Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Determinants of serum cotinine and hair cotinine as biomarkers of childhood secondhand smoke exposure

A Corrigendum to this article was published on 20 October 2010

Abstract

Understanding the determinants of childhood secondhand smoke (SHS) exposure is important in measuring and preventing exposure to this widespread environmental contaminant. We evaluated the ability of a broad set of factors to explain variability in serum cotinine, reflecting recent exposure, and hair cotinine, reflecting longer-term exposure. We included repeated measures from 223 elementary-school-age asthmatic children residing with a smoker. We used a manual model-building approach and likelihood ratio tests to select a model predicting each biomarker, and also compared the predictive ability of determinants using Akaike Information Criteria. Potential determinants included a comprehensive parent questionnaire, household nicotine, home ventilation characteristics, exposure in vehicles and others’ homes, child demographics, and family social class. Variables in each of these categories remained in the final model for both serum (R2 of 0.61) and hair cotinine (R2 of 0.45). A comprehensive set of factors was required to best predict cotinine. Studies should use biomarkers for the best quantitative assessment of SHS exposure. Hair cotinine may be a problematic measure because it was highly influenced by racial differences that were unexplained by SHS exposure. When biospecimen collection is not possible, a household nicotine measurement is warranted. If only questionnaires are available, multiple questions are required to best characterize exposure, such as number of cigarettes, hours spent in a room with concurrent smoking, maternal smoking, and approximate home size.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  • Akaike H. A new look at the statistical model identification. IEEE Transactions on Automatic Control 1974: 19 (6): 716–723.

    Article  Google Scholar 

  • Al-Delaimy W.K. Hair as a biomarker for exposure to tobacco smoke. Tob Control 2002: 11 (3): 176–182.

    Article  CAS  Google Scholar 

  • Bakoula C.G., Kafritsa Y.J., Kavadias G.D., Haley N.J., and Matsaniotis N.S. Factors modifying exposure to environmental tobacco smoke in children (Athens, Greece). Cancer Causes Control 1997: 8 (1): 73–76.

    Article  CAS  Google Scholar 

  • Benowitz N.L. Biomarkers of environmental tobacco smoke exposure. Environ Health Perspect 1999: 107 (Suppl 2): 349–355.

    Article  Google Scholar 

  • Benowitz N.L., Perez-Stable E.J., Fong I., Modin G., Herrera B., and Jacob III P. Ethnic differences in N-glucuronidation of nicotine and cotinine. J Pharmacol Exp Ther 1999: 291 (3): 1196–1203.

    CAS  PubMed  Google Scholar 

  • Bernert Jr J.T., McGuffey J.E., Morrison M.A., and Pirkle J.L. Comparison of serum and salivary cotinine measurements by a sensitive high-performance liquid chromatography-tandem mass spectrometry method as an indicator of exposure to tobacco smoke among smokers and nonsmokers. J Anal Toxicol 2000: 24 (5): 333–339.

    Article  CAS  Google Scholar 

  • Bernert Jr J.T., Turner W.E., Pirkle J.L., Sosnoff C.S., Akins J.R., Waldrep M.K., Ann Q., Covey T.R., Whitfield W.E., Gunter E.W., Miller B.B., Patterson Jr D.G., Needham L.L., Hannon W.H., and Sampson E.J. Development and validation of sensitive method for determination of serum cotinine in smokers and nonsmokers by liquid chromatography/atmospheric pressure ionization tandem mass spectrometry. Clin Chem 1997: 43 (12): 2281–2291.

    CAS  PubMed  Google Scholar 

  • Braun J.M., Froehlich T.E., Daniels J.L., Dietrich K.N., Hornung R., Auinger P., and Lanphear B.P. Association of environmental toxicants and conduct disorder in U.S. children: NHANES 2001–2004. Environ Health Perspect 2008: 116 (7): 956–962.

    Article  Google Scholar 

  • Caldwell B.M., and Bradley R.R. Home Observation for the Measured Environment. University of Arkansas at Little Rock, Little Rock, AR, USA, 1984.

    Google Scholar 

  • Coghlin J., Hammond S.K., and Gann P.H. Development of epidemiologic tools for measuring environmental tobacco smoke exposure. Am J Epidemiol 1989: 130 (4): 696–704.

    Article  CAS  Google Scholar 

  • Crawford F.G., Mayer J., Santella R.M., Cooper T.B., Ottman R., Tsai W.Y., Simon-Cereijido G., Wang M., Tang D., and Perera F.P. Biomarkers of environmental tobacco smoke in preschool children and their mothers. J Natl Cancer Inst 1994: 86 (18): 1398–1402.

    Article  CAS  Google Scholar 

  • Dehn D.L., Claffey D.J., Duncan M.W., and Ruth J.A. Nicotine and cotinine adducts of a melanin intermediate demonstrated by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Chem Res Toxicol 2001: 14 (3): 275–279.

    Article  CAS  Google Scholar 

  • DiFranza J.R., Aligne C.A., and Weitzman M. Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics 2004: 113 (4 Suppl): 1007–1015.

    PubMed  Google Scholar 

  • Forastiere F., Agabiti N., Dell’Orco V., Pistelli R., Corbo G.M., Brancato G., Pacifici R., Zuccaro P., and Perucci C.A. Questionnaire data as predictors of urinary cotinine levels among nonsmoking adolescents. Arch Environ Health 1993: 48 (4): 230–234.

    Article  CAS  Google Scholar 

  • Gareri J. Motherisk Laboratory, Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto. Personal communication regarding hair cotinine reliability testing procedures. Communicated to A. Kalkbrenner, January 14, 2010.

  • Groner J.A., Hoshaw-Woodard S., Koren G., Klein J., and Castile R. Screening for children's exposure to environmental tobacco smoke in a pediatric primary care setting. Arch Pediatr Adolesc Med 2005: 159 (5): 450–455.

    Article  Google Scholar 

  • Halterman J.S., Borrelli B., Tremblay P., Conn K.M., Fagnano M., Montes G., and Hernandez T. Screening for environmental tobacco smoke exposure among inner-city children with asthma. Pediatrics 2008: 122 (6): 1277–1283.

    Article  Google Scholar 

  • Hammond K.S., and Leaderer B.P. A diffusion monitor to measure exposure to passive smoking. Environ Sci Technol 1987: 21 (5): 494.

    Article  CAS  Google Scholar 

  • Harville D. Maximum likelihood approaches to variance component estimation and to related problems. J Am Stat Assoc 1977: 72 (358): 320–338.

    Article  Google Scholar 

  • Henderson F.W., Reid H.F., Morris R., Wang O.L., Hu P.C., Helms R.W., Forehand L., Mumford J., Lewtas J., and Haley N.J., et al. Home air nicotine levels and urinary cotinine excretion in preschool children. Am Rev Respir Dis 1989: 140 (1): 197–201.

    Article  CAS  Google Scholar 

  • Henschen M., Frischer T., Pracht T., Spiekerkotter E., Karmaus W., Meinert R., Lehnert W., Wehrle E., and Kuehr J. The internal dose of passive smoking at home depends on the size of the dwelling. Environ Res 1997: 72 (1): 65–71.

    Article  CAS  Google Scholar 

  • Hornung R.W., and Reed L.D. Estimation of average concentration in the presence of nondetectable values. Appl Occup Environ Hyg 1990: 5 (1): 46–51.

    Article  CAS  Google Scholar 

  • Irvine L., Crombie I.K., Clark R.A., Slane P.W., Goodman K.E., Feyerabend C., and Cater J.I. What determines levels of passive smoking in children with asthma? Thorax 1997: 52 (9): 766–769.

    Article  CAS  Google Scholar 

  • Jaakkola M.S., and Jaakkola J.J. Assessment of exposure to environmental tobacco smoke. Eur Respir J 1997: 10 (10): 2384–2397.

    Article  CAS  Google Scholar 

  • Jarvie J.A., and Malone R.E. Children's secondhand smoke exposure in private homes and cars: an ethical analysis. Am J Public Health 2008: 98 (12): 2140–2145.

    Article  Google Scholar 

  • Jarvis M.J., Strachan D.P., and Feyerabend C. Determinants of passive smoking in children in Edinburgh, Scotland. Am J Public Health 1992: 82 (9): 1225–1229.

    Article  CAS  Google Scholar 

  • Johansson A., Hermansson G., and Ludvigsson J. How should parents protect their children from environmental tobacco-smoke exposure in the home? Pediatrics 2004: 113 (4): e291–e295.

    Article  Google Scholar 

  • Jurado D., Munoz C., Luna Jde D., and Fernandez-Crehuet M. Environmental tobacco smoke exposure in children: parental perception of smokiness at home and other factors associated with urinary cotinine in preschool children. J Expo Anal Environ Epidemiol 2004: 14 (4): 330–336.

    Article  CAS  Google Scholar 

  • Kum-Nji P., Meloy L., and Herrod H.G. Environmental tobacco smoke exposure: prevalence and mechanisms of causation of infections in children. Pediatrics 2006: 117 (5): 1745–1754.

    Article  Google Scholar 

  • Kumar R., Curtis L.M., Khiani S., Moy J., Shalowitz M.U., Sharp L., Durazo-Arvizu R.A., Shannon J.J., and Weiss K.B. A community-based study of tobacco smoke exposure among inner-city children with asthma in Chicago. J Allergy Clin Immunol 2008: 122 (4): 754–759 e1.

    Article  Google Scholar 

  • Klein J., and Koren G. Hair analysis—a biological marker for passive smoking in pregnancy and childhood. Hum Exp Toxicol 1999: 18 (4): 279–282.

    Article  CAS  Google Scholar 

  • Knight J.M., Eliopoulos C., Klein J., Greenwald M., and Koren G. Passive smoking in children. Racial differences in systemic exposure to cotinine by hair and urine analysis. Chest 1996: 109 (2): 446–450.

    Article  CAS  Google Scholar 

  • Langone J.J., Gjika H.B., and Van Vunakis H. Nicotine and its metabolites. Radioimmunoassays for nicotine and cotinine. Biochemistry 1973: 12 (24): 5025–5030.

    Article  CAS  Google Scholar 

  • Mannino D.M., Caraballo R., Benowitz N., and Repace J. Predictors of cotinine levels in US children: data from the Third National Health and Nutrition Examination Survey. Chest 2001: 120 (3): 718–724.

    Article  CAS  Google Scholar 

  • Mendola P., Selevan S.G., Gutter S., and Rice D. Environmental factors associated with a spectrum of neurodevelopmental deficits. Ment Retard Dev Disabil Res Rev 2002: 8 (3): 188–197.

    Article  Google Scholar 

  • Perez-Stable E.J., Herrera B., Jacob III P., and Benowitz N.L. Nicotine metabolism and intake in black and white smokers. JAMA 1998: 280 (2): 152–156.

    Article  CAS  Google Scholar 

  • Peterson E.L., Johnson C.C., and Ownby D.R. Use of urinary cotinine and questionnaires in the evaluation of infant exposure to tobacco smoke in epidemiologic studies. J Clin Epidemiol 1997: 50 (8): 917–923.

    Article  CAS  Google Scholar 

  • Sexton K., Adgate J.L., Church T.R., Hecht S.S., Ramachandran G., Greaves I.A., Fredrickson A.L., Ryan A.D., Carmella S.G., and Geisser M.S. Children's exposure to environmental tobacco smoke: using diverse exposure metrics to document ethnic/racial differences. Environ Health Perspect 2004: 112 (3): 392–397.

    Article  Google Scholar 

  • Spanier A.J., Hornung R., Lierl M., and Lanphear B.P. Environmental exposures and exhaled nitric oxide in children with asthma. J Pediatr 2006: 149 (2): 220–226.

    Article  CAS  Google Scholar 

  • Tutka P., Wielosz M., and Zatonski W. Exposure to environmental tobacco smoke and children health. Int J Occup Med Environ Health 2002: 15 (4): 325–335.

    PubMed  Google Scholar 

  • Uematsu T., Mizuno A., Nagashima S., Oshima A., and 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. Br J Clin Pharmacol 1995: 39 (6): 665–669.

    Article  CAS  Google Scholar 

  • Wilkinson J.D., Arheart K.L., and Lee D.J. Accuracy of parental reporting of secondhand smoke exposure: The National Health and Nutrition Examination Survey III. Nicotine Tob Res 2006: 8 (4): 591–597.

    Article  Google Scholar 

  • Wilson S.E., Kahn R.S., Khoury J., and Lanphear B.P. Racial differences in exposure to environmental tobacco smoke among children. Environ Health Perspect 2005: 113 (3): 362–367.

    Article  Google Scholar 

  • Wilson S.E., Kahn R.S., Khoury J., and Lanphear B.P. The role of air nicotine in explaining racial differences in cotinine among tobacco-exposed children. Chest 2007: 131 (3): 856–862.

    Article  CAS  Google Scholar 

  • Wipfli H., Avila-Tang E., Navas-Acien A., Kim S., Onicescu G., Yuan J., Breysse P., and Samet J.M. Secondhand smoke exposure among women and children: evidence from 31 countries. Am J Public Health 2008: 98 (4): 672–679.

    Article  Google Scholar 

  • Woodruff S.I., Conway T.L., Edwards C.C., and Hovell M.F. Acceptability and validity of hair collection from Latino children to assess exposure to environmental tobacco smoke. Nicotine Tob Res 2003: 5 (3): 375–385.

    Article  CAS  Google Scholar 

  • Yolton K., Dietrich K., Auinger P., Lanphear B.P., and Hornung R. Exposure to environmental tobacco smoke and cognitive abilities among U.S. children and adolescents. Environ Health Perspect 2005: 113 (1): 98–103.

    Article  CAS  Google Scholar 

  • Yolton K., Khoury J., Hornung R., Dietrich K., Succop P., and Lanphear B. Environmental tobacco smoke exposure and child behaviors. J Dev Behav Pediatr 2008: 29 (6): 450–457.

    Article  Google Scholar 

Download references

Acknowledgements

This project was funded by National Heart Lung and Blood Institute R01 H165731 and an environmental epidemiology traineeship, National Institute of Environmental Health Science T32 ES007018. We thank the interviewers, environmental technicians, laboratory personnel, and families who participated in the Cincinnati Asthma Prevention Study; Dr. Julia Klein and her laboratory for hair cotinine analyses; and Dr. Julie Daniels, Dr. Brian Pence, Dr. Caroline Dilworth, and Dr. Mandy Golembesky for their assistance.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amy E Kalkbrenner.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kalkbrenner, A., Hornung, R., Bernert, J. et al. Determinants of serum cotinine and hair cotinine as biomarkers of childhood secondhand smoke exposure. J Expo Sci Environ Epidemiol 20, 615–624 (2010). https://doi.org/10.1038/jes.2010.7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jes.2010.7

Keywords

This article is cited by

Search

Quick links