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)