Workers who smoke cigarettes are more expensive to employ. Why? Because smoking negatively affects the health of smokers which increases the cost of health care insurance—to the tune of $193 billion between 2000 and 2014. Consider that lost productivity accounted for $97 billion and health care expenditures accounted for $96 billion. Wow! No wonder employers are interested in hiring workers who do not smoke and the Affordable Care Act, commonly known as Obamacare, actually paves the way for employers to screen applicants and employees for Cotinine, a metabolite of Nicotine that proves that a person has been smoking.

Whether you are considering cotinine testing for employment or as part of a corporate wellness program, to screen job applicants or deter smoking as part of a cessation program you need to consider testing for cotinine.

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 studies have shown that approximately 20% of employees that 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.

What is cotinine?
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 salivary, blood or urine samples. Cotinine is the preferred method of testing for nicotine exposure, as cotinine has a longer half-life than nicotine.2 For example, the half-life of nicotine in a person’s blood is 30 minutes to three hours, while the half-life of cotinine is 15-20 hours.3

What yields a positive cotinine result?
Quest Diagnostics Health & Wellness 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.

Can someone who does not use tobacco test positive for cotinine?
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 Health & Wellness 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).

Resources:  1, 2. “Factsheet – Cotinine.” Centers for Disease Control and Prevention. 2015.


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