Use of cotinine urinalysis to verify self-reported tobacco use among male psychiatric out-patients.
BACKGROUND
There is a complex and significant correlation between respiratory disorders and psychiatric conditions. Reliability of self-reported tobacco use has been questioned in recent times.


OBJECTIVE
The current study aims at assessment of accuracy of self-reported tobacco use (both smoked and smokeless) among psychiatric out-patients.


METHODS
We recruited 131 consecutive subjects from the out-patient psychiatry department of a tertiary care hospital.


METHODS
Male patients meeting the study criteria were approached for participation in the study. They were asked about their recent tobacco use history. Those reporting recent use were assessed for severity of dependence using Fagerstrom Test for Nicotine Dependence (FTND)-smoking and FTND-smokeless scales. Quantitative urine cotinine analysis was performed using the Enzyme Linked Immunesorbant Assay (ELISA) method. Based on this method, a (50 ng/ml) cut off score for urinary cotinine level for tobacco use was set.


METHODS
Concordance between the self-report of tobacco use and urinary cotinine level was assessed using the Cohen's kappa. Additionally, Pearson's correlation coefficient was used to examine the correlation between the FTND-smoking and FTND-smokeless scales and the urinary cotinine levels.


RESULTS
The values of Cohen's kappa suggest no significant concordance between the self-reported recent tobacco use and urinary cotinine levels for both smoking and smokeless tobacco forms. The discordance was present irrespective of a higher (550 ng/ml) or a lower (50 ng/ml) cut off score for a urinary cotinine level. Pearson's correlation coefficient failed to reveal any significant direct correlation between the FTND scores and urinary cotinine levels.


CONCLUSIONS
It is recommended to use biological markers such as urinary cotinine levels to corroborates the information provided by the patients.
National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Yatan Pal Singh
YP
Balhara
Raka
R
Jain
A Shyam
AS
Sundar
Rajesh
R
Sagar