The relationship between cotinine concentrations and inflammatory markers among highly secondhand smoke exposed non-smoking adolescents

Cytokine. 2014 Mar;66(1):17-22. doi: 10.1016/j.cyto.2013.12.007. Epub 2013 Dec 31.


Background: Secondhand smoke (SHS) exposure is a risk factor of respiratory, cardiovascular and inflammatory diseases, however its association with inflammatory markers among highly SHS exposed adolescents has not yet been explored.

Methods: Participants included in this study were a subset of 68 non-smoking adolescents, aged 12.5-17.5 from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, recruited from Crete Greece. Smoking and SHS exposure was assessed via serum cotinine concentrations. Cytokines (Interleukin-1β, 2, 4, 5 and 6, tumor necrosis factor-α, interferon-γ, tumor growth factor-β1), immunoglobulins IgG, IgA, IgM, complement factors C3, C4, high sensitivity C-reactive protein, and endothelial inflammatory markers [soluble E-selectin, soluble L-selectin, soluble intercellular adhesion molecules (sICAM-1) and soluble vascular cell adhesion molecules-1 (sVCAM-1)] were assessed. Inflammatory markers in the lower 25th percentile and upper 75th percentile groups of cotinine levels were compared and multivariate linear regression analysis was performed controlling for age, sex and BMI.

Results: Cotinine concentrations were notably elevated (geometric mean 0.82ng/ml, 95%CI 0.62-1.07) in this study population. A significant decrease in IL-4 (130.09 vs. 25.77pg/ml, p=0.014) and IL-6 (19.52 vs. 5.52pg/ml, p=0.008) concentrations between the upper 75th percentile cotinine level group and lower 25th percentile cotinine level group was observed. In a multivariate linear regression analysis, cotinine concentrations had a weak inverse association with IL-4 and IL-6 (p=0.028 and p=0.06) which was not statistically significant when adjusted for multiple comparisons (modified Bonferroni, p>0.016). No differences in the other variables was noted.

Conclusions: Among highly SHS exposed adolescents, cotinine levels had weak inverse association with IL-4 and IL-6, which did not achieve statistical significance. However, our results potentially indicate an immunosuppressive role of SHS. Further research is warranted to explore this hypothesis.

Keywords: Adolescent; Cotinine; HELENA study; Inflammatory marker; Secondhand smoke exposure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Biomarkers / blood*
  • Cotinine / blood*
  • Environmental Exposure*
  • Female
  • Greece
  • Humans
  • Inflammation Mediators / blood*
  • Linear Models
  • Male
  • Multivariate Analysis
  • Smoking
  • Tobacco Smoke Pollution / adverse effects*


  • Biomarkers
  • Inflammation Mediators
  • Tobacco Smoke Pollution
  • Cotinine