Association between early gestation passive smoke exposure and neonatal size among self-reported non-smoking women by race/ethnicity: A cohort study

Understanding implications of passive smoke exposure during pregnancy is an important public health issue under the Developmental Origins of Health and Disease paradigm. In a prospective cohort of low-risk non-smoking pregnant women (NICHD Fetal Growth Studies—Singletons, 2009–2013, N = 2055), the association between first trimester passive smoke exposure and neonatal size was assessed by race/ethnicity. Plasma biomarker concentrations (cotinine, nicotine) assessed passive smoke exposure. Neonatal anthropometric measures included weight, 8 non-skeletal, and 2 skeletal measures. Linear regression evaluated associations between continuous biomarker concentrations and neonatal anthropometric measures by race/ethnicity. Cotinine concentrations were low and the percent above limit of quantification varied by maternal race/ethnicity (10% Whites; 14% Asians; 15% Hispanics; 49% Blacks). The association between cotinine concentration and infant weight differed by race/ethnicity (Pinteraction = 0.034); compared to women of the same race/ethnicity, per 1 log-unit increase in cotinine, weight increased 48g (95%CI -44, 139) in White and 51g (95%CI -81, 183) in Hispanic women, but decreased -90g (95%CI -490, 309) in Asian and -93g (95%CI -151, -35) in Black women. Consistent racial/ethnic differences and patterns were found for associations between biomarker concentrations and multiple non-skeletal measures for White and Black women (Pinteraction<0.1). Among Black women, an inverse association between cotinine concentration and head circumference was observed (−0.20g; 95%CI −0.38, −0.02). Associations between plasma cotinine concentration and neonatal size differed by maternal race/ethnicity, with increasing concentrations associated with decreasing infant size among Black women, who had the greatest biomarker concentrations. Public health campaigns should advocate for reducing pregnancy exposure, particularly for vulnerable populations.

Characterization of urinary cotinine concentrations among non-smoking adults in smoking and smoke-free homes in the Korean national environmental health survey (KoNEHS) cycle 3 (2015–2017)

Background Although many indoor public places have implemented smoke-free regulations, private homes have remained sources of tobacco smoke pollutants. This study examined differences in urinary cotinine concentrations in the Korean non-smoking adult population between living in smoking and smoke-free homes, and the relationship of urinary cotinine concentrations with socio-demographic factors in smoke-free homes. Methods Samples from 2575 non-smoking adults (≥19 years old) in the Korean National Environmental Health Survey cycle 3 (2015–2017), a representative Korean study, were used. Smoking and smoke-free homes were defined based on whether there were smokers at homes. Weighted linear regression models were used to determine urinary cotinine concentrations and identify factors associated with urinary cotinine. Results The geometric mean of urinary cotinine concentrations for non-smoking adults living in smoking homes was 2.1 μg/L (95% confidence interval [CI] = 1.8–2.4), which was significantly higher than the mean of 1.3 μg/L (95% CI = 1.2–1.4) for those living in smoke-free homes. Urinary cotinine concentrations were different significantly by home smoking status in most socio-demographic subgroups. Data from smoke-free home showed urinary cotinine concentration in adults was significantly higher in those who lived in homes with ventilation duration < 30 min/day, those who spent more time indoors at home, those who spent less time outdoors, and those who worked in non-manual or manual occupations. Conclusions The urinary cotinine concentration in Korean non-smoking adults living in smoking homes was higher than that in adults living in smoke-free homes. Even in smoke-free homes, home-related factors, such as ventilation duration and time spent indoors, were associated with urinary cotinine concentration. Further study is warranted to examine potential sources of tobacco smoke pollution in smoke-free homes.

Preliminary Evidence for Cannabis and Nicotine Urinary Metabolites as Predictors of Verbal Memory Performance and Learning Among Young Adults

Objective:Verbal memory deficits are linked to cannabis use. However, self-reported episodic use does not allow for assessment of variance from other factors (e.g., cannabis potency, route of consumption) that are important for assessing brain-behavior relationships. Further, co-occurring nicotine use may moderate the influence of cannabis on cognition. Here we utilized objective urinary measurements to assess the relationship between metabolites of cannabis, 11-nor-9-carboxy-∆9-tetrahydrocannabinol (THCCOOH), and nicotine (cotinine) on verbal memory in young adults.Method:Adolescents and young adults (n = 103) aged 16–22 completed urinary drug testing and verbal memory assessment (RAVLT). Linear regressions examined the influence of THCCOOH and cotinine quantitative concentrations, and their interaction, on RAVLT scores, controlling for demographics and alcohol. Cannabis intake frequency was also investigated. Secondary analyses examined whether past month or recency of use related to performance, while controlling for THCCOOH and cotinine concentrations.Results:THCCOOH concentration related to both poorer total learning and long delay recall. Cotinine concentration related to poorer short delay recall. Higher frequency cannabis use status was associated with poorer initial learning and poorer short delay. When comparing to self-report, THCCOOH and cotinine concentrations were negatively related to learning and memory performance, while self-report was not.Conclusions:Results confirm the negative relationship between verbal memory and cannabis use, extending findings with objective urinary THCCOOH, and cotinine concentration measurements. No moderating relationship with nicotine was found, though cotinine concentration independently associated with negative short delay performance. Findings support the use of both urinary and self-report metrics as complementary methods in substance use research.

Thirdhand smoke exposure: Differences in smoke exposure indices and cultural norms between hotels and motels in South Korea

The legal regulations and cultural environment for smoking bans in hotels and motels in South Korea differ depending on the type of accommodation. The aim of this study was to assess the thirdhand smoke exposure for hotel and motel guests staying at accommodations who are expected to be relatively vulnerable to thirdhand smoke. Biomarkers for 28 participants were assessed before and after lodging at a hotel or motel for approximately 14 h. Hotel participants had statistically decreased urinary cotinine concentrations after their stay, whereas motel participants experienced increased concentrations. The concentration of nicotine-derived nitrosamine ketone in dust in hotels was lower than that in motels, and the higher dust nicotine-derived nitrosamine ketone concentration in motels had more effect on an increase in urinary cotinine concentration. Both hotels and motels legally allowed smoking in guest rooms. However, the study participants in hotels were less exposed to thirdhand smoke than those in motels.

Effect of parental smoking on their children’s urine cotinine level in Korea: A population-based study

Background Children may be exposed to tobacco products in multiple ways if their parents smoke. The risks of exposure to secondhand smoke (SHS) are well known. This study aimed to investigate the association between parental smoking and the children’s cotinine level in relation to restricting home smoking, in Korea. Methods Using the Korea National Health and Nutrition Health Examination Survey data from 2014 to 2017, we analyzed urine cotinine data of parents and their non-smoking children (n = 1,403), in whose homes parents prohibited smoking. We performed linear regression analysis by adjusting age, sex, house type, and household income to determine if parent smoking was related to the urine cotinine concentration of their children. In addition, analysis of covariance and Tukey’s post-hoc tests were performed according to parent smoking pattern. Finding Children’s urine cotinine concentrations were positively associated with those of their parents. Children of smoking parents had a significantly higher urine cotinine concentration than that in the group where both parents are non-smokers (diff = 0.933, P < .0001); mothers-only smoker group (diff = 0.511, P = 0.042); and fathers-only smoker group (diff = 0.712, P < .0001). In the fathers-only smoker group, the urine cotinine concentration was significantly higher than that in the group where both parents were non-smoker (diff = 0.221, P < .0001), but not significantly different compared to the mothers-only smoker group (diff = - -0.201, P = 0.388). Children living in apartments were more likely to be exposed to smoking substances. Conclusion This study showed a correlation between parents’ and children’s urine cotinine concentrations, supporting the occurrence of home smoking exposure due to the parents’ smoking habit in Korea. Although avoiding indoor home smoking can decrease the children’s exposure to tobacco, there is a need to identify other ways of smoking exposure and ensure appropriate monitoring and enforcement of banning smoking in the home.

Characterization of Urinary Cotinine Concentrations Among Non-smoking Adults in Smoking and Smoke-free Homes in the Korean National Environmental Health Survey (KoNEHS) Cycle 3 (2015–2017)

Background: Although many indoor public places have implemented smoke-free regulations, private homes have remained sources of tobacco smoke pollutants. The purpose of this study was to determine urinary cotinine concentrations in the Korean non-smoking adult population who lived in smoking and smoke-free homes, and to examine the relationship of urinary cotinine concentrations with socio-demographic factors. Methods: Samples from 2575 non-smoking adults (≥19 years old) in the Korean National Environmental Health Survey Cycle 3 (2015–2017), a representative Korean study, were used. Smoking and smoke-free homes were defined based on whether there were smokers at homes. Weighted linear regression models were used to determine urinary cotinine concentrations and identify factors associated with urinary cotinine. Results: The geometric mean of urinary cotinine concentrations for non-smoking adults living in smoking homes was 2.4 μg/g creatinine (Cr; 95% confidence interval [CI] = 2.1–2.7), which was significantly higher than the mean of 1.4 μg/g Cr (95% CI = 1.3–1.6) for those living in smoke-free homes. In adults living in smoking homes, the urinary cotinine concentration was only associated with job classification. In adults living in smoke-free homes, several factors were associated with urinary cotinine concentration. Urinary cotinine concentration in adults living in smoke-free homes was significantly higher in those who lived in homes with ventilation duration <30 min/day, those who spent more time indoors at home, those who spent less time outdoors, and those who worked in non-manual occupations.Conclusions: The urinary cotinine concentration in Korean non-smoking adults living in smoking homes was higher than that in adults living in smoke-free homes. Even in smoke-free homes, home-related factors, such as ventilation duration and time spent indoors, were associated with urinary cotinine concentration. Further study is warranted to examine potential sources of tobacco smoke pollution in smoke-free homes.

Evaluating the Psychometric Properties of the Severson 7-item Smokeless Tobacco Dependence Scale (SSTDS)

Introduction The objective of the study was to assess the psychometric properties of the Severson 7-item Smokeless Tobacco Dependence Scale (SSTDS). Methods Data from 95 male exclusive smokeless tobacco users were obtained through a self-administered mail survey to evaluate the reliability and validity of the SSTDS. Reliability of the scale was assessed by measures of internal consistency including, Cronbach’s coefficient alpha and item-total correlation. Other ST dependence scales and salivary cotinine concentration were used to evaluate concurrent validity. Structure model of the scale was ascertained by exploratory factor analysis. Overall accuracy and optimal cutoff score were obtained to evaluate SSTDS as a screening tool for ST dependence Results The SSTDS had high reliability as assessed by the internal consistency coefficient (ordinal α=0.83). SSTDS total score was significantly correlated with Fagerström Test for Nicotine Dependence for ST users - FTND-ST (r=0.42) and modified Tobacco Dependence Screener - TDS (r=0.58). Exploratory factor analysis of the SSTDS identified two underlying factors measuring distinct dimensions of dependence. With reference to TDS based dependence diagnosis, SSTDS demonstrated good diagnostic accuracy (AUC=0.82, 95%CI: 0.74–0.90). Salivary cotinine concentration was not associated with the total score of the SSTDS; however, at an optimal cutoff score of SSTDS &gt;9, everyday ST users classified as dependent had significantly higher cotinine concentration. Conclusions SSTDS is a reliable measure of dependence that has higher concurrent validity and reliability as compared to other commonly used smokeless tobacco (ST) dependence scales. Further research is needed using a larger and more diverse sample of ST users to unequivocally establish the validity of the scale. Implications Smokeless tobacco dependence has multiple aspects that can be best studied by multidimensional dependence scales. The study findings validate that the SSTDS measures not only the physical dependence but also the behavioral and psychological dimensions of dependence. Good psychometric properties, diagnostic accuracy, and multidimensional structure of SSTDS indicate that it may serve as an effective tool in assessing ST dependence in clinical and research settings.

Identifying the best questions for rapid screening of secondhand smoke exposure among children

Introduction Many children suffer from secondhand smoke exposure (SHSe), which leads to a variety of negative health consequences. However, there is no consensus on how clinicians can best query parents for possible SHSe among children. We employed a data-driven approach to create an efficient screening tool for clinicians to quickly and correctly identify children at risk for SHSe. Methods Survey data from mothers and biospecimens from children were ascertained from the Neurodevelopment and Improving Children’s Health following Environmental Tobacco Smoke Exposure (NICHES) study. Included were mothers and their children whose saliva were assayed for cotinine (n = 351 pairs, mean child age = 5.6 years). Elastic net regression predicting SHSe, as indicated from cotinine concentration, was conducted on available smoking-related questions and cross-validated with 2015-2016 National Health and Nutrition Examination Survey (NHANES) data to select the most predictive items of SHSe among children (n = 1,670, mean child age = 8.4 years). Results Answering positively to at least one of the two final items (“During the past 30 days, did you smoke cigarettes at all?” and “Has anyone, including yourself, smoked tobacco in your home in the past 7 days?”) showed AUC = .82, and good specificity (.88) and sensitivity (.74). These results were validated with similar items in the nationally-representative NHANES sample, AUC = .82, specificity = .78, and sensitivity = .77. Conclusions Our data-driven approach identified and validated two items that may be useful as a screening tool for a speedy and accurate assessment of SHSe among children. Implications The current study used a rigorous data-driven approach to identify questions that could reliably predict secondhand smoking exposure (SHS) among children.Using saliva cotinine concentration levels as a gold standard for determining SHS exposure, our analysis employing elastic net regression identified two questions that served as good classifier for distinguishing children who might be at risk for SHS exposure. The two items that we validated in the current study can be readily used by clinicians, such as pediatricians, as part of screening procedures to quickly identify whether children might be at risk for secondhand smoking exposure.

Comparison of Salivary Cotinine Levels of Neonates Born to Mothers Exposed to Varying Degrees of Passive Cigarette Smoke

Introduction: Obstetrical data reveals that fetuses born to mothers who are exposed to passive smoking show adverse health outcomes. Aims & Objectives: To compare the cotinine levels in neonates born to mothers exposed to varying degrees of passive cigarette smoke versus the control group i.e., mothers who are not exposed to smoking. Place and duration of study: This study was conducted in Obstetrics and Gynecology department of Shaikh Zayed Hospital, Lahore and in emergency Labor Room of Ganga Ram hospital, Lahore from December 2015 to May 2016. Material & Methods: This was a cross-sectional comparative study in which neonatal salivary cotinine level were measured and its relationship with birth weight was observed in 120 subjects, divided in four groups: .i) neonates whose mothers were not-exposed to smoke, neonates whose mothers were exposed to, ii) 1-5 cigarette, iii) 6-10 cigarettes and iv) more than 10 cigarettes per day. Results: Salivary cotinine levels were raised in all four groups with maximum levels seen in group four but there was no statistical difference between groups. Changes in the birth weight were also seen with increased exposure to passive smoking. Conclusion: Salivary cotinine concentration in neonates increases due to passive exposure to cigarette smoke in mothers because of disregard of smokers to the adverse effects of nicotine inside homes and almost no governmental enforcement of laws regarding cigarette smoking in public spaces.