vitamin D
risk factors


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Bakan, A. B., Uzun, N., Arli, S. K., & Yıldız, M. (2020). THE RELATIONSHIP BETWEEN THE COTININE LEVEL IN URINE AND VITAMIN D IN THE UNIVERSITY STUDENTS. Belitung Nursing Journal, 6(6), 214–219.
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Background: Vitamin D deficiency is today acknowledged as a pandemic. Vitamin D deficiency and insufficiency are associated with many chronic diseases, including common cancers, cardiovascular diseases, metabolic syndrome, and infectious and autoimmune diseases.

Objective: This study aims to investigate the relationship between the cotinine level in urine and Vitamin D.

Methods: This study employed a descriptive and relational screening design.  It was conducted with 74 smoking university students between January 2019 and March 2020. Data were collected through socio-demographic form and Fagerstrom test for nicotine dependence. Besides, the participating students’ blood and urine samples were taken in a suitable environment.

Results: The average age of the participating students was 21.50±2.09. Of all the students, 71.6% were males, 62.2% were exposed to the sun between 12 p.m. and 2 p.m., and the average number of cigarettes smoked daily was 13.52±8.22. The average Vitamin D level in blood was 32.4±15.3 (ng/mL), and the average cotinine level in urine was 1.60 ± .32 (ng/L). No statistically significant relationships were found between the Vitamin D level and the cotinine level (p<0.05).

Conclusion: Smoking causes diseases and death in many people, and it is a changeable risk factor.  Nursing practices on the struggle against smoking are effective. No significant relationships were found between the Vitamin D level in blood and cotinine level in urine. Similar studies are recommended to be conducted with larger groups and participants from different age groups.


Copyright (c) 2020 Ayse Berivan Bakan, Naim Uzun, Senay Karadag Arli, Metin Yıldız

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Afzal, S., Bojesen, S. E., & Nordestgaard, B. G. (2013). Low plasma 25-hydroxyvitamin D and risk of tobacco-related cancer. Clinical Chemistry, 59(5), 771-780.

Avila-Tang, E., Al-Delaimy, W. K., Ashley, D. L., Benowitz, N., Bernert, J. T., Kim, S., . . . Hecht, S. S. (2013). Assessing secondhand smoke using biological markers. Tobacco Control, 22(3), 164-171.

Banihosseini, S. Z., Baheiraei, A., Shirzad, N., Heshmat, R., & Mohsenifar, A. (2013). The effect of cigarette smoke exposure on vitamin D level and biochemical parameters of mothers and neonates. Journal of Diabetes & Metabolic Disorders, 12(1), 19.

Benowitz, N. L., Jacob, P., Ahijevych, K., Jarvis, M. J., Hall, S., LeHouezec, J., . . . Velicer, W. (2002). Biochemical verification of tobacco use and cessation. Nicotine Tobacco Research, 4(2), 149-159.

Bialous, S. A., Sarna, L., Wells, M. J., Brook, J. K., Kralikova, E., Pankova, A., . . . Przewozniak, K. (2017). Impact of online education on nurses’ delivery of smoking cessation interventions with implications for evidence-based practice. Worldviews on Evidence-Based Nursing, 14(5), 367-376.

Bringhurst, F. R., Demay, M. B., Krane, S. M., & Kronenberg, H. M. (2005). Bone and mineral metabolism in health and disease. In D. L. Kasper, E. Braunwald, S. Hauser, D. Longo, J. L. Jameson, & A. S. Fauci (Eds.), Harrison’s principles of internal medicine (16th ed., pp. 2238-2286). New York: McGraw-Hill Professional.

Centers for Disease Control and Prevention. (2019). Tobacco use. Retrieved from

Champe, P. C., Harvey, R. A., & Ferrier, D. R. (2007). From the series of Lippincott’s illustrated reviews: Biochemistry. Ankara: Nobel Tıp Kitabevi.

Çifçi, S., Bayram Deger, V., Saka, G., & Ceylan, A. (2018). Smoking prevalance and affecting factors among nursing school students. Van Medical Journal, 25(2), 89-99.

Fagerstrom, K.-O., & Schneider, N. G. (1989). Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine, 12(2), 159-182.

Feldman, D., Krishnan, A. V., Swami, S., Giovannucci, E., & Feldman, B. J. (2014). The role of vitamin D in reducing cancer risk and progression. Nature Reviews Cancer, 14(5), 342-357.

Fidan, F., Alkan, B. M., & Tosun, A. (2014). Pandemic era: Vitamin D deficiency and insufficiency. Turk Osteoporoz Derg/Turkey Osteoporosis Journal, 20, 71-74.

Haufroid, V., & Lison, D. (1998). Urinary cotinine as a tobacco-smoke exposure index: A minireview. International Archives of Occupational and Environmental Health, 71(3), 162-168.

Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266-281.

Holick, M. F., Binkley, N. C., Bischoff-Ferrari, H. A., Gordon, C. M., Hanley, D. A., Heaney, R. P., . . . Weaver, C. M. (2011). Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 96(7), 1911-1930.

Holloway, A. C. (2014). Nicotine. In P. Wexler (Ed.), Encyclopedia of Toxicology (Third Edition) (pp. 514-516). Oxford: Academic Press.

Hossain, S., Hossain, S., Ahmed, F., Islam, R., Sikder, T., & Rahman, A. (2017). Prevalence of tobacco smoking and factors associated with the initiation of smoking among university students in Dhaka, Bangladesh. Central Asian Journal of Global Health, 6(1).

Hossein-nezhad, A., & Holick, M. F. (2013). Vitamin D for health: A global perspective. Mayo Clinic Proceedings, 88(7), 720-755.

Hyppönen, E., Boucher, B. J., Berry, D. J., & Power, C. (2008). 25-hydroxyvitamin D, IGF-1, and metabolic syndrome at 45 years of age: A cross-sectional study in the 1958 British Birth Cohort. Diabetes, 57(2), 298-305.

Katrinaki, M., Kampa, M., Margioris, A., Castanas, E., & Malliaraki, N. (2016). Vitamin D levels in a large Mediterranean cohort: Reconsidering normal cut-off values. Hormones, 15(2), 205-223.

KiliÇ, S. (2012). Sample size, power concepts and sample size calculation. Psychiatry and Behavioral Sciences, 2(3), 140.

Lee, Y.-K., Park, J., Ryu, S.-Y., Choi, S.-W., & Shin, J.-H. (2019). The relationship between smoking, alcohol drinking and vitamin D level among Korean adults: From the Korean national health and nutrition examination survey 2013-2014. Journal of the Korea Academia-Industrial cooperation Society, 20(3), 231-242.

Manavi, K. R., Alston-Mills, B. P., & Thompson, M. P. (2020). History of tobacco, vitamin D and women. International Journal for Vitamin and Nutrition Research, 90(5-6), 389-394.

Manavi, K. R., Alston-Mills, B. P., Thompson, M. P., & Allen, J. C. (2015). Effect of serum cotinine on vitamin D serum concentrations among american females with different ethnic backgrounds. Anticancer Research, 35(2), 1211-1218.

Mansoor, S., Habib, A., Ghani, F., Fatmi, Z., Badruddin, S., Mansoor, S., . . . Jabbar, A. (2010). Prevalence and significance of vitamin D deficiency and insufficiency among apparently healthy adults. Clinical Biochemistry, 43(18), 1431-1435.

Naing, L., Winn, T., & Rusli, B. N. (2006). Practical issues in calculating the sample size for prevalence studies. Archives of Orofacial Sciences, 1, 9-14.

Öngen, B., Kabaroğlu, C., & Parıldar, Z. (2008). Biochemical and laboratory evaluation of Vitamin D. Journal of Turkish Clinical Biochemistry, 6(1), 23-31.

Pardavila-Belio, M. I., García-Vivar, C., Pimenta, A. M., Canga-Armayor, A., Pueyo-Garrigues, S., & Canga-Armayor, N. (2015). Intervention study for smoking cessation in Spanish college students: Pragmatic randomized controlled trial. Addiction, 110(10), 1676-1683.

Pludowski, P., Holick, M. F., Pilz, S., Wagner, C. L., Hollis, B. W., Grant, W. B., . . . Kienreich, K. (2013). Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality—a review of recent evidence. Autoimmunity Reviews, 12(10), 976-989.

Rice, V. H., Heath, L., Livingstone-Banks, J., & Hartmann-Boyce, J. (2017). Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews, 12(12), Cd001188.

Sengezer, T., Yüksel, R. N., Babacan, T., Can, H., & Dilbaz, N. (2016). Evaluation of the relationship between serum vitamin D levels and tobacco use disorder. Anatolian Journal of Psychiatry, 17(3), 196-202.

Sezer, R. E., TanriÖVer, Ö., Arıkan, G. D., & Kacar, M. (2018). A tobacco use survey among university students focusing on waterpipe use and relationship between first-tried tobacco product and becoming an established smoker. Turkish Journal of Family Medicine and Primary Care, 12(4), 281-287.

Shinkov, A., Borissova, A. M., Dakovska, L., Vlahov, J., Kassabova, L., & Svinarov, D. (2015). Winter 25-hydroxyvitamin D levels in young urban adults are affected by smoking, body mass index and educational level. European Journal of Clinical Nutrition, 69(3), 355-360.

Solak, I., Cihan, F. G., Mercan, S., Kethuda, T., & Eryılmaz, M. A. (2018). Evaluation of 25-hydroxyvitamin D levels in Central Anatolia, Turkey. BioMed Research International, 2018, 1-5.

Spedding, S. (2014). Vitamin D and depression: A systematic review and meta-analysis comparing studies with and without biological flaws. Nutrients, 6(4), 1501-1518.

Temel, O., Coskun, A. S., Gok, S., Celik, P., & Yorgancioglu, A. (2009). The effect of nicotine among active, passive smoker health personnel. Turkish Thoracic Journal, 107-112.

Thomas, C. E., Wang, R., Adams-Haduch, J., Murphy, S. E., Ueland, P. M., Midttun, Ø., . . . Yuan, J.-M. (2020). Urinary cotinine is as good a biomarker as serum cotinine for cigarette smoking exposure and lung cancer risk prediction. Cancer Epidemiology and Prevention Biomarkers, 29(1), 127-132.

Tsiaras, W. G., & Weinstock, M. A. (2010). Commentary: Ultraviolet irradiation and oral ingestion as sources of optimal vitamin D. Journal of the American Academy of Dermatology, 62(6), 935-936.

Tucktuck, M., Ghandour, R., & Abu-Rmeileh, N. M. E. (2018). Waterpipe and cigarette tobacco smoking among Palestinian university students: A cross-sectional study. BMC Public Health, 18(1), 1.

Uçar, F., Taşlıpınar, M. Y., Soydaş, A., & Özcan, N. (2012). 25-OH vitamin D levels in patients admitted to Ankara Etlik ihtisas training and research hospital. European Journal of Basic Medical Sciences, 2(1), 12-15.

Uysal, M. A., Kadakal, F., KarÅŸidaÄŸ, C., Bayram, N. G., Uysal, O., & Yilmaz, V. (2004). Fagerstrom test for nicotine dependence: Reliability in a Turkish sample and factor analysis. Tuberk Toraks, 52(2), 115-121.

Vatansev, H., Kutlu, R., Özdengül, A. G., Demırbas, N., Taşer, S., & Yılmaz, F. (2019). Medicine and communication faculty students of tobacco and tobacco products usage differences. Ankara Medical Journal, 19(2), 344-356.

Wacker, M., & Holick, M. F. (2013). Vitamin D—effects on skeletal and extraskeletal health and the need for supplementation. Nutrients, 5(1), 111-148.

World Health Organization. (2017). Report on the global tobacco epidemic, Country Profile: Turkey (Monitoring tobacco use and prevention policies). Retrieved from

World Health Organization. (2020). Tobacco. Retrieved from

Yu, S., Fang, H., Han, J., Cheng, X., Xia, L., Li, S., . . . Hou, L. a. (2015). The high prevalence of hypovitaminosis D in China: A multicenter vitamin D status survey. Medicine, 94(8).

Yüksel, R. N., Altunsoy, N., Tikir, B., Cingi Külük, M., Unal, K., Goka, S., . . . Goka, E. (2014). Correlation between total vitamin D levels and psychotic psychopathology in patients with schizophrenia: Therapeutic implications for add-on vitamin D augmentation. Therapeutic Advances in Psychopharmacology, 4(6), 268-275.

Zielińska-Danch, W., Wardas, W., Sobczak, A., & Szołtysek-Bołdys, I. (2007). Estimation of urinary cotinine cut-off points distinguishing non-smokers, passive and active smokers. Biomarkers, 12(5), 484-496.