Anne Joseph1, Logan Spector, Katherine Wickham, Gregory Janis, Jonathan Winickoff, Bruce Lindgren, Sharon Murphy. 1. Anne Joseph is with the Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis. Logan Spector is with the Department of Pediatrics, Masonic Cancer Center, University of Minnesota. Katherine Wickham is with the Masonic Cancer Center, University of Minnesota. Gregory Janis is with MEDTOX Laboratories, St. Paul, MN. Jonathan Winickoff is with the Center for Child and Adolescent Health Research and Policy and the Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston. Bruce Lindgren is with the Biostatistics and Bioinformatics Core, University of Minnesota. Sharon Murphy is with the Department of Biochemistry, Molecular Biology and BioPhysics, Masonic Cancer Center, University of Minnesota.
Abstract
OBJECTIVES: We assessed tobacco smoke exposure (TSE), defined according to detection of cotinine, in dried blood spots collected from children for lead screening. METHODS: Dried blood spots collected from a national sample of 1541 Black and White children and submitted to a commercial laboratory for lead analysis were analyzed for cotinine. We used an anonymous administrative data set including information on children's characteristics to conduct univariate and multivariate analyses. RESULTS: Cotinine was detected in 61% of dried blood spots; 17% of samples had cotinine levels above 3 nanograms per gram. Median cotinine levels were significantly higher among Black than White children (0.66 ng/g vs 0.30 ng/g) and among Medicaid recipients (0.94 ng/g vs < 0.3 ng/g). In multivariate analyses, significant increases in cotinine levels were associated with Black (vs White) race, older age, Medicaid coverage, higher state smoking rate, and higher average winter temperature. Detectable cotinine levels were significantly associated with higher lead levels. CONCLUSIONS: TSE is highly prevalent among children undergoing lead screening, and exposure levels are greater among Black children and children on Medicaid. TSE may contribute to lead exposure. Concurrent lead screening and biological screening for TSE may be a feasible approach to increasing childhood TSE detection.
OBJECTIVES: We assessed tobacco smoke exposure (TSE), defined according to detection of cotinine, in dried blood spots collected from children for lead screening. METHODS: Dried blood spots collected from a national sample of 1541 Black and White children and submitted to a commercial laboratory for lead analysis were analyzed for cotinine. We used an anonymous administrative data set including information on children's characteristics to conduct univariate and multivariate analyses. RESULTS:Cotinine was detected in 61% of dried blood spots; 17% of samples had cotinine levels above 3 nanograms per gram. Median cotinine levels were significantly higher among Black than White children (0.66 ng/g vs 0.30 ng/g) and among Medicaid recipients (0.94 ng/g vs < 0.3 ng/g). In multivariate analyses, significant increases in cotinine levels were associated with Black (vs White) race, older age, Medicaid coverage, higher state smoking rate, and higher average winter temperature. Detectable cotinine levels were significantly associated with higher lead levels. CONCLUSIONS: TSE is highly prevalent among children undergoing lead screening, and exposure levels are greater among Black children and children on Medicaid. TSE may contribute to lead exposure. Concurrent lead screening and biological screening for TSE may be a feasible approach to increasing childhood TSE detection.
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