1. 1 ETS exposure of children  Respiratory diseases wheezing diminished pulmonary functions asthma bronchiale chronic bronchitis pneumonia  middle ear infections  Carcinogenic PAH adducts – cancer?

2. 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. 3 Pregnancy Outcome - Programm Teplice J.Dejmek, S.Selevan, and many others, 1994-1999  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. 4 Health of Children – Pregnancy Outcome cohort  1994 -1996 - 452 children at age 3 years Immunity and Health of Children Ministry of Environmental Protection, Czech republic M.Dostál  1997- June 1998 - 523 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. 5 Smoking  1. Maternal questionnaire at 3 or 4.5 years (smokers in the family)  5. Urinary cotinine – mothers and children (cohort born 1997- June 1998, at 4.5 years)

6. 6 Counts of mothers who smoke maternal report, N=966

7. 7 Counts of fathers who smoke maternal report, N=921

8. 8 Smokers in household

9. 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. 10 Urinary cotinine levels - mothers

11. 11 Mothers – Q-C discrepancies N=523, cotinine cut off value 500 ng/mg creatinine Yes Questionnaire No 184 339 No Cotinine Yes 11 (6 %) 26 (7.7 %)

12. 12 Urinary cotinine - children

13. 13 Urinary cotinine - children

14. 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. 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. 16 Urinary cotinine - children

17. 17 Urinary cotininine of children – mothers nonsmokers with urinary cotinine > 500 ng/mg creatinine

18. 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 0.71.  The half life of cotinine si substantially longer for infants and young children than adults

19. 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 1997- June 1998, at 4.5 years)