Assessing smoking status in children, adolescents and adults: cotinine cut-points revisited
Assessing smoking status in children, adolescents and adults: cotinine cut-points revisited
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DOI：
10.1111/j.1360-0443.2008.02297.x
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发表时间：
2008-09-01
期刊：
影响因子：
6
通讯作者：
West, Robert
中科院分区：
文献类型：
--
作者：
Jarvis, Martin J.;Fidler, Jennifer;West, Robert
目的 重新评估唾液可替宁切点以区分吸烟状况。正在使用的可替宁切点是从 20 年前或更早的吸烟者和非吸烟者的相对较小的样本中得出的。随着被动吸烟流行率和接触率的下降，最佳切入点可能会发生变化。设计对一般人群的横断面调查，并对自我报告的吸烟情况和唾液可替宁进行评估。参与者 1996-2004 年英格兰健康调查共有 58 791 名 4 岁及以上受访者提供了有效的唾液可替宁样本。测量唾液可替宁浓度、人口统计变量、自我报告的吸烟情况、家中是否吸烟、职业、住房保有权和汽车使用情况产生的社会不利因素的综合指数。结果显示，12 ng/ml 的切点总体表现最佳，在区分确诊吸烟者和从不经常吸烟者方面，特异性为 96.9%，敏感性为 96.7%。该切点还正确识别出 95.8% 的 8-15 岁儿童每周吸 6 支或更多香烟。有证据表明，声称戒烟的人存在严重误报，尤其是青少年（特异性为 72.3%）和 16-24 岁的年轻人（77.5%）。最佳切点因家庭中是否吸烟（18 ng/ml）或不吸烟（5 ng/ml）而异，并且随着社会劣势的增加，存在从 8 ng/ml 到 18 ng/ml 的梯度。结论 非吸烟者接触其他人烟草烟雾的程度是驱动最佳可替宁切点的主要因素。建议在整个年龄范围内普遍使用 12 ng/ml 的临界点，尽管不同的临界点可能适合不同的人群和二手烟接触程度不同的社会。
Aims To reassess saliva cotinine cut-points to discriminate smoking status. Cotinine cut-points that are in use were derived from relatively small samples of smokers and non-smokers 20 or more years ago. It is possible that optimal cut-points may have changed as prevalence and exposure to passive smoking have declined. Design Cross-sectional survey of the general population, with assessment of self-reported smoking and saliva cotinine. Participants A total of 58 791 respondents aged 4 years and older in the Health Survey for England for the years 1996-2004 who provided valid saliva cotinine specimens. Measures Saliva cotinine concentrations, demographic variables, self-reported smoking, presence or absence of smoking in the home, a composite index of social disadvantage derived from occupation, housing tenure and access to a car. Findigns A cut-point of 12 ng/ml performed best overall, with specificity of 96.9% and sensitivity of 96.7% in discriminating confirmed cigarette smokers from never regular smokers. This cut-point also identified correctly 95.8% of children aged 8-15 years smoking six or more cigarettes a week. There was evidence of substantial misreport in claimed ex-smokers, especially adolescents (specificity 72.3%) and young adults aged 16-24 years (77.5%). Optimal cut-points varied by presence (18 ng/ml) or absence (5 ng/ml) of smoking in the home, and there was a gradient from 8 ng/ml to 18 ng/ml with increasing social disadvantage. Conclusions The extent of non-smokers' exposure to other people's tobacco smoke is the principal factor driving optimal cotinine cut-points. A cut-point of 12 ng/ml can be recommended for general use across the whole age range, although different cut-points may be appropriate for population subgroups and in societies with differing levels of exposure to secondhand smoke.