Relative performance of common biochemical indicators in detecting cigarette smoking

• Published in: Addiction (Abingdon, England) Vol. 106; no. 7; pp. 1325 - 1334
• Main Authors: Marrone, Gina F., Shakleya, Diaa M., Scheidweiler, Karl B., Singleton, Edward G., Huestis, Marilyn A., Heishman, Stephen J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2011; Blackwell
• Subjects: Addictive behaviors; Adolescent; Adult; Adult and adolescent clinical studies; Assays; Biochemistry; Biological and medical sciences; biomarker; Biomarkers - metabolism; Breath Tests; carbon monoxide; Carbon Monoxide - analysis; Cigarette industry; cigarette smokers; Cities; cotinine; Cotinine - analysis; Cotinine - pharmacokinetics; Cross-sectional analysis; Cross-Sectional Studies; Data Interpretation, Statistical; Drug abuse; Drug Addiction; Drug testing; Drug use; Drug users; Drugs; Female; Half-Life; Humans; Immunoassay - standards; Law; Male; Medical Research; Medical sciences; nicotine; non-smokers; Pollution; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reagent Kits, Diagnostic - standards; Reference Standards; saliva; Saliva - chemistry; Self Report; Sensitivity and Specificity; Smoking; Smoking - legislation & jurisprudence; Smoking - metabolism; Surveys; Tandem Mass Spectrometry; Tobacco; Tobacco Smoke Pollution - analysis; Tobacco Smoke Pollution - legislation & jurisprudence; Tobacco smoking; Tobacco, tobacco smoking; Toxicology; Treatment Programs; Urban Areas; Urban Population; urine; Performance evaluation; Psychotropic; Tobacco smoking; Biological marker; Assays; Cigarette; Assay; Alkaloid; Smoker; Quality; Antidepressant agent; Carbon monoxide; Cotinine; Human; Urine; Drug addiction; CNS stimulant; non-smokers; biomarker; cigarette smokers; Indicator; Non smoker; Tobacco; Addiction; Saliva; Nicotine
• ISSN: 0965-2140; 1360-0443; 1360-0443
• DOI: 10.1111/j.1360-0443.2011.03441.x

ABSTRACT 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 ≥5 p.p.m. rather than the ≥10 p.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.