Abstract
Background
The objective was to assess the associations of child tobacco smoke exposure (TSE) biomarkers (urinary cotinine, NNAL, and nicotelline N-oxides) and parent-reported smoking and child TSE patterns with total hospital visits, pediatric emergency department (PED) visits, urgent care (UC), revisits, and hospital admissions among 0–9-year-olds.
Methods
A convenience sample of PED/UC patients (N = 242) who presented to a large, US children’s hospital who had baseline urine samples assayed for the TSE biomarkers of interest were included. Biomarker levels were log-transformed, and linear and Poisson regression models were built.
Results
The geometric means of child cotinine, creatinine-adjusted NNAL, and N-oxide levels were 11.2 ng/ml, 30.9 pg/mg creatinine, and 24.1 pg/ml, respectively. The mean (SD) number of daily cigarettes smoked by parents was 10.2 (6.1) cigarettes. Each one-unit increase in log-NNAL levels was associated with an increase in total UC visits (aRR = 1.68, 95% CI = 1.18–2.39) among 0–9-year-olds, while controlling for the covariates. Each one-unit increase in child log-NNAL/cotinine ratio (×103) values was associated with an increase in total hospital visits (aRR = 1.39, 95% CI = 1.10–1.75) and UC visits (aRR = 1.56, 95% CI = 1.14–2.13) over 6 months.
Conclusion
Systematic screening for child TSE should be conducted during all hospital visits. The comprehensive assessment of TSE biomarkers should be considered to objectively measure young children’s exposure.
Impact
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Higher levels of cotinine, a widely used tobacco smoke exposure biomarker, have been associated with higher healthcare utilization patterns among children.
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Less is known on the associations of carcinogenic and tobacco smoke-derived particulate matter biomarker uptake with child healthcare utilization patterns.
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This study assessed the associations of several biomarkers with healthcare utilization patterns among pediatric emergency department patients ages 0–9 years who lived with tobacco smokers.
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Higher urinary NNAL biomarker levels, in individual and ratio form with cotinine, increased children’s risk for urgent care visits over 6 months.
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Higher parent-reported cumulative child tobacco smoke exposure increased children’s risk for hospital admissions.
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All authors contributed to all three of the following criteria: (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published.
Funding
Funded by the National Institute on Drug Abuse (NIH Grant Number K01DA044313), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH Grant Number R01HD083354), and National Institute of Environmental Health Sciences (NIH Grant Numbers R01ES027815, R01ES030743, and R21ES032161). Instrumentation and other analytical chemistry laboratory resources for the urine analyses at UCSF were supported by the National Institutes of Health (P30DA012393 and S10RR026437).
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We obtained consent from parents for their child’s participation since our sample was 0-9-years of age.
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Merianos, A.L., Jandarov, R.A. & Mahabee-Gittens, E.M. Carcinogenic and tobacco smoke-derived particulate matter biomarker uptake and associated healthcare patterns among children. Pediatr Res 93, 143–153 (2023). https://doi.org/10.1038/s41390-022-02031-w
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DOI: https://doi.org/10.1038/s41390-022-02031-w
