (e.g., surveys, biomonitoring) but can be achievable with wastewater analysis, a promising tool of retrieving epidemiology information. This study examined population-wide exposure to tobacco toxicants and carcinogens through wastewater analysis and explored relationships among these chemicals. Cotinine, trans-3'-hydroxycotinine, anabasine, anatabine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) were analysed in samples from Greece, Switzerland and Belgium, where tobacco control policies are different. Measured per-capita mass loads were ranked as: nicotine biomarkers ≫ tobacco markers > carcinogens. Relationships between nicotine biomarkers and tobacco markers implied substantial use of non-tobacco nicotine items besides tobacco products. Geographic profiles of tobacco markers revealed higher levels in Geneva and Athens than Geraardsbergen and Ninove. Environmental third-hand smoke led to NNK detection, with elevated levels observed in Athens where indoor smoking is widespread, posing potential health risks to the population. Our novel outcomes are relevant for public health authorities as they provide indications about external exposure and can thus be used to plan and evaluate tobacco control policies.
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Affiliation(s)
- Foon Yin Lai
- Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium.
| | - Katerina Lympousi
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece
| | - Frederic Been
- Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Lisa Benaglia
- Ecole des Sciences Criminelles, University of Lausanne, 1015, Lausanne, Switzerland
| | - Robin Udrisard
- Ecole des Sciences Criminelles, University of Lausanne, 1015, Lausanne, Switzerland
| | - Olivier Delémont
- Ecole des Sciences Criminelles, University of Lausanne, 1015, Lausanne, Switzerland
| | - Pierre Esseiva
- Ecole des Sciences Criminelles, University of Lausanne, 1015, Lausanne, Switzerland
| | - Nikolaos S Thomaidis
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece
| | - Adrian Covaci
- Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium.
| | - Alexander L N van Nuijs
- Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. Adolescent Tobacco Smoke Exposure, Respiratory Symptoms, and Emergency Department Use. Pediatrics 2018; 142:e20180266. [PMID: 30082449 PMCID: PMC6317548 DOI: 10.1542/peds.2018-0266] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our objective was to examine the relationship between distinct tobacco smoke exposure (TSE) measures and TSE-related symptoms and emergency department (ED) and/or urgent care (UC) use among nonsmoking adolescents without asthma diagnoses. METHODS We performed a secondary analysis of 7389 adolescents who completed the Population Assessment of Tobacco and Health Study wave 2. Logistic regression and Poisson regression models were built. RESULTS Adolescents with TSE were at increased risk of reporting: shortness of breath, finding it hard to exercise, wheezing during or after exercise, and dry cough at night. Adolescents who lived with a smoker and had home TSE were at increased odds of reporting wheezing or whistling in the chest, and only adolescents with home TSE were at increased risk of reporting wheezing that disturbed sleep. Adolescents with TSE were less likely to report very good or excellent overall health and physical health but were more likely to report they sometimes, often, or very often missed school because of illness. Participants who lived with a smoker and had TSE ≥1 hour were more likely to have had an ED and/or UC visit. Participants with any TSE were at increased risk of having a higher number of ED and/or UC visits. CONCLUSIONS Different TSE measures uniquely increased the risk of TSE-related symptoms, but any TSE increased the risk of having a higher number of ED and/or UC visits. The providers at these high-volume settings should offer interventions to adolescents who are exposed to tobacco smoke and their families to decrease these symptoms and related morbidity.
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Affiliation(s)
- Ashley L Merianos
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, Ohio
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Matt GE, Quintana PJE, Hoh E, Zakarian JM, Chowdhury Z, Hovell MF, Jacob P, Watanabe K, Theweny TS, Flores V, Nguyen A, Dhaliwal N, Hayward G. A Casino goes smoke free: a longitudinal study of secondhand and thirdhand smoke pollution and exposure. Tob Control 2018; 27:643-649. [DOI: 10.1136/tobaccocontrol-2017-054052] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/04/2022]
Abstract
BackgroundSecondhand smoke (SHS) in US casinos is common, but little is known about the residue of tobacco smoke pollutants left behind in dust and on surfaces, commonly referred to as thirdhand smoke (THS). We examined SHS and THS pollution and exposure before and during a casino smoking ban and after smoking resumed.MethodsA casino was visited nine times over a 15-month period to collect dust, surface and air samples in eight locations. Finger wipe and urine samples were collected from non-smoking confederates before and after a 4-hour casino visit. Samples were analysed for markers of SHS and THS pollution and exposure.ResultsExceptionally high levels of THS were found in dust and on surfaces. Although the smoking ban led to immediate improvements in air quality, surface nicotine levels were unchanged and remained very high for the first month of the smoking ban. Surface nicotine decreased by 90% after 1 month (P<0.01), but nicotine and tobacco-specific nitrosamines in dust decreased more slowly, declining by 90% only after 3 months (P<0.01). Exposure was significantly reduced after the ban, but the benefits of the ban were reversed after smoking resumed.ConclusionsLong-term smoking in a casino creates deep THS reservoirs that persist for months after a smoking ban. A complete smoking ban immediately improves air quality and significantly reduces exposure to SHS and THS. However, THS reservoirs contribute to continued low-level exposure to toxicants. To accelerate the effect of smoking bans, remediation efforts should address specific THS reservoirs, which may require intensive cleaning as well as replacement of carpets, furniture and building materials.
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Drehmer JE, Walters BH, Nabi-Burza E, Winickoff JP. Guidance for the Clinical Management of Thirdhand Smoke Exposure in the Child Health Care Setting. JOURNAL OF CLINICAL OUTCOMES MANAGEMENT : JCOM 2017; 24:551-559. [PMID: 29217965 PMCID: PMC5716630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explain the concept of thirdhand smoke and how it can be used to protect the health of children and improve delivery of tobacco control interventions for parents in the child health care setting. METHODS Review of the literature and descriptive report. RESULTS The thirdhand smoke concept has been used in the CEASE intervention to improve the delivery of tobacco control counseling and services to parents. Materials and techniques have been developed for the child health care setting that use the concept of thirdhand smoke. Scientific findings demonstrate that thirdhand smoke exposure is harmful and establishes the need for clinicians to communicate the cessation imperative: the only way to protect non-smoking household members from thirdhand smoke is for all household smokers to quit smoking completely. As the scientific knowledge of thirdhand smoke increases, advocates will likely rely on it to encourage completely smoke-free places. CONCLUSION Recent scientific studies on thirdhand smoke are impelling further research on the topic, spurring the creation of tobacco control policies to protect people from thirdhand smoke and stimulating improvements to the delivery of tobacco control counseling and services to parents in child health care settings.
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Affiliation(s)
- Jeremy E. Drehmer
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States
| | - Bethany Hipple Walters
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States
| | - Emara Nabi-Burza
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States
| | - Jonathan P. Winickoff
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States
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Collaco JM, McGrath-Morrow SA. Electronic Cigarettes: Exposure and Use Among Pediatric Populations. J Aerosol Med Pulm Drug Deliv 2017; 31:71-77. [PMID: 29068754 DOI: 10.1089/jamp.2017.1418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
As an emerging inhalational exposure, electronic cigarettes (e-cigarettes) have rapidly gained public awareness with increasing use among adolescents and adults, leading to increased primary use by adolescents and increased secondhand exposure to emissions in infants, children, and adolescents. Although the long-term health risks for primary use and secondhand emission exposure are unknown, limited data from animal studies suggest that there is the potential for long-term lung injury and altered neurocognitive development in children with exposure to nicotine-containing aerosols. In this pediatric-focused review, we discuss the history of e-cigarettes, the demographics of adolescent users, effects on health, and current legislative efforts to protect infants, children, and adolescents from exposure.
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Affiliation(s)
- Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions , Baltimore, Maryland
| | - Sharon A McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions , Baltimore, Maryland
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