Background

Environmental tobacco smoke (ETS) exposure in infants and children causes more frequent and severe asthma attacks, respiratory infections, ear infections, and sudden infant death syndrome. The aim of this study was to measure ETS exposure in children in Israel (ages 4–11 years) using urinary cotinine measurements, in order to compare exposure levels to other international populations, and to assess predictors of ETS exposure in children in Israel.

Methods

A subset of children who participated in the National Health and Nutrition Survey (RAV- MABAT) in 2015–2016 were invited to participate in the Second Israel Biomonitoring Survey. We analyzed urinary cotinine and creatinine concentrations in 103 children. Parents of study participants were interviewed in person on children's exposure to ETS at home and in other environments and on sociodemographic variables. We calculated creatinine-adjusted and unadjusted urinary cotinine geometric means in children and analyzed associations in univariable and multivariable analyses, between sociodemographic variables and parental – reported exposure, and urinary cotinine concentrations.

Results

Based on urinary creatinine measurement, over 60% of children are exposed to ETS (compared to <40% based on parental report). Linear regression showed a positive association between urinary cotinine concentration and reported ETS exposure (p = 0.001). Mean cotinine concentration among children whose parents reported that they are exposed to ETS at home (5.1 μg/l) was significantly higher than the concentration among children whose parents reported they are not exposed to ETS at home (1.6 μg/l, p < 0.001). There was an inverse relationship between total family income and urinary cotinine concentration (p < 0.05). In a multivariable model adjusted for ethnicity and other factors, family income was a significant predictor of urinary cotinine level (p = 0.04, slope = −0.49). Geometric mean creatinine adjusted concentrations in children in the current study were higher than in children in Canada and selected European countries.

Conclusions

We found evidence of widespread exposure to ETS in children in the study. There is an urgent need to protect children in Israel from exposure to ETS.

中文翻译：

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以色列儿童暴露于环境烟草烟雾中的社会经济不平等现象

背景

婴幼儿接触环境烟草烟雾（ETS）会导致更频繁，更严重的哮喘发作，呼吸道感染，耳部感染和婴儿猝死综合症。这项研究的目的是使用尿可替宁测量来测量以色列儿童（4-11岁）的ETS暴露，以比较其他国际人群的暴露水平，并评估以色列儿童ETS暴露的预测因子。

方法

应邀参加了2015-2016年国家健康与营养调查（RAV-MABAT）的一部分儿童，参加了第二次以色列生物监测调查。我们分析了103名儿童的尿中可替宁和肌酐浓度。研究参与者的父母接受了关于儿童在家中和其他环境中的ETS暴露以及社会人口统计学变量的亲自采访。我们计算了儿童肌酐校正和未经校正的尿可替宁的几何均数，并分析了社会人口统计学变量与父母报告的暴露以及尿可替宁浓度之间的单变量和多变量分析之间的关联。

结果

根据尿肌酐测量，超过60％的儿童暴露于ETS（根据父母的报告，该比例<40％）。线性回归显示尿中可替宁浓度与报告的ETS暴露呈正相关（p = 0.001）。父母报告说他们在家中没有ETS的孩子中的平均可替宁浓度（5.1μg/ l）明显高于父母报告说他们在家中没有ETS的孩子中的可替宁浓度（1.6μg/ l，p <0.001） ）。家庭总收入与尿中可替宁浓度呈反比关系（p <0.05）。在针对种族和其他因素进行调整的多变量模型中，家庭收入是尿可替宁水平的重要预测指标（p = 0.04，斜率= -0.49）。

结论

我们在研究中发现了儿童广泛暴露于ETS的证据。迫切需要保护以色列儿童免遭ETS的危害。