David M Mannino, MD(*); Ralph Caraballo, PhD; Neal Benowitz, MD and James Repace, MS. Centers for Disease Control, Atlanta, GA; University of California at San Francisco, San Francisco, CA and Repace and Associates, Bowie, MA.
PURPOSE: We sought to determine what factors predict cotinine levels among children in the U.S.
METHODS: We analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative cross-sectional survey including questionnaire information and measurements of serum cotinine (a metabolite of nicotine) of 5,672 children, representing an estimated 37.7 million U.S. children. We stratified the children into those with environmental tobacco smoke (ETS) at home and those without this exposure We used regression models to predict the log of the cotinine level of the participants with the following independent covariates: age, race/ethnicity (white, black, Mexican-American, and other), number of rooms in the home (6 or more or 5 or fewer), sex, socioeconomic status, region of the country (Northeast, Midwest, South, and West), anti, among children with ETS exposure, the number of cigarettes smoked in the home.
RESULTS: 85% of the children in this survey had cotinine detectable in their blood. Children exposed to ETS had a mean cotinine level of 1.70 ng/mL and children not exposed to ETS had a mean level of 0.36 ng/mL. Among children with no ETS exposure, significant predictors of cotinine levels included race, age, number of rooms in the home, and SES. Among children with ETS exposure these same factors along with the number of cigarettes smoked in the home, were predictors of serum cotinine ew? s. Mexican-American children had lower mean cotinine levels, whereas black children had higher cotinine levels (p [is less than] 0.05 for each). Among children with reported ETS exposure, the strongest predictors of a high cotinine level were number of cigarettes smoked daily (p [is less than] 0.001) and age of the child, with the highest levels being in the youngest children (p [is less than] 0.001). Among children without reported ETS exposure, older children tended to have higher cotinine levels (p [is less than] 0.05).
CONCLUSION: Elevated cotinine levels are detectable in children either with or without known ETS exposures. Our data suggest that efforts by parents or other adults to not smoke in the house may result in exposures and lower cotinine levels. Conversely, even children with no reported exposures at home have detecable serum cotinines, suggesting significant exposures from sources outside of the home.
CLINICAL IMPLICATIONS: Physicians should advise their patients that children should not be exposed to ETS.
COPYRIGHT 2000 American College of Chest Physicians
COPYRIGHT 2001 Gale Group
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