Mobile, Remote, and Individual Focused: Comparing Breath Carbon Monoxide Readings and Abstinence Between Smartphone-Enabled and Stand-Alone Monitors

Abstract Introduction Newly available, smartphone-enabled carbon monoxide (CO) monitors are lower in cost than traditional stand-alone monitors and represent a marked advancement for smoking research. New products are promising, but data are needed to compare breath CO readings between smartphone-en...

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Published in:Nicotine & tobacco research 2021-03, Vol.23 (4), p.741-747
Main Authors: Tuck, Breanna M, Karelitz, Joshua L, Tomko, Rachel L, Dahne, Jennifer, Cato, Patrick, McClure, Erin A
Format: Article
Language:English
Subjects:
Adult
Breath Tests - methods
Carbon Monoxide - analysis
Case-Control Studies
Cotinine - analysis
Female
Humans
Male
Non-Smokers - psychology
Original Investigations
ROC Curve
Smartphone - statistics & numerical data
Smokers - psychology
Smoking - epidemiology
Smoking - psychology
Smoking Cessation - methods
United States - epidemiology
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container_end_page 747
container_issue 4
container_start_page 741
container_title Nicotine & tobacco research
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creator Tuck, Breanna M
Karelitz, Joshua L
Tomko, Rachel L
Dahne, Jennifer
Cato, Patrick
McClure, Erin A
description Abstract Introduction Newly available, smartphone-enabled carbon monoxide (CO) monitors are lower in cost than traditional stand-alone monitors and represent a marked advancement for smoking research. New products are promising, but data are needed to compare breath CO readings between smartphone-enabled and stand-alone monitors. The purpose of this study was to (1) determine the agreement between the mobile iCO (Bedfont Scientific Ltd) with two other monitors from the same manufacturer (Micro+ pro and Micro+ basic) and (2) determine optimal, monitor-specific, cotinine-confirmed abstinence cutoff values. Methods Adult (≥18) smokers (n = 26) and nonsmokers (n = 21) provided three breath CO samples (using three different monitors) in each of 10 sessions, and urine cotinine was measured for gold standard determination of abstinence. CO comparisons (N = 437) were analyzed using regression-based Bland–Altman Analysis of Agreement; receiver operating characteristics curves were used to determine optimal abstinence cutoffs. Results Bland–Altman analyses indicated that the iCO monitor provided higher CO results than both Micro+ monitors. Sensitivity and specificity analyses showed that the optimal CO cutoff for determining abstinence was
doi_str_mv 10.1093/ntr/ntaa203
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New products are promising, but data are needed to compare breath CO readings between smartphone-enabled and stand-alone monitors. The purpose of this study was to (1) determine the agreement between the mobile iCO (Bedfont Scientific Ltd) with two other monitors from the same manufacturer (Micro+ pro and Micro+ basic) and (2) determine optimal, monitor-specific, cotinine-confirmed abstinence cutoff values. Methods Adult (≥18) smokers (n = 26) and nonsmokers (n = 21) provided three breath CO samples (using three different monitors) in each of 10 sessions, and urine cotinine was measured for gold standard determination of abstinence. CO comparisons (N = 437) were analyzed using regression-based Bland–Altman Analysis of Agreement; receiver operating characteristics curves were used to determine optimal abstinence cutoffs. Results Bland–Altman analyses indicated that the iCO monitor provided higher CO results than both Micro+ monitors. Sensitivity and specificity analyses showed that the optimal CO cutoff for determining abstinence was &lt;3 ppm for the Micro+ pro (88% sensitivity, 93% specificity) and Micro+ basic (83% sensitivity, 98% specificity), but was higher for the iCO (&lt;6 ppm; 73% sensitivity, 100% specificity). Conclusions Relative to both Micro+ monitors, the smartphone-enabled iCO provided systematically higher CO values and required a higher cutoff to reliably determine smoking abstinence. This does not indicate that CO values obtained using the iCO are not valid; instead, these results suggest that monitor-specific abstinence cutoffs are needed to ensure accurate bioverification of smoking status. Implications Results from this study indicate that CO values from the smartphone-enabled iCO should not be used interchangeably with the stand-alone Micro+ pro and Micro+ basic, particularly when lower CO values (&lt;10 ppm) are critical (ie, determination of abstinence vs confirming smoking status for study inclusion). Optimal CO cutoffs recommended for determining abstinence on Micro+ and iCO monitors are at &lt;3 and &lt;6 ppm, respectively.</description><identifier>ISSN: 1469-994X</identifier><identifier>ISSN: 1462-2203</identifier><identifier>EISSN: 1469-994X</identifier><identifier>DOI: 10.1093/ntr/ntaa203</identifier><identifier>PMID: 33022057</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adult ; Breath Tests - methods ; Carbon Monoxide - analysis ; Case-Control Studies ; Cotinine - analysis ; Female ; Humans ; Male ; Non-Smokers - psychology ; Original Investigations ; ROC Curve ; Smartphone - statistics &amp; numerical data ; Smokers - psychology ; Smoking - epidemiology ; Smoking - psychology ; Smoking Cessation - methods ; United States - epidemiology</subject><ispartof>Nicotine &amp; tobacco research, 2021-03, Vol.23 (4), p.741-747</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c412t-2991496389a1fb0dd42dd01a075b183d8956de9c62c80541ba72ad38368e6e6c3</citedby><cites>FETCH-LOGICAL-c412t-2991496389a1fb0dd42dd01a075b183d8956de9c62c80541ba72ad38368e6e6c3</cites><orcidid>0000-0001-9211-9460 ; 0000-0002-6961-4399 ; 0000-0001-9744-7818</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33022057$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tuck, Breanna M</creatorcontrib><creatorcontrib>Karelitz, Joshua L</creatorcontrib><creatorcontrib>Tomko, Rachel L</creatorcontrib><creatorcontrib>Dahne, Jennifer</creatorcontrib><creatorcontrib>Cato, Patrick</creatorcontrib><creatorcontrib>McClure, Erin A</creatorcontrib><title>Mobile, Remote, and Individual Focused: Comparing Breath Carbon Monoxide Readings and Abstinence Between Smartphone-Enabled and Stand-Alone Monitors</title><title>Nicotine &amp; tobacco research</title><addtitle>Nicotine Tob Res</addtitle><description>Abstract Introduction Newly available, smartphone-enabled carbon monoxide (CO) monitors are lower in cost than traditional stand-alone monitors and represent a marked advancement for smoking research. New products are promising, but data are needed to compare breath CO readings between smartphone-enabled and stand-alone monitors. The purpose of this study was to (1) determine the agreement between the mobile iCO (Bedfont Scientific Ltd) with two other monitors from the same manufacturer (Micro+ pro and Micro+ basic) and (2) determine optimal, monitor-specific, cotinine-confirmed abstinence cutoff values. Methods Adult (≥18) smokers (n = 26) and nonsmokers (n = 21) provided three breath CO samples (using three different monitors) in each of 10 sessions, and urine cotinine was measured for gold standard determination of abstinence. CO comparisons (N = 437) were analyzed using regression-based Bland–Altman Analysis of Agreement; receiver operating characteristics curves were used to determine optimal abstinence cutoffs. Results Bland–Altman analyses indicated that the iCO monitor provided higher CO results than both Micro+ monitors. Sensitivity and specificity analyses showed that the optimal CO cutoff for determining abstinence was &lt;3 ppm for the Micro+ pro (88% sensitivity, 93% specificity) and Micro+ basic (83% sensitivity, 98% specificity), but was higher for the iCO (&lt;6 ppm; 73% sensitivity, 100% specificity). Conclusions Relative to both Micro+ monitors, the smartphone-enabled iCO provided systematically higher CO values and required a higher cutoff to reliably determine smoking abstinence. This does not indicate that CO values obtained using the iCO are not valid; instead, these results suggest that monitor-specific abstinence cutoffs are needed to ensure accurate bioverification of smoking status. Implications Results from this study indicate that CO values from the smartphone-enabled iCO should not be used interchangeably with the stand-alone Micro+ pro and Micro+ basic, particularly when lower CO values (&lt;10 ppm) are critical (ie, determination of abstinence vs confirming smoking status for study inclusion). Optimal CO cutoffs recommended for determining abstinence on Micro+ and iCO monitors are at &lt;3 and &lt;6 ppm, respectively.</description><subject>Adult</subject><subject>Breath Tests - methods</subject><subject>Carbon Monoxide - analysis</subject><subject>Case-Control Studies</subject><subject>Cotinine - analysis</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Non-Smokers - psychology</subject><subject>Original Investigations</subject><subject>ROC Curve</subject><subject>Smartphone - statistics &amp; numerical data</subject><subject>Smokers - psychology</subject><subject>Smoking - epidemiology</subject><subject>Smoking - psychology</subject><subject>Smoking Cessation - methods</subject><subject>United States - epidemiology</subject><issn>1469-994X</issn><issn>1462-2203</issn><issn>1469-994X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kVtrFTEQgINYbK0--S55koKu5rK3-FA4PfQGLYJV8C3Mbub0RHaTNclW_R_-YNOe01JffEhmyHx8M2QIecXZe86U_OBSyAdAMPmE7PGyVoVS5benj_Jd8jzG74wJzlv-jOxKyYRgVbNH_lz6zg74jn7G0accwRl67oy9sWaGgZ74fo5oPtKlHycI1l3To4CQ1nQJofOOXnrnf1mDWQAml-OdYdHFZB26HukRpp-Ijl6NENK09g6LYwfdgOaOvEr5LhZDfr912eRDfEF2VjBEfLmN--TryfGX5Vlx8en0fLm4KPqSi1QIpXipatkq4KuOGVMKYxgH1lQdb6VpVVUbVH0t-pZVJe-gEWBkK-sWa6x7uU8ON95p7kY0PeavhEFPweZZf2sPVv9bcXatr_2NblRTK1llwcFWEPyPGWPSo409DgM49HPUoiwVb5qqVRl9u0H74GMMuHpow5m-3aPOLfR2j5l-_XiyB_Z-cRl4swH8PP3X9Bdke6of</recordid><startdate>20210319</startdate><enddate>20210319</enddate><creator>Tuck, Breanna M</creator><creator>Karelitz, Joshua L</creator><creator>Tomko, Rachel L</creator><creator>Dahne, Jennifer</creator><creator>Cato, Patrick</creator><creator>McClure, Erin A</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9211-9460</orcidid><orcidid>https://orcid.org/0000-0002-6961-4399</orcidid><orcidid>https://orcid.org/0000-0001-9744-7818</orcidid></search><sort><creationdate>20210319</creationdate><title>Mobile, Remote, and Individual Focused: Comparing Breath Carbon Monoxide Readings and Abstinence Between Smartphone-Enabled and Stand-Alone Monitors</title><author>Tuck, Breanna M ; Karelitz, Joshua L ; Tomko, Rachel L ; Dahne, Jennifer ; Cato, Patrick ; McClure, Erin A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c412t-2991496389a1fb0dd42dd01a075b183d8956de9c62c80541ba72ad38368e6e6c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Breath Tests - methods</topic><topic>Carbon Monoxide - analysis</topic><topic>Case-Control Studies</topic><topic>Cotinine - analysis</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Non-Smokers - psychology</topic><topic>Original Investigations</topic><topic>ROC Curve</topic><topic>Smartphone - statistics &amp; numerical data</topic><topic>Smokers - psychology</topic><topic>Smoking - epidemiology</topic><topic>Smoking - psychology</topic><topic>Smoking Cessation - methods</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tuck, Breanna M</creatorcontrib><creatorcontrib>Karelitz, Joshua L</creatorcontrib><creatorcontrib>Tomko, Rachel L</creatorcontrib><creatorcontrib>Dahne, Jennifer</creatorcontrib><creatorcontrib>Cato, Patrick</creatorcontrib><creatorcontrib>McClure, Erin A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Nicotine &amp; tobacco research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tuck, Breanna M</au><au>Karelitz, Joshua L</au><au>Tomko, Rachel L</au><au>Dahne, Jennifer</au><au>Cato, Patrick</au><au>McClure, Erin A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mobile, Remote, and Individual Focused: Comparing Breath Carbon Monoxide Readings and Abstinence Between Smartphone-Enabled and Stand-Alone Monitors</atitle><jtitle>Nicotine &amp; tobacco research</jtitle><addtitle>Nicotine Tob Res</addtitle><date>2021-03-19</date><risdate>2021</risdate><volume>23</volume><issue>4</issue><spage>741</spage><epage>747</epage><pages>741-747</pages><issn>1469-994X</issn><issn>1462-2203</issn><eissn>1469-994X</eissn><abstract>Abstract Introduction Newly available, smartphone-enabled carbon monoxide (CO) monitors are lower in cost than traditional stand-alone monitors and represent a marked advancement for smoking research. New products are promising, but data are needed to compare breath CO readings between smartphone-enabled and stand-alone monitors. The purpose of this study was to (1) determine the agreement between the mobile iCO (Bedfont Scientific Ltd) with two other monitors from the same manufacturer (Micro+ pro and Micro+ basic) and (2) determine optimal, monitor-specific, cotinine-confirmed abstinence cutoff values. Methods Adult (≥18) smokers (n = 26) and nonsmokers (n = 21) provided three breath CO samples (using three different monitors) in each of 10 sessions, and urine cotinine was measured for gold standard determination of abstinence. CO comparisons (N = 437) were analyzed using regression-based Bland–Altman Analysis of Agreement; receiver operating characteristics curves were used to determine optimal abstinence cutoffs. Results Bland–Altman analyses indicated that the iCO monitor provided higher CO results than both Micro+ monitors. Sensitivity and specificity analyses showed that the optimal CO cutoff for determining abstinence was &lt;3 ppm for the Micro+ pro (88% sensitivity, 93% specificity) and Micro+ basic (83% sensitivity, 98% specificity), but was higher for the iCO (&lt;6 ppm; 73% sensitivity, 100% specificity). Conclusions Relative to both Micro+ monitors, the smartphone-enabled iCO provided systematically higher CO values and required a higher cutoff to reliably determine smoking abstinence. This does not indicate that CO values obtained using the iCO are not valid; instead, these results suggest that monitor-specific abstinence cutoffs are needed to ensure accurate bioverification of smoking status. Implications Results from this study indicate that CO values from the smartphone-enabled iCO should not be used interchangeably with the stand-alone Micro+ pro and Micro+ basic, particularly when lower CO values (&lt;10 ppm) are critical (ie, determination of abstinence vs confirming smoking status for study inclusion). Optimal CO cutoffs recommended for determining abstinence on Micro+ and iCO monitors are at &lt;3 and &lt;6 ppm, respectively.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>33022057</pmid><doi>10.1093/ntr/ntaa203</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-9211-9460</orcidid><orcidid>https://orcid.org/0000-0002-6961-4399</orcidid><orcidid>https://orcid.org/0000-0001-9744-7818</orcidid><oa>free_for_read</oa></addata></record>
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source Oxford Journals Online
subjects Adult
Breath Tests - methods
Carbon Monoxide - analysis
Case-Control Studies
Cotinine - analysis
Female
Humans
Male
Non-Smokers - psychology
Original Investigations
ROC Curve
Smartphone - statistics & numerical data
Smokers - psychology
Smoking - epidemiology
Smoking - psychology
Smoking Cessation - methods
United States - epidemiology
title Mobile, Remote, and Individual Focused: Comparing Breath Carbon Monoxide Readings and Abstinence Between Smartphone-Enabled and Stand-Alone Monitors
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