Secondhand tobacco smoke (SHS) is a significant public health problem for all ages worldwide. Children are more vulnerable to the health effects of SHS because of the inhalation of more air per body volume compared to adults. The study aimed to assess neurobehavioral performance among SHS exposed Egyptian basic school children (10–12 years) and its relationship with urinary cotinine levels. Multistage cluster sampling was carried out, where 181 children (80 exposed and 101 non-exposed children) were recruited. A questionnaire on SHS exposure was sent to students’ parents/caregivers. Urine samples were taken for assessment of cotinine levels by enzyme immunoassay. A Neurobehavioral test battery was measured. The exposed children had significantly lower performance in tests of attention (PASAT) [5.22 ± 5.10 vs. 6.98 ± 5.87, p = 0.035], visuomotor speed (Digit Symbol and Trail making A) [41.40 ± 18.01 vs. 46.53 ± 15.89 and 107.92 ± 44.34 vs. 92.44 ± 37.09; respectively] than non-exposed subjects. The neurobehavioral effects were correlated with urinary cotinine levels among children exposed to SHS compared to unexposed children. The study revealed poor performance in neurobehavioral domains of attention and visuomotor skills among children exposed to SHS. This necessitates the implementation of antismoking media awareness programs on the harmful effects of SHS and how to protect children from it.
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Abdel-Khalek AM (1994) Development of personality traits. J Contemp Psychol 3:29–54
Abdel-Rasoul G, Abou Salem M, Mechael A, Hendy O, Rohlman D, Ismail A (2008) Effects of occupational pesticide exposure on children applying pesticides. Neurotoxicology 29(5):833–838
Abou El-Ellaa SS, Tawfik MA, El Bassuonib MA, Yahiaa MI (2014) Urinary cotinine level in passive smoker nondiabetic children of diabetic families. Menoufia Med J 27:23–27
Anger K (2003) Education: Neurobehavioural tests and systems to assess neurotoxic exposures in the workplace and community. Occup Environ Med 60(7):531–538
Balhara YPS, Jain R (2013) A receiver operated curve-based evaluation of change in sensitivity and specificity of cotinine urinalysis for detecting active tobacco use. J Cancer Res Ther 9(1):84–89
Boyaci H, Etiler N, Duman C, Basyigit I, Pala A (2006) Environmental tobacco smoke exposure in school children: parent report and urine cotinine measures. Pediatr Int 48:382–389
Braun JM, Daniels JL, Kalkbrenner A, Zimmerman J, Nicholas JS (2009) The effect of maternal smoking during pregnancy on intellectual disabilities among 8-year-old children. Pediatr Perinat Epidemiol 23:482–491
Chastang J, Baïz N, Cadwalladder JS, Robert S, Dywer J, Charpin DA (2015) Postnatal environmental tobacco smoke exposure related to behavioral problems in children. PLoS One 10(8):e0133604
Cheraghi M, Salvi S (2009) Environmental tobacco smoke (ETS) and respiratory health in children. Eur J Pediatr 168:897–905
Cho SC, Hong YC, Kim JW, Park S, Park MH, Hur J (2013) Association between urine cotinine levels, continuous performance test variables, and attention deficit hyperactivity disorder and learning disability symptoms in school-aged children. Psychol Med 43:209–219
Desouky D, Elnemr G, Alnawawy A, Taha A (2016) The relation between exposure to environmental tobacco smoke and the quantity of cotinine in the urine of school children in Taif City, Saudi Arabia. Asian Pac J Cancer Prev 17:139–145
Florescu A, Ferrence R, Einarson T, Selby P, Soldin O, Koren G (2009) Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: focus on developmental toxicology. Ther Drug Monit 31:14–30
Goniewicz ML, Eisner MD, Eduardo L, Lazcano-Ponce E, Zielinska-Danch W, Koszowski SA, Havel C, Jacob P, Benowitz NL (2011) Comparison of urine cotinine and the tobacco-specific nitrosamine metabolite 4-(methylnitrosamino)-1-(3-Pyridyl)-1-Butanol (NNAL) and their ratio to discriminate active from passive smoking. Nicotine Tob Res 13:202–208
Hecht SS, Ye M, Carmella SG, Fredrickson A, Adgate J, Greaves I, Church T, Ryan A, Mongin S, Sexton K (2001) Metabolites of a tobacco-specific lung carcinogen in the urine of elementary school-aged children. Cancer Epidemiol Biomark Prev 10:1109–1116
Ismail AA, Bodner TE, Rohlman DS (2012) Neurobehavioral performance among agricultural workers and pesticide applicators: a meta-analysis study. Occup Environ Med 69:457–464
Kabir Z, Connolly G, Alpert H (2011) Secondhand smoke exposure and neurobehavioral disorders among children in the United States. Pediatrics 128(2):263–270
Kulza M, Wozniak A, Przybylowska SM, Czarnywojtek A, Kurhanska-Flisykowska A, Florek E (2012) Saliva cotinine determination using high-performance liquid chromatography with diode - array detection. Przegl Lek 69(10):837–840
Lezak MD, Howieson DB, Bigler ED, Tranel D (2012) Neuropsychological assessment, Fifth edn. Oxford University Press, Oxford
Niedbala RS, Haley N, Kardos S, Kardos K (2002) Automated homogeneous immunoassay analysis of cotinine in the urine. J Anal Toxicol 26:166–170
Park S, Cho S, Hong YC, Kim JW, Min-Sup Shin MS, Yoo H, Han D, Cheong J, Kim B (2014) Environmental tobacco smoke exposure and Children’s intelligence at 8–11 years of age. Environ Health Perspect 122(10):1123–1128
Puig C, Garcia-Algar O, Monleon T, Pacifici R, Zuccaro P, Sunyer J, Figueroa C, Pichini S, Vall O (2008) A longitudinal study of environmental tobacco smoke exposure in children: parental self-reports versus age-dependent biomarkers. BMC Public Health 8:47
Rohlman DS, Anger WK, Pamele JL (2011) Correlating neurobehavioral performance with biomarkers of organophosphorus pesticide exposure. Neurotoxicology 32:268–276
Ruckinger S, Rzehak P, Chen CM, Sausenthaler S, Koletzko S, Bauer CP (2010) Prenatal and postnatal tobacco exposure and behavioral problems in 10-year-old children: results from the GINI-plus prospective birth cohort study. Environ Health Perspect 118(1):150–154
Ryan JJ, Prifitera A, Larsen J (1982) Reliability of the WAIS-R with a mixed patient sample. Percept Mot Skills 55(3 Pt 2):1277–1278
Stepanov I, Hecht SS, Duca G, Mardari I (2006) Uptake of the tobacco-specific lung carcinogen 4-(methylnitrosamino)- 1-(3-pyridyl)-1-butanone by Moldovan children. Cancer Epidemiol Biomark Prev 15:7–11
Susanto A, Putri P, Hudoyo A, Taufik F, Nurwidya F, Andarini S (2018) Urinary cotinine level in Indonesian children exposed to domestic cigarette smoke. J Nat Sci Biol Med 9:77–81
Tang EA, Delaimy WK, Ashley DL, Benowitz N, Bernert JT, Kim S, Samet JM, Hecht SS (2013) Assessing second-hand smoke using biological markers. Tob Control 22(3):164–171
Tiesler CM, Chen CM, Sausenthaler S, Herbarth O, Lehmann I, Schaaf B (2011) Passive smoking and behavioral problems in children: results from the LISA plus prospective birth cohort study. Environ Res 111(8):1173–1179
Tombaugh TN (2006) A comprehensive review of the paced auditory serial addition test (PASAT). Arch Clin Neuropsychol 21(1):53–76
Twardella D, Bolte G, Fromme H, Wildner M, von Kries R (2010) Exposure to secondhand tobacco smoke and child behavior—results from a cross-sectional study among preschool children in Bavaria. Acta Paediatr 99:106–111
US Department of Health and Human Services (2006) The health consequences of involuntary exposure to tobacco smoke: a report of the surgeon general. Centers for Disease Control and Prevention, Atlanta. https://www.surgeongeneral.gov/library/reports/secondhandsmoke/fullreport.pdf. Accessed 27 Jan 2019
Xu X, Cook RL, Ilacqua VA, Kan H, Talbott EO (2010) Racial differences in the effects of postnatal environmental tobacco smoke on neurodevelopment. Pediatrics 126:705–711
Yeramaneni S, Dietrich K, Yolton K, Parsons P, Aldous K, Haynes E (2015) Secondhand tobacco smoke exposure and Neuromotor function in rural children. J Pediatr 167(2):253–259
Yolton K, Dietrich K, Auinger P, Lanphear BP, Hornung R (2005) Exposure to environmental tobacco smoke and cognitive abilities among U.S. children and adolescents. Environ Health Perspect 113:98–103
Yolton K, Khoury J, Xu Y, Succop P, Lanphear B, Bernert JT (2009) Low- level prenatal exposure to nicotine and infant neurobehavior. Neurotoxicol Teratol 31:356–363
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Salem, E.AA., Saheen, H.M. & Allam, H.K. Secondhand tobacco smoke, does it have an impact on the neurobehavioral performance of the exposed children?. Environ Sci Pollut Res 27, 44701–44708 (2020). https://doi.org/10.1007/s11356-020-08989-6
- Secondhand tobacco smoke
- Urinary cotinine
- Basic school children