{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:15:45Z","timestamp":1793139345038,"version":"4.5.0"},"reference-count":69,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"unspecified","delay-in-days":50,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CA188813"],"award-info":[{"award-number":["CA188813"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,2,2]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cannabis use is far more common among adults who smoke tobacco than adults who do not, and its use is increasing among people who smoke tobacco with children living in the home. Given the well-established evidence that caregiver smoking is the primary source of children\u2019s secondhand exposures to these products, the increasing trend in caregiver co-use is raising public health concerns about children\u2019s co-exposure. Emerging data indicates that adult co-use is linked to additive health consequences, such as elevated nicotine and other tobacco-related toxicant blood levels, relative to use of only tobacco. It is unknown whether children\u2019s co-exposure leads to similar additive consequences. This study examined whether children\u2019s co-exposure to secondhand tobacco and cannabis smoke related to higher urinary levels of cotinine (the primary nicotine metabolite) relative to children exposed to only tobacco smoke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study performed a cross-sectional analysis of baseline data from the \u2018Babies Living Safe and Smokefree\u2019 tobacco intervention randomised controlled trial. All participants (N=396) included low-income mothers who smoked tobacco daily and were primary caretakers of young children (&lt;6 years old). Multivariable regression was performed to test the hypothesis that maternal co-smoking would relate to children\u2019s elevated cotinine levels in a model including potential confounding variables (eg, children\u2019s mean daily tobacco smoke exposure, maternal nicotine dependence level).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean participant age was 30.11+6.52 years old, and their children\u2019s age was 30.24+20.0 months old. In the past 7\u2009days, 146 (36.9%) participants reported smoking cannabis on at least 1\u2009day. Multivariable regression modelling showed that maternal co-smoking was associated with higher children\u2019s cotinine levels (p=0.04).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Maternal co-use of tobacco and cannabis, relative to tobacco smoking only, is associated with higher cotinine levels in their children. Given that caregiver smoking is the primary source of young children\u2019s exposure to both tobacco and cannabis, clinicians and the public could be better informed about the potential additive health risks of co-exposure without diluting existing health messaging and prevention efforts focused on use and exposure risks related to each product independently. Results point to the need for sustained public health efforts to reduce children\u2019s exposure to these toxicants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003739","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T16:45:20Z","timestamp":1771605920000},"page":"e003739","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association between children\u2019s secondhand co-exposure to tobacco and cannabis smoke and elevated urinary cotinine levels: a cross-sectional analysis"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3703-9630","authenticated-orcid":false,"given":"Bradley N","family":"Collins","sequence":"first","affiliation":[{"name":"Social and Behavioral Sciences, Barnett College of Public Health, Temple University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J","family":"Lepore","sequence":"additional","affiliation":[{"name":"Social and Behavioral Sciences, Barnett College of Public Health, Temple University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Berardi","sequence":"additional","affiliation":[{"name":"Chapman University, Orange, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee D","family":"Goodwin","sequence":"additional","affiliation":[{"name":"The City University of New York, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2703-7001","authenticated-orcid":false,"given":"Karen","family":"Wilson","sequence":"additional","affiliation":[{"name":"University of Rochester School of Medicine and Dentistry, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Baishya","sequence":"additional","affiliation":[{"name":"Social and Behavioral Sciences, Barnett College of Public Health, Temple University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"2026022008450953000_4.1.e003739.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2024.108129"},{"key":"2026022008450953000_4.1.e003739.2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6946a4"},{"key":"2026022008450953000_4.1.e003739.3","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.15585\/mmwr.mm6748a3","article-title":"Exposure to Secondhand Smoke Among Nonsmokers \u2014 United States, 1988\u20132014","volume":"67","author":"Tsai","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026022008450953000_4.1.e003739.4","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1001\/jamainternmed.2020.3975","article-title":"Disparities in Secondhand Smoke Exposure in the United States","volume":"181","author":"Shastri","year":"2021","journal-title":"JAMA Intern Med"},{"key":"2026022008450953000_4.1.e003739.5","unstructured":"Key substance use and mental health indicators in the united states: results from the 2023 national survey on drug use and health (HHS publication no.pep24-07-021, NSDUH series h-59). 2024."},{"key":"2026022008450953000_4.1.e003739.6","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2018.1512623"},{"key":"2026022008450953000_4.1.e003739.7","doi-asserted-by":"crossref","first-page":"109563","DOI":"10.1016\/j.drugalcdep.2022.109563","article-title":"Impact of cannabis legalization in the United States on trends in cannabis use and daily cannabis use among individuals who smoke cigarettes","volume":"238","author":"Weinberger","year":"2022","journal-title":"Drug Alcohol Depend"},{"key":"2026022008450953000_4.1.e003739.8","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.36571","article-title":"Sociodemographic Characteristics Associated With and Prevalence and Frequency of Cannabis Use Among Adults in the US","volume":"4","author":"Jeffers","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026022008450953000_4.1.e003739.9","doi-asserted-by":"crossref","first-page":"102754","DOI":"10.1016\/j.drugpo.2020.102754","article-title":"International differences in patterns of cannabis use among adult cigarette smokers: Findings from the 2018 ITC Four Country Smoking and Vaping Survey","volume":"79","author":"Gravely","year":"2020","journal-title":"International Journal of Drug Policy"},{"key":"2026022008450953000_4.1.e003739.10","doi-asserted-by":"crossref","unstructured":"Goodwin RD , Cheslack-Postava K , Santoscoy S , et al . 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