Korean J Health Promot.  2019 Sep;19(3):138-144. 10.15384/kjhp.2019.19.3.138.

Urine Cotinine for Assessing the Association between Secondhand Smoke Exposure and Depression in Adult Non-Smokers in Korea: Analysis of the Korea National Health and Nutrition Examination Survey 2016

• Kim YH
• Kim BS
• Won CW
• Kim S
• Jang HJ

• KMID: 2459994
• DOI: http://doi.org/10.15384/kjhp.2019.19.3.138

Abstract

BACKGROUND
Exposure to secondhand smoke (SHS) has been shown to cause health problems. Recent studies demonstrated an association of SHS with depression and poor mental health. The urinary cotinine concentration (Ucot) is an objective indicator of exposure to SHS. In this study, we evaluated the association between depression and Ucot in adult non-smokers adults in Korea.
METHODS
We analyzed the data of 3,417 adults, aged ≥19 years, who participated in the seventh Korea National Health and Nutrition Examination Survey (2016). The eligible subjects were non-smokers. Depression was evaluated using the Patient Health Questionnaire-9 (PHQ-9). The subjects were dichotomized into two groups: the high depressive symptom group (PHQ-9 ≥10 [n=185]) and the low depressive symptom group (PHQ-9 <10 [n=3,232]). The demographic, socioeconomic, and clinical characteristics of the subjects were retrieved from the survey data. Ucot was dichotomized into high-Ucot (≥10 ng/mL) and low-Ucot (<10 ng/mL). The Ucot and other characteristics were compared between the two groups. To adjust for confounding variables, we conducted a logistic regression analysis and determined the difference in Ucot between the two groups.
RESULTS
After adjusting for confounders, the high depressive symptom group was found to be associated with high-Ucot (odds ratio, 1.824; 95% confidence interval, 1.020-3.262). Sex, education, socioeconomic status, marital status, occupational status, limitation of activity, and the presence of an underlying diseases (diabetes and dyslipidemia) had a significant effect on depression.
CONCLUSIONS
This concluded that depression was associated with high urine cotinine level in adult non-smokers.

Keyword

Non-smokers; Tobacco; Cotinine; Depression; Korea National Health and Nutrition Survey

MeSH Terms

Adult*
Confounding Factors (Epidemiology)
Cotinine*
Depression*
Education
Employment
Humans
Korea*
Logistic Models
Marital Status
Mental Health
Nutrition Surveys*
Social Class
Tobacco
Tobacco Smoke Pollution*
Cotinine
Tobacco Smoke Pollution

Reference

1. Janson C, Chinn S, Jarvis D, Zock JP, Torén K, Burney P, et al. Effect of passive smoking on respiratory symptoms, bronchial responsiveness, lung function, and total serum IgE in the European Community Respiratory Health Survey: a cross-sectional study. Lancet. 2001; 358(9299):2103–2109.

2. Ha KC, Paik NW, Park DU, Yoon CS, Kim W, Choi SJ, et al. A study on indicators for environmental tobacco smoke at indoor office environments. J Korean Soc Occup Environ Hyg. 2003; 13(2):152–159.

3. Eisner MD, Klein J, Hammond SK, Koren G, Lactao G, Iribarren C. Directly measured second hand smoke exposure and asthma health outcomes. Thorax. 2005; 60(10):814–821.

4. Eisner MD, Wang Y, Haight TJ, Balmes J, Hammond SK, Tager IB. Secondhand smoke exposure, pulmonary function, and cardiovascular mortality. Ann Epidemiol. 2007; 17(5):364–373.

5. Health effects of exposure to environmental tobacco smoke. California Environmental Protection Agency. Tob Control. 1997; 6(4):346–353.

6. Dome P, Lazary J, Kalapos MP, Rihmer Z. Smoking, nicotine and neuropsychiatric disorders. Neurosci Biobehav Rev. 2010; 34(3):295–342.

7. Hamer M, Stamatakis E, Batty GD. Objectively assessed secondhand smoke exposure and mental health in adults: cross-sectional and prospective evidence from the Scottish Health Survey. Arch Gen Psychiatry. 2010; 67(8):850–855.

8. Gim W, Yoo JH, Shin JY, Goo AJ. Relationship between secondhand smoking with depressive symptom and suicidal ideation in Korean non-smoker adults: the Korean national health and nutrition examination survey 2010-2012. Korean J Fam Med. 2016; 37(2):97–104.

9. Kang SY, Cho YH, Jeong DW, Lee SY, Kim YJ, Lee JG, et al. Association between secondhand smoke and health-related quality of life in middle-aged Korean adults. Korean J Health Promot. 2015; 15(4):185–193.

10. Haufroid V, Lison D. Urinary cotinine as a tobacco-smoke exposure index: a minireview. Int Arch Occup Environ Health. 1998; 71(3):162–168.

11. Benowitz NL, Schultz KE, Haller CA, Wu AH, Danis KM, Jacob P 3rd. Prevalence of smoking assessed biochemically in an urban public hospital: a rationale for routine cotinine screening. Am J Epidemiol. 2009; 170(7):885–891.

12. Goniewicz ML, Eisner MD, Lazcano-Ponce E, Zielinska-Danch W, Koszowski B, Sobczak A, et al. Comparison of urine cotinine and the tobacco-specific nitrosamine metabolite 4-(methylnitrosamino) -1-(3-pyridyl)-1-butanol (NNAL) and their ratio to discriminate active from passive smoking. Nicotine Tob Res. 2011; 13(3):202–208.

13. World Health Organization. Guidelines for controlling and monitoring the tobacco epidemic. Geneva: World Health Organization;1998.

14. Santos IS, Tavares BF, Munhoz TN, Almeida LSPD, Silva NTBD, Tams BD, et al. Sensitivity and specificity of the patient health questionnaire-9 (PHQ-9) among adults from the general population. Cad Saude Publica. 2013; 29(8):1533–1543.

15. Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012; 184(3):E191–E196.

16. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606–613.

17. Lu Y, Marks MJ, Collins AC. Desensitization of nicotinic agonist-induced [3H]gamma-aminobutyric acid release from mouse brain synaptosomes is produced by subactivating concentrations of agonists. J Pharmacol Exp Ther. 1999; 291(3):1127–1134.

18. McGehee DS, Heath MJ, Gelber S, Devay P, Role LW. Nicotine enhancement of fast excitatory synaptic transmission in CNS by presynaptic receptors. Science. 1995; 269(5231):1692–1696.

19. Marshall DL, Redfern PH, Wonnacott S. Presynaptic nicotinic modulation of dopamine release in the three ascending pathways studied by in vivo microdialysis: comparison of naive and chronic nicotine-treated rats. J Neurochem. 1997; 68(4):1511–1519.

20. Ribeiro EB, Bettiker RL, Bogdanov M, Wurtman RJ. Effects of systemic nicotine on serotonin release in rat brain. Brain Res. 1993; 621(2):311–318.

21. Dagher A, Bleicher C, Aston JA, Gunn RN, Clarke PB, Cumming P. Reduced dopamine D1 receptor binding in the ventral striatum of cigarette smokers. Synapse. 2001; 42(1):48–53.

22. Izenwasser S, Jacocks HM, Rosenberger JG, Cox BM. Nicotine indirectly inhibits [³H]dopamine uptake at concentrations that do not directly promote [³H]dopamine release in rat striatum. J Neurochem. 1991; 56(2):603–610.

23. Benwell ME, Balfour DJ. The effects of nicotine administration on 5-HT uptake and biosynthesis in rat brain. Eur J Pharmacol. 1982; 84(1-2):71–77.

24. Pasco JA, Williams LJ, Jacka FN, Ng F, Henry MJ, Nicholson GC, et al. Tobacco smoking as a risk factor for major depressive disorder: population-based study. Br J Psychiatry. 2008; 193(4):322–326.

25. Decramer M, Rennard S, Troosters T, Mapel DW, Giardino N, Mannino D, et al. COPD as a lung disease with systemic consequences-clinical impact, mechanisms, and potential for early intervention. COPD. 2008; 5(4):235–256.