Re-visiting serum cotinine concentrations among various types of smokers including cigarette only smokers: some new, pre
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RESEARCH ARTICLE
Re-visiting serum cotinine concentrations among various types of smokers including cigarette only smokers: some new, previously unreported results Ram B. Jain 1 Received: 8 June 2020 / Accepted: 30 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Data (N = 11614) from National Health and Nutrition Examination Survey (NHANES) for 1999–2016 for US adults aged ≥ 20 years were analyzed by fitting regression models to estimate unadjusted and adjusted geometric means (AGM) for several different groups of smokers. Serum cotinine level ≥ 3.3 ng/mL was used to distinguish smokers from nonsmokers. AGMs for cigarette only, cigar only, dual cigarette/cigar, e-cigarette or dual e-cigarette/cigarette, and smokeless tobacco only smokers were estimated to be 152.5, 65.1, 92.5, 146.3, and 272.0 ng/mL, respectively. Males were found to have higher cotinine levels than females for dual cigarette and cigar smokers, but the reverse was observed for smokeless tobacco users. Non-Hispanic blacks had higher AGMs than non-Hispanic whites for cigarette only smokers, but the reverse was observed for dual cigarette and cigar smokers. For the first time, serum cotinine estimates for those self-reported nonsmokers who were classified to be smokers (29.4 ng/mL) and those smokers for whom self-reported data for use of tobacco products were missing were also estimated (113.8 ng/mL). Keywords Serum cotinine . Smokers . Gender . Race/ethnicity . NHANES
Introduction Impact of demographic factors like age, race/ethnicity, and gender on serum cotinine levels among smokers has been studied by Caraballo et al. (1998), Chen et al. (2014), Jain (2014, 2015), Jones et al. (2013), Rostron (2013), and Rostron et al. (2015). Among US daily cigarette smokers aged ≥ 20 years, the order of adjusted serum cotinine levels by race/ethnicity was observed to be non-Hispanic blacks (NHB) > non-Hispanic white (NHW) > Mexican Americans (MA) (p < 0.01), but no gender differences were reported (Jain 2014). Among (all) cigarette smokers (Jain 2015), the order of adjusted serum cotinine levels by race/ All data used for analysis for this study are in public domain and available free of charge at www.cdc.gov/nchs/nhanes/index.htm Responsible editor: Lotfi Aleya Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11356-020-10677-4) contains supplementary material, which is available to authorized users. * Ram B. Jain
1
Dacula, USA
ethnicity was observed to be NHB > NHW > non-Hispanic Asians > Hispanics (HISP), but only a borderline statistical difference among NHW and HISP was observed (p = 0.047) and no gender differences were observed. In addition, age was observed to be positively associated with adjusted serum cotinine levels (p < 0.01; Jain 2015) among smokers but negatively associated among nonsmokers (p < 0.01; Jain 2015). NHB nonsmokers were observed to have higher adjusted serum cotinine levels than both HISP and NHAS (Jain 2015), and males were reported to have higher se
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