Urinary cotinine concentration as a biomarker of environmental exposure to Nicotine in Vietnam: Results from a Nationwide Survey in 2024

The CCR level of 20.947 µg/g indicated the optimal cut-off value to distinguish smokers and non-smokers. Vietnam was among countries with high levels of environmental nicotine exposure, with significant variation by sex, education, occupation, income, and region. Urinary cotinine is a reliable biomarker for nicotine exposure and should be integrated into routine surveillance. These findings support the need for stricter enforcement of smoke-free environments and interventions tailored to reduce involuntary tobacco exposure.