title: Environmental tobacco smoke and periodontitis in U.S. non-smokers.
abstract: OBJECTIVE
  The association of second hand smoke or environmental tobacco smoke (ETS) and periodontitis in non-smokers has not been confirmed using a biomarker of ETS exposure. To estimate periodontitis prevalence in non-smokers with detectable serum cotinine, and to investigate racial/ethnic and socioeconomic variation in ETS exposure in a representative sample of the U. S. adult population. Determining periodontitis risk indicators occurring with ETS appears to be a salient purpose as this study is the first of its kind to provide a link (a salivary biomarker) between second hand smoke and risk for periodontitis.
  
  
  METHODS
  Data were collected from the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES). Subjects were 3,137 adults who had smoked fewer than 100 cigarettes and had not used other forms of tobacco. ETS exposure was classified as negligible (cotinine concentrations below sex and race/ethnicity cut-points for smokers), moderate (cotinine 0.5-<1.5 μg/mL) or high (cotinine ≥ 1.5 ng/mL). Periodontitis was classified according to the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) case definition for moderate-severe disease. Survey estimation procedures were used to estimate prevalence and odds ratios (OR) were from multivariable logistic regression models.
  
  
  RESULTS
  ETS exposure was observed in 40.5% of subjects and 2.6% had periodontitis. ETS exposure was inversely associated with educational attainment and family income and was higher in non-Hispanic blacks than whites. After adjusting for age, sex and year of survey, adults with high ETS exposure (cotinine ≥ 1.5 ng/mL) had more than twice the odds of periodontitis as people with negligible exposure (OR=2.3, 95% confidence interval=1.3, 4.1).
  
  
  CONCLUSIONS
  High ETS exposure was a risk indicator for periodontitis in lifetime non-smokers.
authors.affiliation: University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Julie D
authors.initials: JD
authors.lastname: Sutton
authors.forename: Leah M
authors.initials: LM
authors.lastname: Ranney
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Wilder
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sanders
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D003367:Cotinine / Q000032:analysis / Q000097:blood; D003430:Cross-Sectional Studies; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010512:Periodontal Index; D010518:Periodontitis / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry; D012737:Sex Factors; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D015415:Biomarkers; D014028:Tobacco Smoke Pollution; D003367:Cotinine