title: Urinary cotinine levels and environmental tobacco smoke in mothers and children of Romania, Portugal and Poland within the European human biomonitoring pilot study.
abstract: The aim of this study was to explore data from the DEMOCOPHES study population for Romania, Portugal and Poland, in order to assess smoking patterns and the extent of ETS exposure and compare the national study samples with reference to the respective anti-smoking laws. The subset of the DEMOCOPHES study sample consisted of 360 children and their mothers (120 in each of the three countries - Romania (RO), Portugal (PT) and Poland (PL). Smoking was assessed using a detailed questionnaire for the participants, which addresses both active and passive smoking. This assessment uses exposure-relevant questionnaire data, in particular on the home environment and residence, socio-demographic characteristics, lifestyle such as nutrition, smoking behavior, other exposure-relevant behavior and occupational history, as well as urinary cotinine and creatinine measurements. We performed general statistical analysis and innovative receiver operating characteristic (ROC) curve analyses. Smoking prevalence as evaluated by the questionnaire was generally high, and higher than official statistics, which suggests some under-reporting in the countries, particularly in Romania. Urinary cotinine levels provided biochemical confirmation of the high and similar smoking prevalence for the three countries. Concerning ETS exposure, Romania presented significantly higher levels, for children as well as for non-smoking mothers, with Portugal showing significantly lower levels. Compared to non-smoking mothers, the children showed relatively higher ETS exposure levels in all three countries. The established country-specific optimal cut-off values in urinary cotinine to distinguish smokers from non-smokers vary more than those to discriminate ETS exposure extent in non-smoking mothers and children. Although different between countries, these values are a valuable output to monitor effectiveness of both national antismoking laws and educational programs in the three countries. The findings of this study point to the urgent need for stronger, more effective and well enforced smoke-free legislation in the three countries.
authors.affiliation: Environmental Health Center, 58 Busuiocului Street, 400240 Cluj-Napoca, Romania. Electronic address: irlupsa@ehc.ro.
authors.forename: Ioana-Rodica
authors.initials: IR
authors.lastname: Lupsa
authors.affiliation: Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa, Portugal; Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal.
authors.forename: Baltazar
authors.initials: B
authors.lastname: Nunes
authors.affiliation: Nofer Institute of Occupational Medicine, Lodz, Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Ligocka
authors.affiliation: Environmental Health Center, 58 Busuiocului Street, 400240 Cluj-Napoca, Romania.
authors.forename: Anca Elena
authors.initials: AE
authors.lastname: Gurzau
authors.affiliation: Nofer Institute of Occupational Medicine, Lodz, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Jakubowski
authors.affiliation: University of Leuven, Centrum Menselijke Erfelijkheid, Herestraat 49 bus 602, 3000 Leuven, Belgium.
authors.forename: Ludwine
authors.initials: L
authors.lastname: Casteleyn
authors.affiliation: Federal Public Service Health, Food Chain Safety and Environment, Place Victor Horta 40/10, 1060 Brussels, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Aerts
authors.affiliation: Federal Public Service Health, Food Chain Safety and Environment, Place Victor Horta 40/10, 1060 Brussels, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Biot
authors.affiliation: Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium.
authors.forename: Elly
authors.initials: E
authors.lastname: Den Hond
authors.affiliation: Environmental Toxicology, Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo, km2, E- 28220 Madrid, Spain.
authors.forename: Argelia
authors.initials: A
authors.lastname: Castaño
authors.affiliation: Environmental Toxicology, Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo, km2, E- 28220 Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Esteban
authors.affiliation: Federal Environment Agency (UBA, Federal Environment Agency (UBA), Corrensplatz 1, 14195 Berlin, Germany.
authors.forename: Marike
authors.initials: M
authors.lastname: Kolossa-Gehring
authors.affiliation: Federal Environment Agency (UBA, Federal Environment Agency (UBA), Corrensplatz 1, 14195 Berlin, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Fiddicke
authors.affiliation: University of Copenhagen, Department of Public Health, Øster Farimagsgade 5, DK 1353 Copenhagen K, Denmark.
authors.forename: Lisbeth E
authors.initials: LE
authors.lastname: Knudsen
authors.affiliation: Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium; University of Southern Denmark, Odense, Denmark.
authors.forename: Greet
authors.initials: G
authors.lastname: Schoeters
authors.affiliation: Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa, Portugal.
authors.forename: M Fátima
authors.initials: MF
authors.lastname: Reis
mesh_terms: D000328:Adult; D002648:Child; D003367:Cotinine / Q000652:urine*; D004784:Environmental Monitoring / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009035:Mothers; D010865:Pilot Projects; D011044:Poland / Q000453:epidemiology; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D012372:ROC Curve; D012383:Romania / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology / Q000652:urine*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000032:analysis* / Q000706:statistics & numerical data
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine
keywords: Antismoking legislation; Cut-off value; Environmental tobacco smoke; Human biomonitoring; Urinary cotinine