Detectable Cotinine Levels Research Articles

Objective measures of smoking and caffeine intake and the risk of adverse pregnancy outcomes.

In pregnancy, women are encouraged to cease smoking and limit caffeine intake. We employed objective definitions of smoking and caffeine exposure to assess their association with adverse outcomes. We conducted a case cohort study within the Pregnancy Outcome Prediction study to analyse maternal serum metabolomics in samples from 12, 20, 28 and 36 weeks of gestational age. Objective smoking status was defined based on detectable cotinine levels at each time point and objective caffeine exposure was based on tertiles of paraxanthine levels at each time point. We used logistic and linear regression to examine the association between cotinine, paraxanthine and the risk of pre-eclampsia, spontaneous pre-term birth (sPTB), fetal growth restriction (FGR), gestational diabetes mellitus and birthweight. There were 914 and 915 women in the smoking and caffeine analyses, respectively. Compared with no exposure to smoking, consistent exposure to smoking was associated with an increased risk of sPTB [adjusted odds ratio (aOR) = 2.58, 95% CI: 1.14 to 5.85)] and FGR (aOR = 4.07, 95% CI: 2.14 to 7.74) and lower birthweight (β = -387 g, 95% CI: -622 g to -153 g). On univariate analysis, consistently high levels of paraxanthine were associated with an increased risk of FGR but that association attenuated when adjusting for maternal characteristics and objective-but not self-reported-smoking status. Based on objective data, consistent exposure to smoking throughout pregnancy was strongly associated with sPTB and FGR. High levels of paraxanthine were not independently associated with any of the studied outcomes and were confounded by smoking.

Environmental tobacco smoke exposure is associated with increased levels of metals in children’s saliva

BackgroundExposure to environmental tobacco smoke (ETS) has been associated with detectable levels of cotinine (a nicotine metabolite) in children’s saliva. However, tobacco smoke also contains toxic and essential trace metals, including chromium (Cr), copper (Cu), lead (Pb), manganese (Mn), nickel (Ni) and zinc (Zn).ObjectiveThe current study examines whether there is a relationship between ETS exposure, as gauged by salivary cotinine, and salivary levels of these metals in a subset (n = 238) of children from the Family Life Project.MethodsUsing inductively-coupled-plasma optical emission spectrophotometry, we measured levels of metals in saliva from children at ~90 months of age. Salivary cotinine was measured using a commercial immunoassay.ResultsWe found that Cr, Cu, Mn, and Zn were detected in most samples (85–99%) with lower levels of detection for Pb and Ni (9.3% and 13.9% respectively). There were no significant differences in any of the metal concentrations between males and females, nor were levels associated with body mass index, although significant differences in salivary Cr and Mn by race, state and income-to-needs ratio were observed. Children with cotinine levels >1 ng/ml had higher levels of Zn (b = 0.401, 95% CI: 0.183 to 0.619; p = 0.0003) and Cu (b = 0.655, 95% CI: 0.206 to 1.104; p = 0.004) compared to children with levels <1 ng/ml, after controlling for multiple confounders, including sex, race, BMI and income-to-needs ratio. Further, we show that children whose cotinine levels were >1 μg/L were more likely to have detectable levels of Pb in their saliva (b = 1.40, 95% CI: 0.424 to 2.459; p = 0.006) compared to children with cotinine levels <1 ng/ml, also considering confounders.Impact statementThis is the first study to demonstrate significant associations between salivary cotinine and salivary levels of Cu, Zn and Pb, suggesting that environmental tobacco smoke exposure my be one source of increased children’s exposure to heavy metals. This study also demonstrates that saliva samples can be used to measure heavy metal exposure, and thus serve as a non-invasive tool for assessing a broader range of risk indicators.

Prenatal exposure to tobacco and adverse birth outcomes: effect modification by folate intake during pregnancy

BackgroundFetal exposure to tobacco increases the risk for many adverse birth outcomes, but whether diet mitigates these risks has yet to be explored. Here, we examined whether maternal folate intake (from foods and supplements) during pregnancy modified the association between prenatal exposure to tobacco and with preterm delivery, small-for-gestational age (SGA) births, or neonatal adiposity.MethodsMother–child pairs (n = 701) from Healthy Start were included in this analysis. Urinary cotinine was measured at ~ 27 weeks gestation. Diet was assessed using repeated 24-h dietary recalls. Neonatal adiposity (fat mass percentage) was measured via air displacement plethysmography. Interaction was assessed by including a product term between cotinine (< / ≥ limit of detection [LOD]) and folate (< / ≥ 25th percentile [1077 µg/day]) in separate logistic or linear regression models, adjusting for maternal age, race, ethnicity, education, pre-pregnancy body mass index, and infant sex.ResultsApproximately 26% of women had detectable levels of cotinine. Folate intake was significantly lower among women with cotinine ≥ LOD as compared to those with cotinine < LOD (1293 µg/day vs. 1418 µg/day; p = 0.01). Folate modified the association between fetal exposure to tobacco with neonatal adiposity (p for interaction = 0.07) and SGA (p for interaction = 0.07). Among those with lower folate intake, fetal exposure to tobacco was associated with lower neonatal adiposity (mean difference: -2.09%; 95% CI: -3.44, -0.74) and increased SGA risk (OR: 4.99; 95% CI: 1.55, 16.14). Conversely, among those with higher folate intake, there was no difference in neonatal adiposity (mean difference: -0.17%; 95% CI: -1.13, 0.79) or SGA risk (OR: 1.15; 95% CI: 0.57, 2.31).ConclusionsIncreased folate intake during pregnancy (from foods and/or supplements) may mitigate the risk of fetal growth restriction among those who are unable to quit smoking or cannot avoid secondhand smoke during pregnancy.

Developmental Effects of Electronic Cigarette Use.

Electronic cigarettes have gained widespread acceptance among adolescents and young adults. As a result of this popularity, there are concerns regarding the potential harm of primary, secondhand and thirdhand electronic cigarette exposures on fetal and postnatal development. In vitro studies have shown that constituents in electronic cigarette liquids, including nicotine, flavorings, and carrier agents can alter cellular processes and growth. Additionally, aerosolized electronic cigarette emissions have been shown to disrupt organ development and immune responses in preclinical studies. In clinical studies, an association between electronic cigarette use and frequent respiratory symptoms, greater asthma severity and impaired mucociliary clearance has been demonstrated with adolescent and young adult users of electronic cigarettes having twice the frequency of cough, mucus production, or bronchitis compared to nonusers. Along with the popularity of electronic cigarette use, secondhand electronic cigarette exposure has increased substantially; with almost one-fourth of middle and high school children reporting exposure to secondhand vapors. The health consequences of secondhand electronic cigarette exposure on children and other vulnerable populations are poorly understood but detectable levels of cotinine have been measured in nonusers. Pregnant women and their offspring are another vulnerable group at increased risk for health consequences from electronic cigarette exposure. Nicotine crosses the placenta and can disrupt brain and lung development in preclinical studies. This article will focus on the physiological and health effects associated with primary or secondhand exposure to electronic cigarettes. It is expected that with ongoing availability of electronic cigarettes as well as the accumulation of additional follow-up time for long-term outcomes, the risks associated with exposure will become better clarified. © 2022 American Physiological Society. Compr Physiol 12:3337-3346, 2022.

Comparison of Levels of Three Tobacco Smoke Exposure Biomarkers in Children of Smokers.

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.

Characteristics of inner-city children with life-threatening asthma

BackgroundIntensive care unit (ICU) admission is a risk factor for fatal asthma. Little is known about risk factors for pediatric ICU admissions for asthma. ObjectiveTo examine characteristics of underserved minority children with prior ICU admissions for asthma. MethodsBaseline survey data, salivary cotinine levels, and allergen specific IgE serologic test results were obtained from children with uncontrolled asthma enrolled in a randomized clinical trial of a behavioral education environmental control intervention. Characteristics of children with and without prior ICU admission were compared using χ2 and t tests. Logistic regression assessed significance of higher odds of prior ICU admission comparing factor-level categories. ResultsPatients included 222 primarily African American (93.7%), male (56%), Medicaid-insured (92.8%) children with a mean (SD) age of 6.4 (2.7) years with uncontrolled asthma. Most (57.9%) had detectable cotinine levels, 82.6% were sensitized to more than 1 environmental allergen, and 27.9% had prior ICU admissions. Prior ICU patients were more likely to be very poor (<$10,000 per year) and sensitized to more than 1 allergen tested (most importantly mouse) (P < .05). Allergen sensitization in the groups did not differ for cockroach, cat, dog, Alternaria, Aspergillus, dust mite, grass, or tree. Although more ICU patients received combination controller therapy, they also overused albuterol. Only 27.4% of ICU patients received specialty care in the previous 2 years, which was not significantly different from non-ICU patients. ConclusionChildren with high mortality risk, including history of ICU admission, were twice as likely to live in extreme poverty, have atopy (particularly mouse allergen), use combination controller therapy, and overuse albuterol. Trial RegistrationClinicalTrials.gov Identifier: NCT01981564.

Characteristics of Pediatric Emergency Revisits After an Asthma-Related Hospitalization

We identify and characterize factors related to subsequent emergency revisits among children hospitalized for asthma. This population-based, prospective, observational cohort included children aged 2 to 16 years, hospitalized for asthma at an urban pediatric facility and followed for greater than or equal to 12 months. The primary outcome was asthma-related emergency revisit within 12 months of discharge. Revisits were identified by billing codes, respiratory chief complaints, and medications administered (eg, albuterol, systemic corticosteroids), dispensed, or prescribed. Predictors and covariates include demographic, socioeconomic, access, and environmental exposure variables collected during index admission. Multivariable logistic regression was used to evaluate the association between predictors and odds of asthma-related revisit. A total of 671 children were enrolled; the majority were boys (65%), aged 4 to 11 years (59%), black (59%), and publicly insured (73%). There were 274 patients (41%) who were treated for asthma-related emergency revisits within 12 months of the index admission. In adjusted models, younger children, black children, children with excellent reported access to primary care, and children with a history of inhaled steroids were more likely to experience emergency revisits. Low income, detectable cotinine levels, and traffic exposure did not independently predict revisit. Asthma-related emergency revisit is common after hospitalization, with more than 40% of children returning within 12 months. Socioeconomic and exposure-related risk factors typically predictive of asthma morbiditywere not independently associated with emergency revisit among children in this cohort.

Non-smoking pregnant women and their fetuses are exposed to environmental tobacco smoke as a result of living in multiunit housing

This study investigates whether pregnant women and their fetuses are exposed to environmental tobacco smoke (ETS) as a result of living in apartments. We measured cotinine concentrations in serum, a biomarker of exposure to ETS, in non-smoking women's umbilical cord blood collected at delivery and in maternal blood drawn shortly after delivering a baby. Concurrently, information was collected regarding the women's housing situation, whether family members or co-workers smoked, and other potential exposure factors. Newborns whose non-smoking mothers lived in an apartment during pregnancy were more than three times (OR 3.17, 95% CI 1.62-6.21) more likely to have detectable levels of cotinine in their cord blood serum than babies whose mothers lived in a detached house. There is a strong association between detectable concentrations of cotinine in cord blood serum and living in an apartment, even after adjusting for confounders, such as exposure at home or at work. A similar association was observed between the detectable levels of cotinine in maternal serum and living in an apartment (OR 1.95, 95% CI 1.03-3.71).

Thirdhand smoke contamination in hospital settings: assessing exposure risk for vulnerable paediatric patients

BackgroundTobacco has regained the status of the world's number two killer behind heart/vascular disease. Thirdhand smoke (THS) residue and particles from secondhand smoke (SHS) are suspected health hazards (eg, DNA...

Comparison of Cotinine Salivary Levels in Hookah Smokers, Passive Smokers, and Non-Smokers.

At present smoking is considered a great health-related problem. Smoking cigarettes and use of tobacco are on the rise in the Middle East countries; therefore, the number of people exposed to passive cigarette smoke is increasing, too. The aim of the present study was to determine and compare salivary cotinine levels in hookah smokers, individuals exposed to passive cigarette smoke and non-smoker (passive smokers). In the present cross-sectional study, unstimulated salivary samples were collected from 150 subjects, including 50 hookah smokers, 50 passive smokers, and 50 non-smokers. Bioassay Technology Laboratory cotinine kit was used to determine salivary levels of cotinine using the enzyme-linked immunosorbent assay (ELISA) technique at a sensitivity rate of 0.019 pg/ml. Data were analyzed with SPSS software using t-test and Pearson's correlation coefficient. The highest salivary cotinine levels were recorded in hookah users (20.24 ± 5.62 ng/ml), followed by passive smokers (16.09 ± 3.51 ng/ml), in descending order. No detectable cotinine levels were observed in non-smokers. Pearson's correlation coefficient showed a strong and positive correlation between use of hookah and salivary cotinine levels (r = 0.932, P = 0.001). Based on the results of the present study, salivary cotinine levels were higher in hookah smokers compared with passive smokers and non-smokers, in descending order.

Regulation of Tissue Plasminogen Activator Expression in Human Epithelial Cells

FEBRUARY 2015 AB80 Abstracts S A T U R D A Y 256 Characteristics of Inner City Children with Life-Threatening Asthma Mary E. Bollinger, DO, Arlene Butz, ScD, CRNP, Cassie LewisLand, MS, Francesca DiPaula, BS, Shawna Mudd, DNP, CRNP; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, Johns Hopkins University School of Medicine, Baltimore, MD, Johns Hopkins University School of Nursing, Baltimore, MD. RATIONALE: Prior intensive care unit (ICU) admission is a risk factor for fatal asthma. The purpose of this study was to examine characteristics of underserved children with a history of ICU admissions for asthma. METHODS: Baseline survey data, salivary cotinine and allergen specific IgE serology were obtained from underserved children with uncontrolled asthma enrolled in a randomized clinical trial of a multifaceted Emergency Department/ home-based asthma intervention. Baseline characteristics of children with and without a prior history of ICU admission were compared using chi-square and ANOVA. RESULTS: Subjects included 100 primarily African American (95%), Medicaid insured (97%) children (Mean age56.25 yrs; 56% male) with uncontrolled asthma. Atopy was high with 80.2% sensitized to > 1 environmental allergen. Most (54.1%) had detectable cotinine levels. Almost one-third (31%) had prior ICU admissions. ICU subjects were more likely to be sensitized to dustmite (p50.009) and ragweed (p50.002) and trended toward higher cockroach sensitization (p50.09) than non-ICU subjects. Allergen sensitization between the two groups did not differ for mouse, cat, dog, alternaria, aspergillus, grass or tree. Cotinine levels were similar. Albuterol overuse was prevalent (>70%); appropriate controller medication use was poor (32%). Although ICU subjects were more likely to have seen their PCP for asthma in prior 3 months, only 31% had seen an asthma specialist in the previous 2 years. CONCLUSIONS: Children at risk for fatal asthma should undergo asthma specialty evaluation to optimize controller medication use, assess environmental sensitivities/exposures and implement individualized trigger avoidance procedures to improve morbidity and mortality in this high risk population.

Biomarker evidence of tobacco smoke exposure in children participating in lead screening.

We assessed tobacco smoke exposure (TSE), defined according to detection of cotinine, in dried blood spots collected from children for lead screening. Dried blood spots collected from a national sample of 1541 Black and White children and submitted to a commercial laboratory for lead analysis were analyzed for cotinine. We used an anonymous administrative data set including information on children's characteristics to conduct univariate and multivariate analyses. Cotinine was detected in 61% of dried blood spots; 17% of samples had cotinine levels above 3 nanograms per gram. Median cotinine levels were significantly higher among Black than White children (0.66 ng/g vs 0.30 ng/g) and among Medicaid recipients (0.94 ng/g vs < 0.3 ng/g). In multivariate analyses, significant increases in cotinine levels were associated with Black (vs White) race, older age, Medicaid coverage, higher state smoking rate, and higher average winter temperature. Detectable cotinine levels were significantly associated with higher lead levels. TSE is highly prevalent among children undergoing lead screening, and exposure levels are greater among Black children and children on Medicaid. TSE may contribute to lead exposure. Concurrent lead screening and biological screening for TSE may be a feasible approach to increasing childhood TSE detection.

Urinary concentrations of environmental contaminants and phytoestrogens in adults in Israel

BackgroundThe Ministry of Health Biomonitoring Study estimated exposure of individuals in the Israeli population to bisphenol A (BPA), organophosphate (OP) pesticides, phthalates, cotinine, polycyclic aromatic hydrocarbons (PAHs), and the phytoestrogenic compounds genistein and daidzein. MethodsIn 2011, 250 individuals (ages 20−74) were recruited from five different regions in Israel. Urine samples were collected and questionnaire data were obtained, including detailed dietary data (food frequency questionnaire and 24hour recall). Urinary samples were analyzed for BPA, OP metabolites (dialkyl phosphates), phthalate metabolites, cotinine, PAH metabolites, genistein, and daidzein. Results and discussionBPA urinary concentrations were above the limit of quantification (LOQ) in 89% of the samples whereas urinary concentrations of phthalate metabolites were above the LOQ in 92–100% of the samples. PAH metabolites were above the LOQ in 63–99% of the samples whereas OP metabolites were above the LOQ in 44–100% of the samples. All non-smoking participants had detectable levels of cotinine in their urine; 63% had levels above the LOQ, and the rate of quantification was high compared to the general non-smoking population in Canada. Median creatinine adjusted concentrations of several OP metabolites (dimethyl phosphate, dimethyl thiophosphate) were high in our study population compared to the general US and Canadian populations. Median creatinine adjusted urinary BPA concentrations in the study population were comparable to those in Belgium and Korea; higher than those reported for the general US, German, and Canadian populations; and very low compared to health-based threshold values. Phthalate concentrations were higher in our study population compared to the general US population but values were very low compared to health-based threshold values. Median creatinine adjusted PAH concentrations were generally comparable to those reported for the general US population; median creatinine adjusted daidzein concentrations were high in our population compared to the general US population whereas genistein concentrations were comparable. ConclusionsWe interpreted observed urinary contaminant levels observed in our study by comparing values with health-based threshold values and/or values from international human biomonitoring studies. Using this data interpretation scheme, we identified two contaminants as being of potential public health concern and high priority for public health policy intervention: environmental tobacco smoke (ETS) and OP pesticides. We used the data collected in this study to support public health policy interventions. We plan to conduct a follow-up biomonitoring study in 2015 to measure ETS and OP exposure in the general population in Israel, to evaluate the effectiveness of relevant policy interventions.

Tobacco Smoke Exposure in a Sample of Boston Public Housing Residents

There is no safe level of tobacco smoke exposure. Nonsmoking residents of public housing are at particular risk of suffering the health consequences of tobacco smoke exposure. To compare levels of tobacco smoke exposure among nonsmoking residents of the Boston Housing Authority (BHA) to previously published data from the National Health and Nutrition Examination Survey and identify factors associated with such exposure in the BHA. Nonsmoking adults and children from two BHA housing developments were invited to participate in a tobacco smoke exposure screening in which they completed a short survey and provided a saliva sample for cotinine analysis. Data were collected in 2011 and analyzed in 2012. Of 51 eligible study participants, 88% (95% CI=76%, 95%) had detectable cotinine levels (0.15 ng/mL lower limit of detection) compared to at most 56% of residents nationally (using a more sensitive 0.05 ng/mL lower limit of detection). Geometric mean cotinine levels among study participants were 0.52 ng/mL (95% CI=0.37 ng/mL, 0.74 ng/mL) compared to at most 0.10 ng/mL nationally. Residents living in homes with strict no-smoking rules had lower cotinine levels than those without such rules (0.40 ng/mL vs 1.07 ng/mL, p=0.006). Tobacco smoke exposure is substantially higher in this sample of nonsmoking BHA residents than among nonsmoking Americans nationally. A comprehensive prohibition on smoking in BHA housing units enacted in October 2012 will help protect this highly exposed group of residents and serve as a model for other housing authorities.

Attention deficit hyperactivity disorder among children exposed to secondhand smoke: A logistic regression analysis of secondary data

BackgroundA growing body of literature examines the association of postnatal secondhand smoke exposure with attention deficit hyperactivity disorder (ADHD) in children, but the findings are mixed. ObjectiveWe compare prevalence of ADHD in children aged 4–15 years who were exposed to postnatal secondhand smoke with prevalence in those who were not exposed, and examine the association of postnatal secondhand smoke exposure with ADHD using both reported and cotinine-measured secondhand smoke exposure. Design and settingWe analyze secondary data from the 1999–2004 U.S. National Health and Nutrition Examination Surveys. ParticipantsAnalyses using reported secondhand smoke exposure and cotinine-measured exposure included 6283 and 6033 children aged 4–15 respectively, including 419 and 404 children who either had a reported physician diagnosis of ADHD or were taking stimulant medications. MethodsThe association of secondhand smoke exposure with ADHD was examined by two multiple logistic regression models that differ in the secondhand smoke measurement used. ResultsAfter controlling for maternal smoking during pregnancy, gender, age, race/ethnicity, preschool attendance, health insurance coverage, and exposure to lead, children with reported secondhand smoke exposure at home were more likely to have ADHD (adjusted odds ratio=1.5, 95% confidence interval: 1.1-2.0) than those who were not exposed. After controlling for these covariates, children with detectable cotinine levels were more likely to have ADHD (adjusted odds ratio=1.8, 95% confidence interval: 1.3-2.5) than those with non-detectable levels. ConclusionsOur findings suggest that secondhand smoke exposure in children is strongly associated with ADHD independent of other risk factors and this association is robust using both measurements of secondhand smoke exposure. Further research is needed to understand the mechanism underlying this association. Nurses and other healthcare professionals can play an important role in encouraging parents to quit smoking to reduce children's exposure to secondhand smoke and their risk of ADHD.

Secondhand Smoke Exposure Among Canadians: Cotinine and Self-Report Measures From the Canadian Health Measures Survey 2007-2009

Secondhand smoke (SHS) exposure is associated with numerous adverse health effects, including cancer, cardiovascular disease, asthma, respiratory infections, and decreased pulmonary function. This study provides population estimates of SHS exposure among the Canadian nonsmoking population based on self-report and urinary cotinine concentrations. The 2007-2009 Canadian Health Measures Survey, a nationally representative cross-sectional survey, collected data from Canadians aged 6-79 years, and it includes self-report and urinary cotinine measures of tobacco smoke exposure (n = 4,455). An estimated 22% of nonsmokers reported being exposed to SHS every day or almost every day. Of those, 70% of children (6-11 years) and 48% of adolescents (12-19 years) had detectable cotinine levels compared with 23% of adults (20-79 years). An estimated 77% of nonsmokers exposed to SHS only in the home had detectable cotinine levels compared with 11% of nonsmokers exposed to SHS only outside the home. Of those exposed to SHS only in the home, a higher percentage of children (5.1%) had detectable cotinine levels compared with adults (3.1%). Despite well-known health risks associated with exposure to tobacco smoke, a substantial proportion of the Canadian population continues to be exposed to SHS. Higher percentages of certain subpopulations had detectable cotinine concentrations, including children, adolescents, and those exposed to SHS in the home.

OP55 Socioeconomic Inequalities in Childhood Exposure to Secondhand Smoke Before and after Smoke-Free Legislation in three UK Countries

BackgroundSecondhand smoke (SHS) exposure is higher among children from lower socioeconomic status (SES) families, contributing to the intergenerational reproduction of health inequalities. Legislation prohibiting smoking in enclosed public places was...

Socioeconomic inequalities in childhood exposure to secondhand smoke before and after smoke-free legislation in three UK countries

BackgroundSecondhand smoke (SHS) exposure is higher among lower socioeconomic status (SES) children. Legislation restricting smoking in public places has been associated with reduced childhood SHS exposure and increased smoke-free homes. This paper examines socioeconomic patterning in these changes.MethodsRepeated cross-sectional survey of 10 867 schoolchildren in 304 primary schools in Scotland, Wales and Northern Ireland. Children provided saliva for cotinine assay, completing questionnaires before and 12 months after legislation.ResultsSHS exposure was highest, and private smoking restrictions least frequently reported, among lower SES children. Proportions of saliva samples containing <0.1 ng/ml (i.e. undetectable) cotinine increased from 31.0 to 41.0%. Although across the whole SES spectrum, there was no evidence of displacement of smoking into the home or increased SHS exposure, socioeconomic inequality in the likelihood of samples containing detectable levels of cotinine increased. Among children from the poorest families, 96.9% of post-legislation samples contained detectable cotinine, compared with 38.2% among the most affluent. Socioeconomic gradients at higher exposure levels remained unchanged. Among children from the poorest families, one in three samples contained >3 ng/ml cotinine. Smoking restrictions in homes and cars increased, although socioeconomic patterning remained.ConclusionsUrgent action is needed to reduce inequalities in SHS exposure. Such action should include emphasis on reducing smoking in cars and homes.

EXPOSURE TO SECONDHAND SMOKE AND REPRODUCTIVE OUTCOMES BY MATERNAL HISTORY OF ASTHMA

Background and Aims: Cigarette smoking in women is highly prevalent in South European countries. Multiple studies confirm that tobacco consumption is associated with reduced birthweight. Less clear is the reproductive effects of secondhand smoke (SHS) exposure. An issue that has not been clarified is the reproductive effect of these exposures among subgroups, and particularly the potential higher risk among mothers with a history of asthma. We assessed the role of pre-natal maternal tobacco use and SHS on reproductive outcomes and assessed the interaction with maternal history of asthma. Methods: Data was collected from two birth cohorts, the INMA study, established in Spain and the Rhea study in Crete, Greece. Given that decreased birthweight is determined mostly by exposure to smoking during the later half of pregnancy we measured cotinine at the 32 weeks of pregnancy in 2219 and 510 women, respectively. Results: All women had detectable levels of cotinine. Only 35% and 3% reported not being exposed to SHS or active smoking in the INMA and Rhea cohorts, respectively. Active smoking (cotinine&gt;100ng/mL) was related to a 150g decrease in birthweight and a relative risk of 2 for small for gestational age and fetal growth restriction only in the INMA cohort. Among those exposed to SHS (cotinine:20-100ng/mL) the decrease in birthweight was 20 and 26g, respectively, but these differences could be due to chance. These results were not modified by maternal asthma. Household exposure to SHS was associated with lower birthweight, but only in the Greek cohort. Conclusions: In countries with high prevalence of smoking and SHS exposure, cotinine levels compatible with no active smoking during the third trimester of pregnancy had a non-significant decrease in birthweight or impaired reproductive outcomes, perhaps due to the lack of unexposed women. Maternal history of asthma did not modify the results.

Household smoking behaviours and exposure to environmental tobacco smoke among infants: are current strategies effectively protecting our young?

To determine the prevalence of infant exposure to environmental tobacco smoke (ETS) among infants attending child health clinics in regional NSW; the association between such exposure and household smoking behaviours; and the factors associated with smoking restrictions in households with infants. Parents completed a computer-based questionnaire and infant urine samples were collected. Information was obtained regarding the smoking behaviours of household members and samples were analysed for cotinine. Twenty seven per cent of infants had detectable levels of cotinine. Infant ETS exposure was significantly associated with the smoking status of household members, absence of complete smoking bans in smoking households and having more than one smoker in the home. Smoking households were significantly less likely to have a complete smoking ban in place. This study suggests that a significant proportion of the population group most vulnerable to ETS were exposed. Future efforts to reduce children's exposure to ETS need to target cessation by smoking parents, and smoking bans in households of infants where parents are smokers if desired reductions in childhood ETS-related illness are to be realised.