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Reference Intervals for Urinary Cotinine Levels and the Influence of Sampling Time and Other Predictors on Its Excretion Among Italian Schoolchildren

Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro, 5, 00185 Rome, Italy
Department of Medicine and Surgery, Laboratory of Industrial Toxicology, University of Parma, 43121 Parma, Italy
Department of Technological Innovations, National Institute for Insurance against Accidents at Work, Via IV Novembre 144, 00187 Rome, Italy
Department of Agricultural, Environmental and Food Sciences (DiAAA), University of Molise, Via De Sanctis, 86100 Campobasso, Italy
Institute of Ecotoxicology and Environmental Sciences, 700156 Kolkata, India
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(4), 817;
Received: 20 March 2018 / Revised: 12 April 2018 / Accepted: 17 April 2018 / Published: 21 April 2018
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
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(1) Background: Environmental Tobacco Smoke (ETS) exposure remains a public health problem worldwide. The aims are to establish urinary (u-) cotinine reference values for healthy Italian children, to evaluate the role of the sampling time and of other factors on children’s u-cotinine excretion. (2) Methods: A cross-sectional study was performed on 330 children. Information on participants was gathered by a questionnaire and u-cotinine was determined in two samples for each child, collected during the evening and the next morning. (3) Results: Reference intervals (as the 2.5th and 97.5th percentiles of the distribution) in evening and morning samples were respectively equal to 0.98–4.29 and 0.91–4.50 µg L−1 (ETS unexposed) and 1.39–16.34 and 1.49–20.95 µg L−1 (ETS exposed). No statistical differences were recovered between median values found in evening and morning samples, both in ETS unexposed and exposed. Significant predictors of u-cotinine excretions were ponderal status according to body mass index of children (β = 0.202; p-value = 0.041 for evening samples; β = 0.169; p-value = 0.039 for morning samples) and paternal educational level (β = −0.258; p-value = 0.010; for evening samples; β = −0.013; p-value = 0.003 for morning samples). (4) Conclusions: The results evidenced the need of further studies for assessing the role of confounding factors on ETS exposure, and the necessity of educational interventions on smokers for rising their awareness about ETS. View Full-Text
Keywords: cotinine; urine; children; Italy; environmental tobacco smoke exposure cotinine; urine; children; Italy; environmental tobacco smoke exposure

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Protano, C.; Andreoli, R.; Mutti, A.; Manigrasso, M.; Avino, P.; Vitali, M. Reference Intervals for Urinary Cotinine Levels and the Influence of Sampling Time and Other Predictors on Its Excretion Among Italian Schoolchildren. Int. J. Environ. Res. Public Health 2018, 15, 817.

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