Nav: Home

Almost all adolescents in an economically disadvantaged urban population exposed to tobacco smoke

February 23, 2018

Bottom Line: Ninety-four percent of adolescents ages 13 to 19 in an economically disadvantaged, largely minority population in San Francisco had measurable levels of a biomarker specific for exposure to tobacco smoke (NNAL).

Journal in Which the Study Was Published:Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Author: Neal L. Benowitz, MD, professor of Medicine and Bioengineering & Therapeutic Sciences, and chief of the Division of Clinical Pharmacology at the University of California, San Francisco (UCSF).

Background: Benowitz explained that exposure of adolescents to secondhand smoke poses a public health challenge because it increases risk for respiratory infections, aggravates asthma, and is linked to an increased likelihood of becoming an active smoker.

In a prior study, Benowitz and colleagues showed that 87 percent of adolescents in an economically disadvantaged population had evidence of exposure to nicotine, as defined by the presence of cotinine in urine samples.

In this study, they set out to assess tobacco smoke exposure in this population by measuring levels of NNAL in urine samples. Benowitz explained that NNAL is detectable in urine for much longer periods after tobacco exposure compared with cotinine and that it is present only in the urine of people exposed to tobacco. He and his colleagues, therefore, investigated whether NNAL would be a more sensitive biomarker of exposure to secondhand smoke compared with cotinine, more likely to identify adolescents only intermittently exposed.

How the Study Was Conducted and Results: The researchers measured levels of cotinine and NNAL in urine samples from 465 adolescents who received pediatric care at the Children's Health Center at Zuckerberg San Francisco General Hospital. Among these adolescents, 91 percent had public health insurance and 8 percent had no health insurance; 53 percent were Latino, 22 percent African-American, 11 percent Asian, and 3 percent white.

Overall, 94 percent of the adolescents had detectable levels of NNAL, compared with 87 percent for cotinine. Thus, using the NNAL biomarker indicated a higher prevalence of tobacco exposure in this population compared with cotinine.

Using a level of more than 30 ng of cotinine per ml of urine as a biomarker of active smoking, which is consistent with prior research, 12 percent of the adolescents were identified as active smokers. Eighty-two percent of the adolescents were identified as nonsmokers who had been exposed to secondhand smoke because they had detectable levels of NNAL but did not have cotinine levels above 30 ng per ml of urine.

The percentage of individuals who were identified as active smokers was highest among the African-American adolescents, 32 percent. In addition, the level of NNAL in the urine of nonsmokers was highest among African-American nonsmokers, suggesting higher levels of secondhand smoke exposure.

Author Comment: "Now, using the tobacco-specific biomarker and lung carcinogen NNAL, we find an even higher prevalence of tobacco exposure, which eliminates the possibility that the [prior] result with cotinine was due to consumption of nicotine-containing products such as tomatoes, potatoes, eggplant, and black tea," said Benowitz

"Our data show nearly ubiquitous exposure to tobacco smoke in this population of economically disadvantaged adolescents, which highlights the need for new public health initiatives to reduce exposure," he added. "It also suggests that routine urine screening for NNAL or cotinine, with counseling intervention in those screening positive for exposure, could help address this public health challenge."

Limitations: According to Benowitz, the main limitations of the study are that it was conducted at a single hospital and that ethnic minorities comprised the majority of the study population, both of which mean the results might not be generalizable to all urban adolescents.
-end-
Funding & Disclosures: This study was supported by funds from the Flight Attendant Medical Research Institute Bland Lane Center of Excellence on Secondhand Smoke at UCSF, and the National Institute of Health's National Institute on Drug Abuse and National Center for Research Resources. Benowitz is a consultant to Pfizer and Achieve Life Sciences, which market or are developing medications to aid smoking cessation. He has served as a paid expert witness in litigation against tobacco companies.

Follow us: Cancer Research Catalyst http://blog.aacr.org; Twitter @AACR; and Facebook http://www.facebook.com/aacr.org

About the American Association for Cancer Research:

Founded in 1907, the American Association for Cancer Research (AACR) is the world's first and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer. AACR membership includes more than 40,000 laboratory, translational, and clinical researchers; population scientists; other health care professionals; and patient advocates residing in 120 countries. The AACR marshals the full spectrum of expertise of the cancer community to accelerate progress in the prevention, biology, diagnosis, and treatment of cancer by annually convening more than 30 conferences and educational workshops, the largest of which is the AACR Annual Meeting with more than 21,900 attendees. In addition, the AACR publishes eight prestigious, peer-reviewed scientific journals and a magazine for cancer survivors, patients, and their caregivers. The AACR funds meritorious research directly as well as in cooperation with numerous cancer organizations. As the Scientific Partner of Stand Up To Cancer, the AACR provides expert peer review, grants administration, and scientific oversight of team science and individual investigator grants in cancer research that have the potential for near-term patient benefit. The AACR actively communicates with legislators and other policymakers about the value of cancer research and related biomedical science in saving lives from cancer. For more information about the AACR, visit http://www.AACR.org.

American Association for Cancer Research

Related Health Insurance Articles:

Health insurance expansion linked to fewer sudden cardiac arrests
The incidence of sudden cardiac arrest, a sudden and usually deadly loss of heart function, declined significantly among previously uninsured adults who acquired health insurance through the Affordable Care Act, also known as 'Obamacare,' according to a study published today in the Journal of the American Heart Association.
Analysis indicates that insurance expansion improves access to care, health, and survival
There is strong evidence that expanding health insurance increases access to care, improves health in a variety of ways, and reduces mortality, according to Harvard T.H.
Generous health insurance plans encourage overtreatment, but may not improve health
Offering comprehensive health insurance plans with low deductibles and co-pay in exchange for higher annual premiums seems like a good value for the risk averse, and a profitable product for insurance companies.
Study shows health insurance plans too complicated to understand
A new survey by experts at the Health Disparities Institute of UConn Health shows that many patients across Connecticut are struggling to understand their complex, jargon-filled private health insurance plans and even to use their plan benefits correctly.
With health insurance at risk, community health centers face cut-backs
Repeal of key provisions of the Affordable Care Act, combined with a failure to renew critical funding streams, would result in catastrophic funding losses for community health centers-forcing these safety net providers to cut back on services, lay off staff or shut down clinical sites, according to a report published today.
Evaluating the benefits of health insurance on cancer care
A new Dartmouth study shows that patients have lower rates of cancer-specific survival based on where they live and their social determinants of health.
American College of Physicians praises blocked health insurance merger
The American College of Physicians (ACP) praises the ruling by a federal judge yesterday that blocked a proposed merger between health insurers Aetna and Humana.
More with mental illness and substance use disorders have health insurance
Significantly more people with mental illness and substance use disorders had insurance coverage in 2014 due to the expansion of health insurance under the Affordable Care Act, but many barriers to treatment remain, new Johns Hopkins Bloomberg School of Public Health research suggests.
'Cadillac tax' may precipitate changes to employer-provided health care insurance
Even if the Affordable Care Act is ultimately repealed, the law's so-called 'Cadillac tax' on high-cost health care plans has already affected employers' health insurance offerings, says Richard L.
Study links health literacy to higher levels of health insurance coverage
The federal Affordable Care Act is intended to make it easier for individuals to buy health insurance, but are the uninsured equipped to navigate the choices faced in the insurance marketplace?

Related Health Insurance Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#514 Arctic Energy (Rebroadcast)
This week we're looking at how alternative energy works in the arctic. We speak to Louie Azzolini and Linda Todd from the Arctic Energy Alliance, a non-profit helping communities reduce their energy usage and transition to more affordable and sustainable forms of energy. And the lessons they're learning along the way can help those of us further south.