Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
School of Human Services, University of Cincinnati, Cincinnati, OH, USA.
Environ Res. 2021 Nov;202:111722. doi: 10.1016/j.envres.2021.111722. Epub 2021 Jul 21.
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.
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.
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.
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.
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.
儿童整体烟草烟雾暴露（TSE）包括二手烟（SHS）吸入、摄取、皮肤吸收以及环境中灰尘和表面的三手烟（THS）残留的吸入。
我们的目标是比较尿可替宁作为近期整体 TSE 生物标志物和手上尼古丁作为儿童接触环境中尼古丁污染的标志物的不同作用。我们探讨了这些标志物与社会人口统计学、父母吸烟、儿童 TSE 和临床诊断的差异关联。
从与吸烟者同住的 276 名儿科急诊患者（中位年龄为 4.0 岁）中收集数据。使用 LC-MS/MS 测定儿童手上的尼古丁和尿液中的可替宁水平。父母报告烟草使用和儿童 TSE。审查病历以评估出院诊断。
所有儿童的手上都可检测到尼古丁（GeoM=89.7ng/拭子；95%CI=[78.9; 102.0]）和尿液中的可替宁（GeoM=10.4ng/ml；95%CI=[8.5; 12.6]）。尽管手上的尼古丁和尿液中的可替宁高度相关（r=0.62，p<0.001），但种族群体之间的尿液可替宁几何平均值存在差异，且家庭收入较低的儿童的尿液可替宁几何平均值较高（p<0.05），这与手上的尼古丁不同。独立于尿液可替宁，年龄、种族和民族，手上尼古丁水平较高的儿童患病毒性/其他传染病（aOR=7.49；95%CI=[2.06; 27.24]，p=0.002）、肺部疾病（aOR=6.56；95%CI=[1.76; 24.43]，p=0.005）和细菌感染（aOR=5.45；95%CI=[1.50; 19.85]，p=0.03）的风险增加。相比之下，尿液可替宁水平与儿童手部尼古丁水平和人口统计学无关，与诊断无关联。
手上尼古丁和尿液可替宁的不同关联表明，这两种标志物反映了不同的暴露特征，这些特征对儿科疾病的发生有不同的贡献。由于儿童环境中的 THS 直接导致手上的尼古丁，因此需要对吸烟者和不吸烟者的儿童进行更多研究，以确定手上尼古丁作为 THS 暴露标志物的作用及其在烟草相关儿科疾病发展中的潜在作用。
