The Accuracy of a Lower-Cost Breath Carbon Monoxide Meter in Distinguishing Smokers from Non-smokers

Abstract

Breath carbon monoxide (CO) is a biochemical marker of recent cigarette smoking (see Bittoun, 2008; Society for Research on Nicotine and Tobacco Subcommittee on Biochemical Verification, 2002). Breath CO correlates well with other established assays of cigarette smoking, such as COHb concentration in blood samples (Hald, Overgaard, & Grau, 2003; Jarvis, Belcher, Vesey, & Hutchison, 1986), and urinary cotinine levels (Marrone, Paulpillai, Evans, Singleton, & Heishman, 2010; Marrone et al., 2011), and has high levels of sensitivity and specificity in distinguishing between cigarette smokers and non-smokers (Javors, Hatch, & Lamb, 2005; MacLaren et al., 2010; Perkins, Karelitz, & Jao, 2013; Raiff, Faix, Turturici, & Dallery, 2010). Further, as the collection of blood or urine samples is relatively invasive, breath CO provides a useful assay for researchers, clinicians, and physicians as a non-invasive, efficient method for assessing recent cigarette smoking. The clinical utility of breath CO has been established in a variety of contexts and across several populations of smokers. For example, adolescent (National Survey on Drug Use and Health, 2011) and pregnant (Cnattingius, 2004) smokers represent vital target populations for smoking prevention and cessation efforts. Given the often surreptitious nature of cigarette smoking in these populations, breath CO provides an accurate and reliable method for verifying self-report assessments, which may be unreliable under some conditions (Dolcini, Adler, Lee, & Bauman, 2003; Shipton et al., 2009). Breath CO has also been used as a sensitive measure for the verification of smoking abstinence in the context of behavioural interventions for smoking cessation (i.e., contingency man-