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Zettergren A, Sompa S, Palmberg L, Ljungman P, Pershagen G, Andersson N, Lindh C, Georgelis A, Kull I, Melen E, Ekström S, Bergstrom A. Assessing tobacco use in Swedish young adults from self-report and urinary cotinine: a validation study using the BAMSE birth cohort. BMJ Open 2023; 13:e072582. [PMID: 37438074 DOI: 10.1136/bmjopen-2023-072582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES Studies on health effects of tobacco often rely on self-reported exposure data, which is subjective and can lead to misclassification. The aim of this study was to describe the prevalence of cigarette smoking, snus and e-cigarette use, as well as to validate self-reported tobacco use among young adults in Sweden. METHOD Participants of a population-based Swedish cohort (n=3052), aged 22-25 years, assessed their tobacco use in a web questionnaire. Urinary cotinine was analysed in a subsample of the study population (n=998). The agreement between self-reported tobacco use and urinary cotinine was assessed using Cohen's Kappa coefficient (κ) at a cut-off level of 50 ng/mL. RESULTS Patterns of tobacco use differed between men and women. Among men, 20.0% reported daily snus use, 5.8% daily cigarette smoking and 5.6% any e-cigarette use. In contrast, 3.2% of the women reported daily snus use, 9.0% daily cigarette smoking and 2.4% any e-cigarette use. Among the tobacco use categories, daily snus users had the highest levels of cotinine. Of reported non-tobacco users, 3.5% had cotinine levels above the cut-off, compared with 68.0% among both occasional cigarette smokers and snus users, 67.5% among all e-cigarette users and 94.7% and 97.8% among daily cigarette smokers and snus users, respectively. Agreement between self-reported tobacco use and urinary cotinine was classified as strong for daily use of cigarettes (κ=0.824) and snus (κ=0.861), while moderate to weak for occasional smoking (κ=0.618), occasional snus use (κ=0.573) and any e-cigarette use (κ=0.576). CONCLUSIONS We found high validity of self-reported tobacco use in our study population, particularly for daily tobacco use. Further, we found that daily snus users were exposed to high levels of cotinine. Together with previous findings, our results indicate good validity of self-reported tobacco use among young adults.
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Affiliation(s)
- Anna Zettergren
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Shanzina Sompa
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Palmberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christian Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Antonios Georgelis
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Inger Kull
- Sachs' Children and Youth Hospital, Södersjukhuset AB, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Erik Melen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset AB, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Ekström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Anna Bergstrom
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
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Jung J, Park HJ, Jung M. Association between Parental Cotinine-verified Smoking Status and Childhood Asthma: a Population-based Nationally Representative Analysis. J Korean Med Sci 2021; 36:e193. [PMID: 34342184 PMCID: PMC8329391 DOI: 10.3346/jkms.2021.36.e193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Environmental tobacco smoke exposure due to parents is a modifiable risk factor for childhood asthma, but many studies have evaluated parental smoking using self-reported data. Therefore, we aimed to analyze the relationship between parental cotinine-verified smoking status and asthma in their children. METHODS This population-based cross-sectional study used data from the Korean National Health and Nutrition Examination Survey from 2014 to 2017. Participants aged 0 to 18 years with complete self-reported physician-diagnosed childhood asthma and measurement of their parental urinary cotinine levels were included. Parental urinary cotinine-verified smoking status was defined using both urinary cotinine levels and self-report, as active, passive, and non-smoker. Sample weights were applied to all statistical analyses because of a complex, multistage and clustered survey design. Logistic regression model was used to analyze the relationship between childhood asthma and parental smoking. RESULTS A total of 5,264 subjects aged < 19 years were included. The prevalence of asthma was 3.4%. The proportions of paternal and maternal urinary cotinine-verified active smokers during the study period were 50.4% and 16.9%, respectively. When parental urinary cotinine level increased, the proportion of parental low household income was increased (P < 0.001). There was no significant association between the parental urinary cotinine-verified smoking group and childhood asthma group. However, the adjusted odds ratios of childhood asthma in the middle and highest tertile of paternal urinary cotinine levels compared with those in lowest tertile were 1.95 (95% confidence interval [CI], 0.98-3.89) and 2.34 (95% CI, 1.21-4.54), respectively. CONCLUSION There seems to be a dose-related association between paternal urinary cotinine levels and the risk of childhood asthma. Because of the high rate of paternal smoking, further studies are needed to develop a targeted strategy to reduce parental smoking for childhood asthma.
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Affiliation(s)
- Jinho Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea
| | - Hyun Joon Park
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea
| | - Minyoung Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea.
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Pinheiro GP, Souza-Machado CD, Fernandes AGO, Mota RCL, Lima LL, Vasconcellos DDS, Luz Júnior IPD, Silva YRDS, Lima VB, Oliva STD, Mello LMD, Couto RD, Chatkin JM, Cruz CMS, Cruz ÁA. Self-reported smoking status and urinary cotinine levels in patients with asthma. ACTA ACUST UNITED AC 2018; 44:477-485. [PMID: 30304204 PMCID: PMC6459745 DOI: 10.1590/s1806-37562017000000018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/26/2018] [Indexed: 11/21/2022]
Abstract
Objective: To determine the frequency of active smoking among patients with asthma and individuals without asthma by self-report and urinary cotinine measurement. Methods: This was a cross-sectional study conducted in the city of Salvador, Brazil, and involving 1,341 individuals: 498 patients with severe asthma, 417 patients with mild-to-moderate asthma, and 426 individuals without asthma. Smoking status was determined by self-report (with the use of standardized questionnaires) and urinary cotinine measurement. The study variables were compared with the chi-square test and the Kruskal-Wallis test. Results: Of the sample as a whole, 55 (4.1%) reported being current smokers. Of those, 5 had severe asthma, 17 had mild-to-moderate asthma, and 33 had no asthma diagnosis. Of the 55 smokers, 32 (58.2%) were daily smokers and 23 (41.8%) were occasional smokers. Urinary cotinine levels were found to be high in self-reported nonsmokers and former smokers, especially among severe asthma patients, a finding that suggests patient nondisclosure of smoking status. Among smokers, a longer smoking history was found in patients with severe asthma when compared with those with mild-to-moderate asthma. In addition, the proportion of former smokers was higher among patients with severe asthma than among those with mild-to-moderate asthma. Conclusions: Former smoking is associated with severe asthma. Current smoking is observed in patients with severe asthma, and patient nondisclosure of smoking status occurs in some cases. Patients with severe asthma should be thoroughly screened for smoking, and findings should be complemented by objective testing.
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Affiliation(s)
- Gabriela Pimentel Pinheiro
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - Carolina de Souza-Machado
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Escola de Enfermagem, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | | | | | - Liranei Limoeiro Lima
- . Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | | | - Ives Pereira da Luz Júnior
- . Laboratório de Química Analítica e Ambiental, Instituto de Química, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | | | - Valmar Bião Lima
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Programa de Pós-Graduação em Medicina em Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - Sérgio Telles de Oliva
- . Departamento de Química Analítica, Instituto de Química, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - Luane Marques de Mello
- . Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | - Ricardo David Couto
- . Laboratório de Bioquímica Clínica, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - José Miguel Chatkin
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Constança Margarida Sampaio Cruz
- . Programa de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública, Salvador (BA) Brasil.,. Obras Sociais Irmã Dulce, Hospital Santo Antônio, Salvador (BA) Brasil
| | - Álvaro Augusto Cruz
- . Programa para o Controle da Asma na Bahia - ProAR - Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
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Hoseini M, Nabizadeh R, Delgado-Saborit JM, Rafiee A, Yaghmaeian K, Parmy S, Faridi S, Hassanvand MS, Yunesian M, Naddafi K. Environmental and lifestyle factors affecting exposure to polycyclic aromatic hydrocarbons in the general population in a Middle Eastern area. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 240:781-792. [PMID: 29778814 DOI: 10.1016/j.envpol.2018.04.077] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to investigate environmental and lifestyle factors affecting exposure to PAHs in the general population in a large city of the Middle East (Tehran) by measuring urinary monohydroxy polycyclic aromatic hydrocarbons (OH-PAHs) and establishing relationships between PAHs exposure and related factors. Urine samples were collected from 222 randomly chosen subjects who were living in the urban area of Tehran, Iran. Subjects were required to complete a detailed questionnaire aimed to document their personal and sociodemographic information, activities, cooking-related appliances, smoking history/exposure, and consumed foodstuff. Identification and quantification of six OH-PAHs was carried out using a gas chromatography with mass spectrometry (GC-MS). The geometric means for 1-OHP, 1-NAP, 2-NAP, 2-FLU, 9-FLU, and 9-PHE for whole population study were 310, 1220, 3070, 530, 330, and 130 ng/g creatinine, respectively. The two naphthalene metabolites contributed on average 77% of the total concentration of six measured OH-PAHs, followed by the 2-FLU, 1-OHP, 9-FLU, and 9-PHE. The most important predictors of urinary PAHs were consumption of grilled/barbecued foods, smoking, and exposure to environmental tobacco smoking. Water pipe smoking was linked to urinary OH-PAH metabolite in a dose-response function. Residential traffic was also related with OH-PAH metabolite concentrations. Other factors including gender, age, exposure to common house insecticides, open burning, and candle burning were found to be statistically associated with the urinary levels of some OH-PAHs. High exposure to PAHs among general population in Middle Eastern large cities and its associated health implications calls for public health measures to reduce PAHs exposure.
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Affiliation(s)
- Mohammad Hoseini
- Research Center for Health Sciences, Institute of Health, Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Nabizadeh
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Juana Maria Delgado-Saborit
- ISGlobal Barcelona Institute for Global Health, Barcelona Biomedical Research Park, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Division of Environmental Health & Risk Management, School of Geography, Earth & Environmental Sciences, University of Birmingham, United Kingdom
| | - Ata Rafiee
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamyar Yaghmaeian
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Parmy
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Faridi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kazem Naddafi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Sundkvist A, Myte R, Bodén S, Enroth S, Gyllensten U, Harlid S, van Guelpen B. Targeted plasma proteomics identifies a novel, robust association between cornulin and Swedish moist snuff. Sci Rep 2018; 8:2320. [PMID: 29396534 PMCID: PMC5797131 DOI: 10.1038/s41598-018-20794-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/24/2018] [Indexed: 01/08/2023] Open
Abstract
Lifestyle behaviors are believed to influence the body’s inflammatory state. Chronic low-grade inflammation contributes to the development of major non-communicable diseases such as diabetes, cardiovascular disease and cancer. Inflammation may thus be an important link between lifestyle and disease. We evaluated self-reported physical activity, tobacco use and alcohol consumption in relation to plasma levels of 160 validated inflammatory and cancer biomarkers. The study included 138 participants from a population-based cohort, all with repeated sampling of plasma and data ten years apart, allowing consideration of both intra- and inter-individual variation. Of 17 relationships identified, the strongest was an independent, positive association between cornulin (CRNN) and Swedish moist snuff (snus) use. We replicated the finding in a second cohort of 501 individuals, in which a dose-response relationship was also observed. Snus explained approximately one fifth of the variance in CRNN levels in both sample sets (18% and 23%). In conclusion, we identified a novel, independent, dose-dependent association between CRNN and snus use. Further study is warranted, to evaluate the performance of CRNN as a potential snus biomarker. The putative importance of lifestyle behaviors on a wide range of protein biomarkers illustrates the need for more personalized biomarker cut-offs.
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Affiliation(s)
- Anneli Sundkvist
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Robin Myte
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Stina Bodén
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala University, Uppsala, Sweden
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
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McElroy JA, Gilbert T, Hair EC, Mathews KJ, Redman SD, Williams A. Obese But Fit: The Relationship of Fitness to Metabolically Healthy But Obese Status among Sexual Minority Women. Womens Health Issues 2017; 26 Suppl 1:S81-6. [PMID: 27397921 DOI: 10.1016/j.whi.2015.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/15/2015] [Accepted: 09/24/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to describe fitness characteristics of metabolically healthy sexual minority women who are obese. METHODS As part of the Healthy Weight in Lesbian and Bisexual Women Initiative funded by the U.S. Office on Women's Health, one site enrolled self-identified lesbian or bisexual women age 40 and older in a randomized controlled trial that evaluated interventions to improve health. Women with waist-to-height ratio of 0.5 or greater were classified as obese. Women without diabetes or cardiovascular disease and with normal range fasting blood level measurements of glucose, triglycerides, high-density cholesterol, and blood pressure were classified as metabolically healthy but obese (MHO). Otherwise, women were classified as metabolically unhealthy obese (MUHO). Fitness measurements included predicted VO2 maximum, 1-minute heart rate recovery, and strength (single maximal leg lift and chest press). Self-reported demographic and physical activity level data were obtained by standardized questionnaires. RESULTS Of the 53 participants who completed the eligibility screener in Columbia, Missouri, 47 were enrolled in the study (89% participation proportion) with 45 categorized as obese. Approximately one-third (38%) were MHO. The majority of MHO and MUHO participants ranked poor or very poor on a composite fitness score that included measures of strength, flexibility, and aerobic fitness (75.0% and 77.8%, respectively). In the logistic regression models, better 1-minute heart rate recovery after peak exercise performance was significantly associated with MHO individuals (odds ratio, 2.92; 95% CI, 1.13-9.10) compared with MUHO. No other fitness measure was significantly different between the two groups. CONCLUSION Consistent with other studies, we identified more than one-third of our obese sexual minority women as MHO. Fitness measures may be potential predictors of MHO status because one measure, heart rate recovery, was significantly associated with MHO status. With the population prevalence of obesity high and even higher among lesbian or bisexual women, sexual minority women are an ideal population for a longitudinal study to better understand MHO characteristics.
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Affiliation(s)
- Jane A McElroy
- Department of Family & Community Medicine, University of Missouri, Columbia, Missouri.
| | - Tess Gilbert
- NORC at the University of Chicago, Bethesda, Maryland
| | - Elizabeth C Hair
- Evaluation Science and Research, Truth Initiative, Washington, DC
| | - Katherine J Mathews
- Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University, St. Louis, Missouri
| | | | - Amy Williams
- Department of Family & Community Medicine, University of Missouri, Columbia, Missouri
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Baird SO, Rinck M, Rosenfield D, Davis ML, Fisher JR, Becker ES, Powers MB, Smits JAJ. Reducing Approach Bias to Achieve Smoking Cessation: A Pilot Randomized Placebo-Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2017. [DOI: 10.1007/s10608-017-9835-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hoseini M, Yunesian M, Nabizadeh R, Yaghmaeian K, Parmy S, Gharibi H, Faridi S, Hasanvand MS, Ahmadkhaniha R, Rastkari N, Mirzaei N, Naddafi K. Biomonitoring of tobacco smoke exposure and self-reported smoking status among general population of Tehran, Iran. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:25065-25073. [PMID: 27677995 DOI: 10.1007/s11356-016-7619-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 09/07/2016] [Indexed: 06/06/2023]
Abstract
The present study aimed to find a correlation between the self-reported smoking status of the residents of Tehran, Iran, and the urine cotinine as a biomarker of exposure to tobacco smoke. The self-reported data was collected from 222 participants who were living in the urban area of Tehran. The urine samples of participants were collected for cotinine analysis. Urine cotinine was measured by an enzymatic immunoassay technique. Tobacco smoking was reported by 76 (34.23 %) participants as the self-reported data, and the number of males in this report was higher than of females (p < 0.001). By adding the number of the self-reported non-smokers with cotinine levels above the cutoff value of >100 ng/ml to self-reported smokers, the smoking prevalence increased from 34.23 % (95 % CI 28.01-40.88 %) to 36.48 % (95 % CI 30.14-43.19 %). Using the cutoff value, sensitivity and specificity of the self-reported smoking status were respectively 90.12 % (95 % CI 81.46-95.64 %) and 98 % (95 % CI 93.91-99.55 %). The levels of agreement between self-reported tobacco smoking and urinary cotinine concentrations was 95.1 % (k = 0.89, p < 0.001, 95 % CI = 0.81-0.95). Based on the results, self-reported smoking can be a valid marker for assessing the tobacco exposure, and it can be of use in large epidemiological studies.
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Affiliation(s)
- Mohammad Hoseini
- Department of Environmental Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Kamyar Yaghmaeian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Water Quality Research, Institute of Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Parmy
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Gharibi
- Health Sciences Research Institute, University of California, Merced, CA, USA
| | - Sasan Faridi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hasanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ahmadkhaniha
- Department of Human Ecology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Rastkari
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Nezam Mirzaei
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.
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Dixon RB, Dasgupta A. Comparison of SemiQuantitative Cotinine Values Obtained by the DRI Immunoassay and Values Obtained by a Liquid Chromatography-Tandem Mass Spectrometry-Based Method: The DRI Immunoassay is Suitable for Screening Purposes Only Because Semiquantitative Values May Be Unreliable. J Clin Lab Anal 2016; 30:1106-1109. [PMID: 27212710 DOI: 10.1002/jcla.21988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/31/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND DRI cotinine assay is suitable only for screening for cotinine in urine specimens. We studied the reliability of DRI cotinine semiquantitative values by comparing them with the cotinine concentration obtained with a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. METHODS Semiquantitative cotinine concentrations in 39 urine specimens obtained by the DRI immunoassay were compared with cotinine concentrations obtained by LC-MS/MS. RESULTS The DRI cotinine assay consistently overestimated cotinine values obtained by the LC/MS/MS method (y = 1.1529 x + 252.24, n = 39, R2 = 0.8899) indicating that semiquantitative values obtained using the DRI assay may be unreliable. However, no false-negative results were observed using the DRI assay. CONCLUSION DRI cotinine assay is suitable only for screening cotinine in urine specimens.
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Affiliation(s)
- R Brent Dixon
- Physician's Choice Laboratory Services, Rock Hill, South Carolina, USA
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, Texas, USA.
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Pitfalls in the assessment of smoking status detected in a cohort of South African RA patients. Rheumatol Int 2016; 36:1365-9. [PMID: 27393331 DOI: 10.1007/s00296-016-3527-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
This study was conceived in an attempt to explain the unexpectedly high frequency of elevated levels of serum cotinine measured retrospectively in a cohort of predominantly black South African females with rheumatoid arthritis (RA), findings that were inconsistent with the smoking histories derived from health questionnaires. The discrepant findings suggested either a greater tendency towards underreporting of smoking status in the study cohort, or possible confounding effects of the use of smokeless tobacco products. In addition to the cohort of RA patients (n = 138, of whom 115 (83 %) were female), blood samples were also taken from a second cohort consisting of 29 declared smokers, 18 (62 %) of whom where females, 29 smokeless tobacco (SLT) users (all female), and 22 non-users of any tobacco products, 18 (82 %) of whom were females. Serum cotinine levels were determined using an ELISA procedure. Cotinine levels of >10.0 ng/ml were detected in serum specimens from 43 (31 %), RA patients of whom 35 (81 %) were female, with a median value of 50.1 ng/ml and interquartile range (iqr) of 68.6. Only 18 of the 35 females indicated that they smoked. The groups of declared smokers and SLT users had equivalent median serum cotinine levels of 88.0 ng/ml (iqr = 10.8 ng/ml) and 87.0 ng/ml (iqr = 15.6 ng/ml), respectively, while cotinine was undetectable in specimens from non-tobacco product users (<0.2 ng/ml). Users of SLT products in South Africa are predominantly female and have serum cotinine levels which are comparable with those of current smokers, raising concerns about the validity of measurement of cotinine as the sole objective marker of smoking status in populations with high usage of SLTs. This situation can be rectified by ensuring that usage of SLT products is accurately recorded in health questionnaires, while inclusion of measurement of one or more additional, objective biomarkers of smoking in combination with cotinine may enable reliable distinction between smoking and usage of SLTs which, given the associated risks, is a strategy of particular relevance in RA.
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Campo L, Polledri E, Bechtold P, Gatti G, Ranzi A, Lauriola P, Goldoni CA, Bertazzi PA, Fustinoni S. Determinants of active and environmental exposure to tobacco smoke and upper reference value of urinary cotinine in not exposed individuals. ENVIRONMENTAL RESEARCH 2016; 148:154-163. [PMID: 27060750 DOI: 10.1016/j.envres.2016.03.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 03/02/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
The aims of this study were (1) to explore the behavioral and sociodemographic factors influencing urinary cotinine (COT-U) levels in active smokers and in environmental tobacco smoke (ETS)-exposed individuals, (2) to assess the specificity and sensitivity of the questionnaire for identifying active smokers and nonsmokers, and (3) to derive the upper reference value of COT-U in non-ETS exposed individuals. The COT-U levels of 495 adults (age range 18-69 years) who classified themselves as active smokers (29%) or as nonsmokers with (17%) or without (83%) ETS exposure were quantified by LC-MS-MS (quantification limit: 0.1µg/L, range of linearity: 0.1-4000µg/L). Median COT-U levels in these groups were 883, 1.38, and 0.39µg/L, respectively. Significant determinants of COT-U levels in active smokers were the number of cigarettes per day, type of smoking product, smoking environment, as well as time between the last cigarette and urine collection. Among ETS-exposed nonsmokers, significant determinants were living with smokers, being exposed to smoke at home, ETS exposure duration, as well as time between the last exposure and urine collection. When a 30-µg/L COT-U cut-off value was used to identify active daily smoking, the sensitivity and specificity of the questionnaire were 94% and 98%, respectively. For ETS exposure, the COT-U value of 1.78 (0.90 confidence interval 1.75-1.78) µg/L, corresponding to the 95th percentiles of the COT-U distribution in non-ETS-exposed participants, is proposed as upper reference value to identify environmental exposure.
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Affiliation(s)
- Laura Campo
- Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Elisa Polledri
- Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Petra Bechtold
- Department of Public Health, Local Health Unit, Modena, Italy
| | - Giulia Gatti
- Department of Public Health, Local Health Unit, Modena, Italy
| | - Andrea Ranzi
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia Romagna, Modena, Italy
| | - Paolo Lauriola
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia Romagna, Modena, Italy
| | | | - Pier Alberto Bertazzi
- Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Silvia Fustinoni
- Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Pacifici R, Pichini S, Palmi I, de la Torre X, Botrè F. Smoking habits of italian athletes undergoing anti-doping control. Drug Test Anal 2015; 8:133-5. [PMID: 26290451 DOI: 10.1002/dta.1837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Roberta Pacifici
- Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Roma, Italy
| | - Simona Pichini
- Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Roma, Italy
| | - Ilaria Palmi
- Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Roma, Italy
| | - Xavier de la Torre
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Roma, Italy
| | - Francesco Botrè
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Roma, Italy
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Lupsa IR, Nunes B, Ligocka D, Gurzau AE, Jakubowski M, Casteleyn L, Aerts D, Biot P, Den Hond E, Castaño A, Esteban M, Kolossa-Gehring M, Fiddicke U, Knudsen LE, Schoeters G, Reis MF. Urinary cotinine levels and environmental tobacco smoke in mothers and children of Romania, Portugal and Poland within the European human biomonitoring pilot study. ENVIRONMENTAL RESEARCH 2015; 141:106-117. [PMID: 25841796 DOI: 10.1016/j.envres.2015.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to explore data from the DEMOCOPHES study population for Romania, Portugal and Poland, in order to assess smoking patterns and the extent of ETS exposure and compare the national study samples with reference to the respective anti-smoking laws. The subset of the DEMOCOPHES study sample consisted of 360 children and their mothers (120 in each of the three countries - Romania (RO), Portugal (PT) and Poland (PL). Smoking was assessed using a detailed questionnaire for the participants, which addresses both active and passive smoking. This assessment uses exposure-relevant questionnaire data, in particular on the home environment and residence, socio-demographic characteristics, lifestyle such as nutrition, smoking behavior, other exposure-relevant behavior and occupational history, as well as urinary cotinine and creatinine measurements. We performed general statistical analysis and innovative receiver operating characteristic (ROC) curve analyses. Smoking prevalence as evaluated by the questionnaire was generally high, and higher than official statistics, which suggests some under-reporting in the countries, particularly in Romania. Urinary cotinine levels provided biochemical confirmation of the high and similar smoking prevalence for the three countries. Concerning ETS exposure, Romania presented significantly higher levels, for children as well as for non-smoking mothers, with Portugal showing significantly lower levels. Compared to non-smoking mothers, the children showed relatively higher ETS exposure levels in all three countries. The established country-specific optimal cut-off values in urinary cotinine to distinguish smokers from non-smokers vary more than those to discriminate ETS exposure extent in non-smoking mothers and children. Although different between countries, these values are a valuable output to monitor effectiveness of both national antismoking laws and educational programs in the three countries. The findings of this study point to the urgent need for stronger, more effective and well enforced smoke-free legislation in the three countries.
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Affiliation(s)
- Ioana-Rodica Lupsa
- Environmental Health Center, 58 Busuiocului Street, 400240 Cluj-Napoca, Romania.
| | - Baltazar Nunes
- Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa, Portugal; Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | | | - Anca Elena Gurzau
- Environmental Health Center, 58 Busuiocului Street, 400240 Cluj-Napoca, Romania
| | | | - Ludwine Casteleyn
- University of Leuven, Centrum Menselijke Erfelijkheid, Herestraat 49 bus 602, 3000 Leuven, Belgium
| | - Dominique Aerts
- Federal Public Service Health, Food Chain Safety and Environment, Place Victor Horta 40/10, 1060 Brussels, Belgium
| | - Pierre Biot
- Federal Public Service Health, Food Chain Safety and Environment, Place Victor Horta 40/10, 1060 Brussels, Belgium
| | - Elly Den Hond
- Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium
| | - Argelia Castaño
- Environmental Toxicology, Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo, km2, E- 28220 Madrid, Spain
| | - Marta Esteban
- Environmental Toxicology, Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo, km2, E- 28220 Madrid, Spain
| | - Marike Kolossa-Gehring
- Federal Environment Agency (UBA, Federal Environment Agency (UBA), Corrensplatz 1, 14195 Berlin, Germany
| | - Ulrike Fiddicke
- Federal Environment Agency (UBA, Federal Environment Agency (UBA), Corrensplatz 1, 14195 Berlin, Germany
| | - Lisbeth E Knudsen
- University of Copenhagen, Department of Public Health, Øster Farimagsgade 5, DK 1353 Copenhagen K, Denmark
| | - Greet Schoeters
- Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium; University of Southern Denmark, Odense, Denmark
| | - M Fátima Reis
- Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa, Portugal
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Zinc Sulfate, a Recently Introduced Urinary Adulterant Can Invalidate Urine Cotinine Test Using Immunoassay but Has Less Effect on Liquid Chromatography Combined With Tandem Mass Spectrometry-Based Test. Ther Drug Monit 2015; 37:681-4. [PMID: 25627403 DOI: 10.1097/ftd.0000000000000186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Zinc sulfate is a recently introduced urinary adulterant, which causes false-negative results with immunoassays used for screening drugs of abuse in urine but whether zinc sulfate also could invalidate urine cotinine assay using immunoassay or liquid chromatography combined with mass spectrometry has never been studied. DESIGN AND METHOD Four urine pools containing none detected to high levels of cotinine were analyzed using DRI cotinine immunoassay on the Olympus 640 analyzer as well as using liquid chromatography combined with tandem mass spectrometry. Specimens were reanalyzed after supplementing with various amounts of zinc sulfate that are known to invalidate immunoassays used for drugs of abuse testing. RESULTS Zinc sulfate in all concentrations studied caused false-negative results using immunoassays, but zinc sulfate also reduced cotinine values by approximately 2.1%-38.4% when analyzed using liquid chromatography combined with mass spectrometry. CONCLUSIONS Zinc sulfate caused false-negative cotinine result when DRI immunoassay was used and also had small to moderate impact on liquid chromatography combined with tandem mass spectrometry-based assay for urine cotinine.
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Park MB, Kim CB, Nam EW, Hong KS. Does South Korea have hidden female smokers: discrepancies in smoking rates between self-reports and urinary cotinine level. BMC Womens Health 2014; 14:156. [PMID: 25495192 PMCID: PMC4319222 DOI: 10.1186/s12905-014-0156-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 11/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female smoking is perceived very negatively in East Asian countries such as South Korea, Japan, and China, as well as in Islamic countries. These countries' self-reported surveys (SRs) tend to produce results that underestimate the number of smokers, owing to the social desirability response bias. The present study seeks to assess South Korea, Europe, and the Americas, by comparing data from SRs with those from urinary cotinine samples. METHODS Current smoking rates were calculated using the SRs and the urinary cotinine concentration (UCC) methods according to socioeconomic factors. In order to examine response accuracy regarding current smoking status in the SRs, participants who both completed the SRs and acquired UCC results were subject to analyses of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and difference ratio (DR) with respect to gender, age, region, economic level, household status, and the presence of chronic disease. RESULTS Based on self-reports, the current smoking rate among women was 7.1% (official smoking rates), while that according to the UCC was 18.2%; the rates for men were 47.8% and 55.1%, respectively. The sensitivity of males was 0.8553, the specificity 0.9768, PPV 0.9783, NPV 0.8465, and the difference ratio (DR) was 1.143. The sensitivity for females was 0.3670, the specificity 0.9956, PPV 0.9486, NPV 0.8761, and the DR was 2.6. These results exhibit a very low response alignment rate compared to males. CONCLUSION This study shows that the actual female smoking rate is significantly higher than that reported officially, but also that the gap is decreasing steadily. Females exhibited a higher rate of false responses, which resulted in an underestimation of the female smoking rate.
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Affiliation(s)
- Myung Bae Park
- Department of Health Administration, Yonsei University, Gangwon-Do, Republic of Korea.
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, 162 Ilsan-Dong, Wonju-City, Gangwon-Do, 220-701, Republic of Korea.
- Yonsei University Institute for Poverty Alleviation and International Development, Gangwon-Do, Republic of Korea.
- Healthy City Research Center, Institute of Health and Welfare, Yonsei University, Gangwon-Do, Republic of Korea.
| | - Chun-Bae Kim
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, 162 Ilsan-Dong, Wonju-City, Gangwon-Do, 220-701, Republic of Korea.
- Yonsei University Institute for Poverty Alleviation and International Development, Gangwon-Do, Republic of Korea.
| | - Eun Woo Nam
- Department of Health Administration, Yonsei University, Gangwon-Do, Republic of Korea.
- Yonsei University Institute for Poverty Alleviation and International Development, Gangwon-Do, Republic of Korea.
- Healthy City Research Center, Institute of Health and Welfare, Yonsei University, Gangwon-Do, Republic of Korea.
| | - Kyeong Soo Hong
- Korea Health Promotion Foundation, Seoul, Republic of Korea.
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Prevalence and validity of self-reported smoking in Indigenous and non-Indigenous young adults in the Australian Northern Territory. BMC Public Health 2014; 14:861. [PMID: 25141772 PMCID: PMC4153984 DOI: 10.1186/1471-2458-14-861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 08/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background In this study, we used data from Australia’s Northern Territory to assess differences in self-reported smoking prevalence between the Indigenous and non-Indigenous populations. We also used urinary cotinine data to assess the validity of using self-reported smoking data in these populations. Methods The Aboriginal Birth Cohort (ABC) is a prospective study of 686 Aboriginal babies born in Darwin 1987–90. The Top End Cohort (TEC) is a study of non-Indigenous adolescents, all born in Darwin 1987–91. In both studies, participants aged between 16 and 21 years, were asked whether they smoked. Urinary cotinine measurements were made from samples taken at the same visits. Results Self-reported smoking prevalence was 68% in the ABC and 14% in the TEC. Among the self-reported non-smokers, the median cotinine levels were higher in the ABC (33 ng/ml) than in the TEC (5 ng/ml), with greater percentages of reported non-smokers in the under 50 ng/ml group in the TEC than in the ABC Conclusions Prevalence of smoking was much higher in the ABC than in the TEC. The higher cotinine levels in ABC non-smokers may reflect an underestimated prevalence, but is also likely to reflect higher levels of passive smoking. A broader approach encompassing social, cultural and language factors with increased attention to smoking socialisation factors is required.
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Ozoh OB, Dania MG, Irusen EM. The Prevalence of Self-Reported Smoking and Validation with Urinary Cotinine Among Commercial Drivers in Major Parks in Lagos, Nigeria. J Public Health Afr 2014; 5:316. [PMID: 28299115 PMCID: PMC5345460 DOI: 10.4081/jphia.2014.316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 12/23/2013] [Accepted: 02/04/2014] [Indexed: 11/23/2022] Open
Abstract
The validity of self-reported smoking is questionable because smokers are inclined to deny smoking. We aimed to determine the prevalence of self-reported smoking among intra-city commercial drivers in Lagos, and assess its validity based on urinary cotinine assessment. This study was conducted at three major motor parks in Lagos, Nigeria. Information on smoking status and habits was obtained from 500 consecutive male drivers using a structured questionnaire during a face-to-face interview. Eighty-one self-reported smokers and non-smokers were selected by systematic random sampling for urinary cotinine assessment using cotinine strips. The prevalence of self-reported smoking was compared to the prevalence of smoking based on urinary cotinine and the specificity and positive predictive values of self-reported smoking was determined. Prevalence of self-reported current smoking was 32% and 17.9% of non-smokers were passive smokers. Among 81 drivers in whom urinary cotinine assessment was performed, the prevalence of smoking based on self-report was 34 (42%) compared to 41 (50.6%) when based on urinary cotinine, (X2=38.56, P<0.001). The rate of misclassification among self-reported non-smokers as smokers was 21.3% and misclassification rate for self-reported smokers as non-smokers was 8.8%. The sensitivity of self-reported smoking in accurately classifying smoking status was 91.2% and the specificity was 78.7%. The prevalence of self-reported cigarette smoking among commercial drivers in Lagos is high and a significant proportion of self-reported non-smokers are passive smokers. Self-reported smoking status obtained during face-to-face interview appears unreliable in obtaining accurate smoking data in our locality.
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Affiliation(s)
- Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos , Nigeria
| | - Michelle G Dania
- Department of Medicine, College of Medicine, University of Lagos , Nigeria
| | - Elvis M Irusen
- Division of Pulmonology, University of Stellenbosch , Cape Town, South Africa
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Lee SR, Lee CK, Im H, Yang W, Urm SH, Yu SD, Lee JH, Suh CH, Kim KH, Son BC, Kim JH, Kim SY, Lee SW, Lee JT. Secondhand smoke exposure and urine cotinine concentrations by occupation among Korean workers: results from the 2008 Korea National Survey for Environmental Pollutants in the Human Body. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2014; 11:314-325. [PMID: 24219421 DOI: 10.1080/15459624.2013.863130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study aimed to estimate the status of secondhand smoke (SHS) exposure through urine cotinine analysis among nonsmoking workers in Korea and to analyze factors affecting urine cotinine concentrations. Data were based on "The 2008 Korea National Survey for Environmental Pollutants in the Human Body," a cross-sectional study of the National Institute of Environmental Research of Korea. We selected 1448 nonsmoking adult workers from 200 localities to participate in this survey. Urine cotinine concentrations were analyzed using a gas chromatograph-mass selective detector. We calculated separate covariate-adjusted geometric means for socio-demographic variables for males, females, and total subjects by analysis of covariance (ANCOVA). Statistical analyses were performed using SPSS version 18.0 (SPSS Inc., Chicago, Ill.). The prevalence of self-reported exposure to SHS was 36.9%. The geometric mean (95% confidence interval) of urine cotinine concentrations among all participants was 16.50 (14.48-18.80) μg/L. Gender, living area, education, and SHS exposure showed significant differences in urine cotinine concentrations. The urine cotinine concentrations of farmworkers and blue-collar workers such as skilled agricultural, forestry, and fishery workers, and elementary occupations were higher than those of white-collar workers such as clerical support workers, technicians, and associate professionals. Such a high proportion of the population having high urine cotinine levels indicates widespread exposure to SHS among nonsmoking workers in Korea. Furthermore, the urine cotinine levels among nonsmoking workers exposed to SHS varied by occupation. The measured urine cotinine concentration is suggested to be a valuable indication of SHS exposure in Korea.
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Affiliation(s)
- So Ryong Lee
- a Department of Occupational and Environmental Medicine, College of Medicine & Institute of Environmental and Occupational Medicine Inje University , Busan , Korea
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Medicine students and exposure to environmental tobacco smoke. Int J Occup Med Environ Health 2013; 26:313-20. [DOI: 10.2478/s13382-013-0100-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 11/11/2012] [Indexed: 11/21/2022] Open
Abstract
Abstract
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20
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Simultaneous measurement of urinary total nicotine and cotinine as biomarkers of active and passive smoking among Japanese individuals. Environ Health Prev Med 2012; 18:244-50. [PMID: 23011941 DOI: 10.1007/s12199-012-0307-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 09/05/2012] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Measuring urinary cotinine is a popular and established method of biologically monitoring exposure to tobacco smoke. However, the lower detection limit of cotinine often impedes the evaluation of passive (second-hand) smoking and this, together with unconverted nicotine, does not reflect actual levels of exposure. Furthermore, a portion of the Japanese population might have decreased ability to metabolize nicotine. The present study was therefore carried out to validate the simultaneous analysis of total concentrations of free nicotine and cotinine and their glucuronides to determine actual levels of voluntary and involuntary exposure to cigarette smoke. METHODS Urine samples from 118 Japanese smokers and 117 non-smokers were analyzed using gas chromatography-mass spectrometry. Voluntary and involuntary smoking status was self-reported and workplace smoking restrictions were objectively evaluated. RESULTS The integrated sum of all concentrations showed 2.2- and 2.4-fold higher total levels (free and glucuronide) of nicotine and cotinine relative to the free levels. Median (quartiles) of total nicotine and cotinine were 1635 (2222) and 3948 (3512) ng/mL in smokers, and 3.5 (5.3) and 2.8 (4.2) ng/mL in non-smokers. Concentrations of urinary nicotine were higher than those of cotinine in 21 % of smokers and in 54 % of non-smokers. Nicotine and cotinine levels were significantly associated with a smoking habit, as well as being significantly associated with the workplace and home environments of non-smokers. CONCLUSIONS The present method can monitor voluntary and involuntary exposure to tobacco smoke. Measuring total urinary nicotine levels might be useful for analyzing exposure to cigarette smoke among non-smokers.
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Narkowicz S, Polkowska Ż, Namieśnik J. Analysis of Markers of Exposure to Constituents of Environmental Tobacco Smoke (ETS). Crit Rev Anal Chem 2012. [DOI: 10.1080/10408347.2012.629948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Sasaki S, Braimoh TS, Yila TA, Yoshioka E, Kishi R. Self-reported tobacco smoke exposure and plasma cotinine levels during pregnancy--a validation study in Northern Japan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2011; 412-413:114-118. [PMID: 22078365 DOI: 10.1016/j.scitotenv.2011.10.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 05/31/2023]
Abstract
Maternal smoking is a critical public health concern requiring the establishment of its prevalence rate and clinical impact. Maternal self-reported information of tobacco smoke exposure requires validation using accurate biochemical analysis. This study examined the association between self-reported exposure to tobacco smoke and plasma cotinine level in Japanese pregnant women. We collected information about smoking and secondhand smoke (SHS) exposure during pregnancy from 5128 pregnant women in a prospective cohort design, and analyzed biochemically maternal blood samples using the enzyme-linked immunosorbent assay (ELISA) technique. Based on self-reports, the subjects were classified into three groups: 650 smokers, 728 ex-smokers and 3750 non-smokers. Using the receiver operating characteristic (ROC) curve, plasma cotinine cut-off value of 11.48 ng/mL was established for separating smokers from non-smokers, resulting in a smoking prevalence of 14%. A cotinine cut-off value of 0.21 ng/mL for discriminating exposed and unexposed nonsmokers resulted in a 63% prevalence of exposure to tobacco smoke among nonsmokers. Cotinine biomarker analysis proved accurate in validating self-reported smoking information in the subjects. Lower validity of SHS exposure suggests a need to confirm questionnaire information with biochemical analysis.
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Affiliation(s)
- Seiko Sasaki
- Department of Public Health, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo 060-8638, Japan
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Abidin EZ, Semple S, Omar A, Rahman HA, Turner SW, Ayres JG. A survey of schoolchildren's exposure to secondhand smoke in Malaysia. BMC Public Health 2011; 11:634. [PMID: 21824403 PMCID: PMC3162528 DOI: 10.1186/1471-2458-11-634] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 08/08/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is a lack of data describing the exposure of Malaysian schoolchildren to Secondhand Smoke (SHS). The aim of this study is to identify factors influencing schoolchildren's exposures to SHS in Malaysia. METHOD This cross-sectional study was carried out to measure salivary cotinine concentrations among 1064 schoolchildren (10-11 years) attending 24 schools in Malaysia following recent partial smoke-free restrictions. Parents completed questionnaires and schoolchildren provided saliva samples for cotinine assay. RESULTS The geometric mean (GM) salivary cotinine concentrations for 947 non-smoking schoolchildren stratified by household residents' smoking behaviour were: for children living with non-smoking parents 0.32 ng/ml (95% CI 0.28-0.37) (n = 446); for children living with a smoker father 0.65 ng/ml (95% CI 0.57-0.72) (n = 432); for children living with two smoking parents 1.12 ng/ml (95% CI 0.29-4.40) (n = 3); for children who live with an extended family member who smokes 0.62 ng/ml (95% CI 0.42-0.89) (n = 33) and for children living with two smokers (father and extended family member) 0.71 ng/ml (95% CI 0.40-0.97) (n = 44). Parental-reported SHS exposures showed poor agreement with children's self-reported SHS exposures. Multiple linear regression demonstrated that cotinine levels were positively associated with living with one or more smokers, urban residence, occupation of father (Armed forces), parental-reported exposure to SHS and education of the father (Diploma/Technical certificate). CONCLUSIONS This is the first study to characterise exposures to SHS using salivary cotinine concentrations among schoolchildren in Malaysia and also the first study documenting SHS exposure using salivary cotinine as a biomarker in a South-East Asian population of schoolchildren. Compared to other populations of similarly aged schoolchildren, Malaysian children have higher salivary cotinine concentrations. The partial nature of smoke-free restrictions in Malaysia is likely to contribute to these findings. Enforcement of existing legislation to reduce exposure in public place settings and interventions to reduce exposure at home, especially to implement effective home smoking restriction practices are required.
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Affiliation(s)
- Emilia Zainal Abidin
- Scottish Centre for Indoor Air, Environmental & Occupational Medicine, Population Health, Division of Applied Health Sciences, School of Medicine and Dentistry, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD Aberdeen, UK
| | - Sean Semple
- Scottish Centre for Indoor Air, Environmental & Occupational Medicine, Population Health, Division of Applied Health Sciences, School of Medicine and Dentistry, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD Aberdeen, UK
| | - Affandi Omar
- Biochemistry Unit, Specialised Diagnostic Unit, Institute of Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - Hejar A Rahman
- Department of Community Health, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Stephen W Turner
- Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen AB25 2ZG Scotland UK
| | - Jon G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston Birmingham, B15 2TT, UK
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Marrone GF, Shakleya DM, Scheidweiler KB, Singleton EG, Huestis MA, Heishman SJ. Relative performance of common biochemical indicators in detecting cigarette smoking. Addiction 2011; 106:1325-34. [PMID: 21438939 PMCID: PMC3137283 DOI: 10.1111/j.1360-0443.2011.03441.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS Many cities have banned indoor smoking in public places. Thus, an updated recommendation for a breath carbon monoxide (CO) cut-off is needed that optimally determines smoking status. We evaluated and compared the performance of breath CO and semiquantitative cotinine immunoassay test strips (urine and saliva NicAlert®) alone and in combination. DESIGN Cross-sectional study. SETTING Urban drug addiction research and treatment facility. PARTICIPANTS Ninety non-treatment-seeking smokers and 82 non-smokers. MEASUREMENTS Participants completed smoking histories and provided breath CO, urine and saliva specimens. Urine and saliva specimens were assayed for cotinine by NicAlert® and liquid chromatography-tandem mass spectrometry (LCMSMS). FINDINGS An optimal breath CO cut-off was established using self-report and LCMSMS analysis of cotinine, an objective indicator, as reference measures. Performance of smoking indicators and combinations were compared to the reference measures. Breath CO ≥5 parts per million (p.p.m.) optimally discriminated smokers from non-smokers. Saliva NicAlert® performance was less effective than the other indicators. CONCLUSIONS In surveys of smokers and non-smokers in areas with strong smoke-free laws, the breath carbon monoxide cut-off that discriminates most effectively appears to be ≥5 p.p.m. rather than the ≥10 p.p.m. cut-off often used. These findings may not generalize to clinical trials, regions with different carbon monoxide pollution levels or areas with less stringent smoke-free laws.
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Affiliation(s)
- Gina F. Marrone
- Nicotine Psychopharmacology Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Diaa M. Shakleya
- Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Karl B. Scheidweiler
- Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | | | - Marilyn A. Huestis
- Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Stephen J. Heishman
- Nicotine Psychopharmacology Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
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Carpenter MJ, Baker NL, Gray KM, Upadhyaya HP. Assessment of nicotine dependence among adolescent and young adult smokers: a comparison of measures. Addict Behav 2010; 35:977-82. [PMID: 20624670 PMCID: PMC2919624 DOI: 10.1016/j.addbeh.2010.06.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 04/30/2010] [Accepted: 06/14/2010] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Tobacco use often starts in adolescence, yet assessment of dependence among adolescent smokers remains a challenge, particularly given the potential discord between self-reports of smoking behavior and actual use. We could find no prior study, among adolescents, that directly compares the association between objective biomarkers of tobacco exposure (e.g., cotinine) and multiple measures of dependence. This study examined the concurrent validity of two common dependence measures: the Fagerström Test for Nicotine Dependence (FTND) and the Hooked on Nicotine Checklist (HONC). We further examined the FTND by removing the one item on cigarettes smoked per day. METHODS Based within a parent clinical trial for adolescent smoking cessation, eligible participants were 12-21years old, smoking >/=5cigarettes per day on average, and with urine cotinine >100ng/ml at baseline. Results are based on participants who completed each measure and who provided a urine cotinine sample at baseline (N=73). RESULTS Results showed that the FTND was associated with cotinine (p<0.001; R(2)=0.25), and that this relationship held true for the revised FTND as well (p<0.001; R(2)=0.18). However, the HONC was only marginally associated with cotinine (p=0.06; R(2)=0.09). DISCUSSION Our results suggest that the FTND may be better associated with actual smoking behavior in adolescents as compared to the HONC. Pending replication, our data provide caution with regard to assessment of nicotine dependence at least among established adolescent smokers who have more entrenched smoking behavior.
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Affiliation(s)
- Matthew J Carpenter
- Department of Psychiatry, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA.
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Champagne BM, Sebrié EM, Schargrodsky H, Pramparo P, Boissonnet C, Wilson E. Tobacco smoking in seven Latin American cities: the CARMELA study. Tob Control 2010; 19:457-62. [PMID: 20709777 PMCID: PMC2991061 DOI: 10.1136/tc.2009.031666] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective This study aimed to explore tobacco smoking in seven major cities of Latin America. Methods The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study is a cross-sectional epidemiological study of 11 550 adults between 25 and 64 years old in Barquisimeto, Venezuela; Bogota, Colombia; Buenos Aires, Argentina; Lima, Peru; Mexico City, Mexico; Quito, Ecuador; and Santiago, Chile. Tobacco smoking, including cigarettes, cigars and pipes, was surveyed among other cardiovascular risk factors. Results Santiago and Buenos Aires had the highest smoking prevalence (45.4% and 38.6%, respectively); male and female rates were similar. In other cities, men smoked more than women, most markedly in Quito (49.4% of men vs 10.5% of women). Peak male smoking prevalence occurred among the youngest two age groups (25–34 and 35–44 years old). Men and women of Buenos Aires smoked the highest number of cigarettes per day on average (15.7 and 12.4, respectively). Men initiated regular smoking earlier than women in each city (ranges 13.7–20.0 years vs 14.2–21.1 years, respectively). Exposure to secondhand tobacco smoke at workplace for more than 5 h per day was higher in Barquisimeto (28.7%), Buenos Aires (26.8%) and Santiago (21.5%). The highest prevalence of former smokers was found among men in Buenos Aires, Santiago and Lima (30.0%, 26.8% and 26.0% respectively). Conclusions Smoking prevalence was high in the seven CARMELA cities, although patterns of smoking varied among cities. A major health and economic burden is inevitable in urban Latin America unless effective comprehensive tobacco control measures recommended by the World Health Organisation Framework Convention on Tobacco Control are implemented.
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Current world literature. Curr Opin Organ Transplant 2010; 15:254-61. [PMID: 20351662 DOI: 10.1097/mot.0b013e328337a8db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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