Salivary Cotinine Levels Research Articles

Exposure to polycyclic aromatic hydrocarbons and newborn biometric indicators

The aim of the study was to examine the impact of polycyclic aromatic hydrocarbons (PAH) on foetal growth. The prospective Polish Mother and Child Cohort study was performed in 8 regions of Poland. The study population consisted of 449 mother-child pairs All women were interviewed three times during pregnancy (once in each trimester). 1-hydroxypyrene (1-HP) concentration in urine was chosen as the biomarker of exposure to PAH. The urine sample collected from the participant women between 20-24 weeks of pregnancy was analysed using high performance liquid chromatography (HPLC). The active and passive smoking exposure was verified by determination of saliva cotinine level using high performance liquid chromatography coupled with tandem mass spectrometry/positive electrospray ionisation (LC-ESI+MS/MS) and isotope dilution method. The exposure to PAH measured by 1-HP level in urine of pregnant women was significantly associated with child birth weight (β = -158.3; p = 0.01), chest circumference (β = -0.7; p = 0.02) and cephalisation index (β = 4.2; p = 0.01) after adjustment for gestational age, child gender, pregnant woman marital status, educational level, season of last menstruation period (LMP), prepregnancy body mass index (BMI), and weight gain in pregnancy. After inclusion salivary cotinine levels into the analysis, the results were not statistically significant. Prenatal exposures to PAH adversely influence foetal development including child weight, length, head and chest circumference. Tobacco smoking is the important source of PAH. After controlling for active and passive smoking, the observed associations were not statistically significant.

Effects of smoking on salivary C-telopeptide pyridinoline cross-links of type I collagen and osteocalcin levels

Aim This study was planned to investigate whether smoker patients with inflammatory periodontal disease exhibit different salivary concentrations of C-telopeptide pyridinoline cross-links of type I collagen (ICTP) and osteocalcin (OC) compared to the non-smoker and/or ex-smoker counterparts. Methods Whole saliva samples, full-mouth clinical periodontal recordings were obtained from 67 otherwise healthy patients with inflammatory periodontal disease. According to self-reports there were 34 smokers, 22 non-smokers and 11 ex-smokers. Salivary cotinine, ICTP and OC levels were determined by enzyme-linked immunoassays. Results Salivary cotinine measurements confirmed self-reports about smoking. Smoker patients revealed significantly higher plaque index values than non-smokers ( p < 0.05). Bleeding on probing values were significantly lower in smoker group than ex-smoker group ( p < 0.05). There was no significant difference between the study groups in salivary ICTP levels ( p > 0.05). OC levels in smoker group was significantly lower than the other groups ( p < 0.001). Salivary ICTP levels correlated negatively with number of teeth present ( p < 0.05), positively with bleeding on probing ( p < 0.01). Salivary OC levels correlated negatively with years smoked ( p < 0.01). Conclusions Within the limits of this study, smoking seems to suppress salivary osteocalcin level but ICTP levels seem not to be affected by smoking status. This suppression in OC levels may be one mechanism of deteriorating effects of smoking on periodontal health.

Assessment of Exposure to Secondhand Smoke at Outdoor Bars and Family Restaurants in Athens, Georgia, Using Salivary Cotinine

Exposure to secondhand smoke (SHS) in outdoor settings is a growing public health concern due to recent indoor smoking bans. The objective of this study was to measure salivary cotinine, a metabolite of nicotine, in subjects aged 21–30 exposed to SHS outside bars and restaurants in Athens, Georgia. Nonsmokers participated during 6-hr periods in outdoor standing or seating areas of bars and restaurants where indoor smoking was banned, as well as a control outdoor location with no smokers over six weekends during the summer and early fall of 2007. Pre- and post-exposure saliva samples (N = 25 person-days at the bar site, N = 28 person-days at the restaurant site, and N = 11 person-days at the control) were collected and analyzed for cotinine. The mean change in the response, (ln(post) - ln(pre)) salivary cotinine levels, was significantly impacted by the type of site (bar, restaurant, control) (F = 5.09; d.f. = 2, 6.7; p = 0.0455). The median percent increase in salivary cotinine from pre-test to post-test was estimated to be 162%, 102%, and 16% at the bar, restaurant, and control sites, respectively, values that were significant increases at bars (t = 4.63; d.f. = 9.24; p = 0.0011) and restaurants (t = 4.33; d.f. = 4.47; p = 0.0097) but not at the control sites. On average, these pre-test to post-test increases in salivary cotinine were significantly higher at bar sites than control sites (t = 3.05; d.f. = 9.85; p = 0.0176) and at restaurant sites compared with control sites (t = 2.35; d.f. = 5.09; p = 0.0461). Nonsmokers outside restaurants and bars in Athens, Georgia, have significantly elevated salivary cotinine levels indicative of secondhand smoke exposure.

9040 Short term (2-month) survival prognostication in newly-diagnosed patients with Non-Small Cell Lung Cancer

This study was planned to investigate whether smoker patients with inflammatory periodontal disease exhibit different salivary concentrations of C-telopeptide pyridinoline cross-links of type I collagen (ICTP) and osteocalcin (OC) compared to the non-smoker and/or ex-smoker counterparts.Whole saliva samples, full-mouth clinical periodontal recordings were obtained from 67 otherwise healthy patients with inflammatory periodontal disease. According to self-reports there were 34 smokers, 22 non-smokers and 11 ex-smokers. Salivary cotinine, ICTP and OC levels were determined by enzyme-linked immunoassays.Salivary cotinine measurements confirmed self-reports about smoking. Smoker patients revealed significantly higher plaque index values than non-smokers (p < 0.05). Bleeding on probing values were significantly lower in smoker group than ex-smoker group (p < 0.05). There was no significant difference between the study groups in salivary ICTP levels (p > 0.05). OC levels in smoker group was significantly lower than the other groups (p < 0.001). Salivary ICTP levels correlated negatively with number of teeth present (p < 0.05), positively with bleeding on probing (p < 0.01). Salivary OC levels correlated negatively with years smoked (p < 0.01).Within the limits of this study, smoking seems to suppress salivary osteocalcin level but ICTP levels seem not to be affected by smoking status. This suppression in OC levels may be one mechanism of deteriorating effects of smoking on periodontal health.

Evaluation of School-Based Smoking-Cessation Interventions for Self-Described Adolescent Smokers

The goal was to compare the efficacy of school-based, multisession, group smoking-cessation interventions versus a single group session in increasing quit rates among adolescent smokers. Eight schools were assigned randomly to use 1 of 2 group smoking-cessation programs previously shown to increase quit rates among adolescents (Not on Tobacco [NOT] or Kickin' Butts). We reformatted the programs to twice-weekly 25- to 30-minute sessions delivered during lunch periods. Smoking status was assessed at end of program (EOP) and 1, 3, 6, and 12 months later. Self-reported quit status was confirmed with salivary cotinine levels. A total of 407 students (56% black and 52% female; mean age: 16 years) participated. Kickin' Butts participants were no more likely to quit than control subjects. In the conservative analysis (students with missing follow-up data classified as smokers), NOT participants were 1.92 times (95% confidence interval [CI]: 1.09-3.40 times) more likely to self-report quitting at 1 month. In the Bayesian analysis (missing follow-up data imputed by using all available data), NOT participants were significantly more likely than control subjects to self-report quitting at EOP (relative risk [RR]: 1.26 [95% CI: 1.10-1.43]), 1 month (RR: 2.07 [95% CI: 1.68-2.56]), and 12 months (RR: 1.58 [95% CI: 1.22-2.04]). Cotinine-confirmed quit rates were significantly greater among NOT participants, compared with control subjects, at EOP and 1 month. The reformatted NOT program had a modest effect on adolescents interested in quitting. Kickin' Butts, as reformatted for this project, did not have any effect on quit rates.

Association of cotinine levels and preeclampsia among African-American women

Although prior studies have shown that smoking reduces preeclampsia risk, the relationship between nicotine level and preeclampsia risk is not known. Our objective was to study the effects of smoking on the incidence of preeclampsia in African-American women using cotinine, a quantitative marker of nicotine. We performed a secondary analysis of data collected prospectively in Project District of Columbia Healthy Outcomes of Pregnancy Education. Our study included 724 African-American women. Self-reported smoking, cotinine levels, and pregnancy outcomes were examined. Some 18% of participants were smokers. Women with salivary cotinine levels greater than 200 ng/ml had infants with lower birth weights and a higher incidence of small-for-gestational-age infants than women with cotinine levels of 200 ng/ml or less. Exact logistic regression analysis revealed that women with salivary cotinine levels greater than 200 ng/ml had a significantly lower incidence of preeclampsia, compared with women with cotinine levels of 200 ng/ml or less, in unadjusted analysis (odds ratio [OR] = 0.16, 95% CI = 0-0.90). After controlling for age, parity, and medical comorbidities, the trend was observed, but the effect was no longer significant (adjusted odds ratio [AOR] = 0.19, 95% CI = 0-1.11). We found no significant differences in preeclampsia rates using lower cutoffs of cotinine exposure. We did not observe a decrease in preeclampsia incidence at low or moderate cotinine levels. Women with the highest cotinine levels may have a decreased risk for preeclampsia, although this effect was not significant after controlling for other risk factors.

Evaluation of the relationship between passive smoking and salivary electrolytes, protein, secretory IgA, sialic acid and amylase in young children

Objective To evaluate the relationship between passive smoking as determined by salivary cotinine levels and salivary electrolytes, protein, secretory IgA, sialic acid and amylase in children. Design Saliva was collected from 90 passive smoker (PS) subjects (the study group) and 90 healthy age-matched children (the control group). The study group was divided into three subgroups according the number of cigarettes smoked. Socio-economic status, dental and dietary habits were recorded by questionnaire. Stimulated salivary calcium (Ca), phosphate (P), sodium (Na), potassium (P), total protein, amylase activity, sialic acid level, secretory IgA concentration and cotinine level were analysed. All data were analysed using SPSS, version 13.0. Results Socio-economic status, dental and dietary habits were similar between the two groups. The salivary electrolytes concentrations did not reveal significant difference between the two groups ( p > 0.05). The mean cotinine levels of PS children were 1.58 ± 4.3 ng/mL. The salivary concentrations of protein were similar between the two groups ( p > 0.05). The salivary secretory IgA concentration was significantly lower in the PS group than controls. The sialic acid level and amylase activity in PS group were found significantly higher compared with the controls ( p < 0.05). No difference was observed for all these parameters with sex ( p > 0.05). When saliva samples were analysed for output, the sialic acid level and amylase activity increased significantly in PS subjects ( p < 0.05). Further, the output of secretory IgA concentration was found significantly lower compared with the controls ( p < 0.05). Conclusion In conclusion, we show that passive smoking was associated with a decrease in secretory IgA concentration, whereas with increase in amylase activity and sialic acid level of stimulated whole saliva in young children.

Bar workers’ health and environmental tobacco smoke exposure (BHETSE): symptomatic improvement in bar staff following smoke-free legislation in Scotland

Objective:To examine changes in the health of bar workers after smoke-free legislation was introduced.Design:Longitudinal study following bar workers from before legislation introduction, at 2 months after introduction and at 1...

Association Between Involuntary Smoking and Salivary Markers Related to Periodontitis: A 2‐Year Longitudinal Study

Insufficient data exist regarding the longitudinal influence of involuntary smoking on periodontitis progression. This study examined the relationship between involuntary smoking and periodontitis progression and the effects of involuntary smoking on salivary inflammatory and microbiologic markers related to periodontitis. Participants were recruited during annual health checkups in 2003 and 2005. In 2005, 200 of 273 (73%) Japanese employees examined at baseline underwent periodontal measurements, including clinical attachment level (CAL) and probing depth (PD). Periodontitis progression was identified when a subject displayed one or more teeth with an increase > or = 2.0 mm in CAL and PD during the 2 years. Salivary marker levels, including cotinine, were determined by enzyme assay, including enzyme-linked immunosorbent assay. The proportions of six periodontal pathogens in saliva were assessed using real-time polymerase chain reaction methodology. Based on receiver-operating characteristic analysis, non-, involuntary, and active smokers were defined as subjects exhibiting salivary cotinine levels of 0, 1 to 7, and > or = 8 ng/ml, respectively. By simple logistic regression analysis, age, alcohol consumption, smoking, breakfast habits, and working hours were related to the risk for significant periodontitis progression. Multiple logistic regression analysis revealed significantly higher periodontitis odds ratios (OR) in involuntary (OR = 2.23; 95% confidence interval [CI]: 1.03 to 4.83) and active (OR = 2.27; 95% CI: 1.02 to 5.04) smokers relative to non-smokers following adjustment for covariates. Levels of salivary markers, including albumin, aspartate aminotransferase, and lactoferrin, were significantly elevated in involuntary smokers relative to non-smokers. In contrast, the percentages of periodontal pathogens did not differ between the smoking groups, with the exception of Prevotella nigrescens, which displayed significantly lower levels in involuntary smokers compared to non-smokers. Involuntary smoking increased the inflammatory response and was associated with a greater risk for periodontitis progression.

A community-based study of tobacco smoke exposure among inner-city children with asthma in Chicago

Little is known about the level of tobacco exposure and the factors that influence exposure in children with persistent asthma. We sought to measure tobacco smoke exposure and determine factors associated with exposure in a large urban sample of asthmatic children. This cross-sectional study is based on a community-based cohort of 482 children (8-14 years old) with persistent asthma. Caregiver and household tobacco use were reported by the caregiver. Child tobacco smoke exposure was assessed by using salivary cotinine level. Multivariate linear regression of log-transformed salivary cotinine levels were used to characterize the relationship between smoke exposure and caregiver, household, and demographic characteristics. We used a multivariate logistic model to characterize associations with caregiver smoking. Overall, 68.5% of children had tobacco smoke exposure. Compared with nonexposed children, those exposed to smoking by a caregiver or another household member had cotinine levels that were 1.68 (95% CI, 1.45-1.94) or 1.40 (95% CI, 1.22-1.62) times higher, respectively. Compared with Hispanic children, African American and white/other children had 1.55 (95% CI, 1.16-2.06) and 1.59 (95% CI, 1.18-2.14) times higher cotinine levels, respectively. Child exposure was also associated with caregiver depression symptoms (odds ratio, 1.01; 95% CI, 1.01-1.02), and higher household income was protective (odds ratio, 0.73; 95% CI, 0.56-0.95). Independent predictors of caregiver smoking included a protective effect of higher education (odds ratio, 0.35; 95% CI, 0.15-0.83) and a positive association with potential problematic drug/alcohol use (odds ratio, 2.30; 95% CI, 1.39-3.83). Tobacco smoke exposure was high in this urban sample of asthmatic children. Caregiver smoking was strongly associated with child exposure and also was associated with lower socioeconomic status, non-Hispanic ethnicity, and depression symptoms.

Saliva concentrations of RANKL and osteoprotegerin in smoker versus non‐smoker chronic periodontitis patients

To compare the salivary receptor activator of NF-kappaB ligand (RANKL) and osteoprotegerin (OPG) concentrations in smokers versus non-smokers with chronic periodontitis. Whole saliva samples were obtained from 67 untreated chronic periodontitis patients, of whom 34 were smokers, and from 44 maintenance patients, of whom 22 were smokers. Full-mouth clinical periodontal measurements were recorded. Saliva cotinine, sRANKL and OPG concentrations were determined by ELISA. Statistical analysis was performed using the Mann-Whitney U test, Bonferroni's correction for multiple comparisons and Spearman's correlations. Untreated smokers exhibited significantly higher values of clinical periodontal recordings than untreated non-smokers (all p<0.05). Salivary cotinine level correlated with clinical attachment level (p=0.023). Smoker versus non-smoker maintenance groups showed no significant differences in clinical parameters. There were significant differences in sRANKL and OPG concentrations between untreated and maintenance groups (all p<0.01). Salivary OPG concentration was significantly lower (all p<0.01) and the sRANKL/OPG ratio was higher (all p<0.01) in smokers than in non-smokers. OPG concentration correlated positively with probing depth, clinical attachment level and bleeding on probing (all p<0.005) and negatively with pack-year, and cotinine level (p<0.05). Salivary RANKL and OPG concentrations are suggested to be affected by smoking as not only the untreated but also the treated smokers exhibited higher RANKL and lower OPG concentrations than non-smokers.

Association of passive smoking with caries and related salivary biomarkers in young children

Objective To investigate the association between passive smoking, as determined by salivary cotinine level, and caries, salivary pH, buffering capacity, flow rate and microbiological counts in young children. Design Ninety passive smokers (PS) with a mean age of 5.02 years and 90 healthy age-matched controls were included in this study. Family income, smoking habits of household members, parental education levels, child's tooth-brushing habit and child's daily dietary sugar exposure were recorded by questionnaire. Three categories were formed with respect to the number of cigarettes smoked. A dmft score was calculated according to the criteria recommended by the World Health Organization. The children were also investigated for stimulated salivary cotinine level, pH, flow rate, buffering capacity and salivary Streptococcus mutans and lactobacilli colonisation. Results There were no significant differences in tooth-brushing habit, sugar exposure, family income and parental education levels between the two groups ( P > 0.05). The mean cotinine level of the PS subjects was 1.58 ± 4.3 ng/ml. The dmft scores, and salivary S. mutans and lactobacilli colonisation in PS children were significantly higher than in the control subjects ( P < 0.05). Statistically significant decreases in salivary pH, flow rate and buffering capacity were found in the PS subjects ( P < 0.05). Conclusion PS children are at increased risk of caries compared with control subjects.

Changes in air quality and second-hand smoke exposure in hospitality sector businesses after introduction of the English Smoke-free legislation

To monitor and disseminate the short-term effects of the English Smoke-free legislation on air quality and employee exposure in businesses of the hospitality industry. Indoor particle concentrations and salivary cotinine levels were measured in businesses in the hospitality sector and non-smoking employees one month before and after the implementation of the legislation. Results were immediately released to the media to announce the improvements in air quality and employee exposure to the wider public. Measurements were collected in 49 businesses and from 75 non-smoking individuals. Indoor PM(2.5) concentrations decreased by 95% from 217 microg/m(3) at baseline to 11 microg/m(3) at follow-up (P < 0.001). Salivary cotinine in employees was reduced by 75%, from 3.6 ng/ml at baseline to 0.9 ng/ml at follow-up (P < 0.001). The findings were presented to the public through press releases and interviews and were cited in over 20 media articles. The project demonstrates the positive effects of the English Smoke-free legislation on air quality and second-hand smoke exposure in the hospitality industry sector. We believe that quick and positive feedback to the public on the effects of smoking restrictions is essential when introducing public health legislation such as the Smoke-free legislation.

Environmental Tobacco Smoke and Behaviors of Inner-City Children With Asthma

To explore the relationship between environmental tobacco smoke (ETS) exposure and behavior among inner-city children with significant asthma. We analyzed baseline data for 200 children 4 to 10 years old who were enrolled in an asthma program. Environmental tobacco smoke exposure was measured by the child's salivary cotinine level. Caregivers completed the 28-item Behavior Problem Index (BPI). Positive responses were summed for a total BPI score, and children with scores >14 were considered to have significant behavior problems. We conducted Student t tests and multivariate regression analyses to determine the association of children's cotinine levels with BPI scores. Overall, 56% of children were male, 65% were black, and 72% had Medicaid. Mean cotinine level was 1.47 ng/mL. Overall, 30% of children had total BPI scores >14. Children with cotinine values >1.47 ng/mL had significantly higher scores compared with children with lower cotinine values on total BPI (12.5 vs 10.2), as well as externalizing (9.0 vs 7.2), antisocial (2.3 vs 1.7), and immature (2.1 vs 1.6) subscales. In a multivariate model, log cotinine remained independently associated with externalizing (P = .04), headstrong (P = .04), and antisocial behavior (P = .04). Cotinine levels are independently associated with problem behaviors among this sample of urban children with asthma.

A review of the efficacy of smoking-cessation pharmacotherapies in nonwhite populations

Background: Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States. Research suggests that behavioral support strategies and pharmacotherapy can improve abstinence rates. However, both approaches, especially pharmacotherapy, have been understudied in nonwhite US populations. Objective: The aim of this review was to evaluate the efficacy of smoking-cessation pharmacotherapy in nonwhite US populations. Methods: Using search terms smoking cessation, nicotine replacement therapy, bupropion SR, varenicline, minority, ethnicity, African American, black, Hispanic, American Indian, and Alaska Native, a literature search was conducted to identify English-language studies that evaluated the use of smoking-cessation pharmacotherapies in nonwhite patients in MEDLINE (1966\\2-December 2007), International Pharmaceutical Abstracts (1980\\2-January 2008), Database of Abstracts of Reviews of Effectiveness (1990\\2-December 2007), and EMBASE Drugs & Pharmacology (1991\\2-third quarter 2007). Results: Nine studies were identified and assessed. Six studies looked at smoking-cessation pharmacotherapy in black smokers, 1 in Hispanic smokers, 1 in Native American smokers, and 1 in white and nonwhite smokers. In black smokers (N = 410; mean cigarettes per day [cpd], 20.4) who received the nicotine patch versus placebo, the 30-day self-reported abstinence rates were 21.5% versus 13.7% ( P = 0.03) at 10 weeks and 17.1% versus 11.7% ( P = NS) at 6 months. In black smokers (N = 600; mean [SD] cpd, 16.1 [7.5]) who received sustained-release (SR) bupropion 150 mg BID versus placebo for 7 weeks, the 7-day biochemically verified abstinence rates at weeks 6 and 26 were 36.0% versus 19.0% (Δ, 17%; 95% CI, 9.7\\2-24.4; P < 0.001) and 21.0% versus 13.7% (Δ, 7.3%; 95% CI, 1.0\\2-13.7; P = 0.02). Predictors of smoking cessation included use of bupropion SR (abstinence rate, 41.5% vs 21.1%; P<0.001); smoking nonmentholated cigarettes (abstinence rate, 28.3% in mentholated smokers [n = 417] vs 41.5% in nonmentholated smokers [n = 118]; P = 0.006); not smoking within 30 minutes of awakening (abstinence rate, 26.4% [n = 420] in those who did vs 48.7% [n = 115] in those who did not; P < 0.001); and lower baseline salivary cotinine levels (256.8 [137.0] ng/mL in those who became abstinent vs 305.6 [143.4] ng/mL in those who remained smokers; P < 0.001). In black light (≤10 cpd) smokers (N = 753) who received nicotine gum 2 mg, the biochemically verified 7-day abstinence rates at weeks 8 and 26 in mentholated versus nonmentholated smokers were 22.6% versus 26.8% ( P = NS) and 11.2% versus 18.8% ( P = 0.015), respectively; at week 26, the abstinence rates in those who received gum + mentholated cigarettes (n = 309) versus gum + nonmentholated cigarettes (n = 67) were 14% versus 24% ( P = 0.031). In Hispanic smokers (N = 108; mean [SD] cpd, 18.8 [10.2]) who received nicotine patch versus placebo for 10 weeks, 46% versus 26% (χ 2 = 4.01; P = 0.05) were abstinent from weeks 2 to 10 (completed all doses of patch); patients who were more acculturated and received active treatment had a higher abstinence rate than less acculturated patients (63% vs 47%; P value not provided). In Native American smokers (N = 252; cpd not provided) who received nicotine patch + counseling and were followed up at 3, 6, 9, and 12 months, selfreported abstinence rates were 31% (49/156), 30% (21/71), 24% (13/55), and 21% (4/19), respectively (P values not provided). In a 6-month study in white (n = 191) and nonwhite (n = 108) smokers (mean [SD] cpd, 21 [11]) randomized to receive a nicotine patch (n = 144) versus nasal spray (n = 155) for 8 weeks, the carbon monoxide\\2-verified 7-day abstinence rates were 34.7% versus 29.0%; at 6 months, these rates were 18.1% versus 15.5% ( P = NS). In nonwhite patients, logistic regression analysis at 6 months found that a higher proportion of patients randomized to receive nasal spray did not smoke for ≥7 consecutive days (odds ratio, 0.20; 95% CI, 0.05-0.77; P = 0.02). Conclusions: Data from the studies in this review support the use of smoking-cessation pharmacotherapy (nicotine patch and bupropion SR) in nonwhite patients. Black patients, who smoked within 30 minutes of awakening, smoked mentholated cigarettes, and had high salivary cotinine levels may have difficulty quitting regardless of the number of cigarettes smoked per day; therefore, determining the type of cigarettes smoked (mentholated vs nonmentholated) and salivary cotinine levels may be helpful in assessing the severity of smoking addiction and guide pharmacotherapy (eg, starting at higher doses of nicotine-replacement therapy in a light smoker). Other than smoking-cessation behavioral studies, there is a lack of congruent smoking-cessation pharmacotherapy studies in American Indian/Alaska Native, Hispanic, and other ethnic populations.

Determinants of salivary cotinine level: a population-based study in Brazil

A cross-sectional population-based study was conducted to assess, in active smokers, the relationship of number of cigarettes smoked and other characteristics to salivary cotinine concentrations. A random sample of active smokers aged 15 years or older was selected using a stepwise cluster sample strategy, in the year 2000 in Rio de Janeiro, Brazil. The study included 401 subjects. Salivary cotinine concentration was determined using gas chromatography with nitrogen-phosphorus detection. A standard questionnaire was used to collect demographic and smoking behavioral data. The relation between the number of cigarettes smoked in the last 24h and cotinine level was examined by means of a nonparametric fitting technique of robust locally weighted regression. Significantly (p<0.05) higher adjusted mean cotinine levels were found in subjects smoking their first cigarette within five minutes after waking up, and in those smoking 1-20 cigarettes in the last 24h who reported inhaling more than (1/2) the time. In those smoking 1-20 cigarettes, the slope was significantly higher for those subjects waiting for more than five minutes before smoking their first cigarette after waking up, and those smoking "light" cigarettes when compared with their counterparts. These heterogeneities became negligible and non-significant when subjects with cotinine >40 ng/mL per cigarette were excluded. There was found a positive association between self-reporting smoking five minutes after waking up, and inhaling more than (1/2) the time are consistent and higher cotinine levels. These can be markers of dependence and higher nicotine intake. Salivary cotinine proved to be a useful biomarker of recent smoking and can be used in epidemiological studies and smoking cessation programs.

Individual differences in salivary cortisol and alpha‐amylase in mothers and their infants: Relation to tobacco smoke exposure

Tobacco smoke exposure affects the activity of both the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). Statistics reveal 41 million children in the U.S. are regularly exposed to tobacco smoke, but we know little about the effects of environmental tobacco smoke exposure on HPA and SNS activity in early childhood. This study assayed cotinine (a metabolite of nicotine), cortisol, and alpha-amylase (sAA) in the saliva of mother-infant dyads from 197 low income and ethnically diverse families. The dyads were identified as tobacco smoke exposed (N = 82) or nonexposed (N = 115) based on maternal self-reports of smoking and salivary cotinine levels greater or less than 10 ng/ml. As expected, higher rates of maternal smoking behavior were associated with higher levels of cotinine in mothers' and their infants' saliva. On average, smoking mothers' salivary cotinine levels were 281 times higher compared to their nonsmoking counterparts, and 23 times higher compared to their own infant's salivary cotinine levels. Infants of smoking mothers had salivary cotinine levels that were four times higher than infants with nonsmoking mothers. Mothers who smoked had higher salivary cortisol levels and lower sAA activity compared to nonsmoking mothers. There were no associations between maternal smoking behavior, infant's salivary cotinine levels, or tobacco exposure group, and cortisol or sAA measured in infant's saliva. The findings are discussed in relation to the influence of smoking tobacco on the validity of salivary biomarkers of stress.

Bar Workers' Exposure to Second-Hand Smoke: The Effect of Scottish Smoke-Free Legislation on Occupational Exposure

To examine changes in bar workers' exposure to second-hand smoke (SHS) over a 12-month period before and after the introduction of Scottish smoke-free legislation on the 26 March 2006. A total of 371 bar workers were recruited from 72 bars in three cities: Aberdeen, Glasgow, Edinburgh and small towns in two rural regions (Borders and Aberdeenshire). Prior to the introduction of the smoke-free legislation, we visited all participants in their place of work and collected saliva samples, for the measurement of cotinine, together with details on work patterns, self-reported exposure to SHS at work and non-work settings and smoking history. This was repeated 2 months post-legislation and again in the spring of 2007. In addition, we gathered full-shift personal exposure data from a small number of Aberdeen bar workers using a personal aerosol monitor for fine particulate matter (PM(2.5)) at the baseline and 2 months post-legislation visits. Data were available for 371 participants at baseline, 266 (72%) at 2 months post-legislation and 191 (51%) at the 1-year follow-up. The salivary cotinine level recorded in non-smokers fell from a geometric mean of 2.94 ng ml(-1) prior to introduction of the legislation to 0.41 ng ml(-1) at 1-year follow-up. Paired data showed a reduction in non-smokers' cotinine levels of 89% [95% confidence interval (CI) 85-92%]. For the whole cohort, the duration of workplace exposure to SHS within the last 7 days fell from 28.5 to 0.83 h, though some bar workers continued to report substantial SHS exposures at work despite the legislation. Smokers also demonstrated reductions in their salivary cotinine levels of 12% (95% CI 3-20%). This may reflect both the reduction in SHS exposure at work and falls in active cigarette smoking in this group. In a small sub-sample of bar workers, full-shift personal exposure to PM(2.5), a marker of SHS concentrations, showed average reductions of 86% between baseline and 2 months after implementation of the legislation. Most bar workers have experienced very large reductions in their workplace exposure to SHS as a result of smoke-free legislation in Scotland. These reductions have been sustained over a period of 1 year.

Correlation Between Nicotine Levels in Pregnant Women With Secondhand Smoke Exposure and Perinatal Conditions

ISEE-439 Objective: Secondhand smoking during pregnancy may increase various perinatal conditions such as low birth weight, premature labor, and premature amniotic rupture. We conducted a study to evaluate the relationship between the cotinine level and perinatal diseases. Material and Methods: We conduct a self-administered questionnaire survey of pregnant women who received regular follow-up at the Obstetric Outpatient Department of a large teaching hospital, and the questionnaire collected data on their exposure to secondhand smoking. We also collect their saliva samples and measured the cotinine levels to evaluate smoking exposure status. The cutoff value of the salivary cotinine level was 0.4 ng/mL, which was adopted from a study in U.K. All the case had signed the informed consent. Results: There were 90 patients included in this study. We found that the exposure time reported by the participant and the education level of the participant were related to the salivary continine level (P < 0.01). We evaluate the association between the salivary cotinine level and perinatal conditions, including preterm delivery, small for gestation age, and Apgar scores by logistic regression, but found no differences between those who had higher continine levels and those who did not. However, of the 61 participants who have a salivary continine level above 0.4 ng/mL, only 16 reported exposure to secondhand smoking. Conclusions: A correlation between salivary continine level and the reported exposure time to secondhand smoking was found, but those who have a higher level (above 0.4 ng/mL) did not have a significant higher risk of giving birth to a baby with unfavorable perinatal conditions. Only about one-fourth of the participants with a level above 0.4 ng/mL reported secondhand smoking. Further studies should be conducted to identify a more appropriate cutoff value for salivary continine level in Taiwanese women for secondhand smoking.

Salivary Cotinine, Doctor-diagnosed Asthma and Respiratory Symptoms in Primary Schoolchildren

Due to impaired airway function, children are at risk for adverse respiratory symptoms if exposed to environmental tobacco smoke (ETS). A community-based, cross-sectional study of 425 children (5-11 years) attending 15 primary schools in a low socio-economic area of Merseyside/UK was undertaken to investigate the association of adverse respiratory symptoms and ETS exposure using a parent-completed questionnaire and children's salivary cotinine measurements. Overall, 28.9% of children had doctor-diagnosed asthma (DDA) and 11.3% a history of hospital admission for respiratory illnesses. The symptom triad of cough, wheeze and breathlessness (C+W+B+) occurred in 12.6% of children. The geometric mean cotinine level was 0.37 ng/ml (95% CI, 0.33-0.42 ng/ml) and it was estimated that 45.6% of children were ETS exposed. A history of asthma in the family was reported for 9.2% of fathers and 7.2% of mothers. Salivary cotinine level was significantly increased in children with DDA compared to those without (P = 0.002). Cotinine-validated levels [adjusted odds ratio (AOR), 1.8; 95% CI, 1.4-2.5), low socio-economic (disadvantaged) status (AOR, 1.4; 1.1-2.9), child's male gender (AOR, 1.6; 1.1-2.5) and maternal smoking (AOR, 2.2; 1.4-3.1) were significantly associated with DDA. The cotinine-validated level (AOR, 1.4; 1.1-2.9) as well as maternal smoking (AOR, 1.8; 1.1-2.5), were also independently associated with C+W+B+. The use of salivary cotinine as an indicator of ETS exposure could be used to inform parents of exposure risk to their asthmatic children and may help re-enforce deterrent efforts to reduce childhood parental smoking exposure.