RESEARCH PAPER
Medical staff contributions to thirdhand smoke contamination in a neonatal intensive care unit
 
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1
Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
2
Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
3
Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
4
Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
5
Division of Environmental Health, School of Public Health, San Diego State University, San Diego, United States
6
Center for Behavioral Epidemiology and Community Health, School of Public Health, San Diego State University, San Diego, United States
7
Department of Psychology, San Diego State University, San Diego, United States
CORRESPONDING AUTHOR
Thomas F. Northrup   

Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, 77030 Texas, United States
Publish date: 2019-04-24
 
Tob. Induc. Dis. 2019;17(April):37
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Non-smoking policies are strictly enforced in neonatal intensive care units (NICUs), which may still become contaminated by thirdhand smoke (THS), posing potential health risks to medically fragile infants. Study aims were to explore contamination routes by characterizing nicotine levels (THS proxy) found on the fingers of NICU medical staff and to assess finger-nicotine correlates.

Methods:
NICU medical staff were surveyed regarding smoking and electronic nicotine devices (ENDS) use/exposure, and household characteristics. Approximately 35% of staff were randomly selected for a finger-nicotine wipe. Three separate quantile regressions modeled percentiles associated with: presence of any finger nicotine, fingernicotine levels above the median field blank level (i.e. 0.377 ng/wipe), and finger-nicotine levels two times the median blank.

Results:
The final sample size was 246 (n=260 approached; n=14 refusals). Over three-quarters (78.5%) reported some exposure to tobacco smoke or ENDS vapor/aerosols. After field-blank adjustments, the median nicotine level (ng/finger wipe) was 0.232 (IQR: 0.021–0.681) and 78.3% of medical staff had measurable finger-nicotine levels. Both being near smoking in friends’/family members’ homes and finger-surface area were related to elevated finger-nicotine levels (p<0.05) in the median blank model.

Conclusions:
Almost four in five NICU staff had measurable finger nicotine, with finger surface area and frequency of reported exposure to tobacco smoke in friends’/family members’ homes emerging as important correlates. Future research will determine the impact of THS on NICU infants. Medical personnel working in a NICU should be cognizant of secondhand smoke and THS, particularly inside friends’/family members’ homes, to reduce potential NICU contamination and infant exposures.

ACKNOWLEDGEMENTS
The authors thank M Spellman, K Peters, J Harrison, A Leyva, O Oshinowo, O Akinwande, H Brotonel, Y Villarreal, and M Klawans for their help conducting the study. The authors thank N Dodder and L Chau for conducting the analyses of nicotine in the finger-nicotine wipes. In addition, the authors thank the staff of the Children’s Memorial Hermann Hospital.
CONFLICTS OF INTEREST
The authors declare that they have no competing interests, financial or otherwise, related to the current work. The authors TF Northrup, AL Stotts, R Suchting, AM Khan, C Green, E Hoh, MF Hovell, GE Matt, declare grants from various organizations detailed under Funding. PJE Quintana has also completed and submitted an ICMJE form for disclosure of potential conflicts of interest.
FUNDING
This work was supported by: the Eunice Kennedy Shriver National Institute of Child Health & Human Development (1R03HD088847; TF Northrup, PI) at the US National Institutes of Health and Department of Health and Human Services; in part by the National Heart, Lung, and Blood Institute (R01 HL107404, AL Stotts, PI; and R01 HL103684-02, MF Hovell, PI) at the US National Institutes of Health and Department of Health and Human Services; also supported by the California Tobacco-Related Disease Research Program (TRDRP1RT-0142; GE Matt, PI); and in part by the California Tobacco-Related Disease Research Program (TRDRP27IR-0019; GE Matt, PI) and the National Institute of Environmental Health Sciences (R01ES027815, MPI: EM Mahabee- Gittens & GE Matt).
AUTHORS' CONTRIBUTIONS
TFN conceptualized and oversaw the study, interpreted data-analytic results, and wrote the initial draft of the manuscript, in consultation with ALS. RS and CG provided statistical expertise and RS wrote relevant data-analytic and results sections of the manuscript. EH oversaw nicotine-wipe analyses and interpreted these results, in consultation with PJEQ, MFH, and GEM. ALS, RS, AMK, CG, PJEQ, EH, MFH, and GEM were co-investigators of the study and all authors provided edits and revisions on several drafts of the manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
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