title: Thirdhand smoke contamination in hospital settings: assessing exposure risk for vulnerable paediatric patients.
abstract: Tobacco has regained the status of the world's number two killer behind heart/vascular disease. Thirdhand smoke (THS) residue and particles from secondhand smoke (SHS) are suspected health hazards (eg, DNA damage) that are likely to contribute to morbidity and mortality, especially in vulnerable children. THS is easily transported and deposited indoors, where it persists and exposes individuals for months, creating potential health consequences in seemingly nicotine-free environments, particularly for vulnerable patients. We collected THS data to estimate infant exposurein the neonatal ICU (NICU)after visits from household smokers. Infant exposure to nicotine, potentially from THS, was assessed via assays of infant urine.
  
  
  
  Participants were mothers who smoked and had an infant in the NICU (N=5). Participants provided surface nicotine samples from their fingers, infants' crib/incubator and hospital-provided furniture. Infant urine was analysed for cotinine, cotinine's major metabolite:trans-3'-hydroxycotinine (3HC) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a metabolite of the nicotine-derived and tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK).
  
  
  
  Incubators/cribs and other furniture had detectable surface nicotine. Detectable levels of cotinine, 3HC and NNAL were found in the infants' urine.
  
  
  
  THS appears to be ubiquitous, even in closely guarded healthcare settings. Future research will address potential health consequences and THS-reduction policies. Ultimately, hospital policies and interventions to reduce THS transport and exposure may prove necessary, especially for immunocompromised children.
authors.affiliation: Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth) Medical School, Houston, Texas, USA.
authors.forename: Thomas F
authors.identifier: 0000-0002-3275-3168
authors.initials: TF
authors.lastname: Northrup
authors.affiliation: Department of Pediatrics, UTHealth Medical School; Medical Director Level III NICU, Children's Memorial Hermann Hospital, Houston, Texas, USA.
authors.forename: Amir M
authors.initials: AM
authors.lastname: Khan
authors.affiliation: Departments of Medicine and Psychiatry, University of California San Francisco; Division of Clinical Pharmacology, San Francisco General Hospital Medical Center, San Francisco, California, USA.
authors.forename: Peyton
authors.initials: P
authors.lastname: Jacob
authors.affiliation: Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA.
authors.forename: Neal L
authors.initials: NL
authors.lastname: Benowitz
authors.affiliation: Division of Environmental Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA.
authors.forename: Eunha
authors.initials: E
authors.lastname: Hoh
authors.affiliation: Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA.
authors.forename: Melbourne F
authors.initials: MF
authors.lastname: Hovell
authors.affiliation: Department of Psychology, San Diego State University, San Diego, California, USA.
authors.forename: Georg E
authors.initials: GE
authors.lastname: Matt
authors.affiliation: Department of Family and Community Medicine, Department of Psychiatry and Behavioral Sciences, UTHealth Medical School, Houston, Texas, USA.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Stotts
mesh_terms: D002273:Carcinogens / Q000032:analysis; D003367:Cotinine / Q000031:analogs & derivatives / Q000652:urine; D004781:Environmental Exposure / Q000032:analysis*; D004784:Environmental Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D009538:Nicotine / Q000032:analysis; D009602:Nitrosamines / Q000652:urine; D011247:Pregnancy; D014028:Tobacco Smoke Pollution / Q000032:analysis*
chemical_list: D002273:Carcinogens; D009602:Nitrosamines; D014028:Tobacco Smoke Pollution; C001381:hydroxycotinine; D009538:Nicotine; C016583:4-(N-methyl-N-nitrosamino)-1-(3-pyridyl)-1-butanone; C099565:4-(methylnitrosamino)-1-(3-pyridyl)-1-butan-1-ol; D003367:Cotinine
keywords: Carcinogens; Cotinine; Environment; Nicotine; Priority/special populations