Send to

Choose Destination
Int J Environ Res Public Health. 2019 Nov 21;16(23). pii: E4625. doi: 10.3390/ijerph16234625.

The Association of Environmental Tobacco Smoke Exposure and Inflammatory Markers in Hospitalized Children.

Author information

Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center; University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA.
Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati; College of Medicine, Cincinnati, OH 45229, USA.
Department of Psychology, San Diego State University, San Diego, CA 92123, USA.


Environmental tobacco smoke (ETS) exposure is associated with altered cytokine levels in children. We sought to examine ETS exposure prevalence and the relationship between ETS exposure and cytokine levels in a sample of hospitalized children. (2) Methods: Inflammatory markers (IL-8, IL-1β, IL-10, and TNF-α) and cotinine were measured in saliva of hospitalized, nonsmoking children (N = 112). To assess the association between ETS exposure and immune system response, we built a multivariate regression model including the four inflammatory markers as the response variables and cotinine, age, sex, and discharge diagnosis as explanatory variables while assessing possible interaction effects. (3) Results: Mean age (SD) was 5.8(5.0) years; Geometric Mean (GeoM) cotinine = 1.8 [95% CI = 1.4-2.2]. Children with non-inflammatory other diagnoses had lower IL-10 (p = 0.003) and TNF-α (p = 0.009) levels than children with inflammatory other diagnoses. Children with asthma (p = 0.01) and bacterial illnesses and/or pneumonia (p = 0.002) had higher IL-8 levels. Independent of diagnosis, there was a significant curvilinear association between cotinine and IL-1β (p = 0.002) reflecting no association for cotinine levels <5 ng/mL and a positive association for >5 ng/mL. (4) Conclusions: Children with higher ETS exposure levels have higher IL-1β levels regardless of age, sex, and diagnosis. ETS exposure may increase pro-inflammatory immune responses in children and may interfere with native immune responses and the ability to heal and fight infection.


children; cotinine; cytokines; inflammatory markers; secondhand smoke exposure

Free full text

Supplemental Content

Full text links

Icon for Multidisciplinary Digital Publishing Institute (MDPI)
Loading ...
Support Center