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Assessing tobacco use in an African population: Serum and urine cotinine cut-offs from South Africa

Journal Article


Abstract


  • Background: Cotinine, a nicotine metabolite, is used to measure tobacco use and exposure, but recommended cut-offs to differentiate tobacco users from those exposed through the environment range from 3 to 58 ng/ml in serum, and 2.5 to 550 ng/ml in urine. Cut-offs may differ by ethnicity, sex and age. As data from adults in Africa are scarce, our aim was to evaluate cut-offs for serum and urine cotinine that best predict self-reported tobacco use in South African adults.

    Methods: Two datasets were explored: African-PREDICT (n = 941 black and white healthy young adults, 20–30 years, serum cotinine); and WHO SAGE Wave 2 (n = 604 adults, 18–102 years, urine cotinine). Population specific cut-offs (ROC analyses) were compared with published cut-offs and self-reported tobacco use.

    Results: Overall, 19% (293 of 1545) reported current tobacco use. The following cotinine cut-offs showed the highest sensitivity and specificity: serum ≥15 ng/ml in black and white men, and white women; serum ≥10 ng/ml in black women; urine ≥300 ng/ml for black, mixed ancestry, and older adults (50-plus years); urine ≥500 ng/ml for younger adults (18–49 years). Specificity was lower for urine than for serum cotinine.

    Conclusion: Our study suggests that a serum cotinine level of ≥15 ng/ml and a urine cotinine level of ≥300 ng/ml best distinguish current tobacco users from non-users generally in the South African adult population.

Authors


  •   Ware, Lisa J. (external author)
  •   Charlton, Karen E.
  •   Kruger, Ruan (external author)
  •   Breet, Yolandi (external author)
  •   van Rooyen, Johannes (external author)
  •   Huisman, Hugo (external author)
  •   Botha, Shani (external author)
  •   Uys, Aletta (external author)
  •   Rennie, Kirsten (external author)
  •   Naidoo, Nirmala (external author)
  •   Kowal, Paul (external author)
  •   Schutte, Aletta E. (external author)

Publication Date


  • 2019

Citation


  • Ware, L. J., Charlton, K., Kruger, R., Breet, Y., van Rooyen, J., Huisman, H., Botha, S., Uys, A. S., Rennie, K. L., Naidoo, N., Kowal, P. & Schutte, A. E. (2019). Assessing tobacco use in an African population: Serum and urine cotinine cut-offs from South Africa. Drug and Alcohol Dependence, 195 82-89.

Scopus Eid


  • 2-s2.0-85059066883

Number Of Pages


  • 7

Start Page


  • 82

End Page


  • 89

Volume


  • 195

Place Of Publication


  • Ireland

Abstract


  • Background: Cotinine, a nicotine metabolite, is used to measure tobacco use and exposure, but recommended cut-offs to differentiate tobacco users from those exposed through the environment range from 3 to 58 ng/ml in serum, and 2.5 to 550 ng/ml in urine. Cut-offs may differ by ethnicity, sex and age. As data from adults in Africa are scarce, our aim was to evaluate cut-offs for serum and urine cotinine that best predict self-reported tobacco use in South African adults.

    Methods: Two datasets were explored: African-PREDICT (n = 941 black and white healthy young adults, 20–30 years, serum cotinine); and WHO SAGE Wave 2 (n = 604 adults, 18–102 years, urine cotinine). Population specific cut-offs (ROC analyses) were compared with published cut-offs and self-reported tobacco use.

    Results: Overall, 19% (293 of 1545) reported current tobacco use. The following cotinine cut-offs showed the highest sensitivity and specificity: serum ≥15 ng/ml in black and white men, and white women; serum ≥10 ng/ml in black women; urine ≥300 ng/ml for black, mixed ancestry, and older adults (50-plus years); urine ≥500 ng/ml for younger adults (18–49 years). Specificity was lower for urine than for serum cotinine.

    Conclusion: Our study suggests that a serum cotinine level of ≥15 ng/ml and a urine cotinine level of ≥300 ng/ml best distinguish current tobacco users from non-users generally in the South African adult population.

Authors


  •   Ware, Lisa J. (external author)
  •   Charlton, Karen E.
  •   Kruger, Ruan (external author)
  •   Breet, Yolandi (external author)
  •   van Rooyen, Johannes (external author)
  •   Huisman, Hugo (external author)
  •   Botha, Shani (external author)
  •   Uys, Aletta (external author)
  •   Rennie, Kirsten (external author)
  •   Naidoo, Nirmala (external author)
  •   Kowal, Paul (external author)
  •   Schutte, Aletta E. (external author)

Publication Date


  • 2019

Citation


  • Ware, L. J., Charlton, K., Kruger, R., Breet, Y., van Rooyen, J., Huisman, H., Botha, S., Uys, A. S., Rennie, K. L., Naidoo, N., Kowal, P. & Schutte, A. E. (2019). Assessing tobacco use in an African population: Serum and urine cotinine cut-offs from South Africa. Drug and Alcohol Dependence, 195 82-89.

Scopus Eid


  • 2-s2.0-85059066883

Number Of Pages


  • 7

Start Page


  • 82

End Page


  • 89

Volume


  • 195

Place Of Publication


  • Ireland