Comparison of tests used to distinguish smokers from nonsmokers
Abstract
Questionnaire and biochemical measures of smoking were studied in 211 hospital outpatients. Eleven different tests of smoke intake were compared for their ability to categorize smokers and nonsmokers correctly. The concentration of cotinine, whether measured in plasma, saliva, or urine, was the best indicator of smoking, with sensitivity of 96-97 per cent and specificity of 99-100 per cent. Thiocyanate provided the poorest discrimination. Carbon monoxide measured as blood carboxyhaemoglobin or in expired air gave sensitivity and specificity of about 90 per cent. Sensitivities of the tests were little affected by the presence among the claimed nonsmokers of a group of 21 "deceivers" who concealed their smoking. It is concluded that cotinine is the measure of choice, but for most clinical applications carbon monoxide provides an acceptable degree of discrimination and is considerably cheaper and simpler to apply.
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Cotinine is a reliable biomarker for nicotine levels (sensitivity of 96-97%, specificity of 99-100%).
“Cotinine is a reliable biomarker for nicotine levels (sensitivity of 96–97%, specificity of 99–100%)19”
From Maternal Smoking during Pregnancy and Newborn Neurobehavior: Effects at 10 to 27 Days (2009) · cites this paper as [19]
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Davis, R. A., Stiles, M. F., deBethizy, J. D., & Reynolds, J. H. (1991) · Food and Chemical Toxicology · doi:10.1016/0278-6915(91)90109-k · Cited by 156 · see citing works
Quality of Measurement of Smoking Status by Self-Report and Saliva Cotinine Among Pregnant Women
Boyd, N. R., Windsor, R. A., Perkins, L. L., & Lowe, J. B. (1998) · Maternal and Child Health Journal · doi:10.1023/a:1022936705438 · Cited by 155 · see citing works
“In studies utilizing saliva cotinine in the general population surveys, smoking misclassification rates have ranged from 2% to 12% [13, 20-22].”
BackgroundTreatment of smoking cessation in smokers with past alcohol/drug problems
Hughes, J. R. (1993) · Journal of Substance Abuse Treatment · doi:10.1016/0740-5472(93)90043-2 · Cited by 153 · see citing works
Conner, M. T., Grogan, S., Simms‐Ellis, R., Flett, K., Sykes‐Muskett, B., Cowap, L., Lawton, R., Armitage, C. J., Meads, D. M., Torgerson, C. J., et al. (2017) · Tobacco Control · doi:10.1136/tobaccocontrol-2016-053539 · Cited by 152 · see citing works
Seet, R. C. S., Lee, J. C., Loke, W. M., Huang, S. H., Huang, H.-W., Looi, W. F., Chew, S. E., Quek, A. M. L., Lim, E. C. H., & Halliwell, B. B. (2011) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2011.03.019 · Cited by 152 · see citing works
Goniewicz, M. L., Eisner, M. D., Lazcano-Ponce, E. C., Zielińska-Danch, W., Koszowski, B., Sobczak, A., Havel, C. M., Jacob, P., & Benowitz, N. L. (2011) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntq237 · Cited by 151 · see citing works
The Origins of the Correlations between Tobacco, Alcohol, and Cannabis Use During Adolescence
Lynskey, M. T., Fergusson, D. M., & Horwood, L. J. (1998) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00402 · Cited by 151 · see citing works
“( Jarvis et al, 1987; Midanik, 1988; Rouse et al, 1982).”
Serum Cotinine Levels, Smoking, and Periodontal Attachment Loss
Gonzalez, Y. M., Nardin, A. D., Grossi, S. G., Machtei, E. E., Genco, R. J., & Nardin, E. (1996) · Journal of Dental Research · doi:10.1177/00220345960750021001 · Cited by 151 · see citing works
Efficacy of a nicotine inhaler in smoking cessation: a double-blind, placebo-controlled trial
Schneider, N. G., Olmstead, R. E., Nilsson, F. O. L., Mody, F. V., Franzon, M., & DOAN, K. (1996) · Addiction · doi:10.1046/j.1360-0443.1996.91912935.x · Cited by 148 · see citing works
West, R., Zatoński, W. A., Przewoźniak, K., & Jarvis, M. J. (2007) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-06-0679 · Cited by 146 · see citing works
“A concentration of 15 ng/mL in saliva or serum is a conservative cut point for detecting active smoking (2, 3).”
Validity of Self-reported Smoking Status among Participants in a Lung Cancer Screening Trial
Studts, J. L., Ghate, S. R., Gill, J. L., Studts, C. R., Barnes, C. N., LaJoie, A. S., Andrykowski, M. A., & LaRocca, R. V. (2006) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-06-0393 · Cited by 146 · see citing works
“Studies comparing nonsmokers and smokers have consistently reported that cotinine in the urine, saliva, or plasma can distinguish active smokers from nonsmokers (13, 14, 20-24).”
BackgroundSmoking cessation increases gingival blood flow and gingival crevicular fluid
Morozumi, T., Kubota, T., Sato, T., Okuda, K., & Yoshie, H. (2004) · Journal Of Clinical Periodontology · doi:10.1111/j.1600-051x.2004.00476.x · Cited by 146 · see citing works
Improving disclosure of smoking by pregnant women
Mullen, P. D., Carbonari, J. P., Tabak, E. R., & Glenday, M. C. (1991) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(91)90105-z · Cited by 145 · see citing works
Patient literacy and the readability of smoking education literature.
Meade, C. D., & Byrd, J. C. (1989) · American Journal of Public Health · doi:10.2105/ajph.79.2.204 · Cited by 145 · see citing works
Role of anticipated regret, intentions and intention stability in adolescent smoking initiation
Conner, M. T., Conner, M. T., Sandberg, T., McMillan, B., & Higgins, A. R. (2006) · British Journal of Health Psychology · doi:10.1348/135910705x40997 · Cited by 141 · see citing works
Are higher doses of nicotine replacement more effective for smoking cessation?
Hughes, J. R., Lesmes, G. R., Hatsukami, D. K., RICHMOND, R. L., Lichtenstein, E. H., Jorenby, D. E., Broughton, J. O., Fortmann, S. P., Leischow, S. J., McKenna, J., et al. (1999) · Nicotine & Tobacco Research · doi:10.1080/14622299050011281 · Cited by 143 · see citing works
Optimum cutoff points for biochemical validation of smoking status.
Cummings, S. R., & Richard, R. J. (1988) · American Journal of Public Health · doi:10.2105/ajph.78.5.574 · Cited by 143 · see citing works
Influences of Mood, Depression History, and Treatment Modality on Outcomes in Smoking Cessation.
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Passive smoking, salivary cotinine concentrations, and middle ear effusion in 7 year old children.
Strachan, D. P., Jarvis, M. J., & Feyerabend, C. (1989) · BMJ · doi:10.1136/bmj.298.6687.1549 · Cited by 141 · see citing works
Biomarkers of exposure to new and emerging tobacco delivery products
Schick, S. F., Blount, B. C., Jacob, P., Saliba, N. A., Bernert, J. T., El Hellani, A., Jatlow, P., Pappas, R. S., Wang, L., Foulds, J., et al. (2017) · American Journal of Physiology-Lung Cellular and Molecular Physiology · doi:10.1152/ajplung.00343.2016 · Cited by 140 · see citing works
Assessing smoking status in children, adolescents and adults: cotinine cut‐points revisited
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“Jarvis et al. (1987) examined the sensitivity and specificity of cotinine, CO, and thiocyanate (Table 3).”
BackgroundInfluentialSociodemographic predictors of success in smoking intervention
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“but it is not unexpected that it correlates less well with success than do other measures of tobacco use.”
BackgroundThe Evolution of Airway Function in Early Childhood Following Clinical Diagnosis of Cystic Fibrosis
Ranganathan, S., Stocks, J., Dezateux, C. A., Bush, A., Wade, A. M., Carr, S. B., Castle, R. A., Dinwiddie, R., Hoo, A., Lum, S., et al. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200309-1344oc · Cited by 135 · see citing works
“Exposure to maternal smoking prenatally and postnatally was assessed from maternal report and current smoking habits confirmed by maternal salivary cotinine ( 14 ).”
MethodAbnormal age-related changes of plasma antioxidant proteins in schizophrenia
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Nicotine vs Placebo Gum in General Medical Practice
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“Among these, cotinine is a metabolite of nicotine that has a relatively long half-life compared to other markers, making it a reliable indicator when used to identify smokers [10-12].”
Inverse relation between serum cotinine concentration and blood pressure in cigarette smokers.
Benowitz, N. L., & Sharp, D. S. (1989) · Circulation · doi:10.1161/01.cir.80.5.1309 · Cited by 131 · see citing works
Cord Serum Cotinine as a Biomarker of Fetal Exposure to Cigarette Smoke at the End of Pregnancy
Pichini, S., Basagaña, X., Pacifici, R., Garcia, O., Puig, C., Vall, O., Harris, J. M., Zuccaro, P., Segura, J., & Sunyer, J. (2000) · Environmental Health Perspectives · doi:10.1289/ehp.001081079 · Cited by 130 · see citing works
“Indeed, not only did a high percentage of mothers who did not report active smoking nor exposure to ETS present urinary levels of cotinine > 50 ng/mL [the cutoff to distinguish active smokers from nonsmokers according to Jarvis et al. ( 20 )], but a certain percentage of newborns also had these high levels.”
BackgroundMethod
- Authors
- Jarvis, M. J., Tunstall-Pedoe, H., Feyerabend, C., Vesey, C., & Saloojee, Y.
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 1987-11
- Volume
- 77
- Issue
- 11
- Pages
- 1435-1438
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- OpenAlex
- W2147528426
- Cited by
- 994
- References
- 21
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 14 · 2023: 14 · 2022: 27 · 2021: 22 · 2020: 25 · 2019: 29 · 2018: 37 · 2017: 35 · 2016: 32 · 2015: 37 · 2014: 34 · 2013: 44 · 2012: 40
- FWCI
- 11.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- smoking detection, cotinine, carbon monoxide, carboxyhemoglobin, thiocyanate, salivary biomarkers, urinary biomarkers, plasma biomarkers, questionnaire-based screening, sensitivity and specificity
- MeSH terms
- Carbon Monoxide, Chromatography, Gas, Cotinine, Evaluation Studies as Topic, Female, Humans, Male, Middle Aged, Nicotine, Pyrrolidinones, Surveys and Questionnaires, Saliva, Smoking, Thiocyanates
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