• Gina F Marrone, Diaa M Shakleya, Karl B Scheidweiler, Edward G Singleton, Marilyn A Huestis, and Stephen J Heishman.
• Nicotine Psychopharmacology Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA.
• Addiction. 2011 Jul 1; 106 (7): 1325-34.

AimsMany 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.DesignCross-sectional study.SettingUrban drug addiction research and treatment facility.ParticipantsNinety non-treatment-seeking smokers and 82 non-smokers.MeasurementsParticipants 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).FindingsAn 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.ConclusionsIn 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.© 2011 Society for the Study of Addiction. No claim to original US government works.

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