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. 2020 Jul 31;17(15):5537.
doi: 10.3390/ijerph17155537.

Determination of Urinary Cotinine Cut-Off Concentrations for Pregnant Women in the Japan Environment and Children's Study (JECS)

Yukiko Nishihama  1 , Shoji F Nakayama  1 , Takahiro Tabuchi  2 , Tomohiko Isobe  1 , Chau-Ren Jung  1 , Miyuki Iwai-Shimada  1 , Yayoi Kobayashi  1 , Takehiro Michikawa  1   3 , Makiko Sekiyama  1 , Yu Taniguchi  1 , Hiroshi Nitta  1 , Shin Yamazaki  1 , On Behalf Of The Japan Environment And Children's Study Group
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Determination of Urinary Cotinine Cut-Off Concentrations for Pregnant Women in the Japan Environment and Children's Study (JECS)

Yukiko Nishihama et al. Int J Environ Res Public Health. .

Abstract

Few studies have assessed the accuracy of self-reported questionnaires to determine smoking habits relative to urinary biomarkers. This study investigated urinary cotinine cut-off concentrations distinguishing active, passive and non-smokers among pregnant women who participated in the Japan Environment and Children's Study, a nationwide birth cohort study. Pregnant participants with measured urinary cotinine concentrations (UCCs) and who completed self-reported questionnaires on smoking status were included (n = 89,895). The cut-off values (COVs) for active and passive smokers were calculated by fitting mixed normal distribution functions to UCCs. The sensitivity and specificity of the questionnaires were subsequently evaluated. The median (interquartile range) UCC was 0.24 (0.083-0.96) µg/g-creatinine, with the detection rate of 89%. The COV for distinguishing active smokers from passive and non-smokers was 36.8 µg/g-creatinine. When this COV was considered to represent the true condition, the questionnaire had a sensitivity of 0.523, a specificity of 0.998, a positive predictive value (PPV) of 0.967 and a negative predictive value (NPV) of 0.957. The COV for distinguishing passive smokers from non-smokers was 0.31 µg/g-creatinine, with the questionnaire having a sensitivity of 0.222, a specificity of 0.977, a PPV of 0.868 and an NPV of 0.644. As many as 78% of passive smokers might be misclassified as non-smokers.

Keywords: cotinine; cut-off value; pregnant women.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distribution of urinary cotinine concentrations in active smokers, passive smokers and non-smokers. The solid line illustrates the probability density plot of the logarithm of creatinine-adjusted urinary cotinine concentrations to the base 10. Dashed lines represent the normal distributions fitted to the original data using a nonparametric EM-like algorithm. Dashed vertical lines show urinary cotinine cut-off concentrations. A rug plot is depicted on the x-axis.
Figure 2
Figure 2
Smoothed histogram of urinary cotinine concentrations grouped by questionnaire responses. Groups of current smokers, passive smokers and non-smokers determined with the questionnaire are represented by the dark grey, grey and light grey solid lines, respectively. The fitted normal distributions are represented by the dashed lines. Dashed vertical lines show urinary cotinine cut-off concentrations.
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