Can Urinary Cotinine Predict Nicotine Dependence Level in Smokers?

Abstract

Background: Although nicotine dependence plays a role as a main barrier for smoking cessation, there is still a lack of solid evidence on the validity of biomarkers to determine nicotine dependence in clinical settings. This study aimed to investigate whether urinary cotinine levels could reflect the severity of nicotine dependence in active smokers. Materials and Methods: Data regarding general characteristics and smoking status was collected using a self-administered smoking questionnaire. The Fagerström test for nicotine dependence (FTND) was used to determine nicotine dependence of the participants, and a total of 381 participants were classified into 3 groups of nicotine dependence: low (n=205, 53.8%), moderate (n=127, 33.3%), and high dependence groups (n=49, 12.9%). Stepwise multiple linear regression model and receiver operating characteristic (ROC) curves analyses were used to determine the validity of urinary cotinine for high nicotine dependence. Results: In correlation analysis, urinary cotinine levels increased with FTND score (r=0.567, P<0.001). ROC curves analysis showed that urinary cotinine levels predicted the high-dependence group with reasonable accuracy (optimal cut-off value=1,000 ng/mL; AUC=0.82; P<0.001; sensitivity=71.4%; specificity=74.4%). In stepwise multiple regression analysis, the total smoking period (β=0.042, P=0.001) and urinary cotinine levels (β=0.234, P<0.001) were positively associated with nicotine dependence, whereas an inverse association was observed between highest education levels (>16 years) and nicotine dependence (β=-0.573, P=0.034). Conclusions: The results of this study support the validity of using urinary cotinine levels for assessment of nicotine dependence in active smokers.

Prevalence and Factors Associated with Smoking Intentions among Non-smoking and Smoking Adolescents in Kota Tinggi, Johor, Malaysia

“…This, however, is inconsistent with the findings reported by Sergent and Dalton (2001), Girma et al (2010), and Jung et al (2012) who revealed that smokers with high nicotine addiction were less likely to stop smoking habit. It was suggested that the addiction had caused smokers to think irrationally which then justified their continued smoking habit and minimized the reasons quit smoking.…”

Nicotine dependence and urinary nicotine, cotinine and hydroxycotinine levels in daily smokers

“…CPD are correlated with cotinine levels (r = 0.48) as observed in other studies reporting correlation coefficients between 0.28 and 0.55. [13][14] The CPD and smoking years also differed significantly between males and females in our study. Males have a higher mean CPD value than females while females had slightly higher smoking years which is in accordance with data on smoking behaviour of the Belgian general population although the general male population starts smoking at younger age than the females.…”

“…13 In another reported approach the urinary cotinine levels were used to predict the nicotine dependence level. 14 Our study included levels of nicotine and hydroxycotinine in addition to cotinine. It is well known that nicotine levels depend highly on the time of the last smoked cigarette due to the short half-life of nicotine (1-2h) in comparison with that of cotinine and hydroxycotinine (6-22h and 4.6-8.3h, respectively).…”

Peripheral Biomarkers of Tobacco-Use Disorder: A Systematic Review

“…Cotinine was associated with FTND scores, and the FTND item showing the strongest individual association with cotinine was again the TTFC. Urinary cotinine was also correlated with overall FTND scores in a study of 381 smokers (31). In this study a receiver operating characteristic (ROC) analysis indicated that urinary cotinine could differentiate highly dependent (FTND≥6) smokers from others with 71% sensitivity and 74% specificity.…”