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, 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 < 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 children at age 3 years Immunity and Health of Children Ministry of Environmental Protection, Czech republic M.Dostál June children at age 4.5 years Early Childhood Effects of Air Pollution Health Effects Institute, Boston, MA, USA I.Hertz-Picciotto F.Kotěšovec, J.Nožička, 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 June 1998, at 4.5 years)
6 Counts of mothers who smoke maternal report, N=966
7 Counts of fathers who smoke maternal report, N=921
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 -80 o C 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 N=523, cotinine cut off value 500 ng/mg creatinine Yes Questionnaire No 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 > 500 ng/mg creatinine Only 5.6% of 178 children from families without any smoker had cotinine >35 ng/mg creatinine Almost 32% of all children had cotinine >35 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 > 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 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 June 1998, at 4.5 years)