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Serum cotinine cut-points for secondhand smoke exposure assessment in children under 5 years: A systemic review.

Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain. CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain. Tobacco Control Unit, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), Badalona, Spain. Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain. School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain. CIBER of Respiratory Diseases (CIBERES), Madrid, Spain. Servicio de Evaluación y Métodos de Intervención, Agència de Salut Pública de Barcelona, Barcelona, Spain. Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain. Epidemiology Unit, Galician Directorate for Public Health, Santiago de Compostela, Spain. Departamento de Salud Pública, Grupo de investigación Promoción de la Salud y Prevención de la Enfermedad (GIPSPE), Universidad de Caldas, Manizales, Colombia. Fundación Carolina, Madrid, Spain.

PloS one. 2022;(5):e0267319
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Abstract

BACKGROUND Serum cotinine has become the most widely used biomarker of secondhand smoke exposure (SHS) over time in all ages. The aim of this study was to review the serum cotinine cut-points used to classify children under 5 years as exposed to SHS. METHODS A systematic review performed in the Pubmed (MEDLINE) and EMBASE databases up to April 2021 was conducted using as key words "serum cotinine", "tobacco smoke pollution" (MeSH), "secondhand smoke", "environmental tobacco smoke" and "tobacco smoke exposure". Papers which assessed SHS exposure among children younger than 5 years old were included. The PRISMA 2020 guidelines were followed. Analysis was pre-registered in PROSPERO (registration number: CRD42021251263). RESULTS 247 articles were identified and 51 fulfilled inclusion criteria. The selected studies were published between 1985-2020. Most of them included adolescents and adults. Only three assessed postnatal exposure exclusively among children under 5 years. None of the selected studies proposed age-specific cut-points for children < 5 years old. Cut-point values to assess SHS exposure ranged from 0.015 to 100 ng/ml. The most commonly used cut-point was 0.05 ng/ml, derived from the assay limit of detection used by the National Health and Nutrition Examination Survey (NHANES). CONCLUSIONS No studies have calculated serum cotinine age-specific cut-points to ascertained SHS exposure among children under 5 years old. Children's age-specific cut-points are warranted for health research and public health purposes aimed at accurately estimating the prevalence of SHS exposure and attributable burden of disease to such exposure, and at reinforcing 100% smoke-free policies worldwide, both in homes, private vehicles and public places.