Carcinogenic and Tobacco Smoke-Derived Particulate Matter Biomarker Uptake and Associated Healthcare Patterns among Children

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, U.S. 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 11.2ng/ml, 30.9pg/mg creatinine, and 24.1pg/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 (x10(3)) 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.