Diagnostic Performance Evaluation of the Novel Index Combining Urinary Cotinine and 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol in Smoking Status Verification and Usefulness for Trend Monitoring of Tobacco Smoking Exposure

During the last decade in Korea, urinary cotinine concentrations in non-current smokers have decreased, making it difficult to distinguish secondhand smoke (SHS) exposure from nonsmokers because of overlapping values between non-current smokers with and without SHS exposure. Additionally, the import...

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Bibliographic Details
Published in:International journal of environmental research and public health 2022-09, Vol.19 (19), p.12147
Main Author: Lee, Hyun-Seung
Format: Article
Language:English
Subjects:
1-Butanol
Biomarkers
Butanol
Cigarettes
Classification
Cotinine
Diagnostic systems
Electronic cigarettes
Electronic Nicotine Delivery Systems
Exposure
Humans
Monitoring
Nicotine
Nitrosamines
Passive smoking
Performance evaluation
Public health
Self report
Smoking
Smoking - epidemiology
Software
Tobacco
Tobacco smoke
Tobacco Smoke Pollution - analysis
Tobacco Smoking
Verification
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Summary:During the last decade in Korea, urinary cotinine concentrations in non-current smokers have decreased, making it difficult to distinguish secondhand smoke (SHS) exposure from nonsmokers because of overlapping values between non-current smokers with and without SHS exposure. Additionally, the importance of smoking status verification to avoid misclassification is increasing with the increased use of e-cigarettes. We developed a novel index combining urinary cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and evaluated its diagnostic performance for the classification of smoking status using the KNHANES VII dataset. A total of 10,116 and 5575 Korean participants aged >19 years with measured urinary cotinine concentrations were enrolled in a training set and validation set, respectively. When using 4.0 as the cutoff value for distinguishing current smokers from non-current smokers, urinary cotinine∙NNAL showed a better diagnostic performance than urinary cotinine or urinary NNAL. Among e-cigarette users, urinary cotinine∙NNAL showed more accurate classification rates than urinary NNAL. Furthermore, urinary cotinine∙NNAL had measurable values in non-current smokers, whereas urinary cotinine had unmeasurable values in one-fourth of all participants. This study shows that urinary cotinine∙NNAL might be a useful biomarker for smoking status verification and trend monitoring of tobacco smoking exposure with increased use of e-cigarettes.
ISSN:1660-4601
1661-7827
1660-4601
DOI:10.3390/ijerph191912147