Salivary Cotinine Concentrations Research Articles

Children Learning About Secondhand Smoke (CLASS III): a protocol for a cluster randomised controlled trial of a school-based smoke-free intervention in Bangladesh and Pakistan

IntroductionSecondhand smoke (SHS) exposure is a major cause of premature death and disease, especially among children. Children in economically developing countries are particularly affected as smoke-free laws are typically only...

The effects of maternal environmental tobacco smoke exposure on periodontal health and mother-infant bonding in relation to salivary cotinine level

Background: Environmental tobacco smoking is produced by active smokers burning the tip of a cigarette and breathed by nonsmokers and measured by cotinine level. It has the potential to raise the risk of periodontal disease. One of the most frequent chronic diseases in adults is periodontal disease. The lower maternal-fetal attachment has been found to predict smoking status in previous studies, but no research has examined whether maternal-fetal attachment predicts environmental tobacco smoking. This study assessed the effects of maternal environmental tobacco smoke exposure on periodontal health and mother-infant bonding concerning salivary cotinine levels. Materials and methods: This is a comparative cross-sectional study comparing environmental tobacco smoke on exposed and non-exposed mothers aged between 20-35 years with their infants aged up to one year who attended primary health care centers in rural areas of AL-Karkh sector/Baghdad. Along with the essential socio-demographic data, a secondhand smoke exposure scale and postpartum bonding questionnaire were employed. Collection of unstimulated saliva from mothers was done according to Navazesh and Kumer in 2008. After that, the clinical Assessment of gingival bleeding and periodontal pockets was performed by using Community Periodontal Index according to the world health organization in 1997. Results: Out of 150 subjects,67(44.66%) were exposed to environmental tobacco whereas the non-exposed mothers were composed of 83 (55.33%). The highest mean number of CPI0(healthy gingiva) and CPI1(gingival bleeding) were among the non-exposed mothers while the highest mean number of CPI2(dental calculus), CPI3 (shallow pocket 4-5mm) and CPI4(deep pocket 6mm or more) were among the exposed mothers. The mean value of cotinine level among the non-exposed mothers was lower than exposed mothers with significant results. A higher salivary cotinine level was linked to a lower maternal-fetal bonding score. Conclusions: Mother’s exposure to environmental tobacco smoke significantly negatively impacts periodontal disease. Furthermore, mothers who have a stronger sense of attachment and affiliation to their fetus have lower salivary cotinine concentrations than mothers who have a less sense of fetal attachment.

Factors associated with secondhand smoke exposure among non-smoking employees in the workplace: A cross-sectional study in Qingdao, China.

ObjectiveThis study was conducted to describe secondhand smoke (SHS) exposure among non-smoking employees in the workplace, and identify factors related to SHS exposure in Qingdao.MethodsThe study participants covered key non-smoking places stipulated in the “Qingdao City Smoking Control Regulations,” which included three categories: restaurants, bars, and office buildings. Airborne nicotine concentration in the workplace and saliva cotinine concentration of employees were measured. The questionnaire included employees’ demographic factors, smoke-free measures in the workplace, employers’ tobacco hazard knowledge, and attitudes towards smoke-free policy.ResultsA total of 222 non-smoking employees and 46 non-smoking employers were included in the study. The median concentrations of airborne nicotine and salivary cotinine were 0.389 μg/m3 and 0.575 ng/mL, respectively. Educational status, average number of workplace smokers per day, exposure time to SHS in the workplace, and whether smoking and non-smoking areas were divided significantly related to airborne nicotine concentration. Age, educational status, exposure time to SHS in the workplace, tobacco control training and publicity, and whether the employers support the “Qingdao Tobacco Control Regulation” were significantly related to salivary cotinine concentration.ConclusionsDespite the implementation of the “Qingdao Smoking Control Regulations” in 2013, the workplace remains an important location for SHS exposure. Interventions such as raising workers’ awareness of the risks associated with SHS exposure through health education and developing smoking prevention and cessation programs to reduce SHS exposure in the workplace are urgently needed.

Changes in the salivary cotinine cut-offs to discriminate smokers and non-smokers before and after Spanish smoke-free legislation

IntroductionHigh levels of cotinine in non-smokers indicate passive exposure to tobacco smoke. This study aims to evaluate variations in salivary cotinine cut-offs to discriminate smokers and non-smokers before and after the implementation of smoke-free legislation (Law 28/2005 and Law 42/2010) in a sample of the adult population of Barcelona, Spain. MethodsThis longitudinal study analyzes salivary cotinine samples and self-reported information from a representative sample (n = 676) of the adult population from Barcelona before and after the approval of smoke-free legislation. We calculated the receiver operating characteristic (ROC) curves, to obtain optimal cotinine cut-off points to discriminate between smokers and non-smokers overall, by sex and age, and their corresponding sensitivity, specificity, and area under the curve. We used linear mixed-effects models, with individuals as random effects, to model the percentage change of cotinine concentration before and after the implementation of both laws. ResultsThe mean salivary cotinine concentration was significantly lower post-2010 law (−85.8%, p < 0.001). The ROC curves determined that the optimal cotinine cut-off points for discriminating non-smokers and smokers were 10.8 ng/mL (pre-2005 law) and 5.6 ng/mL (post-2010 law), with a post-2010 law sensitivity of 92.6%, specificity of 98.4%, and an area under the curve of 97.0%. The post-2010 law cotinine cut-off points were 5.6 ng/mL for males and 1.9 ng/mL for females. ConclusionThe implementation of Spanish smoke-free legislation was effective in reducing secondhand smoke exposure and, therefore, also in reducing the cut-off point for salivary cotinine concentration. This value should be used to better assess tobacco smoke exposure in this population.

Correlation of salivary biomarkers and dental caries in children exposed to passive smoking

Salivary antimicrobial peptides (AMP’s) play an important role in the local defence of oral cavity and expression of these are altered by various factors. Among them cigarette smoke has known to have detrimental effects on salivary immune defence mechanisms. The effect of passive smoking on salivary AMP’s and correlation to dental caries in children has not yet been reported. Thus, this study was aimed to assess the correlation between passive smoking and dental caries in exposed and unexposed children. A randomized cross-sectional study was designed &amp; Self-reported questionnaire was filled by the parents of the participants to obtain the data. Participants were divided into passive exposed (PE) and unexposed (UE) group based on exposure parameters. Clinical examination was performed and DMFS were marked for each subject. Unstimulated saliva was collected for 1 min and SFR was measured by analysing saliva in the graduated tubes after which the saliva was subjected for analysis of salivary cotinine and LL-37 concentration through ELISA kit. The mean DMFS and Salivary cotinine levels were elevated in Passive smoking exposed individuals, showing a positive correlation between DMFS and Salivary cotinine levels to passive smoking, but, the mean salivary LL-37 levels were reduced in passive smoking exposed individuals, showing a negative correlation between Salivary LL-37 levels to passive smoking. There was also a dose-dependent relationship between caries experience and smoking exposure. Reduction of passive smoking is important not only for the prevention of various systemic ill-effects, but also for the promotion of health.

Evaluating the Psychometric Properties of the Severson 7-Item Smokeless Tobacco Dependence Scale (SSTDS).

The objective of the study was to assess the psychometric properties of the Severson 7-item Smokeless Tobacco Dependence Scale (SSTDS). Data from 95 male exclusive smokeless tobacco (ST) users were obtained through a self-administered mail survey to evaluate the reliability and validity of the SSTDS. Reliability of the scale was assessed by measures of internal consistency including Cronbach's coefficient alpha and item-total correlation. Other ST dependence scales and salivary cotinine concentration were used to evaluate concurrent validity. Structure model of the scale was ascertained by exploratory factor analysis. Overall accuracy and optimal cutoff score were obtained to evaluate SSTDS as a screening tool for ST dependence. The SSTDS had high reliability as assessed by the internal consistency coefficient (ordinal α = 0.83). SSTDS total score was significantly correlated with Fagerström Test for Nicotine Dependence for ST users-FTND-ST (r = 0.42) and modified Tobacco Dependence Screener-TDS (r = 0.58). Exploratory factor analysis of the SSTDS identified two underlying factors measuring distinct dimensions of dependence. With reference to TDS based dependence diagnosis, SSTDS demonstrated good diagnostic accuracy (area under the curve: 0.82, 95% confidence interval: 0.74-0.90). Salivary cotinine concentration was not associated with the total score of the SSTDS; however, at an optimal cutoff score of SSTDS >9, everyday ST users classified as dependent had significantly higher cotinine concentration. SSTDS is a reliable measure of dependence that has higher concurrent validity and reliability as compared with other commonly used ST dependence scales. Further research is needed using a larger and more diverse sample of ST users to unequivocally establish the validity of the scale. ST dependence has multiple aspects that can be best studied by multidimensional dependence scales. The study findings validate that the SSTDS measures not only the physical dependence but also the behavioral and psychological dimensions of dependence. Good psychometric properties, diagnostic accuracy, and multidimensional structure of SSTDS indicate that it may serve as an effective tool in assessing ST dependence in clinical and research settings.

Brief Report: Increased Cotinine Concentrations are Associated With Reduced Expression of Cathelicidin (LL-37) and NOD-2 in Alveolar Macrophages of PLWH Who Smoke.

There is a strong link between cigarette smoking and pulmonary complications among people living with HIV. However, the effects of smoking on the local lung immune environment in this population remain unclear. Bronchoalveolar lavage and saliva were collected from HIV-infected smokers involved in a prospective study investigating alveolar macrophage expression of host defense molecules. Salivary cotinine concentrations were inversely related to expression of the immune cell receptor nucleotide-binding oligomerization domain-2 and the cathelicidin antimicrobial peptide LL-37. The negative correlation between salivary cotinine and LL-37 was particularly strong. Our study provides insight into how nicotine may adversely affect lung innate immunity in HIV.

Third-hand exposure at homes: Assessment using salivary cotinine

Background/ObjectivesWhile exposure to secondhand smoke (SHS) is a well-established problem, exposure to third-hand smoke (THS) is scanty known and needs to be studied. The objective of this work is to characterize salivary cotinine concentrations among people who self-reported exposure to SHS and THS at home. MethodsCross-sectional study of a representative sample (n = 736) of the adult population (≥16 years) from the city of Barcelona carried out in 2013–2014. A questionnaire on tobacco use and passive exposure was administered, and a saliva sample was collected for cotinine determination. For this study, the information of the non-smoker participants who provided saliva sample (n = 519) was used. The geometric means (GM) and geometric standard deviations (GSD) of the cotinine concentration were compared according to the type of self-reported exposure at home: (1) Not exposed to SHS or THS; (2) Exposed to SHS and THS; and (3) Only exposed to THS. We used log-linear models to compare the cotinine concentration of each exposed group with respect to the unexposed group, adjusting for sex, age, educational level, and tobacco exposure in other settings. ResultsThe GM of the salivary cotinine concentration was 0.34 ng/ml (GSD = 0.16) among individuals reporting SHS and THS exposure, 0.22 ng/ml (GSD = 0.15) among those reporting only THS exposure and 0.11 ng/ml (GSD = 0.04) among those who declared not to be exposed to SHS nor THS (p-value for trend <0.001). The regression model showed a statistically significant increase in cotinine concentration among those exposed to SHS and THS (188% higher, 95% CI: 153%; 223%), and only exposed to THS (106% higher, IC95. %: 74.5%; 137.0%) when comparing with the unexposed group. No statistically significant differences in cotinine concentration were observed between those exposed to SHS and THS compared to the THS group (−25.8%, 95% CI: −69.5%; 17.9%). Conclusions/RecommendationsPeople exposed to third-hand smoke at home had quantifiable cotinine levels in saliva. No differences in cotinine levels were found between those exposed to second-hand and third-hand smoke at home. The reduction of exposure to third-hand smoke at home should be put into the agenda of tobacco control.

Evaluation of Antioxidant Capacity and Cotinine Levels of Saliva in Male Smokers and Non-smokers.

BackgroundThe cigarette compounds are associated with the increase in the incidence of oral cancer and precancerous lesions. Salivary antioxidant system plays an important role in anti-carcinogenic capacity of saliva. Cotinine, a nicotine metabolite, has a longer half-life in comparison with nicotine and is a suitable marker for exposure to cigarette smoke. This study aims to measure total antioxidant capacity (TAC) and cotinine level in saliva of smokers and non-smokers and compare salivary cotinine level and TAC in each group.MethodsIn this cross-sectional study, 32 smokers and 34 non-smokers were recruited by consecutive sampling from Department of Oral Medicine, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. Salivary cotinine and TAC concentrations were determined using the enzyme-linked immunosorbent assay (ELISA) technique. For data analysis, correlation tests of Spearman, Mann-Whitney U, and independent samples t-test were used.FindingsA significant difference was observed between the two groups in the mean cotinine level and in the mean TAC (P = 0.015, P = 0.027, respectively). TAC showed a weak negative correlation with the cotinine level, but the difference was not significant (P = 0.651).ConclusionAntioxidants are of great importance to smokers because antioxidants are able to scavenge free radicals found in cigarette smoke. According to the results of present study, the salivary TAC in smokers was lower than that of non-smokers, and the salivary cotinine level in smokers was higher than non-smokers. Therefore, smoking endangers the oral cavity health by reducing the salivary TAC. Further studies with a higher sample size and other factors affecting the salivary TAC are needed for definitive comment.

Comparison of Salivary Cotinine Levels of Neonates Born to Mothers Exposed to Varying Degrees of Passive Cigarette Smoke

Introduction: Obstetrical data reveals that fetuses born to mothers who are exposed to passive smoking show adverse health outcomes. Aims &amp; Objectives: To compare the cotinine levels in neonates born to mothers exposed to varying degrees of passive cigarette smoke versus the control group i.e., mothers who are not exposed to smoking. Place and duration of study: This study was conducted in Obstetrics and Gynecology department of Shaikh Zayed Hospital, Lahore and in emergency Labor Room of Ganga Ram hospital, Lahore from December 2015 to May 2016. Material &amp; Methods: This was a cross-sectional comparative study in which neonatal salivary cotinine level were measured and its relationship with birth weight was observed in 120 subjects, divided in four groups: .i) neonates whose mothers were not-exposed to smoke, neonates whose mothers were exposed to, ii) 1-5 cigarette, iii) 6-10 cigarettes and iv) more than 10 cigarettes per day. Results: Salivary cotinine levels were raised in all four groups with maximum levels seen in group four but there was no statistical difference between groups. Changes in the birth weight were also seen with increased exposure to passive smoking. Conclusion: Salivary cotinine concentration in neonates increases due to passive exposure to cigarette smoke in mothers because of disregard of smokers to the adverse effects of nicotine inside homes and almost no governmental enforcement of laws regarding cigarette smoking in public spaces.

The Association Between E-Cigarette Use Behaviors and Saliva Cotinine Concentration Among Healthy E-Cigarette Users in Malaysia.

Electronic cigarettes (e-cigarettes) have rapidly increased in popularity within the last 2 years in Malaysia. The study aims to understand the association between e-cigarette use behaviors and salivary cotinine (a CYP2AA metabolite of nicotine) concentration to inform the development of future e-cigarette control policies. A convenience sample of saliva from 144 e-cigarette users was obtained between November and December 2015. The study participants used refill liquid containing between 0 and 12 mg/ml of nicotine. The overall median cotinine concentration of the study participants was 81.1 ng/ml (interquartile range = 8.5-195.8). Among the zero-nicotine and single e-cigarette users, the median cotinine level was 51.1 (interquartile range = 8.20-125.35) ng/ml. Factors significantly associated with a higher salivary cotinine concentration were dual use of e-cigarettes and tobacco cigarettes, regular and daily e-cigarette use, a longer duration of e-cigarette use, using a higher amount of e-liquid, and a shorter duration to finish a refill. Multivariate analysis revealed that e-cigarette use of 1-6 and 6-12 months (but not 1 month and below) was significantly associated with a higher cotinine concentration. Cotinine found in zero-nicotine e-liquids implies the importance of stringent regulatory governance for the consistency of labeled nicotine content of e-cigarette liquid in the market. Zero-nicotine e-cigarette users should also be informed of the likelihood of environmental exposure to tobacco smoke. Future studies conducted on larger samples are warranted to validate the association between duration of e-cigarette use and salivary cotinine concentration as well as to investigate underlying mechanisms.

Maternal Cotinine Levels and Red Blood Cell Folate Concentrations in the Periconceptual Period.

Studies have examined the association between tobacco use and folate levels in pregnancy, yet few have assessed this relation using objective and accurate measures of both smoking and folate. In this study, we evaluated the association between maternal cotinine levels and periconceptional red blood cell (RBC) folic acid reserves in a cohort of low-income pregnant mothers. Smoking information, based on salivary cotinine, a highly sensitive and specific tobacco smoke exposure biomarker, was used. Furthermore, folate was assessed using RBC folate, an indicator of long-term folate storage. Participants were early to mid-trimester pregnant women who received antenatal care between 2011 and 2015 at the Genesis Clinic of Tampa (Florida). A total of 496 women were enrolled in the study. Associations between smoking status/maternal salivary cotinine concentrations, sociodemographic factors, and folate concentrations were investigated using Tobit regression analyses. The mean folate level of the participants was 718.3 ± 183.2 ng/mL, and only 2 (0.4%) participants were deficient in folate. We observed no significant difference in folate levels by smoking status. In contrast, salivary cotinine levels were significantly associated with decreased RBC folate concentrations (β -11.43, standard error 5.45, P = 0.032). Prepregnancy maternal body mass index, gestational age, stress, and depression also were associated with folate levels. Low RBC folate is associated with perinatal factors, including high maternal cotinine levels, body mass index, stress, and depression. The effect of low folate levels among smokers cannot be overemphasized, considering that tobacco products not only reduce folate levels but also decrease the bioutilization of folate.

Chat-based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster-randomised controlled trial

Mobile instant messaging apps offer a modern way to deliver personalised smoking cessation support through real-time, interactive messaging (chat). In this trial, we aimed to assess the effect of chat-based instant messaging support integrated with brief interventions on smoking cessation in a cohort of smokers proactively recruited from the community. In this two-arm, pragmatic, cluster-randomised controlled trial, we recruited participants aged 18 years or older who smoked at least one cigarette per day from 68 community sites in Hong Kong, China. Community sites were computer randomised (1:1) to the intervention group, in which participants received chat-based instant messaging support for 3 months, offers of referral to external smoking cessation services, and brief advice, or to the control group, in which participants received brief advice alone. The chat-based intervention included personalised behavioural support and promoted use of smoking cessation services. Masking of participants and the research team was not possible, but outcome assessors were masked to group assignment. The primary outcome was smoking abstinence validated by exhaled carbon monoxide concentrations lower than 4 parts per million and salivary cotinine concentrations lower than 10 ng/mL at 6 months after treatment initiation (3 months after the end of treatment). The primary analysis was by intention to treat and accounted for potential clustering effect by use of generalised estimating equation models. This trial is registered with ClinicalTrials.gov, number NCT03182790. Between June 18 and Sept 30, 2017, 1185 participants were randomly assigned to either the intervention (n=591) or control (n=594) groups. At the 6-month follow-up (77% of participants retained), the proportion of validated abstinence was significantly higher in the intervention group than in the control group (48 [8%] of 591 in intervention vs 30 [5%] of 594 in control group, unadjusted odds ratio 1·68, 95% CI 1·03-2·74; p=0·040). Engagement in the chat-based support in the intervention group was low (17%), but strongly predicted abstinence with or without use of external smoking cessation services. Chat-based instant messaging support integrated with brief cessation interventions increased smoking abstinence and could complement existing smoking cessation services. Hong Kong Council on Smoking and Health.

A biomonitoring assessment of secondhand exposures to electronic cigarette emissions.

Electronic cigarette (e-cigarette) conventions regularly bring together thousands of users around the world. In these environments, secondhand exposures to high concentrations of e-cigarette emissions are prevalent. Some biomarkers for tobacco smoke exposure may be used to characterize secondhand e-cigarette exposures in such an environment. Participants who did not use any tobacco product attended four separate e-cigarette events for approximately six hours. Urine and saliva samples were collected from participants prior to the event, immediately after the event, 4-h after the event, and the next morning (first void). Urine samples from 34 participants were analyzed for cotinine, trans-3'-hydroxycotinine, S-(3-hydroxypropyl)-N-acetylcysteine (3-HPMA), S-carboxyethyl-N-acetylcysteine (CEMA), select tobacco-specific nitrosamines (TSNAs), and 8-isoprostane. Saliva samples were analyzed for cotinine and trans-3'-hydroxycotinine. Data from 28 of 34 participants were used in the data analysis. Creatinine-adjusted urinary cotinine concentrations increased up to 13-fold and peaked 4-h after completed exposure (range of adjusted geometric means [AGMs] = 0.352-2.31 μg/g creatinine). Salivary cotinine concentrations were also the highest 4-h after completed exposure (range of AGMs = 0.0373-0.167 ng/mL). Salivary cotinine and creatinine-corrected concentrations of urinary cotinine, trans-3'-hydroxycotinine, CEMA, and 3-HPMA varied significantly across sampling times. Urinary and salivary cotinine, urinary trans-3'-hydroxycotinine, and urinary 3-HPMA concentrations also varied significantly across events. Secondhand e-cigarette exposures lasting six hours resulted in significant changes in exposure biomarker concentrations of both nicotine and acrolein but did not change exposure to tobacco-specific nitrosamines. Additional research is needed to understand the relationship between biomarker concentrations and environmental concentrations of toxicants in e-cigarette emissions.

The Determinants of Salivary Cotinine Concentration in Smokeless Tobacco Users.

BACKGROUND:Smokeless tobacco products due to their high nicotine content are highly addictive and ultimately lead to an increased risk of oral cavity, laryngeal and oesophagal cancer.AIM:This research was conducted with the aim of assessing the relationship between the salivary cotinine concentration and demographic characteristics and smokeless tobacco use for the first time in tradespeople in Chabahar, Iran.METHODS:This descriptive cross-sectional study was conducted on 150 different tradespeople using smokeless tobacco in Chabahar who were selected through simple random sampling in 2018. In addition to the salivary cotinine measurement, data were collected using a researcher-made questionnaire with demographic and behavioural items. The data obtained were analysed in SPSS-16 using descriptive and inferential statistics.RESULTS:The mean salivary cotinine score was 887.7 ± 180.7 in men and 611.2 ± 139.7 in women, making for a significant intergroup difference (P = 0.043). The mean salivary cotinine score was higher in those who used two or more smokeless tobacco products compared to those who used one type of tobacco, and a significant difference was observed between the type of smokeless tobacco used and the salivary cotinine score in the participants (P = 0.005).CONCLUSION:Based on the results of the regression analysis, the type of smokeless tobacco used was a strong predictor of the concentration of salivary cotinine in the participants. It is, therefore, necessary for the government to adopt appropriate policies and take educational measures to reduce the vending and use of these substances.

Salivary LL-37 and periodontal health in children exposed to passive smoking.

Antimicrobial peptides play an important role in the local defence of oral cavity. Cigarette smoke has detrimental effects on immune defence mechanisms. The effect of passive smoking on salivary LL-37, as an antimicrobial peptide, in children has not yet been reported. The aims of this study were to evaluate salivary LL-37 levels in PS-exposed and PS-unexposed children and to investigate the association between salivary LL-37 levels and periodontal clinical parameters. Unstimulated salivary samples were collected from 180 children (90 PS-exposed [38 girls and 52 boys; mean age: 9.36±1.60years] and 90 PS-unexposed [43 girls and 47 boys; mean age: 9.02±1.71years]) in this study. Periodontal clinical parameters, including plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL), were recorded in all children. Salivary cotinine and LL-37 levels were measured by enzyme-linked immunosorbent assay. PI and GI values in PS-exposed children were significantly higher than those in PS-unexposed children. The mean salivary cotinine concentration was significantly higher in PS-exposed children than in control subjects. The mean salivary LL-37 concentration of PS-exposed children was significantly lower (100.71±72.14pg/mL) than that of PS-unexposed children (151.84±107.89pg/mL). Passive smoking could suppress salivary LL-37 concentrations in children.

Nicotine absorption from e-cigarettes over 12 months

BackgroundResearch indicates that, over time, exclusive e-cigarette users (vapers) gradually reduce the nicotine concentration in their e-liquid and transition to more sophisticated devices. Alongside this, consumption of e-liquid increases and constant cotinine levels are maintained. AimsWe aimed to confirm these observations in 27 experienced vapers tested at baseline and 12 months later, by measuring nicotine absorption (via salivary levels of the nicotine metabolite cotinine; ng/mL), nicotine concentrations in e-liquid (mg/mL), volume of e-liquid consumed (mL per day), device types and flavours used, both at baseline and 12 months. ResultsVapers reduced both their nicotine concentrations in e-liquid over 12 months (from 13.83 mg/mL at baseline to 9.91 at follow up) but significantly increased their e-liquid consumption (from 4.44 to 6.84 mL). No significant changes in salivary cotinine concentrations (370.88 ng/mL at baseline and 415.78 ng/mL at follow up) were observed. There was an increase in sub-ohming (using an atomiser coil with resistance of <1 Ω with increased power) at 12 months, and in the use of fruit flavoured e-liquids. ConclusionsOur sample of experienced vapers reduced the concentration of nicotine in their e-liquid over time, but maintained their nicotine intake possibly through self-titration via more intensive puffing. Findings suggest there may be little benefit in reducing nicotine e-liquid concentration since this appears to result in higher e-liquid consumption which may incur both a financial and health cost. Gaining an understanding of underlying reasons for lowering e-liquid concentration would be a useful line of empirical enquiry.

Salivary cotinine concentration and carbon monoxide levels in young adults smoking midwakh in comparison with cigarette smokers

ObjectivesTo estimate and compare the salivary cotinine levels using a semiquantitative method, called NicAlert, between three groups: non-smokers, daily smokers of cigarettes and daily smokers of midwakh, and to compare...

Impact of the Spanish smoking legislation among smokers: A longitudinal study with biomarkers in Barcelona (Spain)

BackgroundThe aim of this study is to assess the impact of the Spanish tobacco control legislation on smoking behavior and salivary cotinine concentration among smokers. MethodsWe used data from a longitudinal study, before (2004–2005) and after (2013–2014) the implementation of the two national smoking bans (in 2006 and 2011), in a representative sample of adults (≥16 years old) from Barcelona (Spain). We only analyzed a subsample of continuing smokers (n = 116). We conducted a survey on smoking behavior and obtained saliva sample for cotinine analyses. For this report, we analyzed a subsample of continuing smokers (n = 116). We calculated geometric means (GM). ResultsAmong continuing smokers, salivary cotinine concentration significantly increased by 28.7% (GM from 91.7 ng/ml to 117.3 ng/ml, p = 0.015) after the implementation of the two Spanish smoke-free bans. Nonetheless, no pattern of change was observed in the self-reported number of cigarettes smoked daily. ConclusionsOur study shows a significant increase in the salivary cotinine concentration among adult continuing smokers after both Spanish legislations. This increase could be due to differences in smoking topography (increase in the depth of inhalation when smoking) along with changes in the type of tobacco smoked (increase in smoking roll-your-own cigarettes or mixed use of roll-your-own and manufactured cigarettes). Our results suggest the need to extend tobacco control policies, focusing on the reduction of use of any type of tobacco product and implementing better treatment to help smokers stop smoking.

Self-Reported Environmental Tobacco Smoke Exposure and Avoidance Compared with Cotinine Confirmed Tobacco Smoke Exposure among Pregnant Women and Their Infants

Background: Exposure to environmental tobacco smoke (ETS) presents substantial health risks for pregnant women and newborn infants. Measurements of ETS include invasive and expensive biochemical tests, as well as less invasive and lower-cost, self-reported exposure and avoidance measures. Better understanding of self-report measures will help to select ETS assessments for evaluation. Methods: This analysis was conducted within the context of a tailored video intervention to reduce tobacco smoking and ETS exposure during pregnancy and after delivery in the control group sample of 147 nonsmoking women. Measurements of salivary cotinine concentration, self-reported ETS exposure, and avoidance behaviors were captured at 32 weeks’ gestation and 6 months postpartum. Results: Salivary cotinine concentration was significantly related to ETS avoidance among pregnant nonsmokers at 32 weeks’ gestation, but not ETS exposure. At 6 months postpartum, both the reported ETS exposure of the infant and maternal avoidance behaviors to reduce her infant’s exposure were associated with the infant’s salivary cotinine concentration. At 32 weeks’ gestation and 6 months postpartum, avoidance behaviors decreased as exposure increased. Discussion: This study suggests that for nonsmoking women during pregnancy, reports of tobacco smoke avoidance are more valid than reports of exposure. After delivery, self-reported ETS exposure or avoidance are associated with each other and the biochemical measurement of salivary cotinine. These results provide researchers and clinicians with evidence to support the inclusion of avoidance behaviors in the selection of ETS measures.