Cited by 621Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesPrenatal Substance Exposure Effects

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Biochemical Verification of Tobacco Use and Abstinence: 2019 Update

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Benowitz, Neal L, Bernert, John T, Foulds, Jonathan, Hecht, Stephen S, Jacob, Peyton, Jarvis, Martin J, Joseph, Anne, Oncken, Cheryl, Piper, Megan E·2020·Nicotine & Tobacco Research

DOI 10.1093/ntr/ntz132PMC PMC7882145

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Abstract

BACKGROUND: The changing prevalence and patterns of tobacco use, the advent of novel nicotine delivery devices, and the development of new biomarkers prompted an update of the 2002 Society for Research on Nicotine and Tobacco (SRNT) report on whether and how to apply biomarker verification for tobacco use and abstinence. METHODS: The SRNT Treatment Research Network convened a group of investigators with expertise in tobacco biomarkers to update the recommendations of the 2002 SNRT Biochemical Verification Report. RESULTS: Biochemical verification of tobacco use and abstinence increases scientific rigor and is recommended in clinical trials of smoking cessation, when feasible. Sources, appropriate biospecimens, cutpoints, time of detection windows and analytic methods for carbon monoxide, cotinine (including over the counter tests), total nicotine equivalents, minor tobacco alkaloids, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol are reviewed, as well as biochemical approaches to distinguishing cigarette smoking from use of electronic nicotine delivery devices (ENDS). CONCLUSIONS: Recommendations are provided for whether and how to use biochemical verification of tobacco use and abstinence. Guidelines are provided on which biomarkers to use, which biospecimens to use, optimal cutpoints, time windows to detection, and methodology for biochemical verifications. Use of combinations of biomarkers is recommended for assessment of ENDS use. IMPLICATIONS: Biochemical verification increases scientific rigor, but there are drawbacks that need to be assessed to determine whether the benefits of biochemical verification outweigh the costs, including the cost of the assays, the feasibility of sample collection, the ability to draw clear conclusions based on the duration of abstinence, and the variability of the assay within the study population. This paper provides updated recommendations from the 2002 SRNT report on whether and how to use biochemical markers in determining tobacco use and abstinence.

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“We will review the suitability and definitions of the two core smoking-related outcome measures, as per current debate in the field, 35 as follows: for 7-day point prevalence abstinence, we will review and potentially adjust down-ward the CO threshold of <10 ppm for biochemical validation,…”
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“[20] showed that the biochemical verification of abstinence appears to be increasingly important, as social norms and other personal factors affect the accuracy of reporting of smoking behaviour.”
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Enhancing long-term smoking abstinence among individuals with a history of cervical intraepithelial neoplasia or cervical cancer (Project ACCESS): protocol for a randomized clinical trial
Vidrine, J. I., Fennell, B. S., Simmons, V. N., Sutton, S. K., Jones, S. R., Woodward, H. W., Hoogland, C. E., & Vidrine, D. J. (2023) · BMC Public Health · doi:10.1186/s12889-023-16189-3 · Cited by 4
“This follows recommendations for community-based smoking cessation trials that do not involve in-person assessments [29, 30].”
BackgroundMethod
A randomised controlled trial to evaluate the effectiveness of a culture and disease-specific, patient-centric multi-component tobacco cessation intervention package for the patients attending non-communicable disease clinics in Punjab, India
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“Apart from increasing scientific rigour and validity, biochemical confirmation of cessation is critical in studies where socio-cultural beliefs, norms, and individual attributes affect the reporting of tobacco use status (Benowitz et al., 2020).”
Randomized Controlled Trial of a Text-Based Smokeless Tobacco Cessation Intervention for Rural and Medically Underserved Communities
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Abstinence-related motivational engagement for smoking cessation: Longitudinal patterns and predictive validity
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“Biochemical verification is logistically and financially challenging, especially in nationwide trials like our parent study [15].”
Background
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“Participants were consid - ered non-smokers if they reported no smoking and had an expired CO ≤ 5 ppm (particles per million) (Benowitz et al., 2019).”
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“Also, biochemical verification of smoking status is not always needed in pragmatic randomized control trials [55] and has lower response rates than self-report data [56].”
Background
Impact of multiple substance use on circulating ST2, a biomarker of adverse cardiac remodelling, in women
Riley, E. D., Kazi, D. S., Coffin, P. O., Vittinghoff, E., Wade, A. N., Bulfone, T. C., Lynch, K. L., Atai, Z., & Wu, A. H. B. (2022) · Biomarkers · doi:10.1080/1354750x.2022.2129451 · Cited by 4
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“COT is measurable in the urine, saliva, blood, hair, and nails of exposed children who live with smokers and nonsmokers [3], and it has a half-life of approximately 16 h [5,9]; thus, COT levels reflect recent TSE.”
Background
Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study
McClure, E. A., Baker, N. L., Walters, K. J., Tomko, R. L., Carpenter, M. J., Bradley, E., Squeglia, L. M., & Gray, K. M. (2023) · JMIR Formative Research · doi:10.2196/47662 · Cited by 4
“Two CO samples per day were deemed necessary to adequately characterize smoking, abstinence, and relapse given the approximate 12-hour half-life of breath CO [40].”
BackgroundMethod
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“Cotinine is the main metabolite of nicotine and has longer half-life with relatively high sensitivity and specificity; compared to expiratory a CO level which has short half-life (2h), so urinary cotinine is a reliable indicator of recent nicotine intake [37].”
Background
Efficacy of mindfulness and goal setting interventions for increasing resilience and reducing smoking in lower socio-economic groups: randomised controlled trial protocol
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“Indeed, smoking cessation effectiveness, as self-reported, was considered a valuable means in large-population-based clinical trials [71].”
Influential
Effects of Ovarian Hormone Levels on Stress, Cigarette Craving, and Smoking in a Laboratory Relapse Paradigm Among Females Who Smoke Daily
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Mahabee‐Gittens, E. M., Matt, G. E., Mazzella, M. J., Doucette, J. T., Ratnani, P., & Merianos, A. L. (2023) · Cytokine · doi:10.1016/j.cyto.2023.156448 · Cited by 3
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“Cotinine concentration in serum, with the threshold value of 14 ng/mL, was applied to determine the smoke exposure (active or passive smoking) [23].”
An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial
Bizier, A., Jones, A., Businelle, M. S., Kezbers, K. M., Hoeppner, B. B., Giordano, T. P., Thai, J. M., Charles, J. J., Montgomery, A., Gallagher, M. W., et al. (2024) · JMIR Research Protocols · doi:10.2196/52090 · Cited by 3
“This is consistent with best practices as well as most published smoking cessation RCTs (refer to the clinical practice guidelines) [54,67].”
Result
Association Between Mycobacterium tuberculosis Sensitization and Insulin Resistance Among US Adults Screened for Type 2 Diabetes Mellitus
Magodoro, I. M., Aluoch, A. O., Claggett, B. L., Nyirenda, M., Siedner, M. J., Wilkinson, K. A., Wilkinson, R. J., & Ntusi, N. (2024) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofae568 · Cited by 3
“We defined tobacco exposure as “none” if serum cotinine was 10 ng/mL, “passive exposure or light smoker” if ≥ 10 and 300 ng/mL, and “heavy smoker” if ≥ 300 ng/mL [25].”
Background
Effectiveness of non-pharmacological school-based therapies for cigarette smoking cessation among adolescents in South and Southeast Asian countries: a systematic review and meta-analysis
Mangrio, F. A., Uthis, P., Rojnawee, S., & Matthews, A. K. (2025) · Osong Public Health and Research Perspectives · doi:10.24171/j.phrp.2024.0320 · Cited by 3
“Therefore, biochemical verification remains the gold standard for rigorously evaluating the effectiveness of smoking cessation interventions [45].”
Toxicant and Nicotine Exposure in Pregnant Smokers, Vapers, and Nicotine-Replacement Users: Cross-Sectional Study
USSHER, M. H., Lewis, S., Marczylo, T. H., Blount, B., Brown, J., Bailey, A., Coleman, T. J., Cooper, S. E., Marks, J., George, M., et al. (2025) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntaf103 · Cited by 3
Association between biomarkers of tobacco consumption and lung cancer risk among daily smokers
González‐Marrón, A., Martín‐Sánchez, J. C., Pérez‐Ortuño, R., Fu, M., Ballbè, M., Cartanyà‐Hueso, À., Santander, N. M., Pascual, J. A., Fernández, E., & Martínez-Sánchez, J. M. (2021) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2022.1993064 · Cited by 3
Nicotine, Tobacco Smoking, and E-Cigarettes
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Nicotine and Tobacco Alkaloid Testing and Challenges: Lessons Learned From a College of American Pathologists Proficiency Testing Survey
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A pilot adaptive trial of text messages, mailed nicotine replacement therapy, and telephone coaching among primary care patients who smoke
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Comparative effectiveness of mobile health smoking cessation approaches among underserved patients in primary care: Study protocol for the PROMOTE-UP trial
Salloum, R. G., Bricker, J. B., Lee, J., Theis, R. P., Pluta, K., Williams, M. P., Naous, J., Mulani, S. R., Cogle, C. R., Rubin, D. A., et al. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107120 · Cited by 3
Testing the Efficacy of a Scalable Telephone-Delivered Guided Imagery Tobacco Cessation Treatment: Protocol for a Randomized Clinical Trial
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“A cutoff of 6 parts per million is recommended [39].”
Reliability of Electronic Health Records in Recording Veterans’ Tobacco Use Status
Sun, D. Q., Basi, J., Kreinbrook, J., Mhaskar, R. S., & Leonelli, F. M. (2023) · Military Medicine · doi:10.1093/milmed/usad290 · Cited by 3
Effectiveness of nicotine salt vapes, cytisine, and a combination of these products, for smoking cessation in New Zealand: protocol for a three-arm, pragmatic, community-based randomised controlled trial
Walker, N. K., Calder, A. J., Barnes, J., Laking, G. R., Parag, V., & Bullen, C. (2023) · BMC Public Health · doi:10.1186/s12889-023-16665-w · Cited by 4
“The primary outcome measure is six-month CA (Rus-sell Standard) defined as self-report of smoking not more than five cigarettes from the Quit date, supported by biochemical validation [30, 31].”
Method
Feasibility of and reactivity to ecological momentary assessment (EMA) during electronic cigarette use initiation in adults who smoke daily
Hoeppner, B. B., Eddie, D., Schick, M. R., Hoeppner, S. S., Kelly, L. M., & Kelly, J. F. (2024) · The European Journal of Psychiatry · doi:10.1016/j.ejpsy.2023.100247 · Cited by 3
Chatbot-Led Support Combined With Counselor-Led Support on Smoking Cessation in China: Protocol for a Pilot Randomized Controlled Trial
Weng, X., Yin, H., Liu, K., Song, C., Xie, J., Guo, N., & Wang, M. P. (2024) · JMIR Research Protocols · doi:10.2196/58636 · Cited by 3
Perioperative Intensive Smoking Cessation Intervention Among Smokers Who Underwent Transurethral Resection of Bladder Tumor (TURBT) in Two Different Settings: A Randomized Controlled Trial
Lydom, L. N., Lauridsen, S. V., Liljendahl, M. S., Schmedes, A., Joensen, U. N., & Tønnesen, H. (2025) · Cancers · doi:10.3390/cancers17040713 · Cited by 3
“CO has a short half-life and reflects recent smoking [28,29].”
Influential
High Frequency and Low Intensity Transcranial Magnetic Stimulation for Smoking Cessation
Ponciano‐Rodríguez, G., Chávez-Castillo, C. A., Ríos-Ponce, A. E., & Villafuerte, G. (2021) · Journal of Addiction · doi:10.1155/2021/9988618 · Cited by 3
“To evaluate smoking cessation, subjects performed a weekly determination of exhaled carbon monoxide (CO) with a carbon monoxide analyzer using as cutoff points values below 10 ppm to determine smoking cessation [20] (Bedfont Scientific Ltd.”
Method
Messaging to prevent and reduce young adults’ waterpipe tobacco smoking: A randomized trial
Keller-Hamilton, B. L., Stevens, E. M., Villanti, A. C., Leshner, G., Wagener, T. L., & Mays, D. M. (2022) · Addictive Behaviors · doi:10.1016/j.addbeh.2022.107546 · Cited by 3
Insulin resistance, and not β-cell impairment, mediates association between Mycobacterium tuberculosis sensitization and type II diabetes mellitus among US adultsPreprint
Magodoro, I. M., Aluoch, A. O., Claggett, B. L., Nyirenda, M., Siedner, M. J., Wilkinson, K., Wilkinson, R., & Ntusi, N. (2024) · medRxiv · doi:10.1101/2024.03.10.24304039 · Cited by 3
Acceptance and Commitment Therapy Wellness Program for Latine Adults Who Smoke and Have Psychological Distress: Protocol for a Feasibility Study
Correa-Fernández, V., Blalock, J. A., Piper, M. E., Canino, G., & Wetter, D. W. (2023) · JMIR Research Protocols · doi:10.2196/44146 · Cited by 2
“Seven-day point prevalence and continuous abstinence will be reported following the Society for Research on Nicotine and Tobacco guidelines [53,54].”
MethodSelf-citation
Impact of the Ottawa model on opiate screening and smoking cessation in methadone-treated patients with opioid use disorder: A retrospective cohort analysis
Lee, S.-W., Yu, P.-C., Yen, T., Hsu, C., Lai, L.-J., Chen, I., & Chang, T. (2024) · Tobacco Induced Diseases · doi:10.18332/tid/191247 · Cited by 2
“This approach is supported by previous research, demonstrating the effectiveness of exhaled CO levels in distinguishing smokers from non-smokers 16 .”
MethodResult
Determinants of persistent smoking among breast cancer survivors
Gali, K., Aryal, S., Bokemeyer, F., Behrens, S., Seibold, P., Obi, N., Becher, H., & Chang-Claude, J. C. (2024) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2024.102913 · Cited by 2
Mobile chat messaging for preventing relapse among people who recently quit smoking: Study protocol for a randomized controlled trial
Su, X., Wong, V., Cheung, Y. T. D., Chan, H. C.-H., Wong, G. N.-T., Lee, J. K. H., Ho, S. Y., Wang, M. P., & Luk, T. T. (2024) · Digital Health · doi:10.1177/20552076241291709 · Cited by 2
Sex-related association between smoke exposure and gallstones in a US population: a cross-sectional study
Huang, X., Hao, X., Wang, T., Zhang, X., Wu, P., Shen, L., Yang, Y., Zhang, W., & Zhang, K. (2025) · BMC Public Health · doi:10.1186/s12889-024-21173-6 · Cited by 4
“Currently, cotinine is considered a sensitive biomarker of smoking exposure, especially within the past 72 h [25, 26].”
Factors associated with smoking cessation in patients with peripheral arterial disease consulting French cessation services
Allagbé, I., Servier, C., & Faou, A.-L. L. (2025) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2025.03.002 · Cited by 2
Cardiometabolic Biomarkers and Systemic Inflammation in US Adolescents and Young Adults With Latent Tuberculosis Infection: A Population-Based Cohort Study
Magodoro, I. M., Ntusi, N., Jao, J. K., Zar, H. J., Claggett, B. L., Siedner, M. J., Wilkinson, K. A., & Wilkinson, R. J. (2025) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofaf194 · Cited by 2
“Serum cotinine, a nicotine biomarker, assessed tobacco smoke exposure from primary and secondhand smoking [28].”
Electronic Nicotine Delivery Systems Use and Nicotine Exposure Among Adults Who Use ENDS Alone or With Cigarettes: The Population Assessment of Tobacco and Health Study 2013–2019
Edwards, K. C., Garcia-Rosales, K. V., Goniewicz, M. L., Ashley, D. L., Hatsukami, D. K., Wang, L., Feng, J., Blount, B. C., Sharma, E., Merrill, L. S., et al. (2025) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntaf083 · Cited by 2
Self-reported smoking, urine cotinine, and risk of incident hypertension: findings from the PREVEND prospective cohort study
Kunutsor, S. K., Rikhtehgaran, R., Touw, D. J., Dullaart, R. P. F., & Bakker, S. J. L. (2025) · Journal of Human Hypertension · doi:10.1038/s41371-025-01073-x · Cited by 2
Assessing the impact of tobacco smoke exposure on early-onset osteoarthritis: A cross-sectional analysis of secondary data from the National Health and Nutrition Examination Survey (NHANES), 1999–2020
Li, Y., Wan, X., & Long, W. (2025) · Tobacco Induced Diseases · doi:10.18332/tid/208426 · Cited by 2
“Cotinine, a metabolite of nicotine, can indicate whether a person is currently smoking, or has been exposed to tobacco smoke in the environment 18 .”
Efficacy of cognitive behavioral therapy‐based smartphone app for smoking cessation in China: A randomized controlled trial
Tang, J., Liu, X., Chen, S., Sun, Y., Zhu, M., Zhou, Z., Liu, Y., Yang, J., Chen, W., & Liao, Y. (2025) · Addiction · doi:10.1111/add.70239 · Cited by 2
“The urinary cotinine cut-off level of 200 ng/mL might overestimate verification rates [32].”
Integrating PBPK modeling and tobacco biomarkers to interpret N-(2-hydroxyethyl)valine (HEV) hemoglobin adducts in the U.S. population
Lin, Y.-S., Morozov, V., & Wu, K. (2025) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2025.114721 · Cited by 2
Mobile instant messaging supported brief physical exercise intervention for smoking cessation: a community-based, cluster randomised controlled trial
Zhao, S. Z., Li, M. Y., Li, Y. J., Luk, T. T., Cheung, D. Y. T., Lai, A. Y. K., Tong, H. S. C., Lai, V., Lam, T. H., & Wang, M. P. (2026) · Thorax · doi:10.1136/thorax-2025-224130 · Cited by 2
“36 The main secondary outcome was validated 7-day abstinence at 3 months post-baseline.”
Mobile Chat Messaging for Smoking Relapse Prevention
Luk, T. T., Su, X., Wong, V., Chan, H. C.-H., Wong, G. N.-T., Lee, J. K. H., Ho, S. Y., Lam, T. H., Cheung, Y. T. D., & Wang, M. P. (2026) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2025.7439 · Cited by 2
Effectiveness of telephone counseling and quitlines in tobacco cessation: A systematic review and meta-analysis
Raj, S., Shabil, M., Sachdeva, M., & Goel, S. (2026) · Annals of Epidemiology · doi:10.1016/j.annepidem.2026.110059 · Cited by 2
Determining the impact of cannabis use on tobacco cessation: Results from a prospective non‐randomized tobacco treatment trial
McClure, E. A., Baker, N. L., Tomko, R. L., Walters, K. J., Chapman, E. K., Carpenter, M. J., & Gray, K. M. (2026) · Addiction · doi:10.1111/add.70382 · Cited by 2
“Cotinine is a metabolite of nicotine and captures use or abstinence from all nicotine products (i.e. is not specific to cigarettes) [41].”
Association between smoking cessation and depressive symptoms according to cessation duration, pack-years, and tobacco product type: a nationwide cross-sectional study in Korea
Kim, J., Lee, E., Hwang, D., Ko, A. J., & Park, E. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1755259 · Cited by 2
“Urinary cotinine, the preferred biomarker of nicotine exposure, can detect undisclosed current smoking status over the previous 2–3 days (35).”
High levels of urinary naphthalene metabolites measured in a sample of California schoolchildren: a call to expand monitoring and identify exposure sources
Hurley, S. E., Castorina, R., Sultana, D., Thompson, M., Jarmul, S., Gunier, R. B., Nirula, A., Ortiz-Pivaral, L., Jacob, P., She, J., et al. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1789602 · Cited by 2
Self-citation
Electrochemical Sensing of Nicotine Using Poly(Safranine)/MoS 2 Nanocomposite Modified Electrode
Narayanan, N., Sharif, S. I. U., Sridharan, G., Atchudan, R., Arya, S. K., & Sundramoorthy, A. K. (2026) · Analytical Letters · doi:10.1080/00032719.2026.2682376 · Cited by 2
“Reliable determination of NIC concentration is therefore essential for toxicological evaluation, quality control of commercial products, and enforcement of regulatory standards (Benowitz et al. 2020).”
Preoperative contingency management intervention for smoking abstinence in cancer patients: trial protocol for a multisite randomised controlled trial
Rojewski, A. M., Fucito, L. M., Baker, N. L., Palmer, A. M., Foster, M. G., Warren, G. W., Bernstein, S. L., & Toll, B. A. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-051226 · Cited by 4
Role of untargeted omics biomarkers of exposure and effect for tobacco research
Shields, P. G. (2023) · Addiction Neuroscience · doi:10.1016/j.addicn.2023.100098 · Cited by 2
“Profiling can be focused on a priori hypotheses, for example in tobacco research this can assess pathways known to be involved in carcinogenesis as hallmarks of cancer [1], or xenobiotic metabolism of carcinogens and other toxicants.”
Background
Validating Wave 1 (2014) Urinary Cotinine and TNE-2 Cut-points for Differentiating Wave 4 (2017) Cigarette Use from Non-use in the United States Using Data from the PATH Study
Edwards, K. C., Khan, A., Sharma, E., Wang, L., Feng, J., Blount, B. C., Sosnoff, C. S., Smith, D. M., Goniewicz, M. L., Pearson, J., et al. (2023) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-22-1228 · Cited by 2
Effectiveness of personalized smoking cessation intervention based on ecological momentary assessment for smokers who prefer unaided quitting: protocol for a randomized controlled trial
Zhang, M. J., He, W. J. A., Luk, T. T., Wang, M. P., Chan, S. S. C., & Cheung, Y. T. D. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1147096 · Cited by 2
Biochemical Verification of Tobacco-Use as an Inclusion Criterion in Smoking Cessation Trials- Lessons From the Cessation of Smoking Trial in the Emergency Department
Pope, I., Suresh, C., Ward, E., Belderson, P., & Notley, C. J. (2023) · Tobacco Use Insights · doi:10.1177/1179173x231193898 · Cited by 2
Simultaneous Measurement and Distribution Analysis of Urinary Nicotine, Cotinine, Trans-3′-Hydroxycotinine, Nornicotine, Anabasine, and Total Nicotine Equivalents in a Large Korean Population
Lee, H., Chun, M., & Lee, S. (2023) · Molecules · doi:10.3390/molecules28237685 · Cited by 2
“Urinary biomarkers can be analyzed by a variety of analytical methods, including immunoassay, gas chromatography (GC), GC-mass spectrometry (GC-MS), liquid chromatography (LC), and liquid chromatography with tandem mass spectrometry (LC-MS/MS) [4].”
BackgroundMethodInfluential
Recirculating bioavailable nicotine metabolite using ascorbic acid: A pragmatic approach for treating nicotine dependence
Arumugam, M., Sundaram, R. L., Jayajothi, V., Arul, M., Suresh, J. A., & Kesavan, S. K. (2023) · Advances in Redox Research · doi:10.1016/j.arres.2023.100089 · Cited by 4
Associations between morning affect and later-day smoking urges and behavior.
Benson, L., Chen, M., Torre, I. D. L., Hébert, E. T., Alexander, A. C., Ra, C. K., Kendzor, D. E., & Businelle, M. S. (2023) · Psychology of Addictive Behaviors · doi:10.1037/adb0000970 · Cited by 2
Actívatexto: Feasibility and Acceptability of a Mobile Intervention That Promotes Smoking Cessation and Physical Activity among Latinos
Lara, D., Alaniz-Cantú, E. I., Siddalingaiaha, S., Oliveira, I., Chávez‐Iñiguez, A., DeJesus, E., Fuller, D., Márquez, D. X., Vásquez, E., Li, D., et al. (2024) · Cancer Research Communications · doi:10.1158/2767-9764.crc-23-0519 · Cited by 2
“However, self-reported smoking abstinence has been judged to be appropriate for minimal contact community interventions that do not involve face-to-face contact (60).”
Background
Efficacy of simple and very brief handgrip and isometric exercises for reducing withdrawal symptoms in cigarette smokers: A pilot randomized controlled trial
Zhang, M. J., Cheung, Y. T. D., Wang, Q., Cheng, C. C. W., Luk, T. T., He, W. J. A., Wang, M. P., & Lam, T. H. (2024) · Tobacco Induced Diseases · doi:10.18332/tid/187839 · Cited by 3
“The second stage required participants to abstain from tobacco products for at least 9 hours, given that the half-life of exhaled CO varies from 2 to 8 hours 21 .”
Background
Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products
Poliakova, N., Shrier, L. A., Harris, S. K., & Bélanger, R. E. (2024) · Tobacco Use Insights · doi:10.1177/1179173x241259603 · Cited by 2
Intensive Intervention on Smoking Cessation in Patients Undergoing Elective Surgery: The Role of Family Physicians
Domić, A., Pilipović-Broćeta, N., Grabež, M., Divac, N., Igic, R. P., & Škrbić, R. (2024) · Medicina · doi:10.3390/medicina60060965 · Cited by 2
“Such experiences have been described in the literature, but there is currently not enough scientific evidence for routines to be applied [40] Self-assessment tests of smoking status, the FTND, and biochemical validation [41] help to make smoking cessation successful [42].”
Background
Race/ethnicity-based discrimination, depressive symptoms, and smoking-related variables among people with HIV participating in a randomized clinical trial for cigarette smoking cessation
Agterberg, S., Shuter, J., Stanton, C. A., Seng, E. K., & Weinberger, A. H. (2024) · AIDS Care · doi:10.1080/09540121.2024.2373403 · Cited by 2
“Smoking abstinence was assessed as dichotomous (abstinent vs. not abstinent) and self-reported 7-day point prevalence smoking abstinence was biochemically con ﬁ rmed based on an exhaled carbon monoxide level of ≤ 6 parts per million (ppm) (Benowitz et al., 2020).”
Self-reported smoking status and exhaled carbon monoxide in secondary preventive follow-up after coronary heart events: Do our patients tell the truth?
Kaldal, A., Tonstad, S., & Jortveit, J. (2024) · Tobacco Prevention & Cessation · doi:10.18332/tpc/191843 · Cited by 2
Mobile Phone-Based Smoking-Cessation Intervention in Patients With Chronic Diseases in China: A Sequential Multiple Assignment Randomized Trial
Weng, X., Song, C., Liu, K., Zhao, S. Z., Yang, H., & Wang, M. P. (2024) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntae230 · Cited by 2
Post-discharge tobacco abstinence in a Mumbai hospital after implementation of tobacco cessation counseling: A pragmatic evaluation of the LifeFirst program
Gupte, H., Kruse, G. R., Chang, Y., Jagiasi, D., Pradhan, S., & Rigotti, N. A. (2024) · PLoS ONE · doi:10.1371/journal.pone.0312319 · Cited by 2
Preliminary evidence that self-incentives uniquely promote smoking cessation in incarcerated populations: A pilot randomized controlled trial
Brown, E., Smith, D. M., & Armitage, C. J. (2024) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2024.209610 · Cited by 2
Feature-level analysis of a novel smoking cessation program integrating app-based behavioral therapy and an electronic cigarette
Schiek, H., Esch, T., & Hoetger, C. (2025) · BMC Digital Health · doi:10.1186/s44247-025-00147-7 · Cited by 4
“Future research should consider incorporating biochemical verification methods to enhance the validity and reliability of smoking abstinence assessments [66].”
Enhancing Text Message Support With Media Literacy and Financial Incentives for Vaping Cessation in Young Adults: Protocol for a Pilot Randomized Controlled Trial
Michaud, T. L., Puga, T. B., Archer, R., Theye, E., Zagurski, C., Estabrooks, P. A., & Dai, H. D. (2025) · JMIR Research Protocols · doi:10.2196/60527 · Cited by 2
Biomarkers of Nicotine and Tobacco Carcinogen Exposure in Socioeconomically Disadvantaged Black Adults Receiving a Brief Smoking Reduction Intervention
Brett, E. I., Slear, J. H. K., Goniewicz, M. L., & King, A. C. (2025) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-24-1789 · Cited by 2
Early Treatment Engagement and Long-Term Smoking Abstinence Among Women With Cervical Intraepithelial Neoplasia or Cervical Cancer
Hoogland, C. E., Sutton, S. K., Fennell, B. S., Simmons, V. N., Vinci, C., Naqa, I. E., Salloum, R. G., Shete, S. S., Hembree, T. N., Vidrine, D. J., et al. (2025) · AJPM Focus · doi:10.1016/j.focus.2025.100361 · Cited by 2
“26”
Relationship of Urinary Cotinine and Secondhand Smoke Exposure With Metabolic Syndrome Among Self-Reported Never-Smokers
Kim, B. J. (2025) · CardioMetabolic Syndrome Journal · doi:10.51789/cmsj.2025.5.e10 · Cited by 2

Authors: Benowitz, N. L., Bernert, J. T., Foulds, J., Hecht, S. S., Jacob, P., Jarvis, M. J., Joseph, A., Oncken, C., & Piper, M. E.
Affiliations: University of California, San Francisco (US)
Centers for Disease Control and Prevention (US)
Pennsylvania State University (US)
University of Minnesota (US)
University College London (GB)
University of Connecticut (US)
University of Wisconsin–Madison (US)
Corresponding author: Benowitz, Neal L
ORCID: Benowitz, Neal L
Foulds, Jonathan
Hecht, Stephen S
Jacob, Peyton
Jarvis, Martin J
Joseph, Anne
Oncken, Cheryl
Piper, Megan E
Venue: Nicotine & Tobacco Research
Publisher: Oxford University Press (OUP)
Published: 2019-10-01
Volume: 22
Issue: 7
Pages: 1086-1097
ISSN: 1462-2203 (ISSN-L)
1469-994X
DOI: 10.1093/ntr/ntz132
PMC: PMC7882145
OpenAlex: W2978389675
Cited by: 619
References: 121
Citations by year: 2026: 99 · 2025: 84 · 2024: 107 · 2023: 103 · 2022: 87 · 2021: 79 · 2020: 54 · 2019: 4
FWCI: 6.58
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations: Nicotine & Tobacco Research (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
eScholarship (California Digital Library) (submittedVersion)
Funders: National Institutes of Health (CC999999)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
Keywords: tobacco use, smoking abstinence, biomarkers, cotinine, carbon monoxide, electronic cigarettes, NNAL, biological specimen, detection window
MeSH terms: Cigarette Smoking, Carbon Monoxide, Cotinine, Humans, Nicotine, United States, Biomarkers, Smoking Cessation, Tobacco Products

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Biochemical Verification of Tobacco Use and Abstinence: 2019 Update

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