title: Determinants of active and environmental exposure to tobacco smoke and upper reference value of urinary cotinine in not exposed individuals.
abstract: The aims of this study were (1) to explore the behavioral and sociodemographic factors influencing urinary cotinine (COT-U) levels in active smokers and in environmental tobacco smoke (ETS)-exposed individuals, (2) to assess the specificity and sensitivity of the questionnaire for identifying active smokers and nonsmokers, and (3) to derive the upper reference value of COT-U in non-ETS exposed individuals. The COT-U levels of 495 adults (age range 18-69 years) who classified themselves as active smokers (29%) or as nonsmokers with (17%) or without (83%) ETS exposure were quantified by LC-MS-MS (quantification limit: 0.1µg/L, range of linearity: 0.1-4000µg/L). Median COT-U levels in these groups were 883, 1.38, and 0.39µg/L, respectively. Significant determinants of COT-U levels in active smokers were the number of cigarettes per day, type of smoking product, smoking environment, as well as time between the last cigarette and urine collection. Among ETS-exposed nonsmokers, significant determinants were living with smokers, being exposed to smoke at home, ETS exposure duration, as well as time between the last exposure and urine collection. When a 30-µg/L COT-U cut-off value was used to identify active daily smoking, the sensitivity and specificity of the questionnaire were 94% and 98%, respectively. For ETS exposure, the COT-U value of 1.78 (0.90 confidence interval 1.75-1.78) µg/L, corresponding to the 95th percentiles of the COT-U distribution in non-ETS-exposed participants, is proposed as upper reference value to identify environmental exposure.
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. Electronic address: laura.campo@policlinico.mi.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Campo
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Polledri
authors.affiliation: Department of Public Health, Local Health Unit, Modena, Italy.
authors.forename: Petra
authors.initials: P
authors.lastname: Bechtold
authors.affiliation: Department of Public Health, Local Health Unit, Modena, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia Romagna, Modena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ranzi
authors.affiliation: Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia Romagna, Modena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Lauriola
authors.affiliation: Department of Public Health, Local Health Unit, Modena, Italy.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Goldoni
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Bertazzi
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Fustinoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002853:Chromatography, Liquid; D003367:Cotinine / Q000652:urine*; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D019570:Inhalation Exposure; D007558:Italy; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012907:Smoking / Q000652:urine*; D011795:Surveys and Questionnaires; D053719:Tandem Mass Spectrometry; D014028:Tobacco Smoke Pollution; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine
keywords: Biomonitoring; Environmental tobacco smoke; LC-MS-MS; Tobacco smoke; Upper reference value; Urinary cotinine