Abstract
Objectives: Cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and N-oxides are biomarkers of tobacco smoke exposure (TSE) used to assess short- and longer-term TSE. The objective of this study was to assess the associations between these TSE biomarkers, sociodemographics, parental smoking, and child TSE patterns among 0–17-year-olds. Methods: A convenience sample of 179 pediatric patients (mean (SD) age = 7.9 (4.3) years) who lived with ≥1 smoker and who had parental assessments completed and urine samples analyzed for the three TSE biomarkers of interest were included. Biomarker levels were log-transformed, univariate regression models were built and Pearson correlations were assessed. Results: In total, 100% of children had detectable levels of cotinine and >96% had detectable NNAL and N-oxide levels. The geometric means of cotinine, NNAL, and N-oxide levels were 10.1 ng/mL, 25.3 pg/mL, and 22.9 pg/mL, respectively. The mean (SD) number of daily cigarettes smoked by parents was 10.6 (6.0) cigarettes. Child age negatively correlated with urinary cotinine (r = −0.202, p = 0.007) and log NNAL levels (r = −0.275, p < 0.001). The highest log-cotinine levels were in children who were younger, of African American race, and whose parents had a lower education, an annual income ≤USD15,000, and no smoking bans. The highest log-NNAL and N-oxide levels were in children whose parents had a lower education, had no smoking bans, and were around higher numbers of cigarettes. Conclusion: Children of smokers who were younger, African American, and had no smoking bans had the highest TSE biomarker levels. Targeted interventions are needed to reduce TSE levels among high-risk children.
Highlights
IntroductionDespite recent decreases in adult tobacco product use [1], tobacco smoke exposure (TSE) remains prevalent in U.S children
Adding to the extant literature, we found that NNAL and N-oxide levels were highest in children: whose parents had a high school education or lower, who did not have home smoking bans, and who were around more cigarettes in any location
This study adds to the literature on tobacco smoke exposure (TSE) in children as it underscores the importance of measuring multiple biomarkers which may assess both secondhand smoke (SHS) and thirdhand smoke (THS)
Summary
Despite recent decreases in adult tobacco product use [1], tobacco smoke exposure (TSE) remains prevalent in U.S children. Of 3–11-year-olds and 33% of adolescents have biochemically confirmed TSE [2]. While exposure to SHS occurs during and up to a few hours after active smoking takes place, exposure to THS can occur for days or years after tobacco products have been burned [3]. The measurement of multiple TSE biomarkers can provide insight into variations in TSE patterns in children as exposure may be brief, over short periods of time (e.g., while visiting a relative’s house), intermittent (e.g., every weekend), or over longer periods of time (e.g., while living in homes without smoking bans)
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