Carcinogenic and tobacco smoke-derived particulate matter biomarker uptake and associated healthcare patterns among children

• Published in: Pediatric research 2023-01, Vol.93 (1), p.143-153
• Main Authors: Merianos, Ashley L., Jandarov, Roman A., Mahabee-Gittens, E. Melinda
• Format: Article
• Language: English
• Subjects: Biomarkers; Biomarkers - urine; Carcinogens; Child; Child, Preschool; Children & youth; Clinical Research Article; Cotinine; Creatinine; Creatinine - urine; Delivery of Health Care; Emergency medical care; Health services utilization; Humans; Infant; Infant, Newborn; Medicine; Medicine & Public Health; Nitrosamines - urine; Particulate Matter; Patient admissions; Pediatric Surgery; Pediatrics; Tobacco Products; Tobacco smoke; Tobacco Smoke Pollution - adverse effects
• ISSN: 0031-3998; 1530-0447; 1530-0447
• DOI: 10.1038/s41390-022-02031-w

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 (×10 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. Impact Higher levels of cotinine, a widely used tobacco smoke exposure biomarker, have been associated with higher healthcare utilization patterns among children. Less is known on the associations of carcinogenic and tobacco smoke-derived particulate matter biomarker uptake with child healthcare utilization patterns. 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. Higher urinary NNAL biomarker levels, in individual and ratio form with cotinine, increased children’s risk for urgent care visits over 6 months. Higher parent-reported cumulative child tobacco smoke exposure increased children’s risk for hospital admissions.