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Cotinine Concentration in Smokers from Different Countries: Relationship with Amount Smoked and Cigarette Type

¹ Division of Biostatistics, Department of Oncology, Johns Hopkins School of Medicine and ² Institute for Global Tobacco Control, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; ³ Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Chinese Center for Disease Control and Prevention, Beijing, China; ⁴ Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico; ⁵ Division of Cancer Epidemiology and Prevention, the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; ⁶ Department of Epidemiology, Prevention, and Surveillance Coordination, National Cancer Institute of Brazil, Rio de Janeiro, RJ, Brazil; and ⁷ Division of Clinical Pharmacology and Experimental Therapeutics, Departments of Medicine and Biopharmaceutical Sciences, University of California at San Francisco, San Francisco, California

Requests for reprints: Jonathan M. Samet, Institute for Global Tobacco Control, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W6041, Baltimore, MD 21205. Phone: 410-955-3296; Fax: 410-955-0863. E-mail: jsamet{at}jhsph.edu

This four-country study examined salivary cotinine as a marker for nicotine intake and addiction among smokers in relation to numbers and types of cigarettes smoked. Smoking characteristics of cigarette smokers in Brazil, China, Mexico, and Poland were identified using a standard questionnaire. Cotinine concentration was measured using a saliva sample from each participant; its relationship with numbers and types of cigarettes smoked was quantified by applying regression techniques. The main outcome measure was salivary cotinine level measured by gas chromatography. In all four countries, cotinine concentration increased linearly with cigarettes smoked up to 20 per day [11.3 ng/mL (95% confidence interval, 10.5-12.2)] and then stabilized as the number of cigarettes exceeded 20 [6.8 ng/mL per cigarette (95% confidence interval, 6.3-7.4) for up to 40 cigarettes]. On average, smokers of regular cigarettes consumed more cigarettes and had higher cotinine levels than light cigarette smokers. Cotinine concentration per cigarette smoked did not differ between regular and light cigarette smokers. Results suggest a saturation point for daily nicotine intake and minimal or no reduction in nicotine intake by smoking light cigarettes. (Cancer Epidemiol Biomarkers Prev 2006;15(10):1799–804)

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