Salivary Cotinine Levels Research Articles

Salivary Levels of Antibacterial Peptide (LL‐37/hCAP‐18) and Cotinine in Patients With Chronic Periodontitis

The purpose of this study is to examine the relationship between salivary LL-37 levels and clinical severity in patients with chronic periodontitis (CP). The presence/absence of four periodontopathic bacteria and salivary cotinine levels were also examined to assess the impact of these factors on LL-37 production. Unstimulated salivary samples were collected from 69 patients with CP. Salivary concentrations of LL-37 and cotinine were measured by enzyme-linked immunosorbent assay. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola in saliva were detected by polymerase chain reaction. Periodontal examination included determination of probing depth (PD), clinical attachment level, bleeding on probing, and plaque control record. Mean salivary LL-37 concentration was 225.0 ± 227.2 ng/mL, and a high prevalence of periodontopathic bacteria was observed. The stepwise ordinal logistic regression model showed that high salivary LL-37 levels were significantly associated with the presence of T. denticola and higher percentage of teeth with PD ≥5 mm. In addition, higher salivary cotinine levels (≥8 ng/mL) were negatively associated with salivary LL-37 levels. Salivary LL-37 level was positively correlated with severe periodontal destruction, and production was apparently associated with periodontopathic bacterial infection. The negative correlations between salivary LL-37 and cotinine levels also suggest that smoking or long-term exposure to environmental tobacco smoke can lead to lower LL-37 levels in the oral cavity and increased risk of periodontitis.

Exposure to Secondhand Smoke Outside of a Bar and a Restaurant and Tobacco Exposure Biomarkers in Nonsmokers

Background: With an increase in indoor smoking bans, many smokers smoke outside establishments and near their entrances, which has become a public health concern.Objectives: We characterized the exposure of nonsmokers to secondhand smoke (SHS) outside a restaurant and bar in Athens, Georgia, where indoor smoking is banned, using salivary cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL).Methods: In a crossover study, we assigned 28 participants to outdoor patios of a restaurant and a bar and an open-air site with no smokers on three weekend days; participants visited each site once and stayed for 3 hr. We collected saliva and urine samples immediately before and after the visits (postexposure) and on the following morning and analyzed samples for cotinine and total NNAL, respectively. Regression models were fitted and changes in biomarkers were contrasted between locations.Results: Postexposure and preexposure geometric mean salivary cotinine concentrations differed by 0.115 ng/mL [95% confidence interval (CI): 0.105, 0.126)] and by 0.030 ng/mL (95% CI: 0.028, 0.031) for bar and restaurant visits, respectively. There were no significant post- and preexposure differences in cotinine levels after control site visits, and changes after bar and restaurant site visits were significantly different from changes after control site visits (p < 0.001). Results comparing next-day and preexposure salivary cotinine levels were similar. Next-day creatinine-corrected urinary NNAL concentrations also were higher than preexposure levels following bar and restaurant visits [1.858 pg/mg creatinine higher (95% CI: 0.897, 3.758) and 0.615 pg/mg creatinine higher (95% CI: 0.210, 1.761), respectively], and were significantly different from changes after the control visits (p = 0.005).Conclusion: Salivary cotinine and urinary NNAL increased significantly in nonsmokers after outdoor SHS exposure. Our findings indicate that such exposures may increase risks of health effects associated with tobacco carcinogens.

Effect of Passive Smoking Using Maternal and Neonatal Salivary Cotinine Measurements

In Japan, the rate of passive smoking among pregnant women is 52.7%, and smokers are usually their husbands (80.8%). Fetal environmental tobacco smoke has been measured using cotinine levels in maternal and neonatal hair, urine, or umbilical cord blood. However, using saliva from neonates immediately after birth has not been explored among noninvasive methods. The aims of this study were to (a) determine the relationship between fathers' smoking status during pregnancy and neonatal and maternal salivary cotinine immediately after delivery and (b) evaluate the potential use of salivary cotinine measurements immediately after birth to determine the exposure of the neonates to passive smoke. A cross-sectional survey design was used. The participants were 34 pairs of nonsmoking mothers and their neonates who had visited for a health check-up at a general hospital in Tokyo. Saliva samples were collected from mothers and their neonates within 24 hours of delivery. All samples were analyzed using an enzyme-linked immunosorbent assay. Information about maternal age, neonate's birth weight, and smoking status of the father were obtained by interview and questionnaire. Salivary cotinine levels in neonates and mothers with indoor-smoking fathers were significantly higher compared with those in neonates and mothers with nonsmoking and outdoor-smoking fathers. A very strong positive correlation was observed between neonatal and maternal cotinine levels. Smoking indoors by the father affected the mother and neonate. Salivary cotinine measurement is a feasible method to evaluate passive exposure of neonates to tobacco smoke.

Nicotine depedence and salivary cotinine concentration in daily smokers

There is scant information on nicotine dependence in smokers not seeking cessation treatment. This study analyses the relationship between nicotine dependence, measured by the Fagerström Test for Nicotine Dependence (FTND), and salivary cotinine concentration in a sample of smokers from the general population. We conducted a cross-sectional study (2004-2005) of a representative sample of the general population of Barcelona, Spain (n=1245). The analysis included 196 daily smokers aged more than 16 years. Information on smoking was obtained by questionnaire and cotinine concentration was determined in saliva. Geometric means of cotinine concentration by every single FTND item were computed, and multivariate linear regression was used to explore the relationship among these variables. Participants smoked a mean of 17.0 cigarettes per day, and the mean FTND score was 3.27 (95% confidence interval: 2.92-3.61). Around 17% of subjects (95% confidence interval: 12.0-22.5%) had high nicotine dependence. Cotinine concentration differed significantly by nicotine dependence levels. In a multiple linear regression model including the sum of the FTND items 2, 3, and 6, and the single FTND items 1, 4, and 5, adjusted for sex, the time to first cigarette after waking up (item 1), the number of cigarettes smoked daily (item 4), and smoking more in the first hours of the day (item 5) were significantly related to salivary cotinine concentration (R(2)=0.414). Salivary cotinine levels were associated with nicotine dependence as measured by the FTND, especially with the items on daily tobacco consumption, time to first cigarette after waking up, and smoking more in the first hours of the day.

Atomoxetine treatment for nicotine withdrawal: a pilot double-blind, placebo-controlled, fixed-dose study in adult smokers

BackgroundMany effective treatments for nicotine addiction inhibit noradrenaline reuptake. Three recent studies have suggested that another noradrenaline reuptake inhibitor, atomoxetine, may reduce smoking behaviors.MethodsThe present double-blind, placebo-controlled, fixed-dose study was carried out over 21 days during which administration of 40 mg atomoxetine was compared to placebo in 17 individuals. Of these, nine were randomized to atomoxetine and eight to placebo. Baseline and weekly measurements were made using the Cigarette Dependence Scale (CDS), Cigarette Withdrawal Scale (CWS), Questionnaire of Smoking Urges (QSU), reported number of cigarettes smoked, and salivary cotinine levels.ResultsThe study results showed that all those on placebo completed the study. In marked contrast, of the nine individuals who started on atomoxetine, five dropped out due to side effects. In a completer analysis there were statistically significant differences at 14 and 21 days in several measures between the atomoxetine and placebo groups, including CDS, CWS, QSU, number of cigarettes smoked (decreasing to less than two per day in the treatment group who completed the study), and a trend towards lower mean salivary cotinine levels. However, these differences were not seen in a last observation carried forward (LOCF) analysis.ConclusionsIn summary, this is the first study to examine the use of atomoxetine in non-psychiatric adult smokers for a period of more than 7 days, and the findings suggest that atomoxetine might be a useful treatment for nicotine addiction. However, the dose used in the current study was too high to be tolerated by many adults, and a dose-finding study is required to determine the most appropriate dose for future studies of this potential treatment for smoking cessation.

Anger, hostility, and aggression as predictors of persistent smoking during pregnancy.

We examined the role of anger, hostility, and aggression, in addition to depression and stress, in predicting persistent smoking during pregnancy in a low-income sample. The sample consisted of 270 pregnant women (189 smokers, 81 nonsmokers) recruited into a prospective study of prenatal cigarette exposure in the first trimester. Persistent pregnancy smoking was defined as self-reporting daily smoking in at least two trimesters, a positive salivary cotinine level in at least two trimesters, or infant meconium positive for nicotine and/ or its metabolites. Persistent smokers reported higher prenatal stress and negative affect symptoms (depression, anger, hostility, aggression) than nonpersistent smokers or nonsmokers. However, in the context of model testing, maternal anger, hostility, and aggression each accounted for unique variance in persistent smoking, whereas symptoms of depression and stress did not. To date, interventions for pregnant low-income smokers have been largely ineffective. The current results suggest that anger management interventions may be particularly effective for low-income persistent pregnant smokers and may be more likely to prevent relapse than depression-focused interventions.

Tobacco Dependence Treatment for Korean Americans: Preliminary Findings

The study was conducted to examine the relative effectiveness of cognitive behavior therapy with a cultural tailoring intervention compared to brief medication management. The study used a two-arm randomized controlled trial in which participant assignment was stratified by gender. The intervention condition received eight weekly 40-min individualized counseling sessions of culturally tailored cognitive behavior therapy, while the control condition received eight weekly 10-min individualized counseling sessions of medication management. Both conditions received nicotine patches for 8 weeks. Data were collected at baseline and at four follow-up points (one and 4 weeks, and three and 6 months post-quit). Treatment outcomes were presented as an intention-to-treat analysis. Thirty Korean immigrants participated in the study. At 6-month follow-up, 57.1% of participants in the intervention and 18.8% of participants in the control had 7-day point prevalence abstinence (odds ratio = 5.8, 95% confidence interval = 1.12-26.04, P = 0.04). Participants' self-reported abstinence was biochemically verified with exhaled carbon monoxide and salivary cotinine levels. A combination of the culturally tailored cognitive behavior therapy and nicotine replacement therapy had a better treatment outcome compared to brief medication management. The promising result suggests a need to further test the intervention in larger samples and longer follow-up assessments before it can be adapted in clinical settings.

Smoking Cessation and Relapse Among Pregnant African-American Smokers in Washington, DC

Smoking is the single most preventable cause of perinatal morbidity. This study examines smoking behaviors during pregnancy in a high risk population of African Americans. The study also examines risk factors associated with smoking behaviors and cessation in response to a cognitive behavioral therapy (CBT) intervention. This study is a secondary analysis of data from a randomized controlled trial addressing multiple risks during pregnancy. Five hundred African-American Washington, DC residents who reported smoking in the 6 months preceding pregnancy were randomized to a CBT intervention. Psycho-social and behavioral data were collected. Self-reported smoking and salivary cotinine levels were measured prenatally and postpartum to assess changes in smoking behavior. Comparisons were made between active smokers and those abstaining at baseline and follow-up in pregnancy and postpartum. Sixty percent of participants reported quitting spontaneously during pregnancy. In regression models, smoking at baseline was associated with older age, <a high school education and illicit drug use. At follow-up closest to delivery, smoking was associated with lower education, smoking and cotinine level at baseline and depression. At postpartum, there was a relapse of 34%. Smokers postpartum were significantly more likely to smoke at baseline and use illicit drugs in pregnancy. Mothers in the CBT intervention were less likely to relapse. African-American women had a high spontaneous quit rate and no response to a CBT intervention during pregnancy. Postpartum mothers' resolve to maintain a quit status seems to wane despite their prolonged period of cessation. CBT reduced postpartum relapse rates.

ADHD medication reduces cotinine levels and withdrawal in smokers with ADHD

Individuals with ADHD may self-medicate with nicotine, the main psychoactive ingredient in tobacco smoke, in order to reduce symptoms and negative moods associated with ADHD. ADHD medication (e.g., methylphenidate and atomoxetine) may mimic some of the effects of nicotine and may aid smoking cessation in smokers with ADHD. The present study examined if ADHD medication reduces smoking and withdrawal in non-treatment seeking smokers with ADHD. Fifteen adult smokers with ADHD participated in the study, which consisted of an experimental phase and field monitoring phase to examine the acute and extended effects, respectively, of ADHD medication. During the experimental phase, smokers were asked to complete a Continuous Performance Task (CPT) and the Shiffman–Jarvik smoking withdrawal questionnaire during the following four conditions: (1) ADHD medication+cigarette smoking, (2) ADHD medication+overnight abstinence, (3) placebo+cigarette smoking, and (4) placebo+overnight abstinence. During the field monitoring phase, participants were asked to provide salivary cotinine samples and complete electronic diaries about smoking, smoking urge, ADHD symptoms, and stress in everyday life for two days on ADHD medication and for two days on placebo. Results of the experimental phase showed that ADHD medication improved task performance on the CPT and reduced withdrawal during overnight abstinence. During the field monitoring phase, ADHD medication reduced salivary cotinine levels compared to placebo. In addition, the electronic diary revealed that ADHD medication improved difficulty concentrating during no smoking events and stress. The findings of the present study suggest that, along with other strategies, ADHD medication may be used to aid smoking withdrawal and cessation in smokers with ADHD.

Smoking and periodontal disease: discrimination of antibody responses to pathogenic and commensal oral bacteria

Smoking is an independent risk factor for the initiation, extent and severity of periodontal disease. This study examined the ability of the host immune system to discriminate commensal oral bacteria from pathogens at mucosal surfaces, i.e. oral cavity. Serum immunoglobulin (Ig)G antibody reactive with three pathogenic and five commensal oral bacteria in 301 current smokers (age range 21-66 years) were examined by enzyme-linked immunosorbent assay. Clinical features of periodontal health were used as measures of periodontitis. Antibody to the pathogens and salivary cotinine levels were related positively to disease severity; however, the antibody levels were best described by the clinical disease unrelated to the amount of smoking. The data showed a greater immune response to pathogens than commensals that was related specifically to disease extent, and most noted in black males. Significant correlations in individual patient responses to the pathogens and commensals were lost with an increasing extent of periodontitis and serum antibody to the pathogens. Antibody to Porphyromonas gingivalis was particularly distinct with respect to the discriminatory nature of the immune responses in recognizing the pathogens. Antibody responses to selected pathogenic and commensal oral microorganisms differed among racial groups and genders. The antibody response to the pathogens was related to disease severity. The level of antibody to the pathogens, and in particular P. gingivalis, was correlated with disease severity in black and male subsets of patients. The amount of smoking did not appear to impact directly serum antibody levels to these oral bacteria.

Degree of dependence influences the effect of smoking on cognitive flexibility

Pre-frontal cortical (PFC) dysfunction has been put forward as the basis for development and maintenance of addiction. To explore this relationship, the present study investigated the effects of smoking on PFC-mediated cognitive flexibility and subjective states in low- (LD) and high-dependent (HD) smokers.Twenty-four LD and 24 HD smokers (Fagerström dependence scores ≤4 and ≥5, respectively) were randomly allocated to non-smoking or smoking condition (12 LD and 12 HD participants per condition). After abstaining from smoking for a minimum of two hours volunteers completed a battery of questionnaires [nicotine-specific Visual Analogue Scales (Nic-VAS), Questionnaire of Smoking Urges (QSU) and Profile of Mood States (POMS)] at baseline [T1] and again after smoking one cigarette or remaining abstinent [T2]. Cognitive flexibility was evaluated at T2 using the Intra-Extra Dimensional Set-Shift test. The Rapid Visual Information Processing test was performed as a control nicotine-sensitive task at several time points during the experiment.Compared to LD smokers, HD smokers had higher salivary cotinine and breath CO levels at baseline and reported more craving (QSU) and felt less stimulated (Nic-VAS), vigorous, friendly and elated (POMS) throughout the experiment. Smoking increased Nic-VAS ratings of ‘Buzzed’ and ‘Dizzy’ and decreased craving in all participants. Smoking selectively impaired cognitive flexibility in HD smokers since HD smokers allocated to the smoking condition made significantly more errors with the intra-dimensional set-shift than their counterparts in the abstinent condition. No effect of smoking on RVIP test was observed, most likely due to the practice effect which was significant in both groups of smokers. The practice effect, however, was more pronounced in LD smokers.This study demonstrates that PFC-mediated cognitive effects of smoking as well as subjective reports vary according to the degree of nicotine dependence.

Relationship of endotoxin and tobacco smoke exposure to wheeze and diurnal peak expiratory flow variability in children and adolescents

The relationship between endotoxin exposure and asthma severity (wheeze and airways obstruction) is not well described. The effects of endotoxin and tobacco smoke exposure on self-reported wheeze and diurnal PEF variability (DV-PEF) were examined in children aged 6-18 years with asthma or wheeze. A cross-sectional study was performed in a rural area. From this study, children who reported wheeze in the previous 12 months or a physician diagnosis of asthma (n = 98) were selected for a case-control study. These subjects, who were the basis for the present analysis, completed: (i) a home environmental assessment, including dust collection to measure endotoxin levels: (ii) a clinic visit, including saliva collection to measure cotinine levels; and (iii) 2 week monitoring of twice daily symptom records, including wheeze, and PEF to calculate DV-PEF. Among these children, 22.4% reported wheeze during the monitoring period. Greater DV-PEF was associated with higher endotoxin loads in play areas (P < 0.05). The association between salivary cotinine levels and high DV-PEF was modified by gender. In females, higher cotinine levels were associated with an increased risk of high DV-PEF compared with lower cotinine levels (P < 0.05), but this was not observed among males. Higher endotoxin exposure was associated with greater DV-PEF among children with asthma or wheeze. While previous studies have suggested that endotoxin exposure protects against the development of asthma, individuals with the disease should avoid high exposure levels to limit exacerbations. The effect of tobacco smoke exposure on lung health may differ between male and female children.

Objectively Measured Secondhand Smoke Exposure and Mental Health in Children

To examine the association between objectively assessed secondhand smoke (SHS) exposure and mental health in a representative sample of British children. Cross-sectional study. Community-based population sample from the 2003 Scottish Health Survey. Nine hundred one nonsmoking children (mean [SD] age, 8.3 [2.5] years). Exposure to SHS was determined from salivary cotinine level and self-report. Psychological distress assessed using the Strengths and Difficulties Questionnaire (SDQ). Forty percent of the sample demonstrated high SHS exposure (cotinine level >0.70 ng/mL). Children with higher cotinine levels were more likely to live in areas of greater socioeconomic deprivation. Participants in the highest cotinine quartile (>0.70 ng/mL) had significantly higher total SDQ scores compared with those in the lowest quartile (age- and sex-adjusted mean difference = 2.8; 95% confidence interval, 1.6 to 3.9). There was evidence of a dose-response effect across the cotinine group (P trend = .001). Of the SDQ subscales, the strongest associations with cotinine levels emerged for hyperactivity and conduct disorder. These associations remained statistically significant after adjustment for possible confounders including social deprivation, single-parent status, body mass index, chronic illness, and physical activity. Objectively assessed SHS exposure was associated with poorer mental health among children.

Exploring Children's Secondhand Smoke Exposure with Early Child Care Providers

Exposure to secondhand smoke (SHS) is a contributor to the increased morbidity and mortality experienced by inner-city African-American children. Limited evidence-based programming exists regarding how to address the negative effects of SHS in this community. A collaboration with an early child care center provided an opportunity to explore factors related to young children's SHS exposure as the first step in developing strategies to reduce exposure. Survey data were obtained between 2008 and 2009 from 63 African-American parents of infants and children aged ≤ 5 years at two early child care centers located in an urban Minneapolis neighborhood. Forty-three of these children had salivary cotinine levels assessed. Parents living below the poverty level were more likely to report that their children were regularly exposed to SHS by family/friends (p = 0.01). Sixty-eight percent of participants reported complete home smoking restrictions, which was significantly correlated with advice from the child's health provider (p = 0.001). Nonsmokers and older parents were less likely to receive advice (p = 0.03). Of the 43 children in whom cotinine levels were assessed, 39.5% had levels > 0.64 ng/ml, which suggests high SHS exposure. Lower cotinine levels were significantly correlated with living in detached houses. Exposure to SHS was common for children in this study. These findings, if supported by additional research, can be used to develop and disseminate targeted health messages about childhood SHS sources/negative effects and strategies to reduce exposure.

Are salivary cotinine levels associated with erectile dysfunction or anorgasmia?

Are salivary cotinine levels associated with erectile dysfunction or anorgasmia?

Relapse to smoking during unaided cessation: clinical, cognitive and motivational predictors

Neurobiological models of addiction suggest that abnormalities of brain reward circuitry distort salience attribution and inhibitory control processes, which in turn contribute to high relapse rates. The aim of this study is to determine whether impairments of salience attribution and inhibitory control predict relapse in a pharmacologically unaided attempt at smoking cessation. One hundred forty one smokers were assessed on indices of nicotine consumption/dependence (e.g. The Fagerström Test of Nicotine Dependence, cigarettes per day, salivary cotinine) and three trait impulsivity measures. After overnight abstinence, they completed experimental tests of cue reactivity, attentional bias to smoking cues, response to financial reward, motor impulsiveness and response inhibition (antisaccades). They then started a quit attempt with follow-up after 7 days, 1 month and 3 months; abstinence was verified via salivary cotinine levels ≤20 ng/ml. Relapse rates at each point were 52.5%, 64% and 76.3%. The strongest predictor was pre-cessation salivary cotinine; other smoking/dependence indices did not explain additional outcome variance and neither did trait impulsivity. All experimental indices except responsivity to financial reward significantly predicted a 1-week outcome. Salivary cotinine, attentional bias to smoking cues and antisaccade errors explained unique as well as shared variance. At 1 and 3 months, salivary cotinine, motor impulsiveness and cue reactivity were all individually predictive; the effects of salivary cotinine and motor impulsiveness were additive. These data provide some support for the involvement of abnormal cognitive and motivational processes in sustaining smoking dependence and suggest that they might be a focus of interventions, especially in the early stages of cessation.

Effects of smoking on trace metal levels in saliva

To compare the salivary levels of trace metals between non-smokers and smokers using inductively coupled plasma mass spectroscopy (ICP-MS). The effect of pretreatment methods on the accuracy of ICP-MS analysis and daily variations in trace metal levels in saliva were also investigated. The participants were 10 male non-smokers (mean age: 27.4 ± 3.4 years) and 30 male smokers (mean age: 26.5 ± 4.1 years). Unstimulated whole saliva was collected. Salivary flow rate, the number of metal restorations in the oral cavity, the level of blood contamination in the saliva and the levels of cotinine and trace metals in the saliva of each participant were determined. Direct dilution of saliva samples with nitric acid showed the most accurate ICP-MS results. Trace metal levels in saliva showed wide daily variations. They were not affected by the number of metal restorations. Trace metal concentrations of saliva samples without blood contamination were much lower than the previously reported values. Salivary levels of cotinine and aluminum were significantly increased in smokers. Saliva can be a medium for trace metal analysis. Salivary levels of cotinine and aluminum can be useful markers to evaluate smoking status.

Objectively Assessed Secondhand Smoke Exposure and Mental Health in Adults

Secondhand smoke (SHS) exposure has been related to various somatic health outcomes, although very little is known about the association between SHS exposure and mental health. To assess the associations between mental health and SHS exposure, which was objectively measured using the salivary cotinine level as a circulating biochemical marker. In a cross-sectional and longitudinal study, a representative sample of 5560 nonsmoking adults (mean [SD] age, 49.8 [15.4] years; 45.5% men) and 2595 smokers (mean [SD] age, 44.8 [14.8] years; 50.2% men) without history of mental illness was drawn from the 1998 and 2003 Scottish Health Survey. A priori, study participants with cotinine values of 15.00 microg/L or higher (to convert to nanomoles per liter, multiply by 5.675) were assumed to be smokers and recategorized as such in all analyses. A score greater than 3 on the 12-item General Health Questionnaire was used as an indicator of psychological distress. Incident psychiatric hospital admissions over 6 years of follow-up were also recorded. Psychological distress was apparent in 14.5% of the sample. In logistic regression analyses of the cross-sectional data, after adjustments for a range of covariates, high SHS exposure among nonsmokers (cotinine level >0.70 and <15.00 microg/L) was associated with higher odds of psychological distress (odds ratio = 1.49; 95% confidence interval, 1.13-1.97) in comparison with participants with cotinine levels below the limit of detection (< or = 0.05 microg/L). In prospective analyses, risk of a psychiatric hospital admission was related to high SHS exposure (multivariate adjusted hazard ratio = 2.84; 95% confidence interval, 1.07-7.59) and active smoking (multivariate adjusted hazard ratio = 3.74; 95% confidence interval, 1.55-8.98). Exposure to SHS is associated with psychological distress and risk of future psychiatric illness in healthy adults. These concordant findings using 2 different research designs emphasize the importance of reducing SHS exposure at a population level not only for physical health but also for mental health.

Objectively Measured Secondhand Smoke Exposure and Risk of Cardiovascular Disease: What Is the Mediating Role of Inflammatory and Hemostatic Factors?

The aim of this study was to examine the association between objectively measured secondhand smoke (SHS) exposure and incident cardiovascular disease (CVD) death and assess the extent to which this association can be explained through novel circulating markers of inflammation and hemostasis. Existing evidence suggests there is an association between SHS and CVD risk, although the mechanisms remain poorly understood. In a prospective study of 13,443 participants living in England and Scotland (age 53.5 +/- 12.6 years, 52.3% women), we measured salivary cotinine (an objective marker of SHS exposure) and novel CVD biomarkers (C-reactive protein, fibrinogen) at baseline. Of the sample, 20.8% had high SHS exposure on the basis of elevated levels of salivary cotinine (range 0.71 to 14.99 ng/ml). During a mean follow-up of 8 years, there were 1,221 all-cause deaths and 364 CVD deaths. High SHS was associated with all-cause (age-adjusted hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 1.02 to 1.53) and CVD death (age-adjusted HR: 1.21, 95% CI: 0.85 to 1.73). High SHS was also associated with elevated CRP, which explained 48% of the association between SHS and CVD death. The excess risk of CVD associated with active smoking was exaggerated in relation to self report (age-adjusted HR: 3.27, 95% CI: 2.48 to 4.31) compared with objective assessment (age-adjusted HR: 2.44, 95% CI: 1.75 to 3.40). Among a large representative sample of British adults we observed elevated levels of low-grade inflammation in otherwise healthy participants exposed to high SHS, and this partly explained their elevated risk of CVD death.

Significance of the 100-point scale to evaluate perceived tobacco dependence

Smoking cessation is one of the primary targets for risk reduction of atherosclerotic cardiovascular disease. It also leads to the prevention of workers' illness or disability. Validation of a 100-point scale to evaluate perceived tobacco dependence was conducted using a 10-item questionnaire (the Tobacco Dependence Screener; TDS), a 6-item questionnaire (Fagerstrom Test for Nicotine Dependence; FTND), and determining the salivary levels of cotinine at Japanese workplaces. A total of 1023 male smokers completed the TDS and FTND and scored themselves on the 100-point scale for tobacco dependence (Study 1). Of the subjects participating in Study 1, 282 male smokers from one workplace presented saliva samples, and the salivary nicotine and cotinine levels were determined by high-performance liquid chromatography (Study 2). After conducting principal axis factor analysis, multiple regression analysis was employed to clarify the association between the score on the 100-point scale for perceived tobacco dependence and several factors such as age, the TDS score, the FTND score, and the salivary cotinine level. The mean age for the subjects was 40.3 years. The mean salivary cotinine level was 235.4 ng/ml, and it increased significantly with increase in the number of cigarettes smoked per day. Cronbach's alpha coefficients for the TDS and FTND were 0.77 and 0.64, respectively. A ROC analysis indicated a cutoff point for the score on the 100-point scale of 61, which yielded a positive result on the TDS ( 5) with 65.7% sensitivity and 70.0% specificity. When FTND 4 was adopted as the gold standard, the sensitivity and specificity became 68.7% and 73.2%, respectively. Three factors were extracted by principal axis factor analysis, explaining 42% of the total variation. Multiple regression analysis revealed that the score on the 100-point scale for evaluating tobacco dependence was positively associated with the TDS and FTND scores, and negatively associated with the age. The adjusted multiple correlation coefficient was 0.262. The 100-point scale, which is a simple and easy tool to evaluate tobacco dependence, must be used in combination with other tobacco dependence questionnaires such as TDS and FTND and also the salivary cotinine level as a biological marker of tobacco exposure to conduct multi-dimensional education to promote smoking cessation.