Introduction: Factors associated with cotinine concentrations have been studied in smokers. Based on these studies, cotinine is recommended as a biomarker to assess severity of tobacco dependence. Evidence of association between cotinine concentrations and various factors among smokeless tobacco (ST) users is limited and mostly comes from tobacco cessation studies. The present study describes the relationship of salivary cotinine concentrations to sociodemographic factors, tobacco use characteristics, and ST products among ST users.
Methods: Data are from a community-based sample of 95 current adult ST users. Study participants provided a saliva sample for cotinine analysis and completed a mail survey that included questionnaires regarding sociodemographic information, tobacco use characteristics, and tobacco dependence measures. Crude and adjusted associations between cotinine and other variables were calculated.
Results: Age, years of ST use, cans per week, and swallowing of tobacco juices were significantly associated with salivary cotinine concentrations in the multiple regression model. Fine-cut ST products resulted in higher cotinine concentrations as compared with long-cut ST products when adjusted for age and tobacco use characteristics (p = .029). The Fagerström Test for Nicotine Dependence for ST users (r = .58, p < .0001) and the modified Tobacco Dependence Screener (r = .24, p < .0001) were both correlated with cotinine concentration.
Conclusion: The findings suggest some similarities in the determinants of cotinine concentrations in ST users and smokers. Swallowing of tobacco juices and type of ST product are unique to ST users and are associated with higher cotinine concentrations.