摘要：Background: Environmental tobacco smoke (ETS) exposure in infants and children causes more frequent and
severe asthma attacks, respiratory infections, ear infections, and sudden infant death syndrome. The aim of this
study was to measure ETS exposure in children in Israel (ages 4–11 years) using urinary cotinine measurements,
in order to compare exposure levels to other international populations, and to assess predictors of ETS exposure
in children in Israel.
Methods: A subset of children who participated in the National Health and Nutrition Survey (RAV- MABAT) in
2015–2016 were invited to participate in the Second Israel Biomonitoring Survey. We analyzed urinary cotinine
and creatinine concentrations in 103 children. Parents of study participants were interviewed in person on
children's exposure to ETS at home and in other environments and on sociodemographic variables. We calculated
creatinine-adjusted and unadjusted urinary cotinine geometric means in children and analyzed associations in
univariable and multivariable analyses, between sociodemographic variables and parental – reported exposure,
and urinary cotinine concentrations.
Results: Based on urinary creatinine measurement, over 60% of children are exposed to ETS (compared
to < 40% based on parental report). Linear regression showed a positive association between urinary cotinine
concentration and reported ETS exposure (p = 0.001). Mean cotinine concentration among children whose
parents reported that they are exposed to ETS at home (5.1 μg/l) was significantly higher than the concentration
among children whose parents reported they are not exposed to ETS at home (1.6 μg/l, p < 0.001). There was
an inverse relationship between total family income and urinary cotinine concentration (p < 0.05). In a multivariable model adjusted for ethnicity and other factors, family income was a significant predictor of urinary
cotinine level (p = 0.04, slope = −0.49). Geometric mean creatinine adjusted concentrations in children in the
current study were higher than in children in Canada and selected European countries.
Conclusions: We found evidence of widespread exposure to ETS in children in the study. There is an urgent need
to protect children in Israel from exposure to ETS.
关键词：Environmental tobacco smoke ; Urinary cotinine ; Human biomonitoring ; Exposure ; Children
