Using breath carbon monoxide to validate self-reported tobacco smoking in remote Australian Indigenous communities

Abstract

BackgroundThis paper examines the specificity and sensitivity of a breath carbon monoxide (BCO) test and optimum BCO cutoff level for validating self-reported tobacco smoking in Indigenous Australians in Arnhem Land, Northern Territory (NT).MethodsIn a sample of 400 people (≥16 years) interviewed about tobacco use in three communities, both self-reported smoking and BCO data were recorded for 309 study participants. Of these, 249 reported smoking tobacco within the preceding 24 hours, and 60 reported they had never smoked or had not smoked tobacco for ≥6 months. The sample was opportunistically recruited using quotas to reflect age and gender balances in the communities where the combined Indigenous populations comprised 1,104 males and 1,215 females (≥16 years). Local Indigenous research workers assisted researchers in interviewing participants and facilitating BCO tests using a portable hand-held analyzer.ResultsA BCO cutoff of ≥7 parts per million (ppm) provided good agreement between self-report and BCO (96.0% sensitivity, 93.3% specificity). An alternative cutoff of ≥5 ppm increased sensitivity from 96.0% to 99.6% with no change in specificity (93.3%). With data for two self-reported nonsmokers who also reported that they smoked cannabis removed from the analysis, specificity increased to 96.6%.ConclusionIn these disadvantaged Indigenous populations, where data describing smoking are few, testing for BCO provides a practical, noninvasive, and immediate method to validate self-reported smoking. In further studies of tobacco smoking in these populations, cannabis use should be considered where self-reported nonsmokers show high BCO.

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

“…Although the babyCOmpact was slightly less accurate than the piCO+, this level of accuracy is commensurate with previous research examining CO cutoffs with more precise breath CO meters (Javors et al, 2005;MacLaren et al, 2010;Perkins et al, 2013;Raiff et al, 2010). Using self-reported smoking status as the standard to classify measures, a cutoff of ࣘ Level 2, which maximised sensitivity and specificity, resulted in no falsepositive and 16% false-negative results.…”

“…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 purpose of the current research was to examine the sensitivity and specificity of a lower-cost semiquantitative CO meter relative to that of a quantitative meter, the sensitivity and specificity of which has been established empirically (MacLaren et al, 2010;Raiff et al, 2010). Specifically, using self-reported smoking status to classify the results of each breath CO measure (i.e., truepositive, false-positive, etc.…”

Attempting Tobacco Cessation - An Oral Physician's Perspective

“…This CO re enters the alveoli vowing to the concentration gradient. Hence the CO level in exhaled air seems to be a reliable indicator of Carboxyhemoglobin in blood (Kumar et al, 2010).These devises are economical, instant, portable and non invasive (Cunnington et al, 2002;MacLaren et al, 2010). 0-6 PPM was considered normal, 7-10 PPM as light smokers and above 10 PPM as a regular smoker as per the specifications of the smokerlyser.…”

Decolonising Research Methodologies in East Arnhem Land

“…The effects and harms of smoking on Indigenous Australians are well documented (Clough et al, 2004;Clough, MacLaren, Robertson, Ivers, & Conigrave, 2011;Kariippanon, 2014;MacLaren et al, 2010;Mulholland, 2008;Robertson, 2011;Stevenson, Bohanna, Robertson, & Clough, 2013), however, the juxtaposition of the common or profane use of ŋarali' and its spiritual and cultural aspects have not been fully explored or addressed in the context of tobacco control in Australia.…”