Abstract
To describe serum cotinine levels in a rural Italian population and to examine its usefulness as an epidemiologic biomarker of nicotine exposure, cross-sectional data collected in 1993 for the MATISS Project (2098 men and 1352 women, aged 20–79 years) were used. The study population consisted of 977 current smokers, 882 nonsmokers reporting exposure to environmental tobacco smoke (ETS) and 1520 nonsmokers reporting no ETS exposure. Mean values of serum cotinine measured by radioimmunoassay for never smokers, ex-smokers and current smokers (including four categories of cigarette consumption), and for categories of ETS exposure in all nonsmokers were calculated. In univariate analysis, there was a positive association between self-reported nicotine exposure and serum cotinine levels in all groups. Using self-reported status as truth, sensitivity and specificity for various cotinine cutoff points were estimated to distinguish nonsmokers from smokers. The value of 15 ng/mL represented the best combined levels of sensitivity (95%) and specificity (96%). Using this cutoff point, the overall misclassification rate for self-reported nonsmokers was 2.1% and about two times greater for the more vs. the less educated. In multivariate analysis, reported ETS exposure among nonsmokers was significantly associated with serum cotinine even after adjusting for age, socio-demographic and behavioural factors, though the strength of the association was not strong. In conclusion, serum cotinine represents a reliable epidemiological marker of nicotine intake and may be helpful when studying ETS exposure. Improved information collection is needed to reduce misclassification among nonsmokers and enhance our understanding of the relationship between ETS and cotinine measures.
References
Advisory Committee to the Surgeon General of the Public Health Service Publication No. 1103. Washington, DC: US Government Printing Office, 1964.
Peto R, Lopez AD, Boreham J, Thun M, Heath Jr C. Mortality from Smoking in Developed Countries 1950-2000. Oxford: Oxford University Press, 1994.
National Research Council (NRC), Committee on Passive Smoking. Environmental Tobacco Smoke: Measuring exposures and assessing health effects. Washington, DC National Academy Press, 1986.
US Environmental Protection Agency (EPA). Respiratory health effects of passive smoking: Lung cancer and other disorders. Washington, DC: US Government Printing Office, 1992. EPA/600/006F.
Wagenknecht LE, Burke GL, Perkins LL, Haley NH, Friedman GD. Misclassification of smoking status in the CARDIA Study: A comparison of self-reported with serum cotinine levels. Am J Public Health 1992; 82: 33–36.
Woodward M, Tunstall-Pedoe H, Smith WCS, Tavendale R. Smoking characteristics and inhalation biochemistry in the Scottish population. J Clin Epidemiol 1991; 44: 1405–1410.
Wagenknecht LE, Manolio TA, Sidney S, Burke GL, Haley NJ. Environmental tobacco smoke exposure as determined by cotinine in black and white young adults: The CARDIA Study. Environ Res 1993; 63: 39–46.
Woodward M, Tunstall-Pedoe H. An iterative technique for identifying smoking deceivers with application to the Scottish Heart Health Study. Prev Med 1992; 21: 88–97.
Benowitz NL, Jacob P. Nicotine and cotinine elimination Pharmacokinetics in smokers and nonsmokers. Clin Pharmacol Ther 1993; 53: 316–323.
Jarvis M, Tunstall-Pedoe H, Feyerabend C, Vesey C, Salloojee Y. Biochemical markers of smoke absorption and self-reported exposure to passive smoking. J Epidem Comm Health 1984; 38: 335–339.
Matsukura S, Taminato T, Kitano N, et al. Effects of environmental tobacco smoke on urinary cotinine excretion in nonsmokers. Evidence for passive smoking. New Engl J Med 1984; 311: 828–832.
Zevin S, Jacob P 3rd, Benowitz N. Cotinine effects on nicotine metabolism. Clin Pharmacol Ther 1997; 61: 649–654.
Pirkle JL, Flegal KM, Bernert JT, Brody DJ, Etzel RA, Maurer KR. Exposure of the US population to environmental tobacco smoke. JAMA 1996; 275: 1233–1240.
Sheen SJ. Detection of nicotine in foods and plant materials. J Food Sci 1988; 53: 1572–1573.
Siegmund B, Leitner E, Pfannhauser W. Determination of nicotine content of various edible nightshades (Solanaceae) and their products and estimation of the associated dietary nicotine intake. J Agric Food Chem 1999; 47: 3113–3120.
Davis RA, Stiles MF, deBethizy JD, Reynolds JH. Dietary nicotine: A source of urinary cotinine. Food Chem Toxicol 1991; 29: 821–827.
Tunstall-Pedoe H, Woodward M, Brown CA. Tea drinking, passive smoking, smoking deception and serum cotinine in the Scottish Heart Health Study. J Clin Epidemol 1991; 44: 1411–1414.
Benowitz NL. Biomarkers of environmental tobacco smoke exposure. Environ Health Perspect 1999; 107: 349–355.
Brunekreef B, Leaderer BP, van Strien R, et al. Using nicotine measurements and parental reports to assess indoor air: The PIAMA birth cohort study. Prevention and Incidence of Asthma and Mite Allergy. Epidemiology 2000; 11: 350–352.
Galeazzi RL, Daenens P, Gugger M. Steady-state concentration of cotinine as a measure of nicotine-intake by smokers. Eur J Clin Pharmacol 1985; 28: 301–304.
Van Vunakis H, Gijka HB, Langone JJ. Radioimmunoassay for nicotine and cotinine. In: O'Neil IK, Brunneman KD, Dodet B, Hoffman D (eds), Environmental Carcinogens-Methods of Analysis and Exposure Measurements, Vol. 9. Lyon: International Agency for Research On Cancer, 1987: 317–330.
Zuccaro P, Pichini S, Altieri I, Rosa M, Pellegrini M, Pacifici R. Interference of nicotine metabolites determination by RIA. Clin Chem 1997; 43: 180–181.
Hovell MF, Zakarian JM, Wahlgren DR, Matt GE, Emmons KM. Reported measures of environmental tobacco smoke exposure: Trials and tribulations. Tob Control 2000; 9: III22–III28.
Pierce JP, Dwyer T, DiGiusto E, et al. Cotinine validation of self-reported smoking in commercially run community surveys. J Chronic Dis 1987; 40: 689–695.
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Seccareccia, F., Zuccaro, P., Pacifici, R. et al. Serum cotinine as a marker of environmental tobacco smoke exposure in epidemiological studies: The experience of the MATISS project. Eur J Epidemiol 18, 487–492 (2003). https://doi.org/10.1023/A:1024672522802
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DOI: https://doi.org/10.1023/A:1024672522802