OBJECTIVES: Cotinine is the most widely used biomarker to distinguish active versus passive smoking. However, there is an overlap in cotinine levels when comparing light or occasional smokers versus heavily exposed passive smokers. 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) is a tobacco-specific nitrosamine measurable in urine with a much longer half-life than cotinine. The aim of the study was to determine optimal cutoff points to discriminate active versus passive smokers and to compare sensitivity and specificity for the use of cotinine, NNAL, and the ratio of the NNAL/cotinine in urine. METHODS: Cotinine and NNAL were measured in urine of 373 active smokers and 228 passive smokers. RESULTS: Geometric mean cotinine levels were 2.03 ng/ml (interquartile interval: 0.43-8.60) and 1,043 ng/ml (658-2,251) and NNAL levels were 5.80 pg/ml (2.28-15.4) and 165 pg/ml (90.8-360) pg/ml in passive and active smokers, respectively. NNAL/cotinine ratio in urine was significantly higher for passive smokers when compared with active smokers (2.85 vs. 0.16, p < .01). The receiver operating characteristics analysis determined optimal cutoff points to discriminate passive versus active smokers: 31.5 ng/ml for cotinine (sensitivity: 97.1% and specificity: 93.9%), 47.3 pg/ml for NNAL (87.4% and 96.5%), and 0.74 x 10⁻³ for NNAL/cotinine ratio (97.3% and 87.3%). CONCLUSIONS: Both urine cotinine and NNAL are sensitive and specific biomarkers for discriminating the source of tobacco smoke exposure. Cotinine is the best overall discriminator when biomarkers are measured while a person has ongoing exposure to tobacco smoke. NNAL because of its long half-life would be particularly useful when there is a delay between exposure and biomarker measurement. The NNAL/cotinine ratio provides similar sensitivity but poorer specificity at discriminating passive versus active smokers when compared with NNAL alone.
OBJECTIVES:Cotinine is the most widely used biomarker to distinguish active versus passive smoking. However, there is an overlap in cotinine levels when comparing light or occasional smokers versus heavily exposed passive smokers. 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) is a tobacco-specific nitrosamine measurable in urine with a much longer half-life than cotinine. The aim of the study was to determine optimal cutoff points to discriminate active versus passive smokers and to compare sensitivity and specificity for the use of cotinine, NNAL, and the ratio of the NNAL/cotinine in urine. METHODS:Cotinine and NNAL were measured in urine of 373 active smokers and 228 passive smokers. RESULTS: Geometric mean cotinine levels were 2.03 ng/ml (interquartile interval: 0.43-8.60) and 1,043 ng/ml (658-2,251) and NNAL levels were 5.80 pg/ml (2.28-15.4) and 165 pg/ml (90.8-360) pg/ml in passive and active smokers, respectively. NNAL/cotinine ratio in urine was significantly higher for passive smokers when compared with active smokers (2.85 vs. 0.16, p < .01). The receiver operating characteristics analysis determined optimal cutoff points to discriminate passive versus active smokers: 31.5 ng/ml for cotinine (sensitivity: 97.1% and specificity: 93.9%), 47.3 pg/ml for NNAL (87.4% and 96.5%), and 0.74 x 10⁻³ for NNAL/cotinine ratio (97.3% and 87.3%). CONCLUSIONS: Both urine cotinine and NNAL are sensitive and specific biomarkers for discriminating the source of tobacco smoke exposure. Cotinine is the best overall discriminator when biomarkers are measured while a person has ongoing exposure to tobacco smoke. NNAL because of its long half-life would be particularly useful when there is a delay between exposure and biomarker measurement. The NNAL/cotinine ratio provides similar sensitivity but poorer specificity at discriminating passive versus active smokers when compared with NNAL alone.
Authors: Brett C Singer; Alfred T Hodgson; Karla S Guevarra; Elisabeth L Hawley; William W Nazaroff Journal: Environ Sci Technol Date: 2002-03-01 Impact factor: 9.028
Authors: S S Hecht; S G Carmella; M Chen; J F Dor Koch; A T Miller; S E Murphy; J A Jensen; C L Zimmerman; D K Hatsukami Journal: Cancer Res Date: 1999-02-01 Impact factor: 12.701
Authors: Neal Benowitz; Maciej Lukasz Goniewicz; Mark D Eisner; Eduardo Lazcano-Ponce; Wioleta Zielinska-Danch; Bartosz Koszowski; Andrzej Sobczak; Christopher Havel; Peyton Jacob Journal: Cancer Epidemiol Biomarkers Prev Date: 2010-08-30 Impact factor: 4.254
Authors: Peter H Whincup; Julie A Gilg; Jonathan R Emberson; Martin J Jarvis; Colin Feyerabend; Andrew Bryant; Mary Walker; Derek G Cook Journal: BMJ Date: 2004-06-30
Authors: Nada O F Kassem; Noura O Kassem; Sandy Liles; Sheila R Jackson; Dale A Chatfield; Peyton Jacob; Neal L Benowitz; Melbourne F Hovell Journal: Regul Toxicol Pharmacol Date: 2017-07-14 Impact factor: 3.271
Authors: Arash Etemadi; Hossein Poustchi; Cindy M Chang; Benjamin C Blount; Antonia M Calafat; Lanqing Wang; Victor R De Jesus; Akram Pourshams; Ramin Shakeri; Meredith S Shiels; Maki Inoue-Choi; Bridget K Ambrose; Carol H Christensen; Baoguang Wang; Gwen Murphy; Xiaoyun Ye; Deepak Bhandari; Jun Feng; Baoyun Xia; Connie S Sosnoff; Farin Kamangar; Paul Brennan; Paolo Boffetta; Sanford M Dawsey; Christian C Abnet; Reza Malekzadeh; Neal D Freedman Journal: Cancer Epidemiol Biomarkers Prev Date: 2019-01-08 Impact factor: 4.254
Authors: Rachel I Vogel; Steven G Carmella; Irina Stepanov; Dorothy K Hatsukami; Stephen S Hecht Journal: Biomarkers Date: 2011-08-03 Impact factor: 2.658
Authors: Suzaynn F Schick; Benjamin C Blount; Peyton Jacob; Najat A Saliba; John T Bernert; Ahmad El Hellani; Peter Jatlow; R Steven Pappas; Lanqing Wang; Jonathan Foulds; Arunava Ghosh; Stephen S Hecht; John C Gomez; Jessica R Martin; Clementina Mesaros; Sanjay Srivastava; Gideon St Helen; Robert Tarran; Pawel K Lorkiewicz; Ian A Blair; Heather L Kimmel; Claire M Doerschuk; Neal L Benowitz; Aruni Bhatnagar Journal: Am J Physiol Lung Cell Mol Physiol Date: 2017-05-18 Impact factor: 5.464
Authors: Miranda R Jones; Benjamin J Apelberg; Maria Tellez-Plaza; Jonathan M Samet; Ana Navas-Acien Journal: Cancer Epidemiol Biomarkers Prev Date: 2012-12-18 Impact factor: 4.254
Authors: Christie A Flanagan; Kathryn R Koller; Abbie W Wolfe; Timothy K Thomas; Neal L Benowitz; Caroline C Renner; Christine Hughes; Dorothy K Hatsukami; Carrie Bronars; Neil J Murphy; Gretchen Day; Paul A Decker; Christi A Patten Journal: Nicotine Tob Res Date: 2016-05-17 Impact factor: 4.244