Maternal and Child Health Journal

, Volume 18, Issue 1, pp 120–128 | Cite as

Estimating Cotinine Associations and a Saliva Cotinine Level to Identify Active Cigarette Smoking in Alaska Native Pregnant Women

  • Julia J. SmithEmail author
  • Renee F. Robinson
  • Burhan A. Khan
  • Connie S. Sosnoff
  • Denise A. Dillard


Studies indicate nicotine metabolism varies by race and can change during pregnancy. Given high rates of tobacco use and limited studies among Alaska Native (AN) women, we estimated associations of saliva cotinine levels with cigarette use and second-hand smoke (SHS) exposure and estimated a saliva cotinine cutoff to distinguish smoking from non-smoking pregnant AN women. Using questionnaire data and saliva cotinine, we utilized multi-variable linear regression (n = 370) to estimate cotinine associations with tobacco use, SHS exposure, demographic, and pregnancy-related factors. Additionally, we estimated an optimal saliva cotinine cutoff for indication of active cigarette use in AN pregnant women using receiver operating characteristic (ROC) curve analysis (n = 377). Saliva cotinine significantly decreased with maternal age and significantly increased with cigarettes smoked per day, SHS exposure, and number of previous full term pregnancies. Using self-reported cigarette use in the past 7 days as indication of active smoking, the area under the ROC curve was 0.975 (95 % CI: 0.960–0.990). The point closest to 100 % specificity and sensitivity occurred with a cotinine concentration of 1.07 ng/mL, which corresponded to sensitivity of 94 % and specificity of 94 %. We recommend using a saliva cotinine cutoff of 1 ng/mL to distinguish active smoking in pregnant AN women. This cutoff is lower than used in other studies with pregnant women, most likely due to high prevalence of light or intermittent smoking in the AN population. Continued study of cotinine levels in diverse populations is needed.


Maternal cigarette smoking Pregnant women Saliva cotinine Alaska native women 



This study was supported by Native American Research Centers for Health (NARCH) grant U26IHS 300012 from the Indian Health Service with the support of National Institutes of Health/National Institute of General Medical Sciences (NIGMS). Findings and conclusions of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NIGMS or NARCH. We would like to acknowledge Dr. Ruth Etzel and Dr. John Bernert for study design; Dr. Rey Decastro, Caroline Renner and Dr. Rachel Tyndale for review of the manuscript; and Dr. Stacey Anderson for obstetrics expertise and study implementation. We would also like to acknowledge the AN women who volunteered to participate in this project.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Julia J. Smith
    • 1
    Email author
  • Renee F. Robinson
    • 1
  • Burhan A. Khan
    • 1
  • Connie S. Sosnoff
    • 2
  • Denise A. Dillard
    • 1
  1. 1.Southcentral Foundation Research DepartmentAnchorageUSA
  2. 2.Division of Laboratory SciencesCenters for Disease Control and PreventionAtlantaUSA

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