Tobacco Smoke Exposure Biomarker Profiles and Healthcare Utilization Patterns Among U.S. Children

This study aimed to examine the associations between distinct tobacco smoke exposure (TSE) biomarkers and healthcare utilization patterns in U.S. children ages 3-11 years with and without current asthma. Secondary data from the 2013-2016 National Health and Nutrition Examination Survey were analyzed (N = 2838). TSE biomarkers included serum cotinine, urinary total nicotine equivalents (TNE2), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), the NNAL/TNE2 ratio, and the N-acetyl-S-(2-cyanoethyl)-L-cysteine (2CyEMA)/TNE2 ratio. We conducted Poisson regression analyses to examine the associations between each biomarker and healthcare visits and hospitalizations within the past 12 months, adjusting for sociodemographic and home TSE covariates. Children without asthma who had higher urinary TNE2 levels (adjusted incidence rate ratio [aIRR] = 1.03, 95% confidence interval [CI] = 1.02-1.04) and children with asthma who had higher urinary 2CyEMA/TNE2 ratio levels (aIRR = 1.05, 95%CI = 1.03-1.07) were at an increased risk of having more healthcare visits. Children without asthma who had higher serum cotinine (aIRR = 1.21, 95%CI = 1.07-1.37) and higher 2CyEMA/TNE2 ratio levels (aIRR = 1.25, 95%CI = 1.14-1.37) were at an increased risk of hospitalizations. Children with asthma who had higher NNAL/TNE2 ratio levels (aIRR = 1.52, 95%CI = 1.11-2.09) were at increased risk of hospitalizations. It is important to consider comprehensive biomarkers of TSE in children, such as TNE, tobacco-specific nitrosamines, and volatile organic compounds, along with healthcare utilization patterns. Child TSE reduction policies are urgently needed.