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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Method
Urinary Cadmium and Cotinine Levels and Hair Mercury Levels in Czech Children and Their Mothers Within the Framework of the COPHES/DEMOCOPHES Projects
Forysová, K., Grafnetterová, A. P., Malý, M., Krsková, A., Mráz, J., Kašparová, L., Čejchanová, M., Sochorová, L., Rödlová, S., & Černá, M. (2017) · Archives of Environmental Contamination and Toxicology · doi:10.1007/s00244-017-0412-y · Cited by 11
Live counselor contact in a Facebook intervention predicts smoking cessation outcomes.
Thrul, J., Meacham, M. C., Tice, C. L., Kelly, O. A., & Ramo, D. E. (2019) · Psychology of Addictive Behaviors · doi:10.1037/adb0000541 · Cited by 11
The Preliminary Efficacy and Feasibility of Group-Based Smoking Cessation Treatment Program for Incarcerated Smokers
Valera, P. A., Acuna, N., & Vento, I. (2020) · American Journal of Men s Health · doi:10.1177/1557988320943357 · Cited by 11
“The Smokerlyzer measures exhaled CO levels in parts per million (ppm), which calculates percent carboxyhemoglobin (%COHb) in the blood based on exhaled breath CO concentration, which is reported to be highly correlated with smoking status (Jarvis et al., 1987; Middleton & Morice, 2000).”
Background
Association of exhaled carbon monoxide with risk of cardio-cerebral-vascular disease in the China Kadoorie Biobank cohort study
Qiu, G., Yu, K., Yu, C., Li, W., Lv, J., Guo, Y., Bian, Z., Yang, L., Chen, Y., Chen, Z., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-76353-2 · Cited by 11
Single gas chromatography method with nitrogen phosphorus detector for urinary cotinine determination in passive and active smokers
Malafatti, L., Maia, P. P., Martins, M. C. G., de Siqueira, M. E. P. B., & Martins, I. (2010) · Brazilian Journal of Pharmaceutical Sciences · doi:10.1590/s1984-82502010000400019 · Cited by 11
“These biochemical markers have been used to estimate active smoking behavior, to validate abstinence from smoking and to evaluate the levels and significance of environmental tobacco smoke (ETS) exposure (Benowitz, 1996).”
Background
Psychosocial Withdrawal Characteristics of Nicotine Compared with Alcohol and Caffeine
Miyata, H., Hironaka, N., Takada, K., Miyasato, K., Nakamura, K., & Yanagita, T. (2008) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1432.030 · Cited by 11
Smoking and urinary cotinine by socioeconomic status in the Heinz Nixdorf Recall Study
Hovanec, J., Weiß, T., Koch, H. M., Pesch, B., Behrens, T., Kendzia, B., Arendt, M., Dragano, N., Moebus, S., Schmidt, B., et al. (2019) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2018-211952 · Cited by 11
An evaluation of niccheck i®
Leischow, S. J., Merikle, E. P., Cook, G. N., Newman, R., & Muramoto, M. L. (1999) · Addictive Behaviors · doi:10.1016/s0306-4603(98)00042-2 · Cited by 11
Psychometric Properties of Health Risk Attitude Measures in Predicting Cessation Among Pregnant Smokers
O'Connor, A. M. C., Davies, B. L., Dulberg, C. S., Buhler, P. L., Nadon, C., Hastings-McBride, B., & Benzie, R. J. (1993) · Medical Care · doi:10.1097/00005650-199307000-00008 · Cited by 11
Observer reports of smoking status: A replication
Hughes, J. R. (1992) · Journal of Substance Abuse · doi:10.1016/0899-3289(92)90046-z · Cited by 11
Effectiveness of performance coaching for enhancing rates of smoking cessation treatment delivery by primary care providers: Study protocol for a cluster randomized controlled trial
Papadakis, S., Pipe, A., Reid, R. D., Tulloch, H. E., Mullen, K., Assi, R., Cole, A. G., & Wells, G. A. (2015) · Contemporary Clinical Trials · doi:10.1016/j.cct.2015.08.013 · Cited by 10
Effect of Second-Hand Smoke Exposure on Establishing Urinary Cotinine-Based Optimal Cut-Off Values for Smoking Status Classification in Korean Adults
Lee, H., Cho, J., Lee, Y.-J., & Park, D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19137971 · Cited by 10
“Urinary cotinine is a noninvasive biomarker, and it has comparable diagnostic performance for tobacco smoke exposure to serum cotinine [13,14].”
Background
Association of N,N-diethyl-m-toluamide (DEET) with obesity among adult participants: Results from NHANES 2007–2016
Cui, Q., Zhu, X., Guan, G., Hui, R., Zhu, L., & Wang, J. (2022) · Chemosphere · doi:10.1016/j.chemosphere.2022.135669 · Cited by 10
A general health promotion approach to helping smokers with non-communicable diseases quit smoking: A pilot randomized controlled trial
Li, W. H. C., Ho, L. L. K., Cheung, A. T., Man Ping, W. O. N. G., Cheung, Y. T. D., Xia, W., & Lam, T. H. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.957547 · Cited by 10
“This involved measuring the carbon monoxide level in the participant’s expired air and the cotinine levels in their saliva in a parallel test; a carbon monoxide level of <4 ppm in the expired air and a salivary cotinine level of less than 115 ng/mL (28) were considered to be in good agreement with self-reported 7-day…”
Method
Differentiating Between Smokers and Nonsmokers Using Serum Cotinine
Tompkins, E. L., Beltran, T., & Bedno, S. A. (2019) · Biomarkers in Medicine · doi:10.2217/bmm-2019-0027 · Cited by 10
Circulating B-Vitamins and Smoking Habits Are Associated with Serum Polyunsaturated Fatty Acids in Patients with Suspected Coronary Heart Disease: A Cross-Sectional Study
Skeie, E., Strand, E., Pedersen, E. R., Bjørndal, B., Bohov, P., Berge, R. K., Svingen, G. F. T., Seifert, R., Ueland, P. M., Midttun, Ø., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0129049 · Cited by 10
“Since both cigarette smoke [14] and smokeless tobacco [52] affects the circulating B-Vitamins and Smoking Habits Are Associated with Serum PUFAs”
Background
Reliability of Self-Reported Nicotine Use as Determined by Serum Cotinine Levels in Patients Referred for Liver Transplantation
Bright, R. P., Martin, K. A., & Krahn, L. E. (2010) · Psychosomatics · doi:10.1016/s0033-3182(10)70721-0 · Cited by 10
Chronic distress and acute vascular stress responses associated with ambulatory blood pressure in low-testosterone African men: the SABPA Study
Malan, N. T., Tobias Stalder, A., Schlaich, M. P., Lambert, G. W., Hamer, M., Schutte, A. E., Huisman, H. W., Schutte, R., Smith, W. T., Mels, C. M. C., et al. (2013) · Journal of Human Hypertension · doi:10.1038/jhh.2013.124 · Cited by 10
Analysis of circulating insulin-like growth factor-1 (IGF-1) and IGF binding protein-3 (IGFBP-3) in tobacco smokers and non-smokers
Palmer, R., Wilson, R. F., Coward, P. Y., & Scott, D. A. (2003) · Tobacco Induced Diseases · doi:10.1186/1617-9625-1-2-157 · Cited by 10
“serum cotinine [35].”
Associations between coherent neural activity in the brain’s value system during antismoking messages and reductions in smoking.
Cooper, N., Tompson, S., O’Donnell, M. B., Vettel, J. M., Bassett, D. S., & Falk, E. B. (2018) · Health Psychology · doi:10.1037/hea0000574 · Cited by 11
“…Jasinska et al., 2012), and have been shown to have a moderate to high correlation with physiological metrics such as expired CO (Falk et al., 2011; Jarvis et al., 1987; Middleton and Morice, 2000) and saliva and serum cotinine (Etter et al., 2000; Patrick et al., 1994; Pokorski et al., 1994;…”
Nicotine and cotinine replacement when nicotine nasal spray is used to quit smoking
Jones, R. L., Nguyen, A., & Man, S. F. P. (1998) · Psychopharmacology · doi:10.1007/s002130050629 · Cited by 10
“It is important to note that the baseline/3-month ratio for cotinine, which has a longer biological half-life than nicotine ( Jarvis et al. 1987 ), was higher than that for COE.”
Result
Validation of Urinary Thiocyanate as a Robust Biomarker of Active Tobacco Smoking in the Prospective Urban and Rural Epidemiological Study
Mathiaparanam, S., Gill, B., Sathish, T., Paré, G., Teo, K. K., Yusuf, S., & Britz‐McKibbin, P. (2023) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntad027 · Cited by 10
A randomized clinical trial to determine the effectiveness of CO-oximetry and anti-smoking brief advice in a cohort of kidney transplant patients who smoke: study protocol for a randomized controlled trial
Pita‐Fernández, S., Seijo-Bestilleiro, R., Pértega-Díaz, S., Alonso-Hernández, Á., Fernández-Rivera, C., Cao-López, M., Seoane‐Pillado, T., López‐Calviño, B., González-Martín, C., & Valdés-Cañedo, F. (2016) · Trials · doi:10.1186/s13063-016-1311-7 · Cited by 9
“In relation to self-reported consumption of tobacco the validity is questioned because of the belief that smokers tend to underestimate the amount they smoke [40–43].”
Background
Anxiety and Depressed Mood Decline Following Smoking Abstinence in Adult Smokers with Attention Deficit Hyperactivity Disorder
Covey, L. S., Hu, M., Winhusen, T. M., Lima, J. E., Berlin, I., & Nunes, E. V. (2015) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2015.07.004 · Cited by 9
Study protocol: A cluster randomised controlled trial of implementation intentions to reduce smoking initiation in adolescents
Conner, M. T., Grogan, S., Lawton, R., Armitage, C. J., West, R. M., Siddiqi, K., Gannon, B., Torgerson, C. J., Flett, K., & Simms‐Ellis, R. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-54 · Cited by 9
Prevalence and validity of self-reported smoking in Indigenous and non-Indigenous young adults in the Australian Northern Territory
Pearce, M. S., Mann, K. D., Singh, G., Davison, B., & Sayers, S. M. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-861 · Cited by 9
“We used a discriminative cut-off of 50 ng/ml, in line with previous studies [14,17,19].”
BackgroundMethodResult
Smokeless and Dual Tobacco Use Among Males Surviving Childhood Cancer: A Report From the Childhood Cancer Survivor Study
Klosky, J. L., Clawson, A. H., Zhang, N., Ali, K. S., Srivastava, D. K., Klesges, R. C., Emmons, K. M., Ness, K. K., Stovall, M., Robison, L. L., et al. (2013) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-12-1302 · Cited by 9
“Future designs should consider strategies that will increase the validity of tobacco use outcomes such as biochemical verification or bogus pipeline (25).”
Background
Optimal Carbon Monoxide Criteria to Confirm Smoking Status Among Postpartum Women
Emery, R. L., & Levine, M. D. (2015) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntv196 · Cited by 9
Associations of thiocyanate, nitrate, and perchlorate exposure with dyslipidemia: a cross-sectional, population-based analysis
Shi, M., Zhu, X., Cheang, I., Zhu, Q., Guo, Q., Liao, S., Gao, R., & Li, X. (2022) · Environmental Science and Pollution Research · doi:10.1007/s11356-022-23296-y · Cited by 9
“Individuals with a cotinine level > 14 ng/mL were classified as smokers (Jarvis et al. 1987).”
Background
Computerized scheduled gradual reduction for smokeless tobacco cessation: development and preliminary evaluation of a self-help program
Jerome, A., Fiero, P. L., & Behar, A. (2000) · Computers in Human Behavior · doi:10.1016/s0747-5632(00)00024-8 · Cited by 9
Measurement of Markers of Tobacco Smoking in Patients with Coronary Heart Disease
Archbold, G. P. R., Cupples, M., Mcknight, A., & Linton, T. (1995) · Annals of Clinical Biochemistry International Journal of Laboratory Medicine · doi:10.1177/000456329503200213 · Cited by 9
Mixture randomized item‐response modeling: a smoking behavior validation study
Fox, J., Avetisyan, M., & van der Palen, J. A. M. (2013) · Statistics in Medicine · doi:10.1002/sim.5859 · Cited by 9
“Many methods are based on the determination of the levels of nicotine and its metabolites in blood or urine, as well as the traces of carbon monoxide (CO) in blood and saliva [7].”
Method

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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