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Why include cotinine testing in your wellness program?

As company-sponsored wellness programs strive to encourage improving health outcomes among employees, many employers provide financial benefits for employees who pass certain screening measures. It is especially common for employers to place Outcome-Based Rewards™ around financial incentives for employees who do not use tobacco products or who are trying to quit using tobacco products.

Some employers rely on their employees to accurately self-report their smoking status, but some employees who self-report as “non-tobacco users” actually test positive for the presence of nicotine. Many employers are now testing cotinine to more accurately assess employee tobacco use and effectively promote smoking cessation at work.

Cotinine is the major metabolite of nicotine, formed shortly after nicotine enters the body. A person can be exposed to nicotine through use of or exposure to tobacco products (cigarettes, chewing tobacco, e-cigarettes, nicotine patches, etc.). Cotinine can be measured in the laboratory from saliva, blood, or urine samples.

Cotinine is the preferred method of testing for nicotine exposure, as cotinine has a longer half-life than nicotine.1 For example, the half-life of nicotine in a person’s blood is 30 minutes to 3 hours, while the half-life of cotinine is 15 to 20 hours.1

Quest Diagnostics utilizes a specific immunoassay to test for the presence of cotinine in a blood specimen. In order to test positive for cotinine, a level of 10ng/mL or greater must be present in the specimen. This level is set 20 to 30 times higher than what is expected for non-users exposed to second-hand smoke, ensuring an accurate depiction of tobacco use.

Although our studies have not found any substances capable of causing false-positives, in rare circumstances, some employees with a positive result claim they are not using tobacco products. Quest Diagnostics believes it is appropriate for employers to have an appeals process and plan in place for employees wishing to challenge the result of their cotinine result, or for employees who are in the process of quitting tobacco with the use of nicotine patches or gum.

The suggested appeals processes can include cotinine retesting or a signed physician affidavit stating the employee does not use tobacco or is in the process of quitting. Persistent concerns about a repeated false-positive immunoassay result can be excluded, if warranted, by confirmatory testing using liquid chromatography/tandem mass-spectroscopy (LC/MS/MS).

How cotinine testing impacts corporate smoking cessation

Employers often provide incentives to employees who do not use tobacco, and to maintain the integrity of the wellness program, it is important that these incentive dollars are going to the correct employees. In a Quest Diagnostics 2014 case study on tobacco use, over 20% of the screening participants who tested positive for cotinine self-reported that they were non-users of tobacco.

By providing cotinine testing, employers will have a more accurate depiction of their population’s tobacco use, as well as what’s needed in their efforts to assist with smoking cessation at work. Additionally, with more accurate data around the tobacco habits of their population, they will see whether employer paid smoking cessation programs will be a beneficial addition to their wellness programs.

1. “Factsheet – Cotinine.” Centers for Disease Control and Prevention. 2015.