Relative performance of common biochemical indicators in detecting cigarette smoking

Gina F. Marrone, Diaa M. Shakleya, Karl B. Scheidweiler, Edward G. Singleton, Marilyn A. Huestis, Stephen J. Heishman

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Aims Many cities have banned indoor smoking in public places. Thus, an updated recommendation for a breath carbon monoxide (CO) cut-off is needed that optimally determines smoking status. We evaluated and compared the performance of breath CO and semiquantitative cotinine immunoassay test strips (urine and saliva NicAlert®) alone and in combination. Design Cross-sectional study. Setting Urban drug addiction research and treatment facility. Participants Ninety non-treatment-seeking smokers and 82 non-smokers. Measurements Participants completed smoking histories and provided breath CO, urine and saliva specimens. Urine and saliva specimens were assayed for cotinine by NicAlert® and liquid chromatography-tandem mass spectrometry (LCMSMS). Findings An optimal breath CO cut-off was established using self-report and LCMSMS analysis of cotinine, an objective indicator, as reference measures. Performance of smoking indicators and combinations were compared to the reference measures. Breath CO ≥5 parts per million (p.p.m.) optimally discriminated smokers from non-smokers. Saliva NicAlert® performance was less effective than the other indicators. Conclusions In surveys of smokers and non-smokers in areas with strong smoke-free laws, the breath carbon monoxide cut-off that discriminates most effectively appears to be ≥5p.p.m. rather than the ≥10p.p.m. cut-off often used. These findings may not generalize to clinical trials, regions with different carbon monoxide pollution levels or areas with less stringent smoke-free laws.

Original languageEnglish (US)
Pages (from-to)1325-1334
Number of pages10
Issue number7
StatePublished - Jul 2011
Externally publishedYes


  • Assays
  • Biomarker
  • Carbon monoxide
  • Cigarette smokers
  • Cotinine
  • Nicotine
  • Non-smokers
  • Saliva
  • Urine

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health
  • General Medicine


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