How Low Should You Go? Determining the Optimal Cutoff for Exhaled Carbon Monoxide to Confirm Smoking Abstinence When Using Cotinine as Reference

Cropsey, Karen L.; Trent, Lindsay R.; Clark, C. Brendan; Stevens, Erin N.; Lahti, Adrienne C.; Hendricks, Peter S.

doi:10.1093/ntr/ntu085

Cited by 129 publications

(104 citation statements)

References 35 publications

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“…Using Bedfont monitors, Erb, Raiff, Meredith, and Dallery (2014) identified CO values <8 ppm as maximizing both sensitivity and specificity for classifying smokers from nonsmokers. By contrast, Perkins et al (2013) found < 5 ppm to be the optimal cutoff for 24 hour abstinence when using the Vitalograph BreathCO monitor, similar to <4 ppm found by Javors, Hatch, and Lamb (2005), Cropsey et al (2014) and Emery and Levine (2015) when also using the Vitalograph monitor. This discrepancy suggests there may be variation between these brands of CO monitors in validating abstinence and raises concern over whether they can be used interchangeably.…”

Section: Introductionsupporting

confidence: 58%

“…The optimal CO value that maximizes sensitivity and specificity for identifying those quit versus not quit should be determined for each monitor type and compared between types, especially within the same participants. Such research may benefit by using other biomarkers of recent nicotine exposure (e.g., cotinine) as a reference point, similar to methods used by Cropsey et al (2014). The use of additional biomarkers as reference would strengthen future studies as these measures would not be affected by other combustibles (e.g., marijuana) and would be sensitive to noncombustible sources of nicotine (e.g., electronic cigarettes, NRT, etc.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Agreement between Expired-Air Carbon Monoxide Monitors

2016

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Introduction The current study examined the level of agreement in expired-air carbon monoxide (CO) values, focusing especially on those confirming abstinence, between the two most commonly used CO monitors, the Vitalograph BreathCO and the Bedfont piCO+ Smokerlyzer. Methods Expired-air samples were collected via both monitors from adult dependent smokers (44 M, 34 F) participating in studies using CO values to confirm abstinence durations of: 24 hours, 12 hours, or no abstinence. All met DSM-IV nicotine dependence criteria and had a mean (SD) Fagerström Test of Cigarette Dependence score of 5.1 (1.8). Paired data collected across multiple visits were analyzed by regression-based Bland-Altman method of Limits of Agreement. Findings Analysis indicated a lack of agreement in CO measurement between monitors. Overall, the Bedfont monitor gave mean (±SEM) readings 3.83 (±.23) ppm higher than the Vitalograph monitor. Mean differences between monitors were larger for those ad lib smoking (5.65±.38 ppm) than those abstaining 12–24 hours (1.71±.13 ppm). Yet, there also was not consistent agreement in classification of 24 hour abstinence between monitors. Conclusions Systematic differences in CO readings demonstrate these two very common monitors may not result in interchangeable values, and reported outcomes in smoking research based on CO values may depend on the monitor used.

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Section: Introductionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Analysis of Agreement between Expired-Air Carbon Monoxide Monitors

2016

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“…The primary smoking outcome measure during follow-up, 7-day point-prevalence abstinence, was confirmed with a CO level ≤4 ppm and salivary cotinine level ≤ 15 ng/ml (Cropsey et al, 2014; Hughes et al, 2003; Lamb et al, 2010). (CO was used within-treatment; cotinine was used at follow-ups except if the person was using nicotine replacement when CO needed to be used instead.)…”

Section: Methodsmentioning

confidence: 96%

Contingent Vouchers and Motivational Interviewing for Cigarette Smokers in Residential Substance Abuse Treatment

Rohsenow

Tidey

Martin

et al. 2015

Journal of Substance Abuse Treatment

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Residential drug treatment provides an opportunity to intervene with smokers substance use disorders (SUD). A randomized controlled clinical trial compared: (1) Contingent Vouchers (CV) for smoking abstinence to Noncontingent Vouchers (NCV), crossed with (2) Motivational Interviewing (MI) or Brief Advice (BA), for 184 smokers in SUD treatment. During the voucher period, 36% of carbon monoxide readings indicated smoking abstinence for those receiving CV versus 13% with NCV (p < .001). Post-treatment point-prevalence abstinence rates were low (3–4% at each follow up), with more abstinence when CV was combined with MI (6.6% on average) than with BA (0% on average). No differential effects on drug use or motivation to quit smoking occurred. Thus, CV had limited effects on long-term smoking abstinence in this population but effects were improved when CV was combined with MI. More effective methods are needed to increase motivation to quit smoking and quit rates in this high-risk population.

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“…Inclusion of study site as a covariate did not change the results of any of the analyses reported above. If CO ≤ 3ppm was used to validate reports of abstinence, 37 the results did not change (effect of race at week +4, OR = 3.69, 95% CI = 1.44, 9.44, p = .007; effect of mean SABQ at week +4, OR = 2.70, 95% CI = 1.17, 6.22, p = .02).…”

Section: Sabq As Mediator Of Relapsementioning

confidence: 99%

Black Cigarette Smokers Report More Attention to Smoking Cues Than White Smokers: Implications for Smoking Cessation

Robinson

Pickworth

Heishman

et al. 2015

NICTOB

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Introduction: Black cigarette smokers have lower rates of smoking cessation compared with Whites. However, the mechanisms underlying these differences are not clear. Many Blacks live in communities saturated by tobacco advertisements. These cue-rich environments may undermine cessation attempts by provoking smoking. Moreover, attentional bias to smoking cues (attention capture by smoking cues) has been linked to lower cessation outcomes. Cessation attempts among Blacks may be compromised by attentional bias to smoking cues and a cue-rich environment. Method: Attention to smoking cues in Black and White smokers was examined in 2 studies. In both studies, assessments were completed during 2 laboratory visits: a nonabstinent session and an abstinent session. In study 1, nontreatment-seeking smokers (99 Whites, 104 Blacks) completed the Subjective Attentional Bias Questionnaire (SABQ; a self-report measure of attention to cues) and the Smoking Stroop task (a reaction time measure of attentional bias to smoking cues). In study 2, 110 White and 74 Black treatment-seeking smokers completed these assessments and attempted to quit. Results: In study 1, Blacks reported higher ratings than Whites on the SABQ (p = .005). In study 2, Blacks also reported higher ratings than Whites on the SABQ (p = .003). In study 2, Blacks had lower biochemical-verified point prevalence abstinence than Whites, and the between-race difference in outcome was partially mediated by SABQ ratings. Conclusion: Blacks reported greater attention to smoking cues than Whites, possibly due to betweenrace differences in environments. Greater attention to smoking cues may undermine cessation attempts.

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How Low Should You Go? Determining the Optimal Cutoff for Exhaled Carbon Monoxide to Confirm Smoking Abstinence When Using Cotinine as Reference

Abstract: It is recommended that researchers and clinicians adopt a more stringent CO cutoff in the range of 3-4 ppm when complete abstinence from smoking is the goal.

Cited by 129 publications

References 35 publications

Analysis of Agreement between Expired-Air Carbon Monoxide Monitors

Analysis of Agreement between Expired-Air Carbon Monoxide Monitors

Contingent Vouchers and Motivational Interviewing for Cigarette Smokers in Residential Substance Abuse Treatment

Black Cigarette Smokers Report More Attention to Smoking Cues Than White Smokers: Implications for Smoking Cessation

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