ArticlePloS one2026
Biomarker-based assessment of tobacco smoke exposure in Saudi females via analysis of urinary cotinine level.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Tobacco smoking remains a leading preventable cause of morbidity and mortality worldwide. In Saudi Arabia, cultural stigma and reliance on self-reported data obstruct precise assessment of female smoking prevalence and second-hand smoke exposure. Urine cotinine, a stable metabolite of nicotine is a well-established objective biomarker for assessing both active and passive tobacco exposure. The current study aimed to: (1) assess tobacco smoke exposure among Saudi females by combining questionnaire data with biomarker measurements, (2) validate an LC-MS/MS method for quantifying urinary cotinine and (3) establish population-specific cutoff values to distinguish smokers and nonsmokers (4) analyse smoking behaviours and influencing factors via a survey questionnaire. A cross-sectional design was employed involving 133 Saudi female participants recruited between May and December 2024. Each provided a urine sample and completed questionnaire on smoking behaviour and second-hand smoke exposure. Urine samples were processed and analysed by LC-MS/MS. Method validation followed ICH-M10 guidelines, assessing linearity (2-500 ng/mL), accuracy (90-107%) and precision (CV < 10%). The method exhibited excellent linearity (R2 ≥ 0.9992). Urinary cotinine was detected in 48 of 133 samples, with concentrations ranging from 0.02 to 7.693 ng/mL. Despite 88.7% of participants self-reporting as nonsmokers, 45.9% reported household second-hand smoke exposure. A cutoff value of 7 ng/mL was established to distinguish smokers from nonsmokers based on ROC analysis. Urinary cotinine, quantified by a validated LC-MS/MS method, provides a reliable and objective assessment of tobacco exposure among Saudi females. This approach addresses the limitations of self-reported data and supports the development of targeted public health interventions aimed at reducing active smoking and second-hand smoke exposure in this population.
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