RESEARCH PAPER
Passive smoking, as measured by hair nicotine, and severity of acute lower respiratory illnesses among children
WK Al-Delaimy 1
,  
J Crane 2
,  
 
 
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1
Department of Public health, Wellington School of Medicine, Wellington, New Zealand
2
Department of Medicine, Wellington School of Medicine, Wellington, New Zealand
CORRESPONDING AUTHOR
WK Al-Delaimy
Department of Public health, Wellington School of Medicine, Wellington, New Zealand
Publish date: 2002-03-15
 
Tobacco Induced Diseases 2002;1(March):27
KEYWORDS
ABSTRACT
The aim of this study was to describe the association between passive smoking and the severity of acute lower respiratory illnesses (ALRI) among 351 children aged 3-27 months admitted to hospital. A total of 297 children provided hair samples, which were analysed for hair nicotine levels as an indicator of passive smoking. A severity of illness grading system was developed by using clinical and management criteria used by the medical staff at hospital. The OR for children with more severe illness being exposed to higher nicotine levels was 1.2, 95% CI: 0.57-2.58 when using dichotomised respiratory severity levels and upper versus lower nicotine quartile levels. In an ordinal logistic regression model, the OR of more severe illness being associated with higher nicotine levels was 1.07 (95% CI: 0.92-1.25). When analysis was limited to the more severe cases, the OR of the least severe category compared to the most severe category, in relation to nicotine levels in hair, was 1.79 (95% CI: 0.5-6.30). The ordinal logistic regression of this group of severely-ill children (OR 1.1 (95% CI: 0.94-1.29) was not substantially different from the overall study subjects. Conclusion: In general, children with more severe illness tended to have higher levels of nicotine in their hair, although the results were within the limit of chance. Possible explanations of our results include environmental tobacco smoke (ETS) being an initiator of ALRI rather than a risk to severity, exposure levels of ETS were too low to demonstrate an effect on severity, or the power of this study was not high enough to detect an association.
 
REFERENCES (42)
1.
Jinot J, Bayard S. Respiratory health effects of exposure to environmental tobacco smoke. Reviews on Environmental Health 1996; 11: 89-100.
 
2.
Australian National Health and Medical Research Council. The effects of passive smoking: A scientific information paper. Canberra, National Health and medical Research Council, 1997.
 
3.
Bonham GS, Wilson RW. Children’s health in families with cigarette smokers. American Journal of Public Health 1981; 71:290-293.
 
4.
Kellner G, Popow-Kraupp T, Kundi M, Binder C, Wallner H, Kunz C. Contribution of rhinoviruses to respiratory viral infections in childhood: a prospective study in a mainly hospitalized infant population. Journal of Medical Virology 1988; 25: 455-469.
 
5.
Mannino DM, Siegel M, Husten C, Rose D, Etzel R. Environmental tobacco smoke exposure and health effects in children: results from the 1991 National Health Interview Survey. Tobacco Control 1996; 5: 13-18.
 
6.
Margolis PA, Keyes LL, Greenberg RA, Bauman KE, LaVange LM. Urinary cotinine and parent history (questionnaire) as indicators of passive smoking and predictors of lower respiratory illness in infants. Pediatric Pulmonology 1997; 23: 417-423.
 
7.
US Environmental Protection Agency: Respiratory health effects of passive smoking: Lung cancer and other disorders. Bethesda, Maryland, Environmental Protection Agency, 1993.
 
8.
Uematsu T, Mizuno A, Nagashima S, Oshima A, Nakamura M. The axial distribution of nicotine content along hair shaft as an indicator of changes in smoking behaviour: evaluation in a smoking-cessation programme with or without the aid of nicotine chewing gum. British Journal of Clinical Pharmacology 1995;39: 665-669.
 
9.
Al-Delaimy WK, Crane J, Woodward A. Questionnaire and hair measurement of exposure to tobacco smoke. Journal of Exposure Analysis and Environmental Epidemiology 2000; 10: 378-384.
 
10.
Al-Delaimy WK, Crane J, Woodward A. Is the hair nicotine level a more accurate biomarker of environmental tobacco smoke exposure than urine cotinine? Journal of Epidemiology and Community Health 2002; 56: 66-71.
 
11.
Zahlsen K & Nilsen OG. Nicotine in hair of smokers and non-smokers: sampling procedure and gas chromatographic/mass spectrometric analysis. Pharmacology and Toxicology 1994; 75: 143-149.
 
12.
Nafstad P, Botten G, Hagen JA, et al. Comparison of three methods for estimating environmental tobacco smoke exposure among children aged between 12 and 36 months. International Journal of Epidemioly1995; 24: 88-94.
 
13.
Fergusson DM, Horwood LJ, Shannon FT, Taylor B. Parental smoking and lower respiratory illness in the first three years of life. Journal of Epidemiology & Community Health 1981; 35: 180-184.
 
14.
Fergusson DM, Horwood LJ. Parental smoking and respiratory illnessduring early childhood: a six-year longitudinal study. Pediatric Pulmonology 1985; 1: 99-106.
 
15.
Wesley AG, Loening WE. Assessment and 2-year follow-up of some factors associated with severity of respiratory infections in early childhood. South African Medical Journal 1996; 86: 365-368.
 
16.
WHO: Proposal for the classification of acute respiratory infections and tuberculosis for the tenth revision of the international classification of diseases. Geneva, Switzerland, WHO, 1985.
 
17.
Margolis PA, Greenberg RA, Keyes LL, et al. Lower respiratory illness in infants and low socioeconomic status. American Journal of Public Health 1992; 82: 1119-1126.
 
18.
Murtagh P, Cerqueiro C, Halac A, Avila M, Salomon H, Weissenbacher M. Acute lower respiratory infection in Argentinian children: a 40 month clinical and epidemiological study. Pediatric Pulmonology 1993; 16: 1-8.
 
19.
Mahoney GN, Al-Delaimy WK. The Measurement of Nicotine in Hair by Reversed-Phase High Performance Liquid Chromatography with Electrochemical Detection. Journal of Chromatography- Biomedical Applications 2001; 753: 179-187.
 
20.
Salmond C, Crampton P, Sutton F. NZDep91: A New Zealand index of deprivation. Australian & New Zealand Journal of Public Health 1998; 22: 835-837.
 
21.
WHO. A programme for controlling acute respiratory infections in children: memorandum from WHO meeting. Bulletin WHO 1984; 62: 47-58.
 
22.
WHO: Programme for control of acute respiratory infections. Geneva, WHO, 1988.
 
23.
Henry RL, Robertson CF, Asher I, et al. Management of acute asthma. Respiratory Paediatricians of Australia and New Zealand. Journal of Paediatrics and Child Health 1993; 29: 101-103.
 
24.
Madico G, Gilman RH, Jabra A, et al. The role of pulse oximetry. Its use as an indicator of severe respiratory disease in Peruvian children living at sea level. Respiratory Group in Peru. Archives of Pediatrics & Adolescent Medicine 1995; 149: 1259-1263.
 
25.
Law BJ, Wang EE, MacDonald N, et al. Does ribavirin impact on the hospital course of children with respiratory syncytial virus (RSV) infection? An analysis using the pediatric investigators collaborative network on infections in Canada (PICNIC) RSV database. Pediatrics 1997; 99: E7.
 
26.
Dobson JV, Stephens-Groff SM, McMahon SR, Stemmler MM, Brallier SL, Bay C. The use of albuterol in hospitalized infants with bronchiolitis. Pediatrics 1998; 101: 361-368.
 
27.
Leventhal J. Clinical predictors of pneumonia as a guide to ordering check roentgenograms. Clinical Pediatrics 1982; 21: 730-734.
 
28.
Rothman K, Greenland S: Modern Epidemiology. Philadelphia, Lippncott-Raven, 1998.
 
29.
Rodriguez WJ, Gruber WC, Groothuis JR, et al. Respiratory syncytial virus immune globulin treatment of RSV lower respiratory tract infection in previously healthy children. Pediatrics 1997; 100: 937-942.
 
30.
Dawson KP, Mogridge N. Acute bronchiolitis: a three year study. New Zealand Medical Journal 1989; 102: 528-529.
 
31.
Reijonen T, Korppi M, Pitkakangas S, Tenhola S, Remes K. The clinical efficacy of nebulized racemic epinephrine and albuterol in acute bronchiolitis. Archives of Pediatrics & Adolescent Medicine 1995; 149: 686-692.
 
32.
Dawson-Saunders B, Trapp R: Basic and Clinical Biostatistics. Norwalk, Connecticut, Appleton & Lange, 1994.
 
33.
SAS II: SAS user’s guide: basics. Cary, North Carolina, 1985.
 
34.
Charlson M, Sax F, MacKenzie C, Fields S, Braham R, Douglas R. Assesing illness severity: does clinical judgment work? Journal of Chronic Diseases 1986; 39: 439-452.
 
35.
Brannen A, Godfrey L, Goetter W. Prediction of outcome from critical illness. A comparison of clinical judgment with a prediction rule. Archives of Internal Medicine 1989; 149: 1083-1086.
 
36.
Mulholland E, Simoes E, Costales M, McGrath E, Manalac E, Gove S. Standerised diagnosis of pneumonia in developing countries. Pediatric Infectious Disease Journal 1992; 11: 77-81.
 
37.
WHO. Guidelines for research on acute respiratory infections: memorandum from a WHO meeting. Bulletin of the World Health Organization 1982; 60: 521-533.
 
38.
Chen Y, Li WX, Yu SZ, Qian WH. Chang-Ning epidemiological study of children’s health: I: Passive smoking and children’s respiratory diseases. International Journal of Epidemiology 1988; 17: 348-355.
 
39.
Gergen PJ, Fowler JA, Maurer KR, Davis WW, Overpeck MD. The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months through 5 years of age in the United States: Third National Health and Nutrition Examination Survey, 1988 to 1994. Pediatrics 1998; 101: E8.
 
40.
Wright AL, Holberg C, Martinez FD, Taussig LM. Relationship of parental smoking to wheezing and nonwheezing lower respiratory tract illnesses in infancy. Group Health Medical Associates. Journal of Pediatrics 1991; 118: 207-214.
 
41.
Sun W, Wu R, Last J. Effects of exposure to environmental tobacco smoke on a human tracheobronchial epithelial cell line. Toxicology 1995; 100: 163-174.
 
42.
Yates DH, Havill K, Thompson MM, Rittano AB, Chu J, Glanville AR. Sidestream smoke inhalation decreases respiratory clearance of 99mTc-DTPA acutely. Australian & New Zealand Journal of Medicine 1996; 26: 513-518.
 
 
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