Characterization of Tobacco Smoke Exposure and Associated Factors in an African American, Maternal Cohort in Atlanta, GA Open Access

Abstract

Background: African Americans (AA) have a greater tobacco smoke exposure burden compared to other races. AA pregnant women have greater exposure compared to White pregnant women, and research on active and passive tobacco smoke exposure and associated factors in AA maternal cohorts is needed. This study characterized tobacco smoke biomarkers in an AA maternal cohort and investigated associated demographic and behavioral factors. 

Methods: Beginning January 2016, 3 urine samples from 104 pregnant women planning to deliver at Emory-affiliated Midtown and Grady Hospitals in Atlanta, GA were collected. Demographic, health, and environmental surveys collected covariates. Urine was analyzed for cotinine (COT), trans-3’ hydroxycotinine (3HC), tetrahydrocannabinolic acid (THCA), and nicotine metabolite ratio (3HC/COT). Regressions were used to investigate associations. 

Results: Geometric means for average COT, 3HC, and 3HC/COT across pregnancy were 10.19 (ug COT/g creatinine), 22.48 (ug 3HC/g creatinine), and 2.21, respectively. Surprisingly, COT and 3HC levels were highest and showed greatest variation at the third trimester. 3HC/COT was highest (2.39) and showed greatest variation at the 1st trimester and decreased to 2.17 at the third trimester. Based on a cut point of COT ≥ 50ng/mL to indicate active smoking, tobacco smoking prevalence during pregnancy was 32.7%, and cessation prevalence was 5.8%. Self-reported secondhand smoke exposure (SHS) prevalence was 43.3%. Tobacco smoking, quit (β = 6.05; 95% CI, 2.08-16.61; p < .001) and continued (β = 51.41; 95% CI, 30.27- 88.23 p < .0001), was the strongest predictor of average COT levels. SHS, income <100% FPL, alcohol use at first trimester, and smoking marijuana were determinants of increased COT levels across pregnancy, and education past high school or GED was protective. Increasing THCA levels (β = 1.03; 95% CI, 1.01-1.04; p < .05) predicted first trimester COT levels, and 24.0% of mothers co-used marijuana and tobacco at first trimester, indicated by COT and THCA levels.

Conclusions: COT and 3HC levels remained high through pregnancy. Future studies should investigate the interaction between COT and THCA and co-use in AA maternal cohorts. Alterations of NMR during pregnancy should be investigated to understand if changes in nicotine metabolism are uniquely contributing to COT burden in AA maternal cohorts.  

Table of Contents

Abstract 1

Introduction 2

Aims & Hypotheses 5

Methods 6

Results 11

Discussion 19

Conclusion 24

References 25

Tables & Figures 29

Appendices 41

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Public Health Education Health Sciences, Obstetrics and Gynecology
Keyword	THCA preterm birth Exposure pregnancy African American adverse birth outcomes Cotinine Atlanta Biomarkers Co-use of marijuana and tobacco
Committee Chair / Thesis Advisor	Dana Boyd Barr, PhD., Emory University

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