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Assessment of the accuracy of salivary cotinine readings from NicAlert strips against a liquid chromatography tandem mass spectrometry assay in self‐reported non‐smokers who passed carbon monoxide but failed NicAlert validation
Author(s) -
Etter JeanFrançois
Publication year - 2019
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.14775
Subject(s) - cotinine , chromatography , tandem mass spectrometry , chemistry , liquid chromatography–mass spectrometry , mass spectrometry , nicotine , saliva , medicine , biochemistry
Background and Aims NicAlert produces semi‐quantitative assessments of cotinine levels in saliva or urine for verification of smoking abstinence. This study aimed to assess the accuracy of NicAlert readings against a liquid chromatography tandem mass spectrometry assay in smokers who had passed expired‐air carbon monoxide (CO) verification but failed NicAlert verification. Design Comparison of NicAlert readings against readings from a reference assay using liquid chromatography tandem mass spectrometry. Setting Geneva, Switzerland. Participants Self‐reported non‐smokers ( n = 92) who in previous testing had CO of 0–3 parts per million (indicating no recent smoking) and reported not using any nicotine product, but had NicAlert readings ≥ 1 (indicating smoking). Measurements NicAlert produces readings of 0, 1 and 2+, which are reported by the manufacturer to correspond to saliva cotinine concentrations of 0–10 ng/ml (indicating not smoking), 10–30 ng/ml and 30+ ng/ml, respectively. Liquid chromatography tandem mass spectrometry was used as the reference. Findings For 82 participants with a NicAlert reading of 1, only two of the liquid chromatography tandem mass spectrometry values were within the purported range of 10–30 ng/ml; 71 were below 4 ng/ml and half the values were below 0.5 ng/ml. Two of the eight participants with NicAlert readings of 2 had laboratory values within the designated range. Neither of the two participants with NicAlert readings of 3 had a cotinine value within the designated range. Conclusions In people who had passed carbon monoxide verification, NicAlert readings yielded a very high false‐positive rate in detecting levels of cotinine indicative of smoking.