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  1. Takao N, Furuta M, Takeshita T, Kageyama S, Goto T, Zakaria MN, et al.
    J Oral Sci, 2023;65(2):107-110.
    PMID: 36990753 DOI: 10.2334/josnusd.22-0388
    PURPOSE: Second-hand smoke has adverse effects on oral health. This cohort study used a multilevel approach to investigate the association of second-hand smoke exposure, as determined by salivary cotinine level, with dental caries in adolescents.

    METHODS: Data from 75 adolescents aged 11 or 12 years and 2,061 teeth without dental caries were analyzed in this study. Annual dental examinations to assess dental caries were conducted between 2018 and 2021. Salivary cotinine and Dentocult SM-Strip level were measured at baseline. Information on the smoking habits of parents, snack frequency, regular dental visits, and use of fluoride toothpaste was collected at baseline from parent-reported questionnaires.

    RESULTS: During the 3-year follow-up, dental caries was noted in 21 adolescents and 43 teeth. Participants exposed to parental smoking had higher salivary cotinine levels than those whose parents did not smoke. The multilevel Cox regression model showed that a high salivary cotinine level was associated with the incidence of dental caries, after adjusting for potential confounding factors (hazard ratio, 3.39; 95% confidence interval 1.08-10.69).

    CONCLUSION: This study suggests that the risk of dental caries is higher for adolescents who have high salivary cotinine levels attributable to second-hand smoke exposure.

    Matched MeSH terms: Cotinine/analysis
  2. Man CN, Fathelrahman AI, Harn GL, Lajis R, Samin AS, Omar M, et al.
    Environ Toxicol Pharmacol, 2009 Jul;28(1):92-6.
    PMID: 21783987 DOI: 10.1016/j.etap.2009.03.003
    The objective of this study was to correlate, differentiate and validate the self-reported smoking status of educated young adults with urinary biomarkers (i.e. nicotine and cotinine). Freshmen students were recruited on voluntary basis. They filled-up self-administered questionnaire and their urine samples were collected for analysis. The urinary nicotine (UN) and cotinine (UC) were measured by gas chromatograph-mass spectrometry. Smokers, non-smokers and ex-smokers were found to be both significantly correlated and different in their UN and UC levels. UC level of 25ng/ml was the optimal cut-off to differentiate smokers from non-smokers. Using this cut-off value, the prevalence of smoking among the students was found to be higher (15.4%) than the self-reported data (14.3%). UC is useful in validating individual recent smoking history and the cut-off could serve as a marker for assessing the clinical impact of smoking and environmental tobacco smoke (ETS) exposure on human health.
    Study site: university health centre, Universiti SainsMalaysia (USM), Pulau Pinang, Malaysia
    Matched MeSH terms: Cotinine*
  3. Wong LP, Mohd Salim SN, Alias H, Aghamohammadi N, Hoe VCW, Isahak M, et al.
    J Addict Nurs, 2020 6 4;31(2):102-109.
    PMID: 32487936 DOI: 10.1097/JAN.0000000000000335
    Electronic cigarettes (e-cigarettes) have rapidly increased in popularity within the last 2 years in Malaysia. The study aims to understand the association between e-cigarette use behaviors and salivary cotinine (a CYP2AA metabolite of nicotine) concentration to inform the development of future e-cigarette control policies. A convenience sample of saliva from 144 e-cigarette users was obtained between November and December 2015. The study participants used refill liquid containing between 0 and 12 mg/ml of nicotine. The overall median cotinine concentration of the study participants was 81.1 ng/ml (interquartile range = 8.5-195.8). Among the zero-nicotine and single e-cigarette users, the median cotinine level was 51.1 (interquartile range = 8.20-125.35) ng/ml. Factors significantly associated with a higher salivary cotinine concentration were dual use of e-cigarettes and tobacco cigarettes, regular and daily e-cigarette use, a longer duration of e-cigarette use, using a higher amount of e-liquid, and a shorter duration to finish a refill. Multivariate analysis revealed that e-cigarette use of 1-6 and 6-12 months (but not 1 month and below) was significantly associated with a higher cotinine concentration. Cotinine found in zero-nicotine e-liquids implies the importance of stringent regulatory governance for the consistency of labeled nicotine content of e-cigarette liquid in the market. Zero-nicotine e-cigarette users should also be informed of the likelihood of environmental exposure to tobacco smoke. Future studies conducted on larger samples are warranted to validate the association between duration of e-cigarette use and salivary cotinine concentration as well as to investigate underlying mechanisms.
    Matched MeSH terms: Cotinine/analysis*; Cotinine/metabolism
  4. Man CN, Gam LH, Ismail S, Lajis R, Awang R
    PMID: 16908224
    Nicotine is a major addictive compound in cigarette. Its smoke is rapidly and extensively metabolized to several metabolites in human. Cotinine as a major metabolite of nicotine is commonly used as a biomarker to determine active and passive smokers. Cotinine has a longer half-life ( approximately 20 h) compared to nicotine ( approximately 2h). A simple, sensitive, rapid and high throughput GC-MS method was developed for simultaneous quantification of urinary nicotine and cotinine in passive and active smokers. In the sample preparation method, the analytes and internal standard were first basified and followed by liquid-liquid extraction. Upon completion, anhydrous sodium sulphate was added to the solvent mixture to trap moistures. The clear extract obtained was directly injected into GC-MS, operating under selective ion monitoring (SIM) mode. Calibration curves in the range of 0.5-5000 ng/mL of the analytes in urine matrix were established with linear correlation coefficients (r(2)) greater than 0.997. The limit of detection for both nicotine and cotinine were 0.20 ng/mL. The mean recoveries for nicotine and cotinine were 93.0 and 100.4%, respectively. The within- and between-assay accuracies were between 2.1 and 7.9% for nicotine and between 0.7 and 11.1% for cotinine. Within- and between-assay precisions of 3.3-9.5% for nicotine and 3.4-9.8% for cotinine were also achieved. The method can be used in routine assessment and monitoring of active smoking and exposure to environmental tobacco smoke. The applicability of the assay was demonstrated in a small-scale comparison study between smokers and non-smokers.
    Matched MeSH terms: Cotinine/urine*; Cotinine/chemistry
  5. Rahman AU, Mohamed MHN, Jamshed S, Mahmood S, Iftikhar Baig MA
    J Pharm Bioallied Sci, 2020 Nov;12(Suppl 2):S671-S675.
    PMID: 33828359 DOI: 10.4103/jpbs.JPBS_245_19
    Background: The Fagerstrom test for nicotine dependence (FTND) is the most widely used scale for assessing nicotine dependence on conventional tobacco cigarettes (TCGs). But the FTND does not evaluate the subject's nicotine dependence to electronic cigarette (EC).

    Objective: The aim of this study was to develop and assess an equivalent modified FTND scale that measures the nicotine dependency via EC.

    Materials and Methods: The investigator developed the equivalent modified FTND scale that scores identical to the original scale, that is, 0-10. The developed scale piloted among 15 EC single users, that is, use only EC verified by carbon monoxide (CO) level of <8ppm. The assessment of the scale was done among 69 EC single users and observed for 1 year to determine their nicotine status.

    Results: The modified scale revealed an acceptable Cronbach α value of 0.725. Further test-retest reliability of the scale showed a satisfactory Spearman's rank correlation coefficient value of 0.730 (P > 0.05). A 1-year observation showed that of 69 single users, 11 single users completely stopped nicotine intake, 24 remained as EC single users, 15 shifted to dual-use, and 19 relapsed to TCG. Surprisingly, the EC users who completely stopped nicotine intake after 1 year had a low average nicotine dependence value of 3 that was measured by the modified FTND scale at the baseline.

    Conclusion: The modified FTND scale precisely identifies the physical dependence to nicotine via EC. Therefore, as per this study results the modified FTND scale can be applied in any EC-related studies to assess nicotine dependency via EC.

    Matched MeSH terms: Cotinine
  6. Nuraisyah Hani Zulkifley, Suriani Ismail, Rosliza Abdul Manaf, Zulkifley Hamid
    MyJurnal
    Introduction: One of the known factors that hindered smoking cessation is nicotine dependence. Measurement of the nicotine dependence is important to better understand cigarette smoking addiction dependence and ways to overcome it. Among methods of nicotine dependence measurement are self-reported Fagerstrom Test for Nicotine Dependence (FTND) and biochemical assessment such as saliva cotinine. Biochemical assessment can be used to measure the accuracy of the self-reported measurement of nicotine dependence. Objective: To explore the correlation between the FTND and the saliva cotinine of the smokers in three different timeline. Methods: A total of 61 male smokers who currently smoke cigarette on daily basis were recruited. The study used the one-group pretest-posttest study design and the data were collected three times. The self-reported measurement were measured by using FTND and the biochemical assessment measured by using saliva cotinine from Saliva Bio oral swab (SOS) with the sensitivity of 0.15ng/ml. Data analysis was conducted by using Pearson correlation. Results: There was a significant association between the FTND score and saliva cotinine level of the smokers at baseline, second and third data collection (p=0.014, p=0.003, p
    Matched MeSH terms: Cotinine
  7. Abdullah N, Al-Junid SH, Looi ML, Chin SF, Mohd Haniff EA, Syed Zakaria SZ, et al.
    Background: Validation of self-reported questionnaire is very crucial in ensuring the quality and reliability of data collection.
    Objective: The aim of this study were i) to validate the questionnaire on tobacco smoke intake and second hand smoke exposure among The Malaysian Cohort (TMC) subjects through the determination of urinary cotinine levels, ii) to determine the optimal cut-off point of urine cotinine that discriminates smokers from non-smokers and iii) to estimate misclassification rate between self-reported smoking and urinary cotinine level.
    Methods: Urine samples from a total of 775 The Malaysian Cohort subjects (104 smokers, 102 former smokers and 569 non-smokers) were obtained and urinary cotinine levels were determined by high-performance liquid chromatography (HPLC). Differences between groups were compared using Kruskal Wallis and Mann-Whitney tests. The Receiver Operating Characteristic (ROC) curved was performed to define the optimal urinary cotinine cut-off point.
    Results: Urinary cotinine concentration significantly (p<0.001) correlated with smoking status (r=0.46), the average number of cigarettes smoked per day (r=0.53), duration of smoking (r=0.33) and number of cigarettes packed per year (r=0.47). Smokers and second hand smokers have significantly higher median cotinine levels (978.40 and 21.31 respectively) compared to non-smokers (15.52) and non-exposed (13.60) subjects. Cotinine level at cut-off value of 1.51 ng/mg creatinine is able to distinguish smokers and non-smokers with a sensitivity of 84.62% and specificity of 81.97%.
    Conclusion: The Malaysian Cohort self-reported smoking questionnaire is a reliable tool in assessing the use of tobacco and second hand smoke exposure among the subjects.
    Study name: The Malaysian Cohort (TMC) project
    Matched MeSH terms: Cotinine
  8. Abidin EZ, Semple S, Omar A, Rahman HA, Turner SW, Ayres JG
    BMC Public Health, 2011 Aug 08;11:634.
    PMID: 21824403 DOI: 10.1186/1471-2458-11-634
    BACKGROUND: There is a lack of data describing the exposure of Malaysian schoolchildren to Secondhand Smoke (SHS). The aim of this study is to identify factors influencing schoolchildren's exposures to SHS in Malaysia.

    METHOD: This cross-sectional study was carried out to measure salivary cotinine concentrations among 1064 schoolchildren (10-11 years) attending 24 schools in Malaysia following recent partial smoke-free restrictions. Parents completed questionnaires and schoolchildren provided saliva samples for cotinine assay.

    RESULTS: The geometric mean (GM) salivary cotinine concentrations for 947 non-smoking schoolchildren stratified by household residents' smoking behaviour were: for children living with non-smoking parents 0.32 ng/ml (95% CI 0.28-0.37) (n = 446); for children living with a smoker father 0.65 ng/ml (95% CI 0.57-0.72) (n = 432); for children living with two smoking parents 1.12 ng/ml (95% CI 0.29-4.40) (n = 3); for children who live with an extended family member who smokes 0.62 ng/ml (95% CI 0.42-0.89) (n = 33) and for children living with two smokers (father and extended family member) 0.71 ng/ml (95% CI 0.40-0.97) (n = 44). Parental-reported SHS exposures showed poor agreement with children's self-reported SHS exposures. Multiple linear regression demonstrated that cotinine levels were positively associated with living with one or more smokers, urban residence, occupation of father (Armed forces), parental-reported exposure to SHS and education of the father (Diploma/Technical certificate).

    CONCLUSIONS: This is the first study to characterise exposures to SHS using salivary cotinine concentrations among schoolchildren in Malaysia and also the first study documenting SHS exposure using salivary cotinine as a biomarker in a South-East Asian population of schoolchildren. Compared to other populations of similarly aged schoolchildren, Malaysian children have higher salivary cotinine concentrations. The partial nature of smoke-free restrictions in Malaysia is likely to contribute to these findings. Enforcement of existing legislation to reduce exposure in public place settings and interventions to reduce exposure at home, especially to implement effective home smoking restriction practices are required.

    Matched MeSH terms: Cotinine/analysis
  9. Onuki M, Yokoyama K, Kimura K, Sato H, Nordin RB, Naing L, et al.
    J Occup Health, 2003 May;45(3):140-5.
    PMID: 14646288
    To assess dermal absorption of nicotine from tobacco leaves in relation to Green Tobacco Sickness (GTS), urinary cotinine concentrations were measured in 80 male tobacco-growing farmers and in 40 healthy males (controls) who did not handle wet tobacco leaves in Kelantan, Malaysia. Among non-smokers, urinary cotinine levels in farmers were significantly higher than those of controls; farmers with urinary cotinine of 50 ng/ml/m2 or above showed eye symptoms more frequently than those below this level (p<0.05). Farmers who did not wear protective equipment had subjective symptoms more frequently than those who used the equipment (p<0.05); some of these symptoms were seen more frequently in organophosphate (Tamaron) users than in non-users. As tobacco farmers evidence a risk of nicotine poisoning from tobacco leaves, assessment including GTS together with effects of pesticides will be necessary.
    Matched MeSH terms: Cotinine/urine*
  10. Abdullah B, Muadz B, Norizal MN, Ismail N, Kornain NK, Kutty M
    PMID: 28494268 DOI: 10.1016/j.ejogrb.2017.05.002
    OBJECTIVE: To compare the pregnancy outcome and cord blood cotinine levels between secondhand smokers and non-secondhand smokers.

    STUDY DESIGN: This was a cross-sectional comparative study in a Malaysian tertiary obstetric hospital involving 200 non-smoking pregnant women at term, of whom 100 were secondhand smokers and 100 were non-secondhand smokers. Those with multiple pregnancies, with a body mass index (BMI) of more than 30kg/m2or who delivered by Caesarean section were excluded. The participants' basic demographic details, delivery details, neonatal outcome and placental weight were recorded. Umbilical cord blood samples were obtained, and cord blood cotinine levels were measured with a Cotinine ELISA kit. The primary outcomes were baby's birth weight, length, and head circumference, Apgar score at 5min and placental weight. The secondary outcome was difference in cord blood cotinine levels between the two groups and the correlation of these differences with the neonatal outcome.

    RESULTS: The secondhand smoker group had significantly lower baby weight (2.94±0.31kg vs 3.05±0.40kg), head circumference (30.87±2.35cm vs 37.13±2.36cm), length (46.58±1.95cm vs 51.53±2.05cm) and placental weight (520±73.5g vs 596±61.3g) and significantly higher cord blood cotinine levels (16.35±12.84ng/mL vs 0.56±0.22ng/mL). Cord blood cotinine levels had significant negative correlations with placental weight (r=-0.461), baby's weight (r=-0.297), baby's head circumference (r=-0.501) and baby's length (r=-0.374).

    CONCLUSION: Secondhand smoke increases the incidence of adverse pregnancy outcomes (newborns'anthropometric measurements and placental weight) and causes higher cord blood cotinine levels.

    Matched MeSH terms: Cotinine/blood*
  11. Mohd Radzi NA, Saub R, Mohd Yusof ZY, Dahlui M, Sujak SL
    Children (Basel), 2021 Feb 14;8(2).
    PMID: 33672960 DOI: 10.3390/children8020144
    The prevalence of concurrent use of combustible and electronic cigarettes (dual-use) is on the rise among Malaysian adolescents. This study compares nicotine dependence among exclusive cigarette users, e-cigarette users, and dual adolescent users. A total of 227 adolescent smokers completed a self-administrated questionnaire with items based on Hooked on Nicotine Checklist (HONC) incorporated. Endorsement of at least one HONC item indicates nicotine dependence. Exhaled carbon monoxide readings and salivary cotinine data were also collected. Over half (52.9%) of the participants were exclusive e-cigarette users (EC). The prevalence of exclusive conventional cigarette smokers (CC) and dual users was 11.9% and 35.2%, respectively. Adolescents who have mothers with secondary school education were more likely to become addicted to nicotine (Adjusted Odd Ratio (aOR) = 2.72; 95% CI = 1.17-6.32). Adolescents' "mother's education" level predicted nicotine dependence. This highlighted the need to target families within the identified demography with a more supportive anti-tobacco program.
    Matched MeSH terms: Cotinine
  12. Arffin F, Al-Bayaty FH, Hassan J
    Arch Gynecol Obstet, 2012 Nov;286(5):1187-91.
    PMID: 22718098 DOI: 10.1007/s00404-012-2417-0
    BACKGROUND: Exposure of pregnant women to environmental tobacco smoke has been shown to be associated with low birth weight. Many studies have suggested that stress have a role in the etiology of preterm birth.

    AIMS: This study carried out from June 2008 to March 2009 to find the relation between environmental tobacco smoke, stress and miscarriage and preterm births.

    METHODS: A total of 33 subjects consisted of multiparous pregnant women that were in their early third trimester were chosen for this investigation. Subjects were divided into test group women with adverse pregnancy outcome, control group women with successful pregnancy. Four ml of unstimulated whole saliva were collected. The concentrations of cotinine and cortisol were evaluated using commercially available ELISA kit.

    RESULTS: Pregnancies in which the average standardized cortisol during history of previous miscarriage(s) which occurred within 6th-27th week or/and history of preterm labor which occurred within 28th-36th weeks of gestation, demonstrated higher cortisol level (1.0201 ± 0.1855 ng/ml) compared to control group 0.9757 ± 0.2860 ng/ml (P = 0.323); statistical analysis showed no significant differences. Women of control group were more likely to be environmental tobacco smoke exposed (1.2714 ± 1.7639 ng/ml) than women with miscarriage and preterm births (0.9889 ± 0.5498 ng/ml).

    CONCLUSION: The results from this primarily study demonstrated no association between cotinine, cortisol, miscarriage and preterm births.

    Matched MeSH terms: Cotinine/analysis
  13. Tan PY, Utravathy V, Ho LY, Foo SG, Tan KKh
    Ann Acad Med Singap, 2016 May;45(5):184-90.
    PMID: 27383717
    INTRODUCTION: Denial of smoking status by pregnant women presents a missed opportunity for referral to smoking cessation programmes that are shown to be effective in helping them quit smoking.

    MATERIALS AND METHODS: A cross-sectional epidemiological survey was conducted to detect the true prevalence of active smoking pregnant patients and the accuracy of self-reporting, investigate the sociodemographic risk factors and test the knowledge of pregnant patients on adverse effects of smoking. This involved 972 antenatal patients of a maternity hospital where participants completed a sociodemographic data survey and answered a knowledge questionnaire. Urine cotinine testing was carried out after informed consent.

    RESULTS: The prevalence of active smokers was 5.2% (n = 50) with 3% (n = 29) being light smokers and 2.2% (n = 21) being heavy smokers. This was significantly higher than self-reported active smoking status of 3.7% (n = 36; P = 0.02). The Malay race, being aged less than 20 years and not having tertiary level qualifications independently increased the likelihood of being an active smoker. Knowledge of the adverse effects of smoking was generally good with a mean total score of 8.18 out of 10 but there were differences amongst the non-smokers, passive smokers, light smokers and active smokers (P = 0.012).

    CONCLUSION: While the prevalence of active smoking among pregnant women is low in Singapore compared to other countries, this study substantiated the unreliability of self-reporting of smoking status in the pregnant population which could complicate referral to smoking cessation programmes. The lower awareness of the harms of smoking during pregnancy among smokers highlights a potential area for improvement.

    Matched MeSH terms: Cotinine/urine
  14. Jubri Z, Latif AA, Top AG, Ngah WZ
    Nutr J, 2013;12:2.
    PMID: 23286246 DOI: 10.1186/1475-2891-12-2
    BACKGROUND:
    Cigarette smoke contains free radicals and an have adverse effect to the immune system. Supplementation of palm oil vitamin E (palmvitee), is known has antioxidant properties is thought to be beneficial for system immune protection against free radicals activity. The objective of the study was to determine the effect of palmvitee supplementation on immune response in smokers.

    METHODS:
    This study involved a group of smokers and nonsmokers who received 200 mg/day palmvitee and placebo for the control group. Blood samples were taken at 0, 12 and 24 weeks of supplementation. Plasma tocopherol and tocotrienol were determined by HPLC, lymphocyte proliferation by lymphocyte transformation test (LTT) and enumeration of lymphocytes T and B cells by flow cytometry. Statistical analysis was performed by Mann-Whitney U-test for non-parametric data distribution and correlation among the variables was examined by Spearman.

    RESULTS:
    Plasma tocopherol and tocotrienol were increased in vitamin E supplemented group as compared to placebo group. Urine cotinine levels and serum α1-antitrypsin were significantly higher in smokers compared to nonsmokers. Lymphocyte proliferation induced by PHA showed an increasing trend with palmvitee supplementation in both smokers and nonsmokers. Natural killer cells were decreased; CD4+ cells and B cells were increased in smokers compared to nonsmokers but were unaffected with vitamin E supplementation except in the percentage of B cells which were increased in nonsmokers supplemented palmvitee compared to placebo. CD4+/CD8+ ratio was increased in smokers compared to nonsmokers. The high TWBC count observed in smokers correlated with the increased CD4+ and B cells.

    CONCLUSIONS:
    Smoking caused alterations in certain immune parameters and palmvitee supplementation tended to cause an increase in lymphocytes transformation test but had no effect on CD3+, CD4+, CD8+, NK cells and B cells except B cells percentage in nonsmokers.
    Matched MeSH terms: Cotinine/urine
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