Serum Cotinine Research Articles

Frequency of Attendance at Religious Services and Exposure to Environmental Tobacco Smoke.

Exposure to environmental tobacco smoke (ETS) is associated with increased risk of disease and death. Reports on ETS and religion are lacking. Data from the National Health and Nutrition Examination Survey were used to test this association. In 4,712 nonsmokers, serum cotinine level of 0.05-3.99ng/mL indicated ETS exposure. Frequency of attendance at religious services was categorized as > = weekly or less. In bivariate analysis, ETS exposure occurred in 28.6% of those with > = weekly attendance but 36.4% of less frequent attenders (p = 0.0004). In logistic regression controlling for multiple confounders OR = 0.72, 95%CI 0.61-0.85. ETS exposure was negatively associated with religion.

Serum Cotinine and Passive Smoking Status Associated with Non-Smoking Newly Diagnosed Women with Breast Cancer in Malaysia

Background: Evidence shows that exposure to passive smoking increases the risk of breast cancer. However, there is a lack of data on the role of serum cotinine level among passive smoker women with breast cancer. The purpose of this study was to investigate the association of serum cotinine level and passive smoking exposure with the risk of breast cancer. Method: We conducted this case-control study on 78 women with newly diagnosed breast cancer and 83 healthy women, aged 21 to 59 years. Neither cases nor controls were ever smokers in their lifetime. The serum cotinine level, as a biological marker of secondhand smoking, was assessed among women exposed to passive smoking. Results: The mean serum cotinine concentrations were higher among cases compared to controls although the difference was not statistically significant (4.6 ± 3.5 ng/mL vs. 2.8 ± 2.2 ng/mL, respectively, P = 0.059). However, serum cotinine significantly increased the risk of breast cancer (OR = 1.22; 95% CI = 1.02, 1.48, P = 0.034). Exposure to passive smoking at home and exposure from a smoker husband increased the risk of breast cancer compared with those with no exposure (OR = 2.17; 95% CI = 1.15, 4.08, P = 0.016; and OR = 2.67; 95% CI = 1.35, 5.29, P = 0.005, respectively). Conclusion: Serum cotinine levels and passive smoking exposure appeared to be independent risk factors associated with the development of breast cancer.

Expired Air Carbon Monoxide Testing Is Effective for Preoperative Screening of Cigarette Use in Orthopaedic Patients: A Prospective Pilot Study of 70 Veterans

Introduction: Screening for cigarette use is standard in the orthopedic pre-operative clinic, however traditional biochemical testing methods, including serum and urine cotinine assays, do not differentiate active smoking from nicotine replacement therapy (NRT). In this prospective pilot study, we hypothesize that exhaled carbon monoxide (eCO) testing will be non-inferior to the gold standard serum cotinine (SC) test in screening for pre-operative cigarette use, will differentiate active smoking from NRT, and will allow for substantial cost savings in a clinic setting. Methods: Adult orthopaedic veterans indicated for elective surgery at our institution were offered inclusion. Self-reported smoking status (SRS), eCO and SC levels were obtained preoperatively. An eCO level of >6 parts per million and a SC level >3 ng/ml were considered positive for recent cigarette use. Agreement between SRS, eCO levels and SC levels, and eCO level test-retest reliability were evaluated. Results: Of the 55 patients enrolled into the study, 4 were self-reported Current Smokers and 51 were self-reported Ex-Smokers or Non-Smokers. Combining SRS with eCO levels as a screening tool for recent cigarette use yielded a sensitivity of 100%, a specificity of 98%, a positive predictive value of 95% and a negative predictive value of 100%. eCO testing differentiated NRT from cigarette use in all non-smoking patients. Test-retest reliability for eCO levels showed perfect agreement for 16 patients that had two or more eCO levels pre-operatively. Conclusion: Exhaled CO testing is as effective as SC testing but can differentiate active smoking from NRT, while maintaining a high level of accuracy and reliability when combined with SRS as a screening tool.

Evaluation of serum/salivary levels of carnosine and cotinine in recurrent wheezing of young children with passive smoking.

Recurrent wheezing is common in young children, with a cumulative prevalence of up to 40 % in the first 6 years of life. In this study, we aimed to evaluate the relationship between the number of wheezing episodes and the number of cigarettes smoked at home and serum / saliva cotinine and carnosine levels in children with recurrent wheezing. This study was conducted with 80 young children with recurrent wheezing, aged between 1-4 years and 50 healthy control groups. Patient population was divided into three groups depending on the number of their exposure to cigarette smoke and wheezing attacks. Serum cotinine, saliva cotinine, serum carnosine, saliva carnosine, vitamin D levels were measured by using the ELISA method. A significant relationship for serum cotinine and saliva cotinine levels was found between groups (p < 0.05). It was determined that as the number of exposure to cigarette smoke and number of wheezing episodes in young children with recurrent wheezing increased, the level of serum/saliva cotinine levels increased significantly, compared to the control group. In contrast, it was determined that as the number of exposure to cigarette smoke and number of wheezing episodes in young children with recurrent wheezing increased, serum/saliva carnosine levels decreased significantly, compared to the control group. In addition, a significant difference in serum vitamin D levels was found between healthy young children and young children with recurrent wheezing (p < 0.05). We think that the measurement of salivary cotinine is a useful and noninvasive marker to evaluate passive smoking exposure in the etiology of recurrent wheezing in young children.

Comparative evaluation of serum cotinine levels in chronic periodontitis and chronic obstructive pulmonary disease.

Context:Periodontitis and chronic obstructive pulmonary disease (COPD) are chronic progressive inflammatory conditions. Smoking has been associated with both chronic periodontitis and COPD. Hence, the present study was designed to correlate serum levels of cotinine with the severity of periodontal disease with or without COPD.Settings and Design:A total of eighty patients, twenty healthy individuals, twenty patients with chronic generalized periodontitis without smoking and without COPD, twenty patients who are smokers with chronic periodontitis without COPD and twenty patients who are smokers with chronic periodontitis and COPD in the age range of 43–65 years were selected for the study.Subjects and Methods:Serum cotinine level assessment, smoking history, and periodontal examination were done in all the patients and the data obtained were statistically analyzed.Results:The mean serum cotinine level was highest in smokers with chronic periodontitis and COPD (93.642 ± 14.727) and it differed significantly between the four groups (P < 0.001). There is a significant positive correlation between the number of cigarettes and serum cotinine levels in both groups involving smoking. There was no significant correlation between serum cotinine level and clinical attachment loss in chronic periodontitis smokers with or without COPD.Conclusions:The result of this study indicates that increased smoking with COPD causes a higher chance of progression of periodontal destruction but it is not statistically significant. Furthermore, this study indicates that the assessment of serum cotinine levels is a reliable method to evaluate smoking exposure.

Tobacco cigarette and cannabis use among new mothers.

In the United States, the prevalence of cannabis use during pregnancy has increased whereas tobacco smoking has decreased. This study aimed to estimate the prevalence of tobacco cigarette smoking and cannabis use among new mothers, stratified by breastfeeding status. Additionally, trend analysis was used to examine changes in tobacco and cannabis use over time. Cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES, 2001-18). United States. Population-based sample of new mothers (within 2years of childbirth) aged 20-44years (n=1332). For each NHANES data cycle, the prevalence of tobacco smoking measured by self-report or serum cotinine was estimated. Additionally, we estimated the prevalence of cannabis use measured by self-report. Using Joinpoint Regression, we tested for significant changes in trends and produced the average 'data-cycle' percentage change (APC). From 2001 to 2018, more than one in five new mothers were tobacco cigarette smokers. New mothers who were breastfeeding were less likely to smoke cigarettes [7.4%, 95% confidence interval (CI)=4.9%, 10.9% compared with mothers who were not breastfeeding (25.7%, 95% CI=22.3%, 29.3%]. Results from Joinpoint regression indicated no robust temporal trends for self-reported tobacco smoking (APC=-1.3, 95% CI=-8.6, 6.7; P=0.7) or for cotinine levels ≥ 4.47ng/ml (APC=0.3, 95% CI=-5.0, 5.9; P=0.9), whereas cannabis use had increased among new mothers (APC=23.7, 95% CI=4.8, 46.0; P=0.02). Consistent with the increase seen among other subgroups, cannabis use has approximately doubled among US new mothers since 2005. There is no significant evidence of a change in tobacco smoking among US new mothers since 2001.

Serum Cotinine Level as a Tobacco Exposure Related Biomarker in Oral Cavity Malignancy

Oral cancer has posed a challenge to us with its incidence as high as around 20% of total body cancers aim of the study was to quantify serum cotinine level as tobacco exposure-related biomarker in controls, chronic tobacco chewers (High risk for oral cavity malignancy) and oral cavity cancer patients. This was a hospital-based case-control study of 24 months duration in controls, chronic tobacco chewers and oral cancer patients. A total of 150 subjects had enrolled after meeting the inclusion &amp; exclusion criteria. The commonest age group of oral cavity malignancy was 41 to 50 years. Males were found to be more affected than females. Tobacco chewing was the most common habits in a male patient and mishri application in female patients. In this study, 90% of patients had a history of tobacco consumption for the last ten years or more. Frequency of tobacco chewing was more in chronic tobacco chewers (30% in more than ten times a day) compared to oral cavity malignancy group (16% in more than ten times a day). The majority (more than 50%) of patients had tumour arising from the buccal mucosa, and histopathological studies revealed that 48% of patients had well-differentiated squamous cell carcinoma. Serum cotinine level in non-tobacco exposure group is less than 1 ng/mL. Conclusion- Tobacco chewing habit is a high-risk factor for oral cancer. Chronic tobacco chewers can be included in the high-risk group for oral cavity cancer. Serum cotinine level can be used as a tumour marker for oral cancer patients.

Examination of xylene exposure in the U.S. Population through biomonitoring: NHANES 2005–2006, 2011–2016

Aim: Xylenes are aromatic hydrocarbons used for industrial applications such as the production of petrochemicals and plastics. Acute xylene exposures can negatively impact health through neurotoxicity and irritation of respiratory and dermal tissues. We quantified urinary biomarkers of xylene exposure [2-methylhippuric acid (2MHA) and a mixture of 3- and 4-methylhippuric acids (34MH)] in a representative sample of the U.S. population. Methods: Spot urine obtained during the National Health and Nutrition Examination Survey 2005–2006 and 2011–2016 was analysed using ultra-high-performance liquid chromatography/tandem mass spectrometry. Exclusive smokers were distinguished from non-users using a combination of self-report and serum cotinine data. Results: The median 2MHA and 34MH levels were higher for exclusive smokers (100 µg/g and 748 µg/g creatinine, respectively) than for non-users (27.4 µg/g and 168 µg/g creatinine, respectively). Participants who smoked cigarettes had significantly higher 2MHA and 34MH levels (p < 0.0001) than unexposed participants. Smoking 1–10, 11–20, and >20 cigarettes per day (CPD) was significantly associated with 181%, 339% and 393% higher 2MHA levels, respectively. For 34MH, smoking 1–10, 11–20, and >20 CPD was significantly associated with 201%, 398%, and 471% higher 34MH levels, respectively. Conclusion: We confirm that tobacco smoke is a significant source of xylene exposure as measured by urinary 2MHA and 34MH levels.

Comparing cotinine and NNAL verification of self-reported smoking status among lung cancer screening eligible population from the 2007–2014 National Health and Nutrition Examination Survey (NHANES)

Background: Biochemical verification of self-reported smoking status is not common among the population eligible for lung cancer screening (LCS). Methods: We used urinary NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides) and serum cotinine as the gold standard to determine the validity and reliability of self-reported smoking status from the 2007–2014 National Health and Nutrition Examination Survey (NHANES). Results: We found 2.3% (n = 652, equivalent to 5.3 million weighted population) of adults eligible for LCS according to the current United States Preventive Services Task Force guideline. Self-reported current smoking status performed similarly against NNAL and cotinine: sensitivity [89.7% (95%CI: 84.9%–94.5%) vs. 89.5% (95%CI: 84.8%–94.3%)]; specificity [99.7% (95%CI: 99.2%–100.0%) vs. 100% (95%CI:100%–100%)]; positive predictive value (PPV) and negative predictive value (NPV) were 99.8% (95%CI:99.4%–100.0%) versus 100% (95%CI:100%–100%) and 85.3% (95%CI: 79.1%–91.5%) versus 85.1% (95%CI: 79.1%–1.0%), respectively; and Kappa [86.5% (95%CI:80.5%–92.5%) vs. 86.5% (95%CI:80.6%–92.3%)]. Performance measures were better among females than males; worst among the non-Hispanic white and best among other race/ethnicity group. The validity and reliability of self-reported smoking status increased with increasing cutpoint levels of both NNAL and cotinine. Conclusions: Self-reported smoking status among people who are at high risk of lung cancer is reasonably reliable. The difference between using NNAL and cotinine appears to be minimal.

Abstract 15034: Exposure to Secondhand Smoke is Associated With Increased Left Ventricular Mass

Background: Exposure to secondhand smoke (SHS), or passive smoking, has been associated with chronic hypertension. However, little is known about the relationship between SHS and left ventricular (LV) hypertrophy, the most common complication of hypertension and a manifestation of cardiac end-organ damage. Hypothesis: SHS exposure is independently associated with LV mass. Methods: This analysis included 4,982 non-smoker participants (age 60.8±13.6 years, 57.8% women, 77.7% whites) from the Third National Health and Nutrition Examination (NHANES-III). Non-smoking was defined by self-report and serum cotinine ≤ 10 ng/dL, a biomarker for tobacco exposure. SHS was defined as serum cotinine level &gt;1 ng/dL. LV mass was estimated using an electrocardiographic model developed and applied in NHANES-III then validated in the Cardiovascular Health Study. Multivariable linear regression was used to examine the cross-sectional association between SHS exposure (vs. no exposure) with estimated LV mass. In similar models, we also examined the associations of LV mass across quartiles of serum cotinine (reference group, 1 st quartile) and in subgroups stratified by race, sex, and hypertension status. Results: About 9.8% (n=489) of the participants were exposed to SHS. Exposure to SHS was associated with an estimated 2.9 gram increase in LV mass, with a dose-response relationship between higher serum cotinine and LV mass ( Table ). These results were consistent in men and women (interaction p-value= 0.31), whites and non-whites (interaction p-value= 0.21), and those with and without hypertension (interaction p-value= 0.88) Conclusion: In a racially diverse sample of non-smokers, SHS is associated with increased LV mass with a dose-response relationship between level of exposure and LV mass. These findings underscore the harmful effect of passive smoking on the cardiovascular system and highlight the need for more restrictions on smoking in public areas.

Adolescent Self-Reported Smoking and Electronic Cigarette Use vs. Serum Cotinine Level, NHANES, 2015–16 and 2017–18

The purpose of this research is to compare serum cotinine cutoffs for nicotine/tobacco exposure and self-reported tobacco use in adolescents. National Health and Nutrition Survey, 2015–18, cotinine levels and tobacco questions were analyzed for frequencies; bivariate and logistic regression analyses. With serum cotinine as the gold standard, self-report of current smoking detected 40.5% who had tobacco/nicotine exposure cotinine levels (sensitivity = 40.5%). Self-report of current smoking and/or e-cigarette use detected 60.0% who had tobacco/nicotine exposure cotinine levels (sensitivity = 60.0%). In this nationally representative study, caution should be considered in relying upon adolescent self-reported cigarette use, and self-reported cigarette and/or e-cigarette use.

Disentangling the Impacts of Cadmium Exposure and Smoking Behavior on Age-Related Cognitive Decline in a Representative U.S. Sample

Background: Cadmium is a toxic metal that has, in a sparse literature, been linked to age-related cognitive decline. We investigated cadmium exposure and cognitive function while considering confounding and modifying effects of tobacco use, given tobacco is a major source of cadmium exposure and is linked to cognitive decline.Methods: We included 2,069 adults age 60 years and older from the National Health and Nutrition Examination Survey (NHANES), 2011-2014, after excluding 262 with missing data, classifying active smokers by self-report or serum cotinine levels &gt;10ng/mL. Cadmium levels in whole blood likely reflected prolonged exposure due to persistence in human tissues: mean=0.52μg/L (standard deviation=0.45μg/L). Cognitive performance was assessed concurrently with blood testing, via four neuropsychological tests: tapping memory, executive function, sustained attention, and working memory, which were standardized and combined to form a composite cognitive z-score mean z=0 (stdev 0.75). We used linear models to estimate change in cognitive function per 1-unit μg/L increase in cadmium, incorporating the NHANES MEC sampling weights.Results: Initial observations of worse cognitive performance with higher cadmium from unadjusted models, β= -0.17 (95% CI -0.24, -0.09), were highly attenuated after adjusting for gender, age, age^2, race/ethnicity, marital status, education level, and poverty income ratio: β= -0.08 (95% CI -0.14, -0.01). Additional adjustment for smoking status (active/former/never) and serum cotinine further attenuated this association: β= -0.05 (95% CI -0.13, 0.03). The cadmium-cognition association was not modified by smoking status; the p value on a likelihood ratio test of cadmium*smoking status=0.34.Conclusion: In contrast to prior studies, our findings suggest that cadmium is not related to cognitive decline, although our design was limited to a single cognitive measure rather than a trajectory of cognitive decline and may have been impacted by missing data. Studies that fail to account for tobacco exposure may over-estimate the neurodegenerative impacts of cadmium.

Associations between Childhood Toenail Manganese Concentrations and Neurodevelopment in Rural Appalachian Ohio

Background: Manganese (Mn) is necessary in trace quantities; however, at increased exposure levels the metal poses a risk to neurologic functions. While there is no universally accepted biomarker of Mn exposure, toenails are novel, noninvasive measures that represent cumulative exposure. The Communities Actively Researching Exposure Study (CARES) is an established pediatric cohort in eastern Ohio which includes children aged 7-9 living near industrial sources of excess Mn exposure. This study aims to understand the relationship between Mn exposure, quantified through toenails, and neurodevelopmental outcomes among CARES participants.Methods: Toenail samples collected from participating children were analyzed for Mn content. Trained team members administered the Wechsler Intelligence Scale for Children-IV (WISC-IV), the Behavioral Assessment System for Children-2 (BASC2), and the Behavior Rating Inventory of Executive Functions (BRIEF). We assessed linear relationships between toenail Mn concentrations and Intelligence Quotient (IQ) and behavioral scores. Quartiles of the distribution for toenail Mn were represented with categorical variables and multiple regression models were ran to assess nonlinearity. Critical confounders such as blood lead and serum cotinine were included.Results: Exposure and outcome data were available for 404 children. Our study suggests a nonlinear relationship among boys, with lower Working Memory IQ scores observed among those with low (β = -3.46; 95% CI -7.54, 0.62) and high (β = -5.07; 95% CI -9.86, -0.29) levels of toenail Mn. The effect of Mn on the global executive function and BRIEF composite scales was 4 to 6 times greater among girls compared to boys, respectively.Conclusions: Toenails appear to be a valuable biomarker for Mn exposure. Gender is a crucial factor with regards to the neurotoxicology of Mn. Future research is needed to further elucidate the toxicokinetics of Mn in toenails as well as the mechanisms behind the influence of gender on the relationship between Mn and neurodevelopment.

Phthalate Exposure and Respiratory Diseases Among Adults and Children: the US NHANES 2007-2016

Background/Aim: Phthalates are used as plasticizers in many consumer products. Although they have associations with multiple adverse health outcomes, studies on phthalate exposure and respiratory outcomes are limited. The objective of our study was to examine the association between phthalate exposure and respiratory diseases in the US population. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2016, we analyzed the data on twelve urinary metabolites and current respiratory diseases (asthma, bronchitis, and emphysema) among adults (≥ 20 years of age) and children and adolescents (6-19 years of age). The logistic regression was conducted to estimate the odds ratios (ORs) per one log10 unit increase in the concentration of urinary phthalate metabolites, and age, gender, race, waist/height ratio, urinary creatinine, serum cotinine level, and poverty index ratio were included in the model for adjustment. Analyses were conducted separately on children and adults to investigate the difference by age. Results: In adults, mono-benzyl phthalate (MBzP) was positively associated with asthma and chronic bronchitis (OR 1.34; 95% CI 1.11-1.61 and OR 1.39; 95% CI 1.02-1.91). Mono-(3-carboxypropyl) phthalate and mono-(carboxynonyl) phthalate also showed the significant associations with chronic bronchitis (OR 1.38; 95% CI 1.04-1.84 and OR 1.44; 95% 1.03-2.02). Although there was a trend with elevated risk between low-molecular-weight phthalates and emphysema, it was not significant (OR 1.26; 95% CI 0.98-1.62 for mono-ethyl phthalate, and OR 1.28; 95% CI 0.80-2.04 for mono-isobutyl phthalate). In children and adolescents, no evidence of associations between phthalates and asthma was found. Conclusion: Our cross-sectional study advocates for the positive associations of high-molecular -weight phthalate metabolites with respiratory diseases among adults. However, in children, the evidence of such association was absent, for which further analysis and research are recommended.

Maternal Obesity Affects the Glucose-Insulin Axis During the First Trimester of Human Pregnancy.

Background and objective: The maternal glucose-insulin axis is central for metabolic adaptations required for a healthy pregnancy. Metabolic changes in obese mothers in early pregnancy have been scantly described. Here we characterized the glucose-insulin axis in the first trimester of human pregnancy and assessed the effect of maternal obesity and fat mass.Methods: In this cross-sectional study, maternal blood samples (N = 323) were collected during voluntary pregnancy termination (gestational age 4+0–11+6 weeks) after overnight fasting. Smokers (N = 198) were identified by self-report and serum cotinine levels (ELISA). Maternal BMI (kg/m2) and serum leptin (ELISA) were used as proxy measures of obesity and maternal fat mass, respectively. BMI was categorized into under-/normal weight (BMI < 25.0 kg/m2), overweight (BMI 25.0–29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2), and leptin in tertiles (1st tertile: leptin < 6.80 ng/ml, 2nd tertile: leptin 6.80–12.89 ng/ml, 3rd tertile: leptin > 12.89 ng/ml). ISHOMA insulin sensitivity index was calculated from glucose and C-peptide (ELISA) serum concentrations. Analyses of covariance including multiple confounders were performed to test for differences in glucose, C-peptide and ISHOMA between gestational age periods, BMI and leptin groups. C-peptide and ISHOMA were log-transformed before analyses.Results: At weeks 7–9, fasting glucose and C-peptide levels were lower (P < 0.01 and P < 0.001, respectively) and insulin sensitivity higher (P < 0.001) than at weeks 4–6. Glucose levels were not significantly different between BMI or leptin categories. In contrast, C-peptide increased by 19% (P < 0.01) between the normal weight and the overweight group and by 39% (P < 0.001) between the overweight and obese group. In the leptin groups, C-peptide increased by 25% (P < 0.001) between the 1st and 2nd leptin tertile and by 15% (P < 0.05) between the 2nd and 3rd leptin tertile. ISHOMA decreased with higher BMI and fat mass. ISHOMA decreased by 18% (P < 0.01) between the normal weight and the overweight group and by 30% (P < 0.01) between the overweight and the obese group. In the leptin groups, ISHOMA decreased by 22% (P < 0.001) between the 1st and 2nd leptin tertile and by 14% (P < 0.05) between the 2nd and 3rd leptin tertile.Conclusions: At the group level, fasting glucose, C-peptide and insulin sensitivity dynamically change in the first trimester of human pregnancy. Maternal obesity is associated with higher C-peptide and lower insulin sensitivity at all periods in the first trimester of human pregnancy, while glucose is unaltered. These findings have implications for the timing of early gestational diabetes mellitus risk screening.

Smoking cessation increases levels of osteocalcin and uncarboxylated osteocalcin in human sera

Smoking is thought to be a risk factor for osteoporosis development; however, the consequences of stopping smoking for bone homeostasis remain unknown. Here we conducted two separate human studies and show that bone mineral density was significantly lower in smokers than in non-smokers. The first was an observational study of pre- and post-menopausal healthy female smokers and non-smokers; the second included 139 current smokers determined to stop smoking. In the second study, levels of bone formation markers such as osteocalcin and uncarboxylated osteocalcin significantly increased after successful smoking cessation, as verified by significantly reduced levels of serum cotinine, a nicotine metabolite. Moreover, nicotine administration to mice reduced bone mineral density and significantly increased the number of osteoclasts in bone. Reduced bone mass phenotypes seen in nicotine-treated mice were significantly increased following nicotine withdrawal, an outcome accompanied by significantly reduced serum levels of tartrate-resistant acid phosphatase, a bone resorption marker. Taken together, our findings suggest that bone homeostasis is perturbed but can be rescued by smoking cessation.

Validation of Self-Reported Smoking Status Among Orthopedic Hip Surgery Patients.

PurposeThe purpose of this study was to determine the accuracy of self-reported non-smoking status in subjects undergoing elective orthopedic surgery as confirmed by serum cotinine levels.MethodsInstitutional Review Board approval was obtained for this retrospective review of consecutive subjects that underwent elective orthopedic surgery by a single fellowship-trained orthopedic surgeon. All patients provided smoking history (active, former, or non-smoker). Serum cotinine levels defined each subject as “non-smoker”, “passive tobacco exposure”, or “active smoker”. Self-reported non-smokers were eligible for inclusion. Subjects were excluded if they failed to provide smoking history, reported themselves as “smokers”, and/or had unavailable serum cotinine levels. Self-reported non-smoking status accuracy was determined by dividing the total number of included subjects by the number of subjects that were defined as “non-smoker” or “passive tobacco exposure” on their serum cotinine test.ResultsA total of 378 patients (mean age of 42.5 (13-78) years and 68% female) self-reported as non-smokers and were included. A total of 369 subjects had serum cotinine levels consistent with “non-smoking” resulting in a self-reported non-smoking status accuracy of 97.6%. None of the former smokers had cotinine levels consistent with active smoker status.ConclusionSubjects undergoing elective orthopedic surgery self-report as non-smokers with an accuracy of 97.6%. This suggests that routine serum cotinine testing of non-smokers in this patient population may not be necessary.

Maternal Marijuana Exposure, Feto-Placental Weight Ratio, and Placental Histology.

Marijuana use is associated with placenta-mediated adverse pregnancy outcomes including fetal growth restriction, but the mechanism remains uncertain. The objective was to evaluate the association between maternal marijuana use and the feto-placental weight ratio (FPR). Secondarily, we aimed to compare placental histology of women who used marijuana to those who did not. This was a secondary analysis of singleton pregnancies enrolled in a multicenter and case-control stillbirth study. Prior marijuana use was detected by electronic medical record abstraction or cord homogenate positive for 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid. Prior tobacco use was detected by self-report or presence of maternal serum cotinine. Stillbirths and live births were considered separately. The primary outcome was FPR. Association of marijuana use with FPR was estimated with multivariable linear modeling adjusted for fetal sex, preterm birth, and tobacco use. Comparisons between groups for placental histology were made using Chi-square and stratified by live birth and stillbirth, term and preterm deliveries, and fetal sex. Of 1,027 participants, 224 were stillbirths and 803 were live births. Overall, 41 (4%) women used marijuana during the pregnancy. The FPR ratio was lower among exposed offspring but reached statistical significance only for term stillbirths (mean 6.84 with marijuana use vs. mean 7.8 without use, p < 0.001). In multivariable modeling, marijuana use was not significantly associated with FPR (p = 0.09). There were no differences in histologic placental features among those with and without marijuana use overall or in stratified analyses. Exposure to marijuana may not be associated with FPR. Similarly, there were no placental histologic features associated with marijuana exposure. Further study of the influence of maternal marijuana use on placental development and function is warranted to better understand the association between prenatal marijuana use and poor fetal growth. · Maternal marijuana exposure was not associated with the feto-placental weight ratio.. · Marijuana exposure was not associated with differences in placental histology.. · Concerning trend toward lower feto-placental weight ratios among marijuana-exposed stillbirths..

Quantification of Seven Terpenes in Human Serum by Headspace Solid-Phase Microextraction-Gas Chromatography-Tandem Mass Spectrometry.

Terpenes are a class of volatile organic hydrocarbons commonly produced by vegetation and released into the atmosphere. These compounds are responsible for the scents of pine forests, citrus fruits, and some flowers. Human terpene exposure can come from inhalation, diet, smoking, and more recently, using e-cigarettes. Terpenes are present in tobacco smoke and are used as flavor chemicals in e-liquids. The health effects of terpenes are not widely known, though several studies have suggested that they may prove useful in future medical applications. We have developed a novel, high-throughput method of quantifying seven terpenes (α-pinene, β-pinene, β-myrcene, 3-carene, limonene, β-caryophyllene, and α-humulene) in human serum to aid human-exposure investigations. This method employs headspace sampling using solid-phase microextraction (SPME) coupled to gas chromatography-tandem mass spectrometry to detect and quantify five monoterpenes and two sesquiterpenes in the low parts-per-trillion to low parts-per-billion range. The intraday and interday variability (percent error) of the method are ≤2 and ≤11%, respectively. In addition, this method showed excellent recovery in human serum (between 80 and 120% for all analytes). The assay precision ranges between 4.0 and 11%. Limits of detection ranged between 0.032 and 0.162 μg/L. Using serum cotinine values to classify tobacco use showed that smokers have higher serum concentrations of six terpenes compared to nonusers. Terpene concentrations were 14-78% higher in smokers than nonusers. Our method can provide essential biomonitoring data to establish baseline exposure levels for terpenes in humans.

Re-visiting serum cotinine concentrations among various types of smokers including cigarette only smokers: some new, previously unreported results.

Data (N = 11614) from National Health and Nutrition Examination Survey (NHANES) for 1999-2016 for US adults aged ≥ 20 years were analyzed by fitting regression models to estimate unadjusted and adjusted geometric means (AGM) for several different groups of smokers. Serum cotinine level ≥ 3.3 ng/mL was used to distinguish smokers from nonsmokers. AGMs for cigarette only, cigar only, dual cigarette/cigar, e-cigarette or dual e-cigarette/cigarette, and smokeless tobacco only smokers were estimated to be 152.5, 65.1, 92.5, 146.3, and 272.0 ng/mL, respectively. Males were found to have higher cotinine levels than females for dual cigarette and cigar smokers, but the reverse was observed for smokeless tobacco users. Non-Hispanic blacks had higher AGMs than non-Hispanic whites for cigarette only smokers, but the reverse was observed for dual cigarette and cigar smokers. For the first time, serum cotinine estimates for those self-reported nonsmokers who were classified to be smokers (29.4 ng/mL) and those smokers for whom self-reported data for use of tobacco products were missing were also estimated (113.8 ng/mL).