4363.0.55.001 - Australian Health Survey: Users' Guide, 2011-13  
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 11/12/2013   
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Contents >> Biomedical Measures >> Cotinine biomarker



The National Health Measures Survey (NHMS) included a test for cotinine as an objective measure of smoking status. The body produces cotinine in the process of breaking down, or metabolising, nicotine from tobacco smoke.1 Levels of cotinine are generally proportionate to the amount of tobacco exposure a person receives through smoking, or in some cases, through exposure to second hand smoke. However, cotinine levels only remain elevated for around 20 hours after exposure to tobacco smoke, therefore it can only provide a measure of short-term exposure.

Self reported data on smoking was also collected in the National Health Survey (NHS) and National Nutrition and Physical Activity Survey (NNPAS). The biomedical results from the NHMS supports the self reported data in estimating smoking prevalence rates and non-smoking persons who are potentially exposed to passive smoke in the household. For details on self reported smoking data, see the relevant Tobacco Smoking and Household and Family Characteristics chapters in this product.

The cotinine test measures the amount of cotinine circulating in the blood at the time of the test.


Cotinine results were obtained for selected persons aged 12 years and over, who agreed to participate in the NHMS and provided a blood sample. Fasting was not required for this test.


A blood sample was collected from participants and cotinine levels were measured at the Douglass Hanly Moir (DHM) laboratory.

There is no consensus on the cut off reference values for defining cotinine levels to determine the level of exposure to tobacco smoke for the Australian population, as there are currently a number of different methods that can be used to measure cotinine. In the NHMS, cut off reference values for indicating exposure to tobacco were sourced from DHM laboratory reference ranges.

In the NHMS, the following definitions were used for serum cotinine:

  • No exposure to tobacco smoke, cotinine levels < 140 nmol/L
  • Exposure to tobacco smoke, cotinine levels ≥ 140 nmol/L.

Further test information about the analysis method and machine used to measure cotinine levels is available in Excel spreadsheet format in the Downloads page of this product.

Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the Downloads page of this product.


Points to be considered when interpreting data for this topic include the following:
  • cotinine results do not confirm a specific diagnosis without consultation with a health professional.
  • There are a number of different test methods for measuring cotinine, which may produce different results. The data from this topic should therefore be used with caution when comparing cotinine results from other studies using a different test method or equation.

Comparability with other surveys

The NHMS is the first ABS survey to collect biomedical data on cotinine levels.

Cotinine data has been collected in other non-ABS surveys. However, caution must be taken when interpreting results due to the differences in scope, assay and the instrument used, and any thresholds applied in the final analysis.


1 Benowitz NL 1996, Cotinine as a Biomarker of Environmental Tobacco Smoke Exposure, Epidemiologic Reviews, <http://epirev.oxfordjournals.org/content/18/2/188.citation>, Last accessed 02/07/2013.

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