School of Human Services, University of Cincinnati, Cincinnati, OH, USA.
Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
Nicotine Tob Res. 2023 Apr 6;25(5):1004-1013. doi: 10.1093/ntr/ntac293.
We assessed tobacco smoke exposure (TSE) levels based on private and public locations of TSE according to race and ethnicity among US school-aged children ages 6-11 years and adolescents ages 12-17 years.
Data were from 5296 children and adolescents who participated in the National Health and Nutrition Examination Survey (NHANES) 2013-2018. Racial and ethnic groups were non-Hispanic white, black, other or multiracial, and Hispanic. NHANES assessed serum cotinine and the following TSE locations: homes and whether smokers did not smoke indoors (home thirdhand smoke [THS] exposure proxy) or smoked indoors (secondhand [SHS] and THS exposure proxy), cars, in other homes, restaurants, or any other indoor area. We used stratified weighted linear regression models by racial and ethnic groups and assessed the variance in cotinine levels explained by each location within each age group.
Among 6-11-year-olds, exposure to home THS only and home SHS + THS predicted higher log-cotinine among all racial and ethnic groups. Non-Hispanic white children exposed to car TSE had higher log-cotinine (β = 1.64, 95% confidence interval [CI] = 0.91% to 2.37%) compared to those unexposed. Non-Hispanic other/multiracial children exposed to restaurant TSE had higher log-cotinine (β = 1.13, 95% CI = 0.23% to 2.03%) compared to those unexposed. Among 12-17-year-olds, home SHS + THS exposure predicted higher log-cotinine among all racial and ethnic groups, except for non-Hispanic black adolescents. Car TSE predicted higher log-cotinine among all racial and ethnic groups. Non-Hispanic black adolescents with TSE in another indoor area had higher log-cotinine (β = 2.84, 95% CI = 0.85% to 4.83%) compared to those unexposed.
TSE location was uniquely associated with cotinine levels by race and ethnicity. Smoke-free home and car legislation are needed to reduce TSE among children and adolescents of all racial and ethnic backgrounds.
Racial and ethnic disparities in TSE trends have remained stable among US children and adolescents over time. This study's results indicate that TSE locations differentially contribute to biochemically measured TSE within racial and ethnic groups. Home TSE significantly contributed to cotinine levels among school-aged children 6-11 years old, and car TSE significantly contributed to cotinine levels among adolescents 12-17 years old. Racial and ethnic differences in locations of TSE were observed among each age group. Study findings provide unique insight into TSE sources, and indicate that home and car smoke-free legislation have great potential to reduce TSE among youth of all racial and ethnic backgrounds.
我们根据种族和民族评估了美国 6-11 岁学龄儿童和 12-17 岁青少年的私人和公共吸烟环境（TSE）暴露水平。
数据来自参加 2013-2018 年全国健康和营养检查调查（NHANES）的 5296 名儿童和青少年。种族和民族群体是非西班牙裔白人、黑人、其他或多种族裔以及西班牙裔。NHANES 评估了血清可替宁和以下 TSE 地点：家庭以及吸烟者是否在室内不吸烟（家庭三手烟[THS]暴露替代物）或在室内吸烟（二手烟[SHS]和 THS 暴露替代物）、汽车、其他家庭、餐馆或任何其他室内区域。我们按种族和民族群体使用分层加权线性回归模型，并评估了每个年龄组内每个地点对可替宁水平的解释差异。
在 6-11 岁儿童中，仅家庭 THS 和家庭 SHS+THS 暴露预测所有种族和民族群体的 log-可替宁水平更高。与未暴露的儿童相比，暴露于汽车 TSE 的非西班牙裔白人儿童的 log-可替宁水平更高（β=1.64，95%置信区间[CI]为 0.91%至 2.37%）。与未暴露的儿童相比，暴露于餐馆 TSE 的非西班牙裔其他/多种族裔儿童的 log-可替宁水平更高（β=1.13，95%CI 为 0.23%至 2.03%）。在 12-17 岁青少年中，家庭 SHS+THS 暴露预测所有种族和民族群体的 log-可替宁水平更高，但非西班牙裔黑人青少年除外。汽车 TSE 预测所有种族和民族群体的 log-可替宁水平更高。在另一个室内区域有 TSE 的非西班牙裔黑人青少年的 log-可替宁水平更高（β=2.84，95%CI 为 0.85%至 4.83%）。
TSE 地点通过种族和民族与可替宁水平具有独特的相关性。需要制定家庭和汽车无烟立法，以减少所有种族和民族背景的儿童和青少年的 TSE。
美国儿童和青少年的 TSE 趋势的种族和民族差异一直保持稳定。本研究结果表明，TSE 地点在种族和民族群体内部对生物化学测量的 TSE 有不同的贡献。家庭 TSE 显著影响 6-11 岁学龄儿童的可替宁水平，而汽车 TSE 显著影响 12-17 岁青少年的可替宁水平。在每个年龄组中都观察到 TSE 地点的种族和民族差异。研究结果提供了 TSE 来源的独特见解，并表明家庭和汽车无烟立法有很大潜力减少所有种族和民族背景的青少年的 TSE。
