Validating Wave 1 (2014) Urinary Cotinine and TNE-2 Cut-points for Differentiating Wave 4 (2017) Cigarette Use from Non-use in the United States Using Data from the PATH Study

Kathryn C. Edwards, Asia Khan, Eva Sharma, Lanqing Wang, June Feng, Benjamin C. Blount, Connie S. Sosnoff, Danielle M. Smith, Maciej L. Goniewicz, Jennifer Pearson, Andrea C. Villanti, Cristine D. Delnevo, Michelle T. Bover-Manderski, Dorothy K. Hatsukami, Raymond Niaura, Colm Everard, Heather L. Kimmel, Kara Duffy, Brian L. Rostron, Arseima Y. Del Valle-PineroDana M. van Bemmel, Cassandra A. Stanton, Andrew Hyland

Research output: Contribution to journalArticlepeer-review


Background: Sex and racial/ethnic identity-specific cut-points for validating tobacco use using Wave 1 (W1) of the Population Assessment of Tobacco and Health (PATH) Study were published in 2020. The current study establishes predictive validity of the W1 (2014) urinary cotinine and total nicotine equivalents- 2 (TNE-2) cut-points on estimating Wave 4 (W4; 2017) tobacco use. Methods: For exclusive and polytobacco cigarette use, weighted prevalence estimates based on W4 self-report alone and with exceeding the W1 cut-point were calculated to identify the percentage missed without biochemical verification. Sensitivity and specificity of W1 cut-points on W4 self-reported tobacco use status were examined.ROCcurves were used to determine the optimalW4 cut-points to distinguish past 30-day users from non-users, and evaluate whether the cut-points significantly differed from W1. Results: Agreement betweenW4self-reported use and exceeding the W1 cut-points was high overall and when stratified by demographic subgroups (0.7%-4.4% of use was missed if relying on selfreport alone). The predictive validity of using the W1 cut-points to classify exclusive cigarette and polytobacco cigarette use at W4 was high (>90% sensitivity and specificity, except among polytobacco Hispanic smokers). Cut-points derived using W4 data did not significantly differ from the W1-derived cut-points [e.g., W1 exclusive =40.5 ng/mL cotinine (95% confidence interval, CI: 26.1-62.8), W4 exclusive = 29.9 ng/mL cotinine (95% CI: 13.5-66.4)], among most demographic subgroups. Conclusions: The W1 cut-points remain valid for biochemical verification of self-reported tobacco use in W4.

Original languageEnglish (US)
Pages (from-to)1233-1241
Number of pages9
JournalCancer Epidemiology Biomarkers and Prevention
Issue number9
StatePublished - Sep 1 2023

Bibliographical note

Publisher Copyright:
© 2023 American Association for Cancer Research.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, U.S. Gov't, P.H.S.
  • Research Support, N.I.H., Extramural


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