ArticleDrug and alcohol dependence2019
Assessing tobacco use in an African population: Serum and urine cotinine cut-offs from South Africa.
Article in Drug and alcohol dependence, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- The Healthy Aging Adult South Africa report card: a systematic review of the evidence between 2013 and 2020 for middle-aged South African men and women.Cardiovascular journal of AfricaPooled it
- Biochemical verification of tobacco use in ICU patients using point-of-care urinary cotinine.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- A Meta-Analysis of Urinary Cotinine Cut-Off Concentrations in Children Under Five Years for Assessing Environmental Tobacco Smoke Exposure.Tobacco use insights · 2026Review
- Self-reported smoking, urine cotinine, and risk of incident hypertension: findings from the PREVEND prospective cohort study.Journal of human hypertension · 2025Article
- Multilevel drivers of tobacco use among people living with HIV in West Nile and Karamoja Regions in Uganda: a mixed-methods study.BMC public health · 2025Article
- Article
- A phone-based tobacco use cessation program for people living with HIV in Uganda and Zambia: study protocol for a randomized controlled trial.Addiction science & clinical practice · 2024Article
- Association between serum cotinine and volatile organic compounds (VOCs) in adults living with HIV, HBV, or HCV (NHANES 2005-2018).Scientific reports · 2022Article
- Effect of Second-Hand Smoke Exposure on Establishing Urinary Cotinine-Based Optimal Cut-Off Values for Smoking Status Classification in Korean Adults.International journal of environmental research and public health · 2022Article
- Reported asthma and dental amalgam exposure among adults in the United States: An assessment of the National Health and Nutrition Examination Survey.SAGE open medicine · 2021Article
- Pensions, consumption and health: evidence from rural South Africa.BMC public health · 2020Article
Corrections and comments
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Authors and funding
12 authors at 6 institutions in 4 countries.
Funding
Abstract
backgroundCotinine, a nicotine metabolite, is used to measure tobacco use and exposure, but recommended cut-offs to differentiate tobacco users from those exposed through the environment range from 3 to 58 ng/ml in serum, and 2.5 to 550 ng/ml in urine. Cut-offs may differ by ethnicity, sex and age. As data from adults in Africa are scarce, our aim was to evaluate cut-offs for serum and urine cotinine that best predict self-reported tobacco use in South African adults.
methodsTwo datasets were explored: African-PREDICT (n = 941 black and white healthy young adults, 20-30 years, serum cotinine); and WHO SAGE Wave 2 (n = 604 adults, 18-102 years, urine cotinine). Population specific cut-offs (ROC analyses) were compared with published cut-offs and self-reported tobacco use.
resultsOverall, 19% (293 of 1545) reported current tobacco use. The following cotinine cut-offs showed the highest sensitivity and specificity: serum ≥15 ng/ml in black and white men, and white women; serum ≥10 ng/ml in black women; urine ≥300 ng/ml for black, mixed ancestry, and older adults (50-plus years); urine ≥500 ng/ml for younger adults (18-49 years). Specificity was lower for urine than for serum cotinine.
conclusionOur study suggests that a serum cotinine level of ≥15 ng/ml and a urine cotinine level of ≥300 ng/ml best distinguish current tobacco users from non-users generally in the South African adult population.
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