Urinary Cotinine-Verified Smoking Status and Serum Lipid Profiles and Lipid Ratios in Korean Older Adults: A Nationwide Cross-Sectional Study

Background: Serum lipid profile is an important factor in predicting the risk of cardiovascular disease, and smoking is considered to affect serum lipid levels adversely by altering lipid metabolism. Although traditional lipid profiles are important in patient evaluation for predicting the risk of cardiovascular disease, the clinical significance of lipid ratios has recently gained attention as well. We aimed to investigate the relationship between smoking and serum lipid profiles and ratios in Korean older adults.METHODS: This cross‐sectional analysis used a nationally representative sample from the 2014–2016 Korea National Health and Nutrition Examination Survey (KNHANES). In total, 4,349 participants aged ≥60 years with urine cotinine values were included. The outcome was a comparison of unfavorable lipid profiles/ratios in respect to urine cotinine-verified smoking status (urine cotinine level ≥50 ng/mL), and quantification of the associations between smoking and unfavorable lipid profiles/ratios using multivariable logistic regression analyses. In our analyses, the lowest quartile (Q1) of high-density lipoprotein cholesterol (HDL-C), and the highest quartile (Q4) of low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and total cholesterol (TC), and their ratios (TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C) were considered as unfavorable.Results: The percentages of unfavorable lipid profiles/ratios except for serum TC and LDL-C were significantly higher in the urine cotinine-verified smoker group. The odds ratios (ORs) and 95% confidence intervals (CIs) of urine cotinine-verified smokers for the Q1 of HDL-C and for the Q4 of TG, TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C were 1.67 (95% CI: 1.29–2.17) and 1.49 (95% CI: 1.14–1.96), 1.50 (95% CI: 1.14–1.97), 1.44 (95% CI: 1.10–1.89), and 1.75 (95% CI: 1.35–2.28), respectively.Conclusion: Urine cotinine-verified smoking status was significantly associated with unfavorable serum lipid profiles/ratios in Korean older adults.

A Comparison of the Factor Analysis on Smoking Cessation Success between Inpatient Smoking Cessation Program and Residential Smoking Cessation Program

Background: Since 2015, Smoking cessation program have been provided by the local smoking cessation support center in Korea. This program consisted of a 5-days of residential smoking cessation program and an inpatient program. This article is to assist smokers to quit smoking by analyzing and comparing the success factor in smoking cessation from the two different programs.Methods: This study was conducted with a total of 996 participants from the residential smoking cessation program and the inpatient program, from January 2018 to December 2020 at the University Hospitals. Based on the registration card information, we did a retrospective research. Success defines that the smoking cessation continued after 6 months of program participation when it is confirmed by urine cotinine test or phone consultation. The outcome of this study was performed by cross-tabulation analysis and regression analysis.Results: The findings show that the expected value of success in smoking cessation is higher as the subject is older in their age (P<0.05 in 60s or older), and more frequent consultations (P<0.01) in both programs. The nicotine dependency (P<0.01), social security system (P<0.01), and drinking experience (P=0.01) showed a meaningful correlation to success in smoking cessation in the residential program.Conclusions: It is required to improve the smoking cessation program to active intervention with frequent consultations when providing these two programs.

Effectiveness of National Residential Smoking Cessation Program

We aimed to investigate the effectiveness of the Korean national five-day residential smoking cessation program and the factors affecting the long-term smoking cessation of participants. The residential smoking cessation program (2017–2018) recruited smokers with a smoking duration ≥ 20 years and who have attempted to quit smoking more than twice and/or smokers with chronic morbidities. Participants underwent an intensive intervention, including individual psychological therapy, group therapy, medical counseling, and pharmacotherapy. The 6-month continuous abstinence rate (CAR) was assessed via self-reports, the urine cotinine levels, and/or expired-air carbon monoxide levels. Logistic regression was used to analyze the adjusted odds ratio (aOR) to assess factors related to smoking cessation. Overall, 484 participants who completed the residential program and questionnaire were evaluated. The 3- and 6-month CAR were 81.82% and 63.22%, respectively. The aOR of 6-month continuous abstinence was lower among participants with severe nicotine dependence (aOR: 0.46, 95% confidence interval [CI]: 0.26–0.81) and higher among participants with combination therapy of varenicline with short-term nicotine replacement therapy (NRT) (aOR: 1.64, 95% CI: 1.07–2.51), with higher self-efficacy (aOR: 1.97, 95% CI: 1.15–3.37). The residential smoking cessation program was effective. High self-efficacy, combination therapy of varenicline with short-term NRT, and low nicotine dependence were associated with a high 6-month CAR.

The Development and Testing of a Perinatal Tobacco, Attitudes, and Behaviors Survey (PTABS)

Background and PurposeAccurate assessment of tobacco use in pregnant smokers is key to effective nursing intervention. There is a lack of valid and reliable tools easily integrated into prenatal care. Therefore, the purpose of this study was to develop and test a perinatal survey, guided by the Health Promotion Model (HPM).MethodsThe survey was tested with 107 pregnant women via iPad. Urine cotinine assays and a process evaluation were conducted.ResultsReliability yielded a Cronbach's alpha of .873 for the ever-smoker sample and .835 for the total sample. Factors dovetailed with HPM constructs.ConclusionsPerinatal Tobacco, Attitudes, and Behaviors Survey (PTABS) exhibits high reliability and validity and is easily utilized. Updates need to include questions on all nicotine products and to be streamlined. With accurate identification of nicotine users nurses can provide targeted interventions early in pregnancy.

Exposure to Secondhand Smoke: Inconsistency between Self-Response and Urine Cotinine Biomarker Based on Korean National Data during 2009–2018

This study aimed to estimate the secondhand smoke (SHS) exposure using urinary cotinine (UCo) to prove that the SHS exposure could not be properly assessed by self-reporting (SR). In total, 28,574 nonsmokers aged >19 years were selected from the Korean National Health and Nutrition Examination Survey data (2009–2018). First, changes in the annual concentration of UCo were analyzed, and the annual SHS exposure rates were measured based on SR and UCo from 2009 to 2018. Then, the average UCo concentration and UCo-measured SHS exposure rate were confirmed according to the subjects’ characteristics. Finally, factors associated with the UCo-measured SHS exposure rate were identified based on multiple regression analysis. The findings showed that the annual UCo concentrations and self-reported SHS exposure rates dropped significantly over the past decade. In contrast, the UCo-measured SHS exposure rate indicated that >80% of nonsmokers are still exposed to SHS. Moreover, we found vulnerable groups using UCo-measured SHS exposure rate. In particular, the self-reported SHS exposure at home and in workplaces and house type was highly associated with SHS exposure. Thus, these findings indicate that the actual SHS exposure could not be properly assessed by SR and should be verified using a biomarker, such as UCo. Considering that even a short-term exposure can be harmful to health, the goal of the policy should be to keep cotinine concentration as low as possible.

Association between Self-Reported Survey Measures and Biomarkers of Second-Hand Tobacco Smoke Exposure in Non-Smoking Pregnant Women

Second-hand tobacco smoke (SHS) causes adverse health outcomes in adults. Further studies are needed to evaluate psychosocial SHS exposure measures in comparison to SHS exposure biomarkers, particularly in pregnant women. This study aimed to compare self-reported SHS exposure to urinary cotinine levels in pregnant women. A cross-sectional correlation design was conducted using a convenience sample of 70 non-smoking pregnant women. Measures included self-reported questionnaires and laboratory confirmation of cotinine levels in the urinary samples. Multiple regression analysis was used to assess the correlation after controlling for potential confounding variables. The average level of urinary cotinine among non-smoking pregnant women was 6.77 ng/mL. Medium-strength correlations were found among psychosocial SHS exposure measures and urine cotinine levels. Questions regarding ‘instances of smoking in front of the individual’ and ‘subjective perceived frequency of SHS exposure in past 7 days’ are feasible items for pregnant women in clinics (particularly the first question). Hence, we suggest that these simple questions should be used to assist pregnant women in reducing the harm associated with SHS exposure.

Association between dual use of e-cigarette and cigarette and chronic obstructive pulmonary disease: an analysis of a nationwide representative sample from 2013 to 2018

Background The association between the dual use of electronic cigarette (e-cigarette) and conventional cigarettes (c-cigarette) and spirometry-defined chronic obstructive pulmonary disease (COPD) has not been studied thoroughly. Methods A total of 47,217 participants were identified in the 2013–2018 Korea National Health and Nutrition Examination Survey; of them, 12,919 participants aged ≥ 40 who underwent spirometry and had no missing data were enrolled. Pulmonary function testing, urinary cotinine, and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) levels were compared between dual users, current smokers, former smokers, and non-users using complex sample linear regression analysis. The odds ratio (OR) for COPD was calculated using a complex sample logistic regression model after adjusting for covariates. Results Among current e-cigarette users, approximately 85% of the participants used c-cigarette concurrently, and 1.3% of all the participants were dual users (2.3% in males and 0.1% in females). Both dual users and current smokers showed higher levels of urine cotinine and NNAL than non-users and former smokers. The weighted prevalence of COPD was the highest in dual users (13.8% for all participants and 14.1% for males). The multivariate-adjusted OR of COPD for male dual users, compared to non-users, was 3.46 (Ptrend < 0.001). The OR for COPD was 3.10 (Ptrend < 0.001) in middle-aged (40–64 years) and 3.70 (Ptrend < 0.001) in older (≥ 65 years) men. In females, the association was not observed and could not be precisely measured because of the small proportion of the smoking population. Conclusions Dual use of e-cigarette and c-cigarette is associated with COPD in males.

Identification and Characterization of Cotinine Hydroxylase CotA that Initiates biodegradation of Wastewater Micropollutant Cotinine in Nocardioides sp. Strain JQ2195

Cotinine is a stable toxic contaminant, produced as a byproduct of smoking. It is of emerging concern due to its global distribution in aquatic environments. Microorganisms have the potential to degrade cotinine, however, the genetic mechanisms of this process are unknown. Nocardioides sp. strain JQ2195 is a pure culture strain that has been reported to degrade cotinine at micropollutant concentrations. This strain utilizes cotinine as its sole carbon and nitrogen source. In this study, a 50 kb gene cluster (designated as cot ) involved in cotinine degradation, was predicted based on genomic and transcriptomic analyses. A novel three-component cotinine hydroxylase gene (designated as cotA1A2A3 ), which initiated cotinine catabolism was identified and characterized. CotA from Shinella sp. HZN7 was heterologously expressed and purified, and shown to convert cotinine into 6-hydroxycotinine. H 2 18 O-labelling and ESI-MS analysis confirmed that the hydroxyl group incorporated into 6-hydroxycotinine was derived from water. This study provides new molecular insights into the microbial metabolism of heterocyclic chemical pollutants. IMPORTANCE In the human body, cotinine is the major metabolite of nicotine, and 10–15% of generated cotinine is excreted in urine. Cotinine is a structural analogue of nicotine and is much more stable than nicotine. Increased tobacco consumption has led to high environmental concentrations of cotinine, which may have detrimental effects on aquatic ecosystems and human health. Nocardioides sp. strain JQ2195 is a unique cotinine-degrading bacterium. However, the underlying genetic and biochemical foundations of cotinine degradation are still unknown. In this study, a 50 kb gene cluster (designated cot ) was identified by genomic and transcriptomic analyses as being involved in the degradation of cotinine. A novel three-component cotinine hydroxylase gene (designated cotA1A2A3 ) catalyzed cotinine to 6-hydroxy-cotinine. This study provides new molecular insights into the microbial degradation and enzymatic transformation of cotinine.