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Open AccessReview

Overview of Cotinine Cutoff Values for Smoking Status Classification

Department of Environmental Health Sciences, Soonchunhyang University, Asan 31538, Korea
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2016, 13(12), 1236; https://doi.org/10.3390/ijerph13121236
Received: 4 September 2016 / Revised: 10 November 2016 / Accepted: 14 November 2016 / Published: 14 December 2016
(This article belongs to the Section Global Health)
While cotinine is commonly used as a biomarker to validate self-reported smoking status, the selection of an optimal cotinine cutoff value for distinguishing true smokers from true nonsmokers shows a lack of standardization among studies. This review describes how the cutoff values have been derived, and explains the issues involved in the generalization of a cutoff value. In this study, we conducted an English-language literature search in PubMed using the keywords “cotinine” and “cutoff” or “self-reported” and “smoking status” and “validation” for the years 1985–2014. We obtained 104 articles, 32 of which provided (1) sensitivity and specificity of a cutoff value and (2) determination methods for the given cutoff value. We found that the saliva cotinine cutoff value range of 10–25 ng/mL, serum and urine cotinine cutoff of 10–20 ng/mL and 50–200 ng/mL, respectively, have been commonly used to validate self-reported smoking status using a 2 × 2 table or a receiver operating characteristics (ROC) curve. We also found that recent large population-based studies in the U.S. and UK reported lower cutoff values for cotinine in serum (3 ng/mL) and saliva (12 ng/mL), compared to the traditionally accepted ones (15 and 14 ng/mg, respectively). View Full-Text
Keywords: cutoff value; cotinine; smoking status; biomarker cutoff value; cotinine; smoking status; biomarker
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Kim, S. Overview of Cotinine Cutoff Values for Smoking Status Classification. Int. J. Environ. Res. Public Health 2016, 13, 1236.

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