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High Cotinine and Healthcare Utilization Disparities Among Low-Income Children
Ashley L Merianos1, Roman A Jandarov2, E Melinda Mahabee-Gittens3
1School of Human Services, University of Cincinnati, Cincinnati, Ohio.
Insights
Elevated child salivary cotinine levels correlate with increased healthcare visits and hospital admissions. Routine cotinine screening can help identify children needing interventions for tobacco smoke exposure.
Area of Science:
- Environmental Health
- Pediatrics
- Biochemistry
Background:
- Childhood exposure to environmental tobacco smoke (ETS) is a significant public health concern.
- Biochemical markers like salivary cotinine are objective measures of ETS exposure.
- Healthcare utilization patterns in children exposed to ETS require further investigation.
Purpose of the Study:
- To assess the association between child salivary cotinine levels and healthcare utilization (visits and admissions) in children aged 0-9 years.
- To examine the relationship between parent-reported smoking, child tobacco smoke exposure, and healthcare utilization.
- To identify participant characteristics associated with higher child cotinine concentrations.
Main Methods:
- Longitudinal data from 313 clinically ill children (0-9 years) exposed to secondhand smoke were analyzed.
- Salivary cotinine levels were measured and log-transformed.
- Poisson and linear regression models were used to assess associations with healthcare visits, hospital admissions, and participant characteristics.
Main Results:
- Higher log-cotinine concentrations were significantly associated with increased pediatric emergency department visits (aRR=1.16) and hospital admissions (aRR=1.50) over a 6-month period.
- Parent-reported smoking and child tobacco smoke exposure did not show significant associations with healthcare utilization.
- Younger age, White ethnicity, prematurity history, winter baseline visit, and living in apartments/multiunit homes were associated with higher cotinine levels.
Conclusions:
- Child salivary cotinine is a strong predictor of healthcare utilization in children exposed to tobacco smoke.
- Routine biochemical screening for cotinine can identify children at high risk.
- Targeted interventions for tobacco smoke exposure reduction are crucial for this vulnerable population.
Introduction:
This study assesses the associations of child salivary cotinine, parent-reported smoking, and child tobacco smoke exposure with the number of child healthcare visits and hospital admissions over a 6-month period. This study also assesses the relationships between participant characteristics and child cotinine.
Methods:
Longitudinal data were evaluated from a sample of 313 clinically ill children aged 0-9 years who lived with a smoker and presented to a pediatric emergency department or urgent care in 2016-2018. In 2020, cotinine measurements were log transformed, and Poisson and linear regression were performed.
Results:
The majority of the children came from low-income homes (66.1%) and had public insurance/self-pay (95.5%). Child cotinine concentrations ranged from 0.1 to 332.0 ng/mL (geometric mean=4.8 ng/mL, 95% CI=4.1, 5.5). Poisson regression results indicated that each 1-unit increase of log-cotinine concentration was associated with an increase in pediatric emergency department visits over a 6-month period after the baseline visit, with an adjusted RR of 1.16 (95% CI=1.01, 1.34). Each 1-unit increase of log-cotinine concentration was associated with an increase in the frequency of hospital admissions over the 6-month period, with an adjusted RR of 1.50 (95% CI=1.08, 2.09). No differences were found between parent-reported smoking or child tobacco smoke exposure and healthcare utilization. Linear regression results indicated that children who were younger (β= -0.227, p=0.049), were White (geometric mean=5.5 ng/mL), had a medical history of prematurity (geometric mean=8.1 ng/mL), and had a winter baseline visit (geometric mean=6.5 ng/mL) had higher cotinine concentrations. Children living in apartments (geometric mean=5.5 ng/mL) and multiunit homes (geometric mean=5.5 ng/mL) had higher cotinine concentrations than those in single-family homes (geometric mean=3.6 ng/mL).
Conclusions:
Routine biochemical screening could identify children who are in need of intensive tobacco smoke exposure reduction interventions.
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