Estimating Cotinine Associations and a Saliva Cotinine Level to Identify Active Cigarette Smoking in Alaska Native Pregnant Women
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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.
KeywordsMaternal 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.
- 1.US Department of Health and Human Services (2004). The health consequences of smoking: A report of the Surgeon General. 2004 [cited 2012 May 25]. Available from http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/chapter5.pdf.
- 2.US Department of Health and Human Services (2006). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. 2006 [cited 2012 May 25]. Available from http://www.surgeongeneral.gov/library/secondhandsmoke/report/chapter5.pdf.
- 4.Pellegrini-Belinchon, J., Miguel-Miguel, G., De Dios-Martin, B., Vicente-Galindo, E., Lorente-Toledano, F., & Garcia-Marcos, L. (2011). Study of wheezing and its risk factors in the first year of life in the province of Salamanca, Spain. The EISL study. Allergologia et immunopathologia (Madr), 40, 164–171.CrossRefGoogle Scholar
- 11.King, B., Dube, S., Kaufmann, R., Shaw, L., & Pechacek, T. (2011). Vital signs: Current cigarette smoking among adults aged ≥18 years–United States, 2005–2010. MMWR, 60, 1207–1212.Google Scholar
- 12.Alaska Department of Health and Social Services (2007). What State Surveys Tell Us About Tobacco Use Among Alaska Natives. 2007 [cited 2012 May 4]. Available from http://dhss.alaska.gov/dph/Chronic/Documents/Tobacco/PDF/AKNativeTobaccoReport.pdf.
- 13.Alaska Department of Health and Social Services (2012). Alaska Tobacco Facts. 2012 [cited 2012 Dec 28]. Available from http://dhss.alaska.gov/dph/Chronic/Documents/Tobacco/PDF/2012_alaska_tobacco_facts.pdf.
- 14.Young, M. B., Perham-Hester, K. A., & Kemberling, M. M. (2011). Alaska maternal and child health data book 2011: Alaska native edition. Anchorage, AK: Alaska Department of Health and Social Services and Alaska Native Tribal Health Consortium.Google Scholar
- 15.American Lung Association. (2010). Key Facts About Smoking Among American Indians and Alaska Natives. Washington DC. 2010 [cited 2012 May 26]. Available from http://www.lungusa.org/stop-smoking/about-smoking/facts-figures/american-indians-tobacco.html.
- 20.Gariti, P., Rosenthal, D. I., Lindell, K., Hansen-Flaschen, J., Shrager, J., Lipkin, C., et al. (2002). Validating a dipstick method for detecting recent smoking. Cancer Epidemiology Biomarkers and Prevention, 11, 1123–1125.Google Scholar
- 36.Benowitz, N. L., Bernert, J. T., Caraballo, R. S., Holiday, D. B., & Wang, J. (2009). Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States between 1999 and 2004. American Journal of Epidemiology, 169, 236–248.CrossRefGoogle Scholar
- 39.Bernert, J. T, Jr, McGuffey, J. E., Morrison, M. A., & Pirkle, (2000). Comparison of serum and salivary cotinine measurements by a sensitive high-performance liquid chromatography-tandem mass spectrometry method as an indicator of exposure to tobacco smoke among smokers and nonsmokers. Journal of Analytical Toxicology, 24, 333–339.CrossRefGoogle Scholar
- 40.Bernert, J. T, Jr, Turner, W. E., Pirkle, J. L., Sosnoff, C. S., Akins, J. R., Waldrep, M. K., et al. (1997). Development and validation of sensitive method for determination of serum cotinine in smokers and nonsmokers by liquid chromatography/atmospheric pressure ionization tandem mass spectrometry. Clinical Chemistry, 43, 2281–2291.PubMedGoogle Scholar
- 43.Alaska Native Epidemiology Center (2009). Alaska Native Health Status Report. Anchorage, AK. 2009 [cited 2012 May 31]. Available from http://www.anthc.org/chs/epicenter/upload/ANHSR.pdf.
- 44.Alaska Native Epidemiology Center. (2011). Anchorage & Mat-Su regional health profile. Anchorage, AK: Alaska Native Tribal Health Consortium.Google Scholar
- 47.US Department of Health and Human Services (2007). Preventing Smoking and Exposure to Secondhand Smoke Before, During, and After Pregnancy. Atlanta: Centers for Disease Control; 2007 [cited 2012 May 26]. Available from http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/smoking.pdf.
- 52.Melvin, C. L., & Tucker, P. (2000). Measurement and definition for smoking cessation intervention research: the smoke-free families experience. Smoke-free families common evaluation measures for pregnancy and smoking cessation projects working group. Tobacco Control, 9, 1187–1190.Google Scholar