Dear Colleagues,

I asked this question in a modified way before. Please read this text carefully before giving an answer.

Let me provide you with some background: We currently run two major school-based trials with 25.000 students total that fill out a paper pencil questionnaire in the classroom setting. We would like to validate the cigarette smoking status via a biochemical method as Gorber et al. clearly pointed out that for our target group smoking status self-reports are of limited reliability: https://www.ncbi.nlm.nih.gov/pubmed/19246437

We are interested in validating if a student smokes cigarettes or not. Please consider the following: We can not afford running two validation methods. It has to be Cotinine Saliva Testing OR Carbon Monoxide in exhaled air (via the Smokerlyzer device).

In our sample there clearly is the problem that as much students smoke e-cigarettes (which also contain nicotine) as well as cigarettes (4,7%). About 2% use both. 

Cotinine saliva would not be able to determine whether a student has smoked cigarettes or e-cigarettes. So in my view CO testing would be the optimal method. However, the recent Cochrane Analysis on school-based prevention recommends Cotinine Saliva but does not even discuss how to deal with e-cigarettes as a confounder.

We monitor both on our questionnaire: Cigarette and e-cigarette use.

I strongly feel that in 2017 cotinine saliva is not the gold standard in validating smoking status anymore but CO-testing.

What is your view on this? Would you agree with my reasoning?

Thank you for your consideration of my inquiry which I highly appreciate.

Kind regards from Germany,

Titus Brinker

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