Korean J Health Promot.  2019 Sep;19(3):138-144. 10.15384/kjhp.2019.19.3.138.

Urine Cotinine for Assessing the Association between Secondhand Smoke Exposure and Depression in Adult Non-Smokers in Korea: Analysis of the Korea National Health and Nutrition Examination Survey 2016

  • 1Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea. bskim7@khmc.or.kr


Exposure to secondhand smoke (SHS) has been shown to cause health problems. Recent studies demonstrated an association of SHS with depression and poor mental health. The urinary cotinine concentration (Ucot) is an objective indicator of exposure to SHS. In this study, we evaluated the association between depression and Ucot in adult non-smokers adults in Korea.
We analyzed the data of 3,417 adults, aged ≥19 years, who participated in the seventh Korea National Health and Nutrition Examination Survey (2016). The eligible subjects were non-smokers. Depression was evaluated using the Patient Health Questionnaire-9 (PHQ-9). The subjects were dichotomized into two groups: the high depressive symptom group (PHQ-9 ≥10 [n=185]) and the low depressive symptom group (PHQ-9 <10 [n=3,232]). The demographic, socioeconomic, and clinical characteristics of the subjects were retrieved from the survey data. Ucot was dichotomized into high-Ucot (≥10 ng/mL) and low-Ucot (<10 ng/mL). The Ucot and other characteristics were compared between the two groups. To adjust for confounding variables, we conducted a logistic regression analysis and determined the difference in Ucot between the two groups.
After adjusting for confounders, the high depressive symptom group was found to be associated with high-Ucot (odds ratio, 1.824; 95% confidence interval, 1.020-3.262). Sex, education, socioeconomic status, marital status, occupational status, limitation of activity, and the presence of an underlying diseases (diabetes and dyslipidemia) had a significant effect on depression.
This concluded that depression was associated with high urine cotinine level in adult non-smokers.


Non-smokers; Tobacco; Cotinine; Depression; Korea National Health and Nutrition Survey
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