Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Erin N. Haynes, DrPH, MS

Committee Member

Erin L. Abner, PhD, MPH

Committee Member

Wayne T. Sanderson, PhD, CIH


Background: Smoking rates in Appalachian counties are about two times higher than in non- Appalachian counties. Apart from the detrimental effects smoking has on the smoker, exposure to second-hand smoke (SHS) can have negative health effects on both adults and children. SHS exposure can result in asthma exacerbations and other respiratory difficulties, impaired neuromotor function, neurobehavioral problems, and decreased performance in school.

Objective: The objective of this study was to determine whether SHS exposure, as measured by serum cotinine, is associated with learning and memory in children, as measured by the California Verbal Learning Test – Children's Version.

Methods: Children 7–9 years of age were enrolled in the Communities Actively Researching Exposure Study (CARES) from Marietta, Cambridge, and East Liverpool, Ohio, and their surrounding communities (N = 510). Manganese and lead levels were collected from blood, and cotinine was extracted from serum. Correlations between these biomarkers were obtained. A backward elimination multivariate analyses was performed for each of the learning and memory outcomes. Explanatory variables that were significant at the 0.1 level were kept in the model.

Results: Geometric means of the biomarkers of environmental exposure cotinine, manganese, and lead were 0.12 ± 8.1 ng/mL. After model selection, the logarithmic transformation of serum cotinine was significantly associated with lower scores for total learning (β= -0.077, p-value = 0.005) and short-delayed recall of list A (β= -0.077, p-value = 0.005).

Conclusion: Higher serum cotinine was associated with deficits in learning and memory performance. Multiple exposures were included in the study, therefore, these results cannot be associated solely with serum cotinine. To further prove these findings, addition studies need to be conducted.

Available for download on Thursday, January 05, 2023

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