Cited by 994Smoking Behavior and CessationChronic Obstructive Pulmonary Disease (COPD) ResearchPrenatal Substance Exposure Effects

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Comparison of tests used to distinguish smokers from nonsmokers

Jarvis, M J, Tunstall-Pedoe, H, Feyerabend, C, Vesey, C, Saloojee, Y·1987·American Journal of Public Health

DOI 10.2105/ajph.77.11.1435

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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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Background
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Cooley, M. E., Wang, Q., Johnson, B. E., Catalano, P. J., Haddad, R. I., Bueno, R., & Emmons, K. M. (2011) · Lung Cancer · doi:10.1016/j.lungcan.2011.10.005 · Cited by 47
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Background
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Method
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Method
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Manzoli, L., Vecchia, C. L., Flacco, M. E., Capasso, L., Simonetti, V., Boccia, S., Baldassarre, A. D., Villari, P., Mezzetti, A., & Cicolini, G. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-883 · Cited by 43
“to find a seller of cotinine portable tests on saliva, and the measurement of breath CO still showed high levels of sensitivity (>90% [27,28]).”
Background
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Generalized confidence intervals for the ratio of means of two normal populations
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Background
Effects of Isometric Exercise on Subfoveal Choroidal Blood Flow in Smokers and Nonsmokers
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Background
Patterns of Cigarette Consumption and Cotinine Levels Among African American Women Smokers
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Baltar, V. T., Xun, W. W., Chuang, S., Relton, C. L., Ueland, P. M., Vollset, S. E., Midttun, Ø., Johansson, M., Slimani, N., Jenab, M., et al. (2011) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-10-1235 · Cited by 43
“A range of studies show that cotinine levels are positively related to the number of hours of passive tobacco exposure (26) or with the number of cigarettes actively smoked(10, 15, 16, 24), but none have compared never- and former-smokers.”
Background
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Result
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“4,4(1,9-10,1) 1,02(1,01-1,03) 1,10(1,04-1,19) 2,09 (0,97-4,49)”
Comparing smoking and smoking cessation process in the Republic of Karelia, Russia and North Karelia, Finland.
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“Reported sensitivities and specificities for exhaled carbon monoxide to classify active smoking are typically in the range of 80–90% (7, 30), implying mis-classification rates as high as 20%.”
BackgroundInfluential
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Hilberink, S. R., Jacobs, J., Opstal, S. V., van der Weijden, T., Keegstra, J., Hilberink, S. R., Muris, J. W. M., Grol, R. P. T. M., & de Vries, H. (2011) · International Journal of General Medicine · doi:10.2147/ijgm.s15231 · Cited by 40
Defensive coping facilitates higher blood pressure and early sub-clinical structural vascular disease via alterations in heart rate variability: The SABPA study
Malan, L., Hamer, M., Schlaich, M. P., Lambert, G. W., Ziemssen, T., Reimann, M., Frasure‐Smith, N., Amirkhan, J. H., Schutte, R., van Rooyen, J. M., et al. (2013) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2013.01.001 · Cited by 40
“Serum cotinine levels, a metabolite of nicotine, were used as a marker of smoking status where>15 mg/L was regarded as being indicative of a smoker [12].”
Method
Developing Analytical Applications for Parahydrogen Hyperpolarization: Urinary Elimination Pharmacokinetics of Nicotine
Reimets, N., Ausmees, K., Vija, S., & Reile, I. (2021) · Analytical Chemistry · doi:10.1021/acs.analchem.1c01281 · Cited by 40
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Effectiveness of physicians-in-training counseling for smoking cessation in African Americans.
Allen, B., Pederson, L. L., & Leonard, E. (1998) · PubMed Central · Cited by 40
Evaluation of two biological markers of tobacco exposure
Ruth, K. J., & Neaton, J. D. (1991) · Preventive Medicine · doi:10.1016/0091-7435(91)90056-a · Cited by 40
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“Cotinine, the primary metabolite of nicotine, can be detected in serum, saliva, and urine; has a long half-life (approximately 16 hours); fluctuates much less than CO on a day-to-day basis; and can quantify smoking habit over the preceding 3 to 4 days.(22) Despite these obvious advantages, urinary cotinine measurement…”
Background
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“Other commonly used biochemical measures of both active smoking and exposure to environmental tobacco smoke (ETS) include the determination of thiocyanate in blood, saliva and urine, carboxyhemoglobin (COHb), and carbon monoxide in exhaled breath (1, 6).”
Influential
Waterpipe Tobacco Dependence in U.K. Male Adult Residents: A Cross-Sectional Study
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Veracidad de la respuesta de los fumadores sobre su abstinencia en las consultas de deshabituación tabáquica
Barrueco, M., Ruiz, C. J., Palomo, L., Torrecilla, M., Romero, P., & Riesco, J. A. (2005) · Archivos de Bronconeumología · doi:10.1157/13071584 · Cited by 39
“CO < 10 ppm 621 607 569 556 403 75,70% 0,59 78,20% 82,20% 77,30% 59,30% (72,8-78,7) (75,3-81,1) (79,4-85,1) (74,3-80,4) (55,7-63,0)”
Determination of a saliva cotinine cut‐off to distinguish pregnant smokers from pregnant non‐smokers
Hegaard, H. K., Kjærgaard, H. W., Møller, L. F., Wachmann, H., & Ottesen, B. (2007) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1080/00016340601147517 · Cited by 39
“(10) found the optimum value of saliva cotinine, which could distinguish smokers from non-smokers, to be 14.”
Background
Elastin-Derived Peptides and Neutrophil Elastase in Bronchoalveolar Lavage Fluid
Betsuyaku, T., Nishimura, M., Yoshioka, A., Takeyabu, K., Miyamoto, K., & Kawakami, Y. (1996) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.154.3.8810611 · Cited by 39
Minor recurrent aphthous stomatitis and smoking: an epidemiological study measuring plasma cotinine
Atkin, P., Xu, X., & Thornhill, M. H. (2002) · Oral Diseases · doi:10.1034/j.1601-0825.2002.01826.x · Cited by 39
An iterative technique for identifying smoking deceivers with application to the Scottish heart health study
Woodward, M., & Tunstall‐Pedoe, H. (1992) · Preventive Medicine · doi:10.1016/0091-7435(92)90008-6 · Cited by 39
Health economics: the end of clinical freedom?
Williams, A. (1988) · BMJ · doi:10.1136/bmj.297.6657.1183 · Cited by 39
Agreement between Self-Reported Smoking and Cotinine Concentration in Adolescents: A Validation Study in Brazil
Malcon, M. C., Menezes, A. M. B., Assunção, M. C. F., Neutzling, M. B., & Hallal, P. C. (2008) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2008.02.002 · Cited by 45
Using expired air carbon monoxide to determine smoking status during pregnancy: Preliminary identification of an appropriately sensitive and specific cut-point
Bailey, B. A. (2013) · Addictive Behaviors · doi:10.1016/j.addbeh.2013.05.011 · Cited by 38
Validity of self-reported adult secondhand smoke exposure
Prochaska, J. J., Grossman, W., Young‐Wolff, K. C., & Benowitz, N. L. (2013) · Tobacco Control · doi:10.1136/tobaccocontrol-2013-051174 · Cited by 38
“From medical records, we obtained information on patients ’ age, gender, marital status and ethnicity with coding limited to Hispanic versus non-Hispanic.”
Method
Optimum Cutoff Value of Urinary Cotinine Distinguishing South Korean Adult Smokers From Nonsmokers Using Data From the KNHANES (2008–2010)
Kim, S., & Jung, A. (2013) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntt027 · Cited by 38
A randomized controlled trial of smoking cessation methods in patients newly-diagnosed with pulmonary tuberculosis
Aryanpur, M., Hosseini, M., Masjedi, M. R., Mortaz, E., Tabarsi, P., Soori, H., Emami, H., Heidari, G., Dizagie, M. K., & Baikpour, M. (2016) · BMC Infectious Diseases · doi:10.1186/s12879-016-1727-4 · Cited by 38
“Finally smoking cessation was evaluated in all three groups by assessing the expiratory carbon monoxide (CO) concentration via PICO Smokerlysers device (Bedfont Scientific Maidstone, UK) based on standard criteria [28].”
Method
Preventing Alcohol and Tobacco Exposed Pregnancies: CHOICES Plus in Primary Care
Velasquez, M. M., von Sternberg, K. L., Floyd, R. L., Parrish, D. E., Kowalchuk, A. A., Stephens, N. S., Ostermeyer, B. K., Green, C., Seale, J. P., & Mullen, P. D. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2017.02.012 · Cited by 38
Longer term exposure to secondhand smoke and health outcomes in COPD: Impact of urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol
Eisner, M. D., Jacob, P., Benowitz, N. L., Balmes, J. R., & Blanc, P. D. (2009) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntp091 · Cited by 38
Response of retinal blood flow to systemic hyperoxia in smokers and nonsmokers
Wimpissinger, B., Resch, H., Berisha, F., Weigert, G., Schmetterer, L. F., & Polak, K. (2005) · Graefe s Archive for Clinical and Experimental Ophthalmology · doi:10.1007/s00417-004-1083-8 · Cited by 38
“[10].”
The construct of internalization: conceptualization, measurement, and prediction of smoking treatment outcome
Acton, G. S., KUNZ, J. D., Wilson, M. R., & Hall, S. M. (2005) · Psychological Medicine · doi:10.1017/s0033291704003083 · Cited by 38
“Third, urine samples must have shown cotinine levels off60 ng/ml (Jarvis et al. 1987).”
Background
Smoking-Cessation and Adherence Intervention Among Chinese Patients with Erectile Dysfunction
Chan, S. S. C., Leung, D. Y. P., Abdullah, A. S. M., Lo, S. S. T., Yip, A. W. C., Kok, W., Ho, S. Y., & Lam, T.-H. (2010) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2010.05.006 · Cited by 37
Oral tobacco cessation with UK resident Bangladeshi women: a community pilot investigation
Croucher, R. E. (2003) · Health Education Research · doi:10.1093/her/18.2.216 · Cited by 38
The effect of a minimal contact smoking cessation programme in out-patients with chronic obstructive pulmonary disease: a pre–post-test study
Monninkhof, E. M., van der Valk, P., van der Palen, J. A. M., Mulder, H., Pieterse, M. E., van Herwaarden, C., & Zielhuis, G. G. (2003) · Patient Education and Counseling · doi:10.1016/s0738-3991(03)00096-x · Cited by 38
“Literature suggests proportions of smoking deceivers varying from 4 to 24% in patients with coronary heart disease, not participating in smoking cessation trials [20,21,31–34].”
Background
Gas stove use and respiratory health among adults with asthma in NHANES III
Eisner, M. D., & Blanc, P. D. (2003) · Occupational and Environmental Medicine · doi:10.1136/oem.60.10.759 · Cited by 38
Prohypertensive Effect of Gestational Personal Exposure to Fine Particulate Matter. Prospective Cohort Study in Non-smoking and Non-obese Pregnant Women
Jedrychowski, W. A., Perera, F. P., Maugeri, U., Spengler, J. D., Mróz, E., Flak, E., Stigter, L., Majewska, R., Kaim, I., Sowa, A., et al. (2012) · Cardiovascular Toxicology · doi:10.1007/s12012-012-9157-z · Cited by 37
“0 ng/L was considered the borderline separating smokers from non-smokers [22, 23].”
Background
Tobacco dependence treatment for hospitalized smokers: A randomized, controlled, pilot trial using varenicline
Steinberg, M. B., Randall, J., Greenhaus, S., Schmelzer, A. C., Richardson, D. L., & Carson, J. L. (2011) · Addictive Behaviors · doi:10.1016/j.addbeh.2011.07.002 · Cited by 37
The efficacy of vigorous-intensity exercise as an aid to smoking cessation in adults with elevated anxiety sensitivity: study protocol for a randomized controlled trial
Smits, J. A. J., Zvolensky, M. J., Rosenfield, D., Marcus, B. H., Church, T. S., Frierson, G. M., Powers, M. B., Otto, M. W., Davis, M. L., Hopkins, L. B., et al. (2012) · Trials · doi:10.1186/1745-6215-13-207 · Cited by 37
“Expired air carbon monoxide levels are assessed with a carbon monoxide monitor [62].”
Simultaneous, rapid, and sensitive quantification of 8-hydroxy-2′-deoxyguanosine and cotinine in human urine by on-line solid-phase extraction LC-MS/MS: correlation with tobacco exposure biomarkers NNAL
Chen, C.-Y., Jhou, Y., Lee, H., & Lin, Y.-W. (2016) · Analytical and Bioanalytical Chemistry · doi:10.1007/s00216-016-9741-3 · Cited by 37
Oxidative stress and DNA damage status in couples undergoing in vitro fertilization treatment
Al‐Saleh, I., Coşkun, S., Al-Rouqi, R., Al-Rajudi, T., Eltabache, C., Abduljabbar, M., & Hassan, S. S. M. (2021) · Reproduction and Fertility · doi:10.1530/raf-20-0062 · Cited by 37
“A 50 μg/L cut-off of COT level in urine was employed to distinguish active smokers from nonsmokers (Jarvis et al. 1987).”
Method
The relationship between urinary phthalate metabolites and polycystic ovary syndrome in women undergoing in vitro fertilization: Nested case-control study
Al‐Saleh, I. (2021) · Chemosphere · doi:10.1016/j.chemosphere.2021.131495 · Cited by 38
Nicotine patch use in pregnant smokers: smoking abstinence and delivery outcomes
Schroeder, D. R., Ogburn, P. L., Hurt, R. D., Croghan, I. T., Ramin, K. D., Offord, K. P., & Moyer, T. P. (2002) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/jmf.11.2.100.107 · Cited by 37
Mortality Rates in Treated Hypertensive Men With Additional Risk Factors Are High But Can Be Reduced A Randomized Intervention Study
Fagerberg, B. (1998) · American Journal of Hypertension · doi:10.1016/s0895-7061(97)00363-4 · Cited by 37
“drugs 66 (26) 62 (25) 38 (17) 51 (22) 18 (11) 15 (8)”
Assessment of tidal breathing parameters in infants with cystic fibrosis
Ranganathan, S., GOETZ, I. A., Hoo, A., Lum, S., Castle, R. A., Stocks, J., & Dezateux, C. A. (2003) · European Respiratory Journal · doi:10.1183/09031936.03.00024703 · Cited by 37
“Exposure to maternal smoking pre and postnatally was assessed from maternal report and current smoking habits confirmed by maternal salivary cotinine [ 18 ].”
Method
Use of urine cotinine to validate smoking self-reports in U.S. Navy recruits
Pokorski, T. L., Chen, W. W., & Bertholf, R. L. (1994) · Addictive Behaviors · doi:10.1016/0306-4603(94)90067-1 · Cited by 37
Motivational interviewing as a smoking cessation strategy with nurses: An exploratory randomised controlled trial
Mujika, A., Forbes, A., Canga‐Armayor, N., de Irala, J., Serrano, I., García, P. G., & Edwards, M. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2013.12.001 · Cited by 36
“Urine cotinine was selected as marker for its sensitivity (97%) and specificity (99%) (Jarvis et al., 1987; Velicer et al., 1992).”
Background
Association of secondhand smoke exposure with mental health in men and women: Cross-sectional and prospective analyses using the UK Health and Lifestyle Survey
Lam, E. T. P., Kvaavik, E., Hamer, M., & Batty, G. D. (2012) · European Psychiatry · doi:10.1016/j.eurpsy.2012.04.001 · Cited by 36
The prevalence of smoking and the knowledge of smoking hazards and smoking cessation strategies among HIV- positive patients in Johannesburg, South Africa
Waweru, P., Anderson, R., Steel, H. C., Venter, F., Murdoch, D. M., & Feldman, C. H. (2013) · South African Medical Journal · doi:10.7196/samj.7388 · Cited by 36
“It has a comparatively long half-life of about 17 hours in body fluid and is widely accepted as a sensitive and reliable marker of exposure to cigarette smoke and is considered to be more reliable than smoking history in determining smoking status[12].”
Alteration of the material properties of the normal supraspinatus tendon by nicotine treatment in a rat model
Ichinose, R., Sano, H., Kishimoto, K. N., Sakamoto, N., Sato, M., & Itoi, E. (2010) · Acta Orthopaedica · doi:10.3109/17453674.2010.524595 · Cited by 36
Partner Support, Psychological Treatment, and Nicotine Gum in Smoking Treatment: An Incremental Study
Ginsberg, D., Hall, S. M., & Rosinski, M. (1992) · International Journal of the Addictions · doi:10.3109/10826089209063465 · Cited by 36
Utility and Relationships of Biomarkers of Smoking in African-American Light Smokers
Ho, M., Faseru, B., Choi, W. S., Nollen, N. L., Mayo, M. S., Thomas, J., Okuyemi, K. S., Ahluwalia, J. S., Benowitz, N. L., & Tyndale, R. F. (2009) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-09-0956 · Cited by 36
“Traditional cutoff levels of expired CO and plasma COT for differentiating between smokers and nonsmokers have previously been determined primarily in heavy smoking Caucasian populations (2, 31).”
BackgroundMethod
Women Who Spontaneously Quit Smoking in Early Pregnancy
Panjari, M., Bell, R. J., Astbury, J., Bishop, S. M., Dalais, F., & Rice, G. E. (1997) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.1997.tb02407.x · Cited by 36
“Driving 13/190 (7) 3061406 (24) Bortd 13/190 (7) 17W406 (42) Need tirne to self 3/190 (2) 63/406 (15) Get strong physical mving 27/190 (14) 1W406 (47) Under pressure fmm children 51190 (3) 771406 (19) Under pressure from work 20/190 (10) 81/406 (20) Under pressure fmm demands 10/190 (5 ) W406 (20) Feerig d i t a b l c…”
Background
The inside scoop on the stuff called snuff: An interview study of 94 adult male smokeless tobacco users
Severson, H. H., Eakin, E., Lichtenstein, E. H., & Stevens, V. J. (1990) · Journal of Substance Abuse · doi:10.1016/s0899-3289(05)80047-1 · Cited by 36

Authors: Jarvis, M. J., Tunstall-Pedoe, H., Feyerabend, C., Vesey, C., & Saloojee, Y.
ORCID: Jarvis, M J
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
DOI: 10.2105/ajph.77.11.1435
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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Comparison of tests used to distinguish smokers from nonsmokers

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