The Eurasian Journal of Medicine
Original Article

Urinary Cotinine and Nicotine Dependence Levels in Regular Male Electronic Cigarette Users


Department of Pulmonolgy and Respiratory Medicine, Universitas Indonesia School of Medicine, Jakarta, Indonesia; Persahabatan Central General Hospital, Jakarta, Indonesia


Dr. H.A. Rotinsulu Lung Hospital, Bandung, Indonesia

Eurasian J Med 2021; 53: 168-173
DOI: 10.5152/eurasianjmed.2021.20009
Read: 221 Downloads: 102 Published: 28 October 2021

Objective: Found in plasma, urine, and saliva, cotinine can be used as a biomarker for nicotine in electronic cigarette (e-cig) users. Nicotine is addictive and causes dependence. Thus, it becomes a problem in smoking cessation programs. This study aimed to determine the relationship between urinary cotinine (UCot) and nicotine dependence levels in regular male e-cig users.

Materials and Methods: This cross-sectional study consecutively included regular male e-cig users and nonsmokers. All subjects were interviewed and had their UCot levels measured using an enzyme-linked immunosorbent assay method. The regular e-cig users completed the Penn State Nicotine Dependence Index questionnaire.

Results: This study recruited 71 males aged 18-45 years divided into e-cig users and non-smokers group. The predominating characteristics in e-cig users are as follows: 23 males (67.6%) aged <30 years, the highest education of senior high school 25 (73.5%) and 25 (73.5%) subjects had occupation. The UCot levels among the e-cig users in the non-dependency group were lower than that of the medium-high dependency group (P = .008). The median value for UCot level in the regular e-cig users was higher than that of the non-smoker group (276.11 [58.01-284.15] ng/mL vs 5.21 [4.65-23.72] ng/mL, P < .001). Factors influencing the UCot levels of the e-cig users were age (P = .041), nicotine level of the e-cig liquid (P = .013), and the flavor of the e-cig liquid (eg, menthol or non-menthol; P = .040).

Conclusion: UCot and nicotine dependence levels in the regular male e-cig users were significantly related. Nicotine dependence was found in 76.5% of the regular male e-cig users. The UCot levels in the e-cig users were significantly higher than in the non-smokers.

Cite this article as: Pamungkasningsih SW, Taufik FF, Samoedro E, Andarini S, Susanto AD. Urinary cotinine and nicotine dependence levels in regular male electronic cigarette users. Eurasian J Med. 2021; 53 (03):168–173

EISSN 1308-8742