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Environmental Tobacco Smoke Exposure Among Children by Urinary Biomarkers and Parent Report

  • Maya Leventer-Roberts
    Correspondence
    Address correspondence to Maya Leventer-Roberts, MD, MPH, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029
    Affiliations
    Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai (M Leventer-Roberts, SS Andra, M Arora, and H Levine), New York, NY

    Department of Pediatrics, Icahn School of Medicine at Mount Sinai (M Leventer-Roberts), New York, NY
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  • Ayala Grinshpun
    Affiliations
    Pediatric Emergency Unit, Shamir Medical Center (Assaf Harofeh) (A Grinshpun and E Kozer), Tzrifin, Israel

    Shamir Academic Nursing School, Shamir Medical Center (A Grinshpun), Tzrifin, Israel
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  • Elkana Kohn
    Affiliations
    Clinical Pharmacology and Toxicology Unit, Shamir Medical Center (Assaf Harofeh) (E Kohn and M Berkovitch), Tzrifin, Israel
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  • Syam S. Andra
    Affiliations
    Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai (M Leventer-Roberts, SS Andra, M Arora, and H Levine), New York, NY
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  • Manish Arora
    Affiliations
    Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai (M Leventer-Roberts, SS Andra, M Arora, and H Levine), New York, NY
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  • Matitiahu Berkovitch
    Affiliations
    Clinical Pharmacology and Toxicology Unit, Shamir Medical Center (Assaf Harofeh) (E Kohn and M Berkovitch), Tzrifin, Israel

    Sackler School of Medicine, Tel Aviv University (M Berkovitch and E Kozer), Tel Aviv, Israel
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  • Eran Kozer
    Affiliations
    Pediatric Emergency Unit, Shamir Medical Center (Assaf Harofeh) (A Grinshpun and E Kozer), Tzrifin, Israel

    Sackler School of Medicine, Tel Aviv University (M Berkovitch and E Kozer), Tel Aviv, Israel
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  • Philip Landrigan
    Affiliations
    Program for Global Public Health and the Common Good, Schiller Institute for Integrated Science and Society, Boston College (P Landrigan), Chestnut Hill, Mass
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  • Hagai Levine
    Affiliations
    Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai (M Leventer-Roberts, SS Andra, M Arora, and H Levine), New York, NY

    Braun School of Public Health, Hebrew University-Hadassah (H Levine), Jerusalem, Israel
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Published:January 08, 2021DOI:https://doi.org/10.1016/j.acap.2021.01.004

      Abstract

      Objective

      The goal of this study was to describe environmental tobacco smoke (ETS) exposure using urinary biomarkers and its correlation with parent report, among children presenting to emergency room.

      Methods

      This is a case control study among children aged 3 to 12 years at a tertiary pediatric emergency department in Israel. Children with respiratory (case) or gastrointestinal (control) symptoms were recruited and their accompanying parent completed a short survey. Urine samples were obtained and analyzed for nicotine, cotinine trans-3’-hydroxycotine. Clinical data were extracted from medical records. We compared tobacco exposure using urinary biomarkers, parent report, and Pearson's product-moment correlation, including 95% confidence intervals, between cases and controls.

      Results

      Forty-nine cases with respiratory symptoms and 96 controls with gastrointestinal symptoms were enrolled in the study. Parent-reported ETS exposure in the previous month was higher in the cases compared to control (71.4% vs 57.3%), although the difference was not statistically significant. The mean values of detectable biomarkers did not differ by between cases and controls. However, there was a correlation between urinary biomarkers and reported ETS exposure (0.278–0.460 for various biomarkers) only among cases.

      Conclusions

      The majority of children in this study had detectable nicotine urinary biomarkers, regardless of their symptoms. However, correlation between parental report and urinary biomarkers was only found among children with symptoms potentially related to ETS. These findings imply that parents of children without respiratory symptoms may underestimate exposure. Efforts to educate parents and caregivers on the risks associated with exposure to ETS should be intensified, regardless of illness.

      Keywords

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      References

        • Massin MM
        • Montesanti J
        • Gérard P
        • et al.
        Spectrum and frequency of illness presenting to a pediatric emergency department.
        Acta Clin Belg. 2006; 61: 161-165https://doi.org/10.1179/acb.2006.027
        • Vanker A
        • Gie RP
        • Zar HJ
        The association between environmental tobacco smoke exposure and childhood respiratory disease: a review.
        Expert Rev Respir Med. 2017; 11: 661-673https://doi.org/10.1080/17476348.2017.1338949
        • McCarville M
        • Sohn MW
        • Oh E
        • et al.
        Environmental tobacco smoke and asthma exacerbations and severity: the difference between measured and reported exposure.
        Arch Dis Child. 2013; 98: 510-514https://doi.org/10.1136/archdischild-2012-303109
        • Borrelli B
        • McQuaid EL
        • Wagener TL
        • et al.
        Children with asthma versus healthy children: differences in secondhand smoke exposure and caregiver perceived risk.
        Nicotine Tob Res. 2014; 16: 554-561https://doi.org/10.1093/ntr/ntt180
        • Max W
        • Sung H-Y
        • Shi Y
        Who is exposed to secondhand smoke? Self-reported and serum cotinine measured exposure in the U.S., 1999-2006.
        Int J Environ Res Public Health. 2009; 6: 1633-1648https://doi.org/10.3390/ijerph6051633
        • Bock BC
        • Becker B
        • Borrelli B
        Smoking behavior and risk perception among the parents of infants in the neonatal intensive care unit.
        Nicotine Tob Res. 2008; 10: 47-54https://doi.org/10.1080/14622200701767795
        • Lonergan BJ
        • Meaney S
        • Perry IJ
        • et al.
        Smokers still underestimate the risks posed by secondhand smoke: a repeated cross-sectional study.
        Nicotine Tob Res. 2014; 16: 1121-1128https://doi.org/10.1093/ntr/ntu046
        • Rosen L
        • Kostjukovsky I
        Parental risk perceptions of child exposure to tobacco smoke.
        BMC Public Health. 2015; 15https://doi.org/10.1186/s12889-015-1434-x
        • Rosen LJ
        • Lev E
        • Guttman N
        • et al.
        Parental perceptions and misconceptions of child tobacco smoke exposure.
        Nicotine Tob Res. 2018; 20: 1369-1377https://doi.org/10.1093/ntr/ntx169
        • Myers V
        • Shiloh S
        • Rosen L
        Parental perceptions of children's exposure to tobacco smoke: development and validation of a new measure.
        BMC Public Health. 2018; 18: 1031https://doi.org/10.1186/s12889-018-5928-1
        • Kim S
        Overview of cotinine cutoff values for smoking status classification.
        Int J Environ Res Public Health. 2016; 13https://doi.org/10.3390/ijerph13121236
        • Aurrekoetxea JJ
        • Murcia M
        • Rebagliato M
        • et al.
        Determinants of self-reported smoking and misclassification during pregnancy, and analysis of optimal cut-off points for urinary cotinine: a cross-sectional study.
        BMJ Open. 2013; 3https://doi.org/10.1136/bmjopen-2012-002034
        • Paci E
        • Pigini D
        • Bauleo L
        • et al.
        Urinary cotinine concentration and self-reported smoking status in 1075 subjects living in central Italy.
        Int J Environ Res Public Health. 2018; 15https://doi.org/10.3390/ijerph15040804
        • Ware LJ
        • Charlton K
        • Kruger R
        • et al.
        Assessing tobacco use in an African population: serum and urine cotinine cut-offs from South Africa.
        Drug Alcohol Depend. 2019; 195: 82-89https://doi.org/10.1016/j.drugalcdep.2018.11.022
        • Levine H
        • Berman T
        • Goldsmith R
        • et al.
        Exposure to tobacco smoke based on urinary cotinine levels among Israeli smoking and nonsmoking adults: a cross-sectional analysis of the first Israeli human biomonitoring study.
        BMC Public Health. 2013; 13: 1241https://doi.org/10.1186/1471-2458-13-1241
        • Chiu Y-L
        • Huang S-J
        • Lai C-H
        • et al.
        Validation of self-reported smoking with urinary cotinine levels and influence of second-hand smoke among conscripts.
        Sci Rep. 2017; 7: 15462https://doi.org/10.1038/s41598-017-15526-y
        • Berman T
        • Barnett-Itzhaki Z
        • Axelrod R
        • et al.
        Socioeconomic inequalities in exposure to environmental tobacco smoke in children in Israel.
        Environ Int. 2018; 121: 643-648https://doi.org/10.1016/j.envint.2018.09.034
        • Myers V
        • Shiloh S
        • Rosen L
        Parental perceptions of children's exposure to tobacco smoke: development and validation of a new measure.
        BMC Public Health. 2018; 18: 1031https://doi.org/10.1186/s12889-018-5928-1
        • Beitel AJ
        • Olson KL
        • Reis BY
        • et al.
        Use of emergency department chief complaint and diagnostic codes for identifying respiratory illness in a pediatric population.
        Pediatr Emerg Care. 2004; 20: 355-360
        • McGuffey JE
        • Wei B
        • Bernert JT
        • et al.
        Validation of a LC-MS/MS method for quantifying urinary nicotine, six nicotine metabolites and the minor tobacco alkaloids–anatabine and anabasine–in smokers’ urine.
        PLoS One. 2014; 9 (Taffe M, ed.)e101816https://doi.org/10.1371/journal.pone.0101816
        • Miller EI
        • Norris H-RK
        • Rollins DE
        • et al.
        A novel validated procedure for the determination of nicotine, eight nicotine metabolites and two minor tobacco alkaloids in human plasma or urine by solid-phase extraction coupled with liquid chromatography–electrospray ionization–tandem mass spectrometry.
        J Chromatogr B. 2010; 878: 725-737https://doi.org/10.1016/j.jchromb.2009.12.018
        • Kuczmarski RJ
        • Ogden CL
        • Guo SS
        • et al.
        2000 CDC growth charts for the United States: methods and development.
        Vital Health Stat 11. 2002; (Available at:) (Accessed August 7, 2019): 1-190
        • Torres S
        • Merino C
        • Paton B
        • et al.
        Biomarkers of exposure to secondhand and thirdhand tobacco smoke: recent advances and future perspectives.
        Int J Environ Res Public Health. 2018; 15: 2693https://doi.org/10.3390/ijerph15122693
        • Matsumoto A
        • Matsumoto A
        • Ichiba M
        • et al.
        Simultaneous measurement of urinary total nicotine and cotinine as biomarkers of active and passive smoking among Japanese individuals.
        Environ Health Prev Med. 2013; 18: 244-250https://doi.org/10.1007/s12199-012-0307-5
        • Jain RB
        Concentrations of urine cotinine and hydroxycotinine among US children, adolescents, and adults: data from NHANES 2013–2014.
        Biomarkers. 2019; 24: 757-763https://doi.org/10.1080/1354750X.2019.1684563
        • Aquilina NJ
        • Delgado-Saborit JM
        • Meddings C
        • et al.
        Environmental and biological monitoring of exposures to PAHs and ETS in the general population.
        Environ Int. 2010; 36: 763-771https://doi.org/10.1016/j.envint.2010.05.015
        • Matt GE
        • Quintana PJE
        • Liles S
        • et al.
        Evaluation of urinary trans-3′-hydroxycotinine as a biomarker of children's environmental tobacco smoke exposure.
        Biomarkers. 2006; 11: 507-523https://doi.org/10.1080/13547500600902458
        • Jatlow P
        • McKee S
        • O'Malley SS
        Correction of urine cotinine concentrations for creatinine excretion: is it useful?.
        Clin Chem. 2003; 49: 1932-1934https://doi.org/10.1373/clinchem.2003.023374
        • Lee M
        • Ha M
        • Hong YC
        • et al.
        Exposure to prenatal secondhand smoke and early neurodevelopment: Mothers and Children's Environmental Health (MOCEH) study.
        Environ Health A Glob Access Sci Source. 2019; 18https://doi.org/10.1186/s12940-019-0463-9
        • Park S
        • Cho SC
        • Hong YC
        • et al.
        Environmental tobacco smoke exposure and children's intelligence at 8-11 years of age.
        Environ Health Perspect. 2014; 122: 1123-1128https://doi.org/10.1289/ehp.1307088
        • Wang Y
        • Yang M
        • Tian L
        • et al.
        Relationship between caregivers’ smoking at home and urinary levels of cotinine in children.
        Int J Environ Res Public Health. 2014; 11: 12499-12513https://doi.org/10.3390/ijerph111212499
        • Boyaci H
        • Etiler N
        • Duman C
        • et al.
        Environmental tobacco smoke exposure in school children: parent report and urine cotinine measures.
        Pediatr Int. 2006; 48: 382-389https://doi.org/10.1111/j.1442-200X.2006.02225.x
        • Jurado D
        • Muñoz C
        • De Dios Luna J
        • et al.
        Environmental tobacco smoke exposure in children: parental perception of smokiness at home and other factors associated with urinary cotinine in preschool children.
        J Expo Anal Environ Epidemiol. 2004; 14: 330-336https://doi.org/10.1038/sj.jea.7500329
        • El Sayed Desouky D
        • Elnemr G
        • Alnawawy A
        • et al.
        The relation between exposure to environmental tobacco smoke and the quantity of cotinine in the urine of school children in Taif City, Saudi Arabia.
        Asian Pacific J Cancer Prev. 2016; 17: 139-145https://doi.org/10.7314/APJCP.2016.17.1.139
        • Yücel U
        • Öcek ZA
        • Çiçeklioǧlu M
        Evaluation of an intensive intervention programme to protect children aged 1-5 years from environmental tobacco smoke exposure at home in Turkey.
        Health Educ Res. 2014; 29: 442-455https://doi.org/10.1093/her/cyu005
        • Lupsa IR
        • Nunes B
        • Ligocka D
        • et al.
        Urinary cotinine levels and environmental tobacco smoke in mothers and children of Romania, Portugal and Poland within the European human biomonitoring pilot study.
        Environ Res. 2015; 141: 106-117https://doi.org/10.1016/j.envres.2015.03.018
        • Sun X
        • Li X
        • Liu D
        • et al.
        Use of a survey to assess the environmental exposure and family perception to lead in children (<6 years) in four valley cities, Northwestern China.
        Int J Environ Res Public Health. 2018; 15https://doi.org/10.3390/ijerph15040740