Chest
Volume 109, Issue 2, February 1996, Pages 446-450
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Clinical Investigations: Smoking
Passive Smoking in Children: Racial Differences in Systemic Exposure to Cotinine by Hair and Urine Analysis

https://doi.org/10.1378/chest.109.2.446Get rights and content

Passive smoking has been shown to adversely affect the health of infants and children. Black children and adults appear to be more susceptible to a variety of tobacco smoke health hazards for unknown reason. The objectives of this study were as follows: (1) to correlate the number of cigarettes reported to have been smoked by parents with urine and hair concentrations of cotinine in children; and (2) to identify race differences in systemic exposure to cotinine in children. This was an observational study in a consulting pediatric office on 169 nonsmoking children between 2 and 18 years of age, not actively smoking. The outcome measures of interest were urinary cotinine concentrations corrected for milligram of creatinine and hair concentration of cotinine (per milligram of hair). There were significant correlations between the number of cigarettes the child was exposed to and urinary cotinine (r=0.68, p=0.0001) or hair cotinine concentrations (r=0.19, p=0.02), and between urinary and hair cotinine (r=0.3, p=0.0005). In this cohort, parents of black children (n=21) tended to smoke less (6.6 ± 3/d, mean±SEM) than white parents (n=97) (12 ± 1.8, mean ± SEM) (p=0.2). Despite being exposed to less cigarettes, black children had higher hair concentrations of cotinine than white children (0.89 ± 0.25 ng/mg vs 0.48 ± 0.05 ng/mg; p=0.05). The ratio hair/urine concentrations of cotinine was twofold higher in black children (0.035±0.01 vs 0.019 ± 0.002; p=0.004). White children with dark hair did not differ significantly from white children with fair hair in any of these indexes. The amount of urinary cotinine per milligram of creatinine caused by 1 cigarette per day was twofold higher in black children (14.7 ± 5.2 ng/mg of creatinine) than in white children (6.3 ± 1.2 ng/mg of creatinine) (p=0.02). These data suggest that black children handle cigarette smoke differently from white children and that black children have higher systemic exposure to this constituent of cigarette smoke.

Section snippets

Subjects

Pediatric patients between the ages of 2 and 18 years attending a consulting pediatric office in Toronto were recruited between July 25 and September 24, 1993. A written consent was obtained from parents of all children younger than 16 years of age and from children older than this age. Assent was signed by all children between 7 and 16 years of age. The study protocol was approved by the Research Ethics Committees of the Toronto Hospital for Sick Children and York Finch General Hospital.

Data Collection

RESULTS

A total of 172 parent-child pairs consented to participate. An additional four parents and one adolescent refused to participate. Four of the consenting children were excluded because they reported in the questionnaire to have smoked actively. Three additional cases were excluded because the questionnaire was not returned and one because the parent was unable to estimate the amount of exposure to smoke. There were 112 (70%) whites, 24 (15%) blacks (West Indians), and 24 (15%) East Indians. A

DISCUSSION

Our study reveals significant correlations between the daily number of cigarettes reported to have been smoked by the parents and the child's concentration of cotinine in either urine or hair. Yet, each of those three measures reflects different characteristics of passive smoking: the number of cigarettes reflects air concentrations of environmental tobacco smoke. Our analysis reveals that the cumulative number of family members who smoke correlates with urine cotinine accumulation, with the

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    Supported by a Start Up Grant, the Research Institute, the Hospital for Sick Children, and by the Medical Research Council of Canada.

    Dr Koren is a Career Scientist of the Ontario Ministry of Health.

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