Journal of Environmental Health Sciences (한국환경보건학회지)

Korean Society of Environmental Health (한국환경보건학회)
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Determination of Urinary Cotinine Cut-Off Point for Discriminating Smokers and Non-Smokers among Adolescents: The Third Cycle of the Korean National Environmental Health Survey (2015~2017)

청소년의 흡연자 선별을 위한 소변 중 코티닌 절사점 결정: 제3기 국민환경보건 기초조사(2015~2017)

  • Jung, Sunkyoung (Graduate School of Urban Public Health, University of Seoul) ;
  • Park, Sangshin (Graduate School of Urban Public Health, University of Seoul)
  • 정선경 (서울시립대학교 도시보건대학원) ;
  • 박상신 (서울시립대학교 도시보건대학원)
  • Received : 2021.07.03
  • Accepted : 2021.08.03
  • Published : 2021.08.31
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Abstract

Background: Smoking exposure may be objectively assessed through specific biomarkers. The most common biomarker for smoking is cotinine concentration in urine, and setting an optimal cut-off point can accurately classify smoking status. Such a cut-off point for Korean adolescents has never been studied. Objectives: The aim of this study was to determine a cut-off point for urinary cotinine concentration for the discrimination of smoking in adolescents. Methods: Participants were adolescents aged 13~18 years who participated in the third cycle of the Korean National Environmental Health Survey. We used urine samples to confirm the level of cotinine concentrations. Smoking status was determined by self-reported questionnaire. We identified the optimal cotinine cut-off point for discriminating smoking status using receiver operating characteristic curve analysis. Results: Of the 904 participants, 28 (3.1%) were smokers, among whom 20 (71.4%) were male. The median urinary cotinine concentrations in smokers was 218 ㎍/L (male: 215 ㎍/L, female: 303 ㎍/L), and that in non-smokers was 1.31 ㎍/L (male: 1.46 ㎍/L, female: 1.18 ㎍/L). We found significant differences in urinary cotinine concentration according to smoking status and sex (p<0.001). Urinary cotinine concentrations performed well for identifying smoking adolescents [area under the curve: 0.954 (male: 0.963, female: 0.908)]. The cut-off that optimally distinguished smokers from non-smokers was 39.85 ㎍/L (sensitivity: 89.3%, specificity: 97.4%). Male [39.85 ㎍/L (sensitivity: 90.0%, specificity: 94.9%)] had a different optimal cut-off point than female [26.26 ㎍/L (sensitivity: 87.5%, specificity: 99.6%)]. Conclusions: This study determined a cut-off point for urinary cotinine of 39.85 ㎍/L (male: 39.85 ㎍/L, female: 26.26 ㎍/L) to distinguish smokers from non-smokers in adolescents.

Keywords

Acknowledgement

이 논문은 환경부 국립환경과학원 제3기 국민환경보건 기초조사(NIER-2017-01-01-001) 자료를 받아 수행하였음. 이 논문은 2021년도 서울시립대학교 교내학술연구비에 의하여 지원되었음.

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