Inflammatory marker levels in children with tobacco smoke exposure.

BACKGROUND: Tobacco smoke exposure (TSE) has inflammatory and immunosuppressive effects which may be associated with altered levels of inflammatory markers and pediatric illnesses. OBJECTIVE: The primary objective was to examine the associations of cotinine-confirmed and parent-reported child TSE patterns and discharge diagnoses with C-reactive protein (CRP), IL-8, and IL-10 in 0-11-year-old pediatric emergency department (PED) patients who lived with ≥ 1 smoker. METHODS: Saliva samples were obtained from 115 children with a mean (SD) age of 3.5 (3.1) years during the PED visit (T0). Saliva was analyzed for cotinine, CRP, IL-8, and IL-10. Parents self-reported their children's TSE patterns; children's medical records were reviewed to identify and categorize discharge diagnoses. Linear regression models were utilized to find T0 associations of cotinine-confirmed and parent-reported child TSE patterns, and PED diagnoses with each inflammatory marker. All models were adjusted for child race/ethnicity, child sex, annual household income, and housing type. The TSE models also adjusted for child discharge diagnosis. RESULTS: At T0, the geometric mean (GeoM) of cotinine was 4.1 ng/ml [95 %CI = 3.2-5.2]; the GeoMs of CRP, IL-8, and IL-10 were 3,326 pg/ml [95 %CI = 2,696-4,105], 474 pg/ml [95 %CI = 386-583], and 1.1 pg/ml [95 %CI = 0.9-1.3], respectively. Parent-reported child TSE patterns were positively associated with ln-transformed CRP levels, while adjusting for the covariates (ß^ = 0.012 [95 %CI:0.004-0.020], p = 0.037). In the parent-reported child TSE pattern model, there were significant positive associations between the covariate of child age with CRP and IL-8 levels (p = 0.028 and p < 0.001, respectively). Children with a bacterial diagnosis had higher IL-8 levels (p = 0.002) compared to the other diagnosis groups. CONCLUSIONS: Results indicate that parent-reported child TSE increases the expression of CRP in ill children and supports prior work demonstrating that IL-8 is higher in children with TSE who have bacterial infections. These findings should be examined in future research with ill children with and without TSE.

Tobacco Smoke Exposure and Sleep Duration among U.S. Adolescents.

OBJECTIVES: Tobacco smoke exposure (TSE) and poor sleep are public health problems with their own set of consequences. This study assessed whether TSE was associated with sleep duration among U.S. adolescents. METHOD: We conducted a secondary analysis of 2013-2018 National Health and Nutrition Examination Survey data including 914 nontobacco-using adolescents ages 16-19 years. TSE measures included cotinine and self-reported home TSE groups including no home TSE, thirdhand smoke (THS) exposure, and secondhand smoke (SHS)+THS exposure. Sleep duration was assessed in hours and categorically as insufficient sleep (recommended hours). Weighted multiple linear regression and multinomial regression models were conducted. RESULTS: Adolescents with higher log-cotinine levels had higher number of sleep hours (ß = 0.31, 95%CI = 0.02,0.60) and were at increased odds of reporting excess sleep (AOR = 1.41, 95%CI = 1.40,1.42), but were at reduced odds of reporting insufficient sleep (AOR = 0.88, 95%CI = 0.87,0.89). Compared to adolescents with no home TSE, adolescents with home THS exposure and home SHS+THS exposure were at increased odds of reporting insufficient sleep (AOR = 2.27, 95%CI = 2.26,2.29; AOR = 2.75, 95%CI = 2.72,2.77, respectively) and excess sleep (AOR = 1.89, 95%CI = 1.87,1.90; AOR = 5.29, 95%CI = 5.23,5.34, respectively). CONCLUSIONS: TSE may affect insufficient and excess sleep duration among adolescents. Eliminating TSE may promote adolescent respiratory and sleep health.

Carcinogenic and tobacco smoke-derived particulate matter biomarker uptake and associated healthcare patterns among children.

BACKGROUND: The objective was to assess the associations of child tobacco smoke exposure (TSE) biomarkers (urinary cotinine, NNAL, and nicotelline N-oxides) and parent-reported smoking and child TSE patterns with total hospital visits, pediatric emergency department (PED) visits, urgent care (UC), revisits, and hospital admissions among 0-9-year-olds. METHODS: A convenience sample of PED/UC patients (N = 242) who presented to a large, US children's hospital who had baseline urine samples assayed for the TSE biomarkers of interest were included. Biomarker levels were log-transformed, and linear and Poisson regression models were built. RESULTS: The geometric means of child cotinine, creatinine-adjusted NNAL, and N-oxide levels were 11.2 ng/ml, 30.9 pg/mg creatinine, and 24.1 pg/ml, respectively. The mean (SD) number of daily cigarettes smoked by parents was 10.2 (6.1) cigarettes. Each one-unit increase in log-NNAL levels was associated with an increase in total UC visits (aRR = 1.68, 95% CI = 1.18-2.39) among 0-9-year-olds, while controlling for the covariates. Each one-unit increase in child log-NNAL/cotinine ratio (×103) values was associated with an increase in total hospital visits (aRR = 1.39, 95% CI = 1.10-1.75) and UC visits (aRR = 1.56, 95% CI = 1.14-2.13) over 6 months. CONCLUSION: Systematic screening for child TSE should be conducted during all hospital visits. The comprehensive assessment of TSE biomarkers should be considered to objectively measure young children's exposure. IMPACT: Higher levels of cotinine, a widely used tobacco smoke exposure biomarker, have been associated with higher healthcare utilization patterns among children. Less is known on the associations of carcinogenic and tobacco smoke-derived particulate matter biomarker uptake with child healthcare utilization patterns. This study assessed the associations of several biomarkers with healthcare utilization patterns among pediatric emergency department patients ages 0-9 years who lived with tobacco smokers. Higher urinary NNAL biomarker levels, in individual and ratio form with cotinine, increased children's risk for urgent care visits over 6 months. Higher parent-reported cumulative child tobacco smoke exposure increased children's risk for hospital admissions.

Electronic cigarette use and cigarette smoking associated with inadequate sleep duration among U.S. young adults.

OBJECTIVE: Nicotine use can influence inadequate sleep, but less is known about the associations of exclusive and dual use of electronic cigarettes (e-cigarettes) with combustible cigarettes in U.S. young adults. This study assessed the associations between current exclusive e-cigarette use, exclusive cigarette smoking, and dual e-cigarette and combustible cigarette use and inadequate sleep duration among U.S. young adults. METHODS: We performed a secondary analysis of 2020 Behavioral Risk Factor Surveillance System (BRFSS) data including 13,978 U.S. young adults ages 18-24 years. Inadequate sleep duration was assessed categorically using the National Sleep Foundation's age-specific recommendations that define <7 h as inadequate sleep. Weighted logistic regression models were performed while adjusting for participants' sex, race/ethnicity, education level, annual household income level, body mass index, current physical activity, mental health status, disability status, current alcohol use, and current smokeless tobacco use. RESULTS: Concerning use patterns, 11.8% of young adults were exclusive e-cigarette users, 4.7% were exclusive cigarette smokers, and 3.8% were dual e-cigarette and combustible cigarette users. Exclusive e-cigarette users (adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.16-1.72), exclusive cigarette smokers (AOR = 1.63, 95%CI = 1.22-2.18), and dual product users (AOR = 2.03, 95%CI = 1.44-2.86) were at increased odds of having inadequate sleep duration compared to non-users, while adjusting for the covariates. Additionally, dual product users were at increased odds (AOR = 1.52, 95%CI = 1.06-2.19) of reporting inadequate sleep duration compared to exclusive e-cigarette users, while adjusting for the covariates. CONCLUSIONS: Current e-cigarette and cigarette use may influence inadequate sleep among U.S. young adults. Tobacco cessation efforts may encourage increased sleep health.

Distinguishing Exposure to Secondhand and Thirdhand Tobacco Smoke among U.S. Children Using Machine Learning: NHANES 2013-2016.

While the thirdhand smoke (THS) residue from tobacco smoke has been recognized as a distinct public health hazard, there are currently no gold standard biomarkers to differentiate THS from secondhand smoke (SHS) exposure. This study used machine learning algorithms to assess which combinations of biomarkers and reported tobacco smoke exposure measures best differentiate children into three groups: no/minimal tobacco smoke exposure (NEG); predominant THS exposure (TEG); and mixed SHS and THS exposure (MEG). Participants were 4485 nonsmoking 3-17-year-olds from the National Health and Nutrition Examination Survey 2013-2016. We fitted and tested random forest models, and the majority (76%) of children were classified in NEG, 16% were classified in TEG, and 8% were classified in MEG. The final classification model based on reported exposure, biomarker, and biomarker ratio variables had a prediction accuracy of 95%. This final model had prediction accuracies of 100% for NEG, 88% for TEG, followed by 71% for MEG. The most important predictors were the reported number of household smokers, serum cotinine, serum hydroxycotinine, and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). In the absence of validated biomarkers specific to THS, comprehensive biomarker and questionnaire data for tobacco smoke exposure can distinguish children exposed to SHS and THS with high accuracy.

Sources of Tobacco Smoke Exposure and Their Associations With Serum Cotinine Levels Among US Children and Adolescents.

INTRODUCTION: We assessed tobacco smoke exposure (TSE) levels based on private and public locations of TSE according to race and ethnicity among US school-aged children ages 6-11 years and adolescents ages 12-17 years. AIMS AND METHODS: Data were from 5296 children and adolescents who participated in the National Health and Nutrition Examination Survey (NHANES) 2013-2018. Racial and ethnic groups were non-Hispanic white, black, other or multiracial, and Hispanic. NHANES assessed serum cotinine and the following TSE locations: homes and whether smokers did not smoke indoors (home thirdhand smoke [THS] exposure proxy) or smoked indoors (secondhand [SHS] and THS exposure proxy), cars, in other homes, restaurants, or any other indoor area. We used stratified weighted linear regression models by racial and ethnic groups and assessed the variance in cotinine levels explained by each location within each age group. RESULTS: Among 6-11-year-olds, exposure to home THS only and home SHS + THS predicted higher log-cotinine among all racial and ethnic groups. Non-Hispanic white children exposed to car TSE had higher log-cotinine (ß = 1.64, 95% confidence interval [CI] = 0.91% to 2.37%) compared to those unexposed. Non-Hispanic other/multiracial children exposed to restaurant TSE had higher log-cotinine (ß = 1.13, 95% CI = 0.23% to 2.03%) compared to those unexposed. Among 12-17-year-olds, home SHS + THS exposure predicted higher log-cotinine among all racial and ethnic groups, except for non-Hispanic black adolescents. Car TSE predicted higher log-cotinine among all racial and ethnic groups. Non-Hispanic black adolescents with TSE in another indoor area had higher log-cotinine (ß = 2.84, 95% CI = 0.85% to 4.83%) compared to those unexposed. CONCLUSIONS: TSE location was uniquely associated with cotinine levels by race and ethnicity. Smoke-free home and car legislation are needed to reduce TSE among children and adolescents of all racial and ethnic backgrounds. IMPLICATIONS: Racial and ethnic disparities in TSE trends have remained stable among US children and adolescents over time. This study's results indicate that TSE locations differentially contribute to biochemically measured TSE within racial and ethnic groups. Home TSE significantly contributed to cotinine levels among school-aged children 6-11 years old, and car TSE significantly contributed to cotinine levels among adolescents 12-17 years old. Racial and ethnic differences in locations of TSE were observed among each age group. Study findings provide unique insight into TSE sources, and indicate that home and car smoke-free legislation have great potential to reduce TSE among youth of all racial and ethnic backgrounds.

Association among friendship skills, involvement in after-school activities, and flourishing for adolescents with asthma and comorbid emotional and behavioral problems.

OBJECTIVES: Primary objectives were to examine the relations among abilities for making and keeping friends, involvement in after-school activities, and flourishing for adolescents with current asthma, as well as comorbid behavior problems, anxiety, or depression. METHODS: Data from the 2021 National Survey of Child Health was analyzed. Parents provided data on one child. Multinomial logistic regression analyses, both unadjusted and adjusted for the sampling weight, were conducted for adolescents with current asthma and comorbid behavior problems, anxiety, or depression. Predictors of flourishing included difficulty in making and keeping friends and involvement in after-school activities. Sex, age, race/ethnic group, and having been bullied were covariates. To examine differences for children with varied comorbid emotional and behavioral problems, relations were tested separately for children with asthma and behavior problems, children with asthma and anxiety, and children with asthma and depression. RESULTS: Skills for making and keeping friends were positively related to flourishing of adolescents with current asthma for all three types of mental health concerns. The relationship between involvements in after-school activities was less clear-cut, as this predictor was not always positively related to flourishing. CONCLUSIONS: Abilities to make and keep friends were related to flourishing, indicating that peer support is a resilience factor. Conversely, it was not clear that involvement in after-school activities was a resilience factor and more research about factors constituting successful after-school involvement for adolescents with asthma is needed. Future research, illuminating how social support from peers and involvement in activities promote flourishing will extend knowledge.

Policy-relevant differences between secondhand and thirdhand smoke: strengthening protections from involuntary exposure to tobacco smoke pollutants.

Starting in the 1970s, individuals, businesses and the public have increasingly benefited from policies prohibiting smoking indoors, saving thousands of lives and billions of dollars in healthcare expenditures. Smokefree policies to protect against secondhand smoke exposure, however, do not fully protect the public from the persistent and toxic chemical residues from tobacco smoke (also known as thirdhand smoke) that linger in indoor environments for years after smoking stops. Nor do these policies address the economic costs that individuals, businesses and the public bear in their attempts to remediate this toxic residue. We discuss policy-relevant differences between secondhand smoke and thirdhand smoke exposure: persistent pollutant reservoirs, pollutant transport, routes of exposure, the time gap between initial cause and effect, and remediation and disposal. We examine four policy considerations to better protect the public from involuntary exposure to tobacco smoke pollutants from all sources. We call for (a) redefining smokefree as free of tobacco smoke pollutants from secondhand and thirdhand smoke; (b) eliminating exemptions to comprehensive smoking bans; (c) identifying indoor environments with significant thirdhand smoke reservoirs; and (d) remediating thirdhand smoke. We use the case of California as an example of how secondhand smoke-protective laws may be strengthened to encompass thirdhand smoke protections. The health risks and economic costs of thirdhand smoke require that smokefree policies, environmental protections, real estate and rental disclosure policies, tenant protections, and consumer protection laws be strengthened to ensure that the public is fully protected from and informed about the risks of thirdhand smoke exposure.

Association of self-reported use of cannabis for the purpose of improving physical, mental, and sleep health with problematic cannabis use risk.

BACKGROUND: Little is known about health-focused cannabis use purposes and their associations with risk for problematic cannabis use. This cross-sectional study examined three broad cannabis use purposes and association with risk for problematic use among young adult cannabis users who report using for > 1 health reasons. METHODS: Young adults completed an electronic survey as part of an ongoing study on substance use and health. Those who self-reported past 6-month use of ≥ 1 cannabis products-smoking, vaping, dabbing, eating, and blunts-were included in the analysis. Their purposes for use were coded into three categories: sleep, mental, and physical health. Problematic cannabis use (PCU) was measured with the three-level structure Cannabis Abuse Screening Test (CAST-3). Adjusted multivariable regression models were used to estimate use purposes associated with with problematic cannabis use at the p < 0.05 level. RESULTS: Participants (n = 954) were mostly female (63.94%) and Hispanic (54.93%). Mental health was the most endorsed reason (73.38%) for use among study sample. Among participants, 36.3% were classified as being at severe risk (CAST-3 score ≥ 8). There was a significant association between PCU risk and reporting cannabis use for physical health (p < 0.01), mental health, and sleep health (p < 0.01) purposes. Those who used cannabis for physical heath purposes had about four times the risk (adjusted relative risk ratio (aRRR) = 4.38, 95% CI = 3.06-6.69), those who used for mental health had about three times the risk (aRRR = 2.81, 95% CI = 1.86-4.72), and those who used for sleep health had almost two times the risk (aRRR = 1.83, 95% CI = 1.17-2.63) for severe PCU. CONCLUSION: All cannabis use purposes examined increased risk of problematic cannabis use. Physical health use purposes was associated with highest PCU risk. This study demonstrates the risk for cannabis use disorder associated with self-medicating with cannabis.

Caregiver strain among non-Hispanic Black and Hispanic male caregivers with self-reported chronic health conditions.

OBJECTIVES: Caregiver strain often stems from unmet needs and is a risk factor for poor physical and psychological health. This study aims to identify factors associated with caregiver strain among middle-aged and older non-Hispanic Black and Hispanic male caregivers living with one or more chronic conditions. DESIGN: Data were analyzed from 418 male caregivers collected through Qualtrics Online Panels using an internet-delivered survey instrument (55.7% non-Hispanic Black, 44.3% Hispanic). Three ordinal regression models were fitted to assess factors associated with Caregiver Strain Scale tertiles: one for all men, one for non-Hispanic Black men only; and one for Hispanic men only. RESULTS: Similarities and differences were observed between the two groups in terms of factors associated with higher caregiver strain (i.e. lower disease self-management efficacy scores, providing ≥20 h of care per week). Uniquely for Non-Hispanic Black male caregivers, higher caregiver strain was associated with living with more children under the age of 18 (ß = 0.35, P = 0.011) and feeling more socially disconnected (ß = 0.41, P = 0.008). Uniquely for Hispanic male caregivers, higher caregiver strain levels were associated with experiencing lower pain levels (ß = -0.14, P = 0.040) and higher fatigue levels (ß = 0.23, P < 0.001). CONCLUSION: Findings from this study suggest that non-Hispanic Black and Hispanic men with chronic conditions have differing caregiving experiences. While bolstering social connectedness and caregiver support services may offset caregiver strain, tailored mental health and disease management programming are needed to meet the specific needs of non-Hispanic Black and Hispanic male caregivers.

Stealth Vaping Among College Students on Four Geographically Distinct Tobacco-Free College Campuses: Prevalence and Practices.

INTRODUCTION: To offset tobacco use among college students, many universities have implemented tobacco-free campus policies. Given how easily e-cigarette users can discreetly vape in places where it is prohibited without being detected (ie, stealth vape), it is important to assess whether students are subverting these policies. This study examined the prevalence of stealth vaping on-campus among students at multiple universities, including frequency and methods for stealth vaping. AIMS AND METHODS: A convenience sample of college students was obtained from four geographically distinct, large, public universities with established policies prohibiting all forms of tobacco use on campus. Participants (N = 863 current e-cigarette users) reported on demographics and e-cigarette use. Those who previously stealth vaped on-campus (n = 422) completed additional questions, including common locations, techniques, and devices/e-liquids used for stealth vaping. RESULTS: Nearly half (48.9%) of past 30-day e-cigarette users reported previously stealth vaping on-campus. Among stealth vapers, 48.1% owned a smaller device for stealth vaping and 38.9% used e-liquids with low visibility vapors. Common on-campus stealth vaping locations included bathrooms, libraries, parking garages, and classrooms. Techniques used for stealth vaping included deep inhale, blowing a hit into one's clothes, and swallowing a hit. CONCLUSIONS: A large percentage of respondents commonly violated campus tobacco-free policies by stealth vaping. For such policies to be effective at reducing on-campus e-cigarette use, there is a need for enhanced monitoring and enforcement. More research is needed to better understand factors influencing stealth vaping behaviors and public health implications. IMPLICATIONS: This sample of college student e-cigarette users commonly violated campus smoke- and tobacco-free policies by stealth vaping on campus. Respondents used a range of methods (eg, smaller device and low visibility e-liquids) and locations (eg, bathrooms, libraries, and parking garages) for stealth vaping. If campus policies are to be effective at reducing on-campus e-cigarette use, there is a need for enhanced monitoring and enforcement. E-cigarette devices specifically designed and marketed to facilitate stealth vaping (eg, resembling USB flash drives and pens) may require regulatory action. More research is needed to better understand factors influencing stealth vaping behaviors and public health implications.

E-cigarette-inclusive smoke-free policies, excise taxes, tobacco 21 and changes in youth e-cigarette use: 2017-2019.

BACKGROUND: We examined whether the implementation of electronic cigarette (e-cigarette) policies at the state level (e-cigarette-inclusive smoke-free (ESF) policies, excise taxes on e-cigarettes and raising tobacco legal purchasing age to 21 years (T21)) affected recent upward trends in youth e-cigarette use. METHODS: Data were from participants from 34 US states who completed the Youth Risk Behavior Survey (YRBS) state surveys in 2017 and 2019 (n=278 271). States were classified as having or not having ESF policies, any e-cigarette excise tax and T21 policies by 1 January 2019. Participants reported ever, past 30-day and frequent (≥20 days) e-cigarette use; past 30-day combustible cigarette smoking; and age, sex and race/ethnicity. Weighted multivariable logistic regression models assessed whether changes in e-cigarette use over time differed by policy status, adjusting for participants' demographics and combustible cigarette smoking. RESULTS: Prevalence of ever and past 30-day youth e-cigarette use in states with ESF policies decreased during 2017-2019, while the prevalence of these measures in states without ESF policies increased. States with T21 policies showed non-significant changes in prevalence of ever and past 30-day youth e-cigarette use, whereas states without T21 policies showed significant increases in ever and past 30-day youth e-cigarette use. States with ESF and T21 policies showed slower increases in youth frequent e-cigarette use. E-cigarette excise taxes were not associated with decreasing prevalence of youth e-cigarette use. CONCLUSIONS: State-level ESF and T21 policies could be effective for limiting growth of youth e-cigarette use despite an overall national increase. Higher e-cigarette excise tax rates may be needed to effectively reduce youth e-cigarette use.

Examination of Current Anxiety Problems with School Engagement and Volunteer and Paid Work among U.S. Adolescents.

This study examined the relationships between current anxiety problems and school engagement, community service or volunteer work, and paid work among U.S. adolescents. The 2018-2019 National Survey of Children's Health (NSCH) dataset was analyzed and included 24,609 adolescents ages 12-17 years. We conducted unadjusted and adjusted logistic regression analyzes. A total of 12.6% of adolescents had healthcare provider-confirmed current anxiety problems. Adolescents with current anxiety were at decreased odds of engaging in school (aOR = 0.35, 95%CI = 0.29, 0.41) and participating in community service or volunteer work (aOR = 0.72, 95%CI = 0.59, 0.86) compared to adolescents without current anxiety. Adolescents with current anxiety were at increased odds of participating in paid work (OR = 1.18, 95%CI = 1.01, 1.38). This study reports that U.S. adolescents with anxiety were less likely to engage in school and participate in community service or volunteer work, but were more likely to participate in paid work compared to their peers without anxiety. Results should inform future interventions targeting adolescents.

Does marijuana use among African American adolescent males differ based on school factors?

Marijuana use among adolescents is a major public health problem. The purpose of this study was to examine whether past-year marijuana use among African American adolescent males differed based on age and school factors. Data from the 2015-2018 National Survey on Drug Use and Health (NSDUH) were analyzed. A national sample of African American students in grades 7 through 12 (n = 5,738) completed the survey. Results indicated that 14.7% reported using marijuana in the past year. Those at highest risk for past-year marijuana use were those who were male, were 16 to 17 years old, were in 9th through 12th grade, did not like going to school, and thought that most/all students in their grade used marijuana. Prevention professionals should consider the links among school attitudes, perceived social norms, and marijuana use when developing programs and interventions. Efforts are needed that are culturally competent and culturally sensitive to help reduce marijuana use rates among African American male adolescents. Future research is needed to further examine school perceptions and marijuana use among this population.

Current anxiety problems and organized activity participation among U.S. adolescents.

The study objectives were to examine the relationships between healthcare provider-confirmed current anxiety problems and organized activity participation including sports, clubs/organizations, and other activities. We used data from the 2018-2019 National Survey of Children's Health including 24,356 adolescents 12-17 years old. Poisson and logistic regression analyses were conducted. About 13% of adolescents had current anxiety problems. Poisson regression results indicated that adolescents with anxiety problems were less likely to participate in a higher total number of organized activities compared to children without anxiety problems. Similarly, logistic regression results indicated that adolescents with anxiety problems were at reduced odds of participating in at least one organized activity compared to adolescents without anxiety problems. Specific to activity type, adolescents with anxiety problems were at reduced odds of participating in sports and clubs/organizations. Study findings should be considered when creating and implementing community health promotion and education prevention programs and interventions for adolescents.

Tobacco smoke exposure and fractional exhaled nitric oxide levels among U.S. adolescents.

BACKGROUND: Fractional exhaled nitric oxide (FeNO) can objectively guide clinical practice in the assessment, diagnosis, and treatment of eosinophilic airway inflammation. FeNO values may be affected by current smoking, but the role of tobacco smoke exposure (TSE) is understudied. OBJECTIVE: This study investigated the associations between biochemically validated and self-reported TSE and FeNO levels among U.S. nonsmoking adolescents without asthma. METHODS: National Health and Nutrition Examination Survey 2007-2012 data were used. TSE was assessed via serum cotinine and self-reported measures. We assessed FeNO continuously and using cutpoints of >35 ppb and >50 ppb to indicate likely eosinophilic inflammation in children and adults, respectively. We conducted linear and logistic regression adjusting for potential covariates. RESULTS: Overall, 34.0% of adolescents had low cotinine (0.05-2.99 ng/ml), 6.2% had high cotinine (≥3.00 ng/ml), and 11.9% had home TSE. Compared to adolescents with no/minimal cotinine, adolescents with high cotinine were at reduced odds to have FeNO >35 ppb (adjusted odds ratio [aOR] = 0.54, 95%CI = 0.43,0.69). Adolescents with low cotinine had lower FeNO values (ß = -2.05, 95%CI = -3.61,-0.49), and were also at decreased odds to have FeNO >35 ppb (aOR = 0.74, 95%CI = 0.66,0.83) and FeNO >50 ppb (aOR = 0.62, 95%CI = 0.53,0.72). Adolescents with home TSE were at reduced odds to have FeNO >50 ppb (aOR = 0.72, 95%CI = 0.57,0.91) than adolescents without home TSE. Adolescents with a higher number of cigarettes/day smoked inside their home were at reduced odds to have FeNO >35 ppb (OR = 0.98, 95%CI = 0.97,0.99) and FeNO >50 ppb (OR = 0.98, 95%CI = 0.96,0.99). CONCLUSIONS: TSE was associated with decreased FeNO levels. The addition of TSE may be clinically important when interpreting thresholds for FeNO.

Concurrent E-cigarette and marijuana use and health-risk behaviors among U.S. high school students.

The use of electronic cigarettes (e-cigarettes) and marijuana remain prevalent problems among adolescents nationwide. We assessed current (past 30-day) exclusive e-cigarette use, exclusive marijuana use, and concurrent use with unintentional injury and violent behaviors, alcohol and other drug use behaviors, and sexual behaviors among U.S. high school students. We analyzed 2017 Youth Risk Behavior Survey data including 12,578 high school students nationwide. Multivariable logistic regression models were performed to compare these health-risk behaviors among exclusive e-cigarette users, exclusive marijuana users, and concurrent users with non-users among the overall sample, and then to compare exclusive e-cigarette users and exclusive marijuana users with concurrent users among current users only. All models adjusted for adolescent sex, grade, and race/ethnicity, and other tobacco product use. Approximately 77% of students were non-users, 5.2% were exclusive e-cigarette users, 9.9% were exclusive marijuana users, and 7.8% were concurrent users. Compared to non-users, exclusive e-cigarette users and exclusive marijuana users were more likely to engage in most negative health-risk behaviors associated with unintentional injuries and violence, alcohol and other drug use, and sexual behaviors. Among current users only, exclusive e-cigarette users and exclusive marijuana users were at reduced odds of engaging in most of these health-risk behaviors when compared to concurrent users of both substances. The relationship between exclusive and concurrent e-cigarette and marijuana use and health-risk behaviors highlights the importance of comprehensive educational efforts during high school. Findings suggest need for more studies on influence of e-cigarette and marijuana use on injury and violence risk among youth.

Combustible and electronic cigarette use and insufficient sleep among U.S. high school students.

The study aimed to investigate the relationships between current exclusive e-cigarette use, exclusive combustible cigarette smoking, and dual use of e-cigarettes and combustible cigarettes, and insufficient sleep among U.S. adolescents. We conducted a secondary data analysis of the 2017 Youth Risk Behavior Survey including 11,296 U.S. high school students. Current (past 30-day) tobacco use groups included exclusive e-cigarette users, exclusive combustible cigarette smokers, and dual-product users. We performed weighted unadjusted and adjusted logistic regression analyses. Insufficient sleep was defined as <8 h/night and < 7 h/night. Overall, 73.4% of adolescents reported insufficient sleep <8 h/night. Compared with non-tobacco users, exclusive e-cigarette users were more likely to report insufficient sleep <8 h/night (odds ratio [OR] = 1.55, 95%CI = 1.12-2.14; adjusted OR [aOR] = 1.57, 95%CI = 1.01-2.43) and < 7 h/night (OR = 1.55, 95%CI = 1.19-2.01; aOR = 1.61, 95%CI = 1.16-2.24). Dual-product users were at increased odds to report insufficient sleep <8 h/night (OR = 3.15, 95%CI = 1.87-5.32) and < 7 h/night (OR = 2.64, 95%CI = 1.87-3.72; aOR = 1.73, 95%CI = 1.14-2.62) than non-tobacco users. Exclusive combustible cigarette smokers were less likely to report insufficient sleep <8 h/night (aOR = 0.49, 95%CI = 0.29-0.84) than non-tobacco users, but no differences were found based on insufficient sleep <7 h/night. When comparing current use groups, exclusive e-cigarette users were at 3.20 increased odds (95%CI = 1.65-6.22) and dual-product users were at 3.26 increased odds (95%CI = 1.51-7.03) to report insufficient sleep <8 h/night when compared with exclusive combustible cigarette smokers after covariate adjustment. Dual-product users were 1.89 times more likely (95%CI = 1.01-3.51) to report insufficient sleep <7 h/night when compared with exclusive combustible cigarette smokers. School-based prevention efforts for tobacco use may promote sufficient sleep in youth.

Family resilience and health among adolescents with asthma only, anxiety only, and comorbid asthma and anxiety.

OBJECTIVES: The objectives were to examine the relationships between current asthma and anxiety and family resilience and overall health status in US adolescents. METHODS: Data were from parents of adolescents (12-17 years) who completed the 2017-2018 National Survey of Children's Health (NSCH). Examined variables included: current asthma and anxiety diagnoses, family resilience, child health status, number of adverse childhood experiences (ACEs), family poverty, parent education, and child demographic factors. Multinomial logistic regression models were performed. RESULTS: Findings indicated that compared to adolescents with high resilience scores, adolescents with anxiety only and comorbid asthma and anxiety were more likely to have moderate or low family resilience scores than adolescents with no asthma or anxiety. Compared with adolescents with an excellent/very good health status, youth with asthma only, anxiety only, and asthma and anxiety had higher odds of having good or fair/poor health status than adolescents with no asthma or anxiety. Among those with current diagnoses, adolescents with asthma only were less likely to have moderate and low resilience scores than adolescents with asthma and anxiety. Adolescents with asthma only and anxiety only were also at reduced odds to have good or fair/poor health status than those with comorbid diagnoses. CONCLUSIONS: Results indicated that anxiety is linked to family resilience of adolescents with and without comorbid asthma. Experiencing a higher number of ACEs was a risk factor for lower family resilience scores and health status. Future research should consider the impact of other mental health problems and family resilience and health status.

Differential associations of hand nicotine and urinary cotinine with children's exposure to tobacco smoke and clinical outcomes.

BACKGROUND: Children's overall tobacco smoke exposure (TSE) consists of both inhalation of secondhand smoke (SHS) and ingestion, dermal uptake, and inhalation of thirdhand smoke (THS) residue from dust and surfaces in their environments. OBJECTIVES: Our objective was to compare the different roles of urinary cotinine as a biomarker of recent overall TSE and hand nicotine as a marker of children's contact with nicotine pollution in their environments. We explored the differential associations of these markers with sociodemographics, parental smoking, child TSE, and clinical diagnoses. METHODS: Data were collected from 276 pediatric emergency department patients (Median age = 4.0 years) who lived with a cigarette smoker. Children's hand nicotine and urinary cotinine levels were determined using LC-MS/MS. Parents reported tobacco use and child TSE. Medical records were reviewed to assess discharge diagnoses. RESULTS: All children had detectable hand nicotine (GeoM = 89.7ng/wipe; 95 % CI = [78.9; 102.0]) and detectable urinary cotinine (GeoM = 10.4 ng/ml; 95%CI = [8.5; 12.6]). Although hand nicotine and urinary cotinine were highly correlated (r = 0.62, p < 0.001), urinary cotinine geometric means differed between racial groups and were higher for children with lower family income (p < 0.05), unlike hand nicotine. Independent of urinary cotinine, age, race, and ethnicity, children with higher hand nicotine levels were at increased risk to have discharge diagnoses of viral/other infectious illness (aOR = 7.49; 95%CI = [2.06; 27.24], p = 0.002), pulmonary illness (aOR = 6.56; 95%CI = [1.76; 24.43], p = 0.005), and bacterial infection (aOR = 5.45; 95%CI = [1.50; 19.85], p = 0.03). In contrast, urinary cotinine levels showed no associations with diagnosis independent of child hand nicotine levels and demographics. DISCUSSION: The distinct associations of hand nicotine and urinary cotinine suggest the two markers reflect different exposure profiles that contribute differentially to pediatric illness. Because THS in a child's environment directly contributes to hand nicotine, additional studies of children of smokers and nonsmokers are warranted to determine the role of hand nicotine as a marker of THS exposure and its potential role in the development of tobacco-related pediatric illnesses.