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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%)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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“This cutoff has high sensitivity (88% for cigarettes and 84% for all types of smoking) and specificity (84%) (22).”
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“Cotinine is a metabolite of nicotine and can be detected in the urine for up to 4 days because of its 17-hour half-life.(18) Several companies manufacture the enzyme immunosorbent assays (ELISAs) that are much like urine pregnancy tests.”
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“Of a total of 32 252 adults surveyed in 1994 and 1996, there were 22 168 self reported non-smokers, of whom 15 312 had a measured plasma cotinine. Detectable concentrations of cotinine were found in 90.3%. Some 547 of self reported non-smokers had cotinine concentrations above a cutpoint of 15 ng/ml used for determini…”
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“Previous research indicates that serum cotinine levels of ≥ 14 ng/mL are most consistent with personal smoking (13,14), so subjects who indicated no current smoking but had serum cotinine levels greater than this level were reclassified as current smokers and excluded from analysis.”
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“1 for the AGA group) ( 30 , 31). Similarly, levels of infant urine cotinine suggested minimal exposure to environmental tobacco smoke in this population (4.0 [1.3–6.8] and 3.3 [1.4–8.9] ng · ml”
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“Previous studies have indicated that the levels of urinary cotinine in non-smokers were usually less than 20 μg/L and the discrimination threshold between active and passive smokers was from 50 to 100 μg/L (Jarvis et al., 1987).”
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“Bioassays Saliva cotinine is a reliable biomarker for nicotine levels (Jarvis et al., 1987).”
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“This was subsequently analyzed for cotinine using gas-liquid chromatography ( 28 ).”
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“…criteria included pregnancy, serious heart disease or recent stroke, a current psychiatric or neurological diagnosis, regular use of prescription (or class A recreational) drugs, and salivary cotinine levels of less than 20 ng/ml (which is inconsistent with active smoking; Jarvis et al. 1987).”
Potential mechanisms of susceptibility to periodontitis in tobacco smokers
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“[28] support cutoff for active tobacco use at cotinine concentrations of 13 ng/mL.”
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Validity of telephone surveys in assessing cigarette smoking in young adults.
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“Cotinine levels are approximately similar when measured in blood or in saliva [16,23,24], so studies using cotinine in blood and in saliva can be compared.”
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“Exposure to SHS was assessed using the salivary cotinine level, which is a reliable and valid circulating biochemical marker of nicotine exposure.(22) A dental roll saturated with the participant’s saliva was placed in a tube and later analyzed using a Hewlett Packard hp5890 gas chromatograph (Hewlett Packard, Palo Al…”
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“Frequent sampling is required because CO is expelled rapidly from the body; breath CO has a half-life of 6 to 8 hr (Jarvis, Tunstall-Pedoe, Feyerabend, Vesey, & Saloojee, 1987).”
BackgroundSmoking characteristics and inhalation biochemistry in the Scottish population
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“Regular smokers typically show salivary cotinine levels in the region of 330 ng/ml, and non-smokers <20 ng/ml (Jarvis et al. 1987).”
Management Of Asthma By Patients And Families
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Strachan, D. P., Jarvis, M. J., & Feyerabend, C. (1990) · American Review of Respiratory Disease · doi:10.1164/ajrccm/142.1.147 · Cited by 84
Longitudinal changes in dehydroepiandrosterone concentrations in men and women
Nafziger, A. N., Bowlin, S. J., Jenkins, P. L., & Pearson, T. A. (1998) · Journal of Laboratory and Clinical Medicine · doi:10.1016/s0022-2143(98)90181-0 · Cited by 82
The RealU online cessation intervention for college smokers: A randomized controlled trial
An, L. C., Klatt, C. M., Perry, C. L., Lein, E., Hennrikus, D. J., Pallonen, U. E., Bliss, R., Lando, H. A., Farley, D. M., Ahluwalia, J. S., et al. (2008) · Preventive Medicine · doi:10.1016/j.ypmed.2008.04.011 · Cited by 83
Second-Hand Tobacco Smoke and Cardiovascular Disease Risk
Dunbar, A., Gotsis, W., & Frishman, W. H. (2012) · Cardiology in Review · doi:10.1097/crd.0b013e31827362e4 · Cited by 79
Takeyabu, K., Betsuyaku, T., Nishimura, M., Yoshioka, A., Tanino, M. A., Miyamoto, K., & Kawakami, Y. (1998) · European Respiratory Journal · doi:10.1183/09031936.98.12051033 · Cited by 82
“The plasma concentration of cotinine, which is the main metabolite of nicotine and biochemically represents the cumulative dose of exposure to cigarette smoke for the previous few days [15], was measured using gas chromatographic techniques.”
MethodMenthol vs nonmenthol cigarettes: effects on smoking behavior.
McCarthy, W. J., Caskey, N. H., Jarvik, M. E., Gross, T. M., Rosenblatt, M. R., & Carpenter, C. L. (1995) · American Journal of Public Health · doi:10.2105/ajph.85.1.67 · Cited by 82
Bupropion for Smoking Cessation: A Randomized Trial
Simon, J. A., Duncan, C., Carmody, T. P., & Hudes, E. S. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.16.1797 · Cited by 81
“We used cotinine levels of 15 ng/mL or higher as an indicator of current tobacco use.(17) For self-reported quitters who had saliva cotinine levels of 15 ng/mL or higher, we ascertained by telephone interview whether they were using NRT at the time the sample was provided.”
MethodCigarette smoking during early pregnancy reduces the number of embryonic germ and somatic cells
Mamsen, L. S., Lutterodt, M. C., Andersen, E. W., Skouby, S. O., Sorensen, K. P., Andersen, C. Y., & Byskov, A. G. (2010) · Human Reproduction · doi:10.1093/humrep/deq215 · Cited by 81
“7 ng/ml in plasma have previously been accepted as a cut-off value for discriminating between smokers and non-smokers (Jarvis et al., 1987).”
BackgroundSmoking during pregnancy and its effects on child cognitive ability from the ages of 8 to 12 years
Fergusson, D. M., & Lloyd, M. (1991) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.1991.tb00700.x · Cited by 81
Ilicali, Ö. C., Keleş, N., Değer, K., Sàgun, Ö. F., & Güldíken, Y. (2001) · The Laryngoscope · doi:10.1097/00005537-200101000-00028 · Cited by 78
“Previous studies that focused on the exposure rates of children have shown that the concentration of cotinine was the best indicator of smoking, with sensitivity of 96% to 97% and specificity of 99% to 100% for urinalysis.(11) Greenberg et al.”
BackgroundRamo, D. E., Thrul, J., Delucchi, K., Hall, S. M., Ling, P. M., Belohlavek, A., & Prochaska, J. J. (2018) · Addiction · doi:10.1111/add.14245 · Cited by 88
“Participants with a salivary cotinine level < 11 ng/ml [38] were considered confirmed non-smokers.”
BackgroundExpired carbon monoxide levels in self‐reported smokers and nonsmokers in prison
Cropsey, K. L., Eldridge, G. D., Weaver, M. F., Villalobos, G. C., & Stitzer, M. L. (2006) · Nicotine & Tobacco Research · doi:10.1080/14622200600789684 · Cited by 78
“In previous research, individuals with expired CO levels of up to 8–10 ppm have been categorized as nonsmokers (Jarvis et al., 1987; Morabia et al., 2001).”
Effects of Large Financial Incentives for Long-Term Smoking Cessation
Etter, J., & Schmid, F. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.04.066 · Cited by 78
“In self-reported nonsmokers who reported use of nicotine medications at follow-up and had a negative carbon monoxide test (0 to 3 ppm) but a NicAlert test $1 (that is, cotinine >10 ng/ml) (17,18), salivary thiocyanate was used to verify smoking abstinence (cutoff: 100 mg/ml) (19,20).”
MethodA double-blind randomized trial of nicotine nasal spray as an aid in smoking cessation
Blöndal, T., Franzon, M., & Westin, Å. (1997) · European Respiratory Journal · doi:10.1183/09031936.97.10071585 · Cited by 77
“Levels of 9 parts per million (ppm) or lower were considered to indicate a nonsmoking status [9].”
BackgroundApplication of biochemical intake markers to passive smoking measurement and risk estimation
Jarvis, M. J. (1989) · Mutation Research/Genetic Toxicology · doi:10.1016/0165-1218(89)90023-2 · Cited by 77
A randomized controlled trial of smoking cessation intervention in pregnancy in an academic clinic
Hartmann, K. E., Thorp, J. M., Pahel-Short, L., & Koch, M. A. (1996) · Obstetrics and Gynecology · doi:10.1016/0029-7844(95)00492-0 · Cited by 76
An Intervention to Reduce Environmental Tobacco Smoke Exposure Improves Pregnancy Outcomes
El-Mohandes, A. A. E., Kiely, M., Blake, S. M., Gantz, M. G., & El‐Khorazaty, M. N. (2010) · PEDIATRICS · doi:10.1542/peds.2009-1809 · Cited by 76
Effectiveness of a smoking cessation intervention in older adults
Tait, R. J., Hulse, G. K., Waterreus, A. J., Flicker, L. A., Lautenschlager, N. T., Jamrozik, K. D., & Almeida, O. P. (2006) · Addiction · doi:10.1111/j.1360-0443.2006.01647.x · Cited by 76
Menthol and nonmenthol cigarettes and smoke exposure in black and white women
Ahijevych, K., Gillespie, J., Demirci, M., & Jagadeesh, J. M. (1996) · Pharmacology Biochemistry and Behavior · doi:10.1016/0091-3057(95)02034-9 · Cited by 76
Metadata
- 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 › Public Health, Environmental and Occupational Health › 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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