gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

Biomarkers of exposure to passive smoking of school children: Frequency and Determinants

Meeting Abstract

  • Agim Thaqi - GSF-Forschungszentrum, Institut für Epidemiologie, Neuherberg
  • Käthie Franke - GSF-Forschungszentrum, Institut für Epidemiologie, Neuherberg
  • Günter Merkel - University of Rostock, Institute of Medical Microbiology, Virology and Hygiene, Rostock
  • H.-E. Wichmann - GSF-Forschungszentrum, Institut für Epidemiologie, Neuherberg
  • Joachim Heinrich - GSF-Forschungszentrum, Institut für Epidemiologie, Neuherberg

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds248

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Veröffentlicht: 8. September 2005

© 2005 Thaqi et al.
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ETS exposure on children is an important and preventable cause of morbidity and an important factor to decrease mortality [1]. The adverse health effects of passive smoking are today undisputed [2]. A overview of studies on passive smoking was done by Wichmann et al [3]. Numerous studies reported on parent’s smoking and children’s ETS exposure [4]. Parental smoking was identified as the most important source of children’s exposure to ETS. This study aims to assess the extent of childrens’ exposure to ETS and quantify potential determinants.

Study population and methods

The third Bitterfeld survey in 1998-1999 is a regional cross-sectional study designed to determine the exposure to environmental contaminants in the regions Bitterfeld, Zerbst and Hettstedt (East-Germany). In the present study, the association between questionnaire derived data on the smoking status of school children and the exposure to ETS at home and biomarkers in urine was investigated.

2,767 children aged 5-14 years participated in an environmental survey in East Germany in 1998-1999 (participation rate 75.9%). A subgroup of 979 children between the ages of 11 and 14 years with complete data on nicotine and cotinine in urine were selected for this analysis. This study population consisted of 73 self-reported smokers (7.5 %), 793 non-smokers (81 %) and 113 children with missing data on smoking status (11.5 %). Nicotine and cotinine concentrations in spontaneous urine sample were determined by HPLC methods with UV-detection and corrected for creatinine. Since the biomarkers were not normally distributed we used geometric means as average. Logistic regression models were applied for this analysis for the non-smokers model, since approximately 40% of the non-smoking school children showed detectable nicotine or cotinine concentrations. We calculated logistic regression models for detectable nicotine and cotinine.


About 40% of self-reported nonsmokers (n=318) were exposed to smoke at home and in 7 cases the parents did not answer the question for ETS exposure at home.

The average nicotine and cotinine concentration of self-reported nonsmokers ranged by two orders of magnitude are GM: 2.6 (95% CI: 2.3 – 2.8) μg/l and GM: 4.8 (95% CI: 4.4 – 5.2) μg/l, respectively. The geometric mean (GM) of nicotine and cotinine excretion in urine was 3-4 times higher among children with reported smoke exposure at home (ETS) versus children who were not exposed at home. There was a high significant dose-dependent increase of children’s excretion of nicotine and cotinine regarding the number of cigarettes that the parents smoked (Table 1 [Tab. 1]). Highly statistically significant effects on nicotine and cotinine excretion were also found for maternal smoking. Furthermore, low parental education, cold season, height of dwelling (≤ 2.40), urine collected on Mondays were statistically significant associated with high nicotine and cotinine excretion levels.


Children exposed to parental smoke showed much higher biomarker levels than the non-smoking spouse of an adult smoker. So, we compared our study findings with the German Environmental Survey (GerES III) for non-smoking adults [5]. The estimated effects for the number of smokers at home between Bitt-III and GerES-III differ greatly (Fig 1 [Fig. 1]). This might reflect ETS exposure and also physical constitutions of the study participants. Already in the year 1995 Willers et al. have reported that at the same level of ETS exposure, young children have nearly two times higher urinary cotinine levels than adults [6].

Our results indicate that maternal smoking at home makes a significant contribution to children’s exposure to environmental tobacco smoke. To our knowledge no such strong maternal smoking effect for 11-14 year old children has been measured before.

This shows that, in particular children need to be protected from ETS at home.


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