Benowitz Neal L, Jain Shonul, Dempsey Delia A, Nardone Natalie, Helen Gideon St, Jacob Peyton
Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA.
Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, CA.
Nicotine Tob Res. 2017 Sep 1;19(9):1048-1054. doi: 10.1093/ntr/ntw390.
Routine biochemical assessment of tobacco smoke exposure could lead to more effective interventions to reduce or prevent secondhand smoke (SHS)-related disease in adolescents. Our aim was to determine using urine cotinine (major nicotine metabolite) measurement the prevalence of tobacco smoke exposure among adolescents receiving outpatient care at an urban public hospital.
Surplus urine was collected in 466 adolescents attending pediatric or urgent care clinics at Zuckerberg San Francisco General Hospital, serving families with lower levels of income and education, in 2013-2014. The majority were Hispanic or African American. Urine cotinine cut points of 0.05 to 0.25 ng/ml, 0.25 to 30 ng/ml, and 30 ng/ml were used to classify subjects as light SHS or thirdhand smoke exposed, SHS or light/intermittent active users, and active tobacco users, respectively.
Among subjects 87% were exposed, including 12% active smoking, 46% SHS and 30% lightly exposed. The SHS exposed group adjusted geometric mean cotinine values were significantly higher in African Americans (1.48 ng/ml) compared to other groups (0.56-1.13 ng/ml).
In a city with a low smoking prevalence (12%), a large majority (87%) of adolescents seen in a public hospital clinic are exposed to tobacco. This is much higher than reported in national epidemiological studies of adolescents, which used a plasma biomarker. Since SHS is associated with significant respiratory diseases and parents and adolescents underreport exposure to SHS, routine biochemical screening should be considered as a tool to reduce SHS exposure. The clinical significance of light exposure needs to be investigated.
Urine biomarker screening found that a large majority (87%) of adolescents treated in an urban public hospital are exposed to tobacco. Since SHS is associated with significant respiratory diseases and parents and adolescents underreport exposure to SHS, routine biochemical screening should be considered as a tool to reduce SHS exposure.
对烟草烟雾暴露进行常规生化评估可能会带来更有效的干预措施，以减少或预防青少年中与二手烟（SHS）相关的疾病。我们的目的是通过测量尿可替宁（主要尼古丁代谢物）来确定在一家城市公立医院接受门诊治疗的青少年中烟草烟雾暴露的患病率。
2013年至2014年期间，在扎克伯格旧金山总医院的儿科或急诊诊所，收集了466名青少年的剩余尿液，这些诊所服务于收入和教育水平较低的家庭。大多数是西班牙裔或非裔美国人。尿可替宁切点分别为0.05至0.25 ng/ml、0.25至30 ng/ml和30 ng/ml，用于将受试者分别分类为轻度二手烟或三手烟暴露者、二手烟或轻度/间歇性主动使用者以及主动烟草使用者。
在受试者中，87%暴露于烟草，包括12%主动吸烟、46%二手烟暴露和30%轻度暴露。与其他组（0.56 - 1.13 ng/ml）相比，非裔美国人中二手烟暴露组调整后的可替宁几何平均值显著更高（1.48 ng/ml）。
在一个吸烟率较低（12%）的城市中，在公立医院诊所就诊的青少年中，绝大多数（87%）暴露于烟草。这远高于使用血浆生物标志物的全国青少年流行病学研究报告的水平。由于二手烟与严重的呼吸系统疾病相关，且父母和青少年对二手烟暴露情况报告不足，应考虑将常规生化筛查作为减少二手烟暴露的一种工具。轻度暴露的临床意义需要进一步研究。
尿液生物标志物筛查发现，在城市公立医院接受治疗的青少年中，绝大多数（87%）暴露于烟草。由于二手烟与严重的呼吸系统疾病相关，且父母和青少年对二手烟暴露情况报告不足，应考虑将常规生化筛查作为减少二手烟暴露的一种工具。
