ETS exposure of children

1
ETS exposure of children

• Respiratory diseases
• wheezing
• diminished pulmonary functions
• asthma bronchiale
• chronic bronchitis
• pneumonia
• middle ear infections
• Carcinogenic PAH adducts cancer?

2
Preliminary monofactorial analyses

• Frequency of smokers
• Discrepancies between the questionnaire data and
  urinary cotinine levels in mothers
• ETS exposure of children (urinary cotinine)

3
Pregnancy Outcome - Programm Teplice J.Dejmek,
S.Selevan, and many others, 1994-1999

• Effects of air pollution and life style on
  pregnancy outcome in districts Teplice and
  Prachatice (CR)
• Data obtained by questionnaires and by assaying
  of biomarkers in the placenta and in venous
  maternal and umbilical blood at birth
• Reproductive risk indicated by birth weight lt
  2500 g, and gestation shorter that 37 weeks
• Blood sampled from each delivery of a newborn at
  risk and from
• a fraction of consecutive control deliveries

4
Health of Children Pregnancy Outcome cohort

• 1994 -1996 - 452 children at age 3 years
• Immunity and Health of Children
• Ministry of Environmental Protection, Czech
  republic
• M.Dostál
• 1997- June 1998 - 523 children at age 4.5 years
• Early Childhood Effects of Air Pollution
• Health Effects Institute, Boston, MA, USA
• I.Hertz-Picciotto
• F.Kotešovec, J.Nožicka, R.Šrám, B.Binková,
  A.Milcová,
• R.James, P.Ituarte, J. Koller
• Pediatricians and nurses

5
Smoking

• 1. Maternal questionnaire at 3 or 4.5 years
• (smokers in the family)
• 5. Urinary cotinine mothers and children
  
• (cohort born 1997- June 1998, at 4.5
  years)

6
Counts of mothers who smokematernal report, N966
7
Counts of fathers who smoke maternal report,
N921
8
Smokers in household
9
Cotinine assay

• Urine samples were delivered by mothers to the
  pediatric offices
• Frozen samples were transported to Prague and
  kept at
• -80oC until analysis
• Cotinine radioimmunoassay kit of Dr. Yunakis,
  Brandeis University, Massachusetts, was used
• (Langone and Yunakis Methods in Enzymology,
  Vol. 84, 1982)
• Cotinine expressed in nanograms per milligram of
  creatinine

10
Urinary cotinine levels - mothers
11
Mothers Q-C discrepancies N523, cotinine cut
off value 500 ng/mg creatinine
Yes Questionnaire No 184 339 No Cotinine Yes 11 (6 ) 26 (7.7 )
12
Urinary cotinine - children
13
Urinary cotinine - children
14
Children - sources of variance

• Mother employed
• Mother smoking outdoors
• Number of cigarettes smoked
• Season, day and time of urine collection
• Housing number of rooms, ventilation
• Pharmacokinetic predisposition (low clearence)
• Ethnicity

15
Conclusions

• 35.5 of mothers and 49 of fathers admitted
  smoking
• There were 57.8 of households with at least one
  smoker
• 7.7 of mothers who said they were nonsmokers
  had urinary cotinine gt 500 ng/mg creatinine
• Only 5.6 of 178 children from families without
  any smoker
• had cotinine gt35 ng/mg creatinine
• Almost 32 of all children had cotinine gt35 ng/mg
  creatinine
• (ETS exposure)
• There were more smokers in Teplice than in
  Prachatice
• Twice as much children () in Teplice than in
  Prachatice
• were probably exposed to ETS (40 versus 20)

16
Urinary cotinine - children
17
Urinary cotininine of children mothers
nonsmokers with urinary cotinine gt 500 ng/mg
creatinine
18
Howel et al. Tob Control 2000, 9(Suppl
3)iii21-28

• 5 studies found significant associations between
  reported quantitative exposure of children to ETS
  and either environmental nicotine or urine
  cotinine assays.
• Coefficients for cotinine ranged from 0.28 to
  0.71.
• The half life of cotinine si substantially longer
  for infants and young children than adults

19
Health of children

• 1. Maternal questionnaires (pregnancy)
• 2. Medical questionnaires (delivery)
• 3. Immunoglobulins levels and lymphocyte
  phenotypes
• 4. Maternal questionnaires at 3 or 4.5 years
• 5. Pediatric questionnaires morbidity
• 6. Urinary cotinine (mothers, children)
• (cohort born 1997- June 1998, at 4.5
  years)