4727.0.55.002 - Australian Aboriginal and Torres Strait Islander Health Survey: Users' Guide, 2012-13  
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 10/09/2014  First Issue
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Contents >> Biomedical Measures >> Cotinine biomarker



The National Aboriginal and Torres Strait Islander Health Measures Survey (NATSIHMS) 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 Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS). The biomedical results from the NATSIHMS support 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 18 years and over, who agreed to participate in the NATSIHMS and who 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, as there are currently a number of different methods that can be used to measure cotinine. In the NATSIHMS, cut off reference values for indicating exposure to tobacco were sourced from DHM laboratory reference ranges.

In the NATSIHMS, 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.
  • Cotinine levels may be present in the blood due to smoking, but can also be present due to practices such as chewing tobacco, using nicotine patches and exposure to passive smoking.
  • Given these issues, it is recommended that self reported smoking estimates from Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results publication be used as the prevalence measure for smoking.

Comparability with other surveys

The NATSIHMS is the first ABS Aboriginal and Torres Strait Islander survey to collect biomedical information. Given it was also the first national level survey (ABS or otherwise) to collect such data for the Aboriginal and Torres Strait Islander population, no comparisons with previous surveys for this population are possible.

However, biomedical data was also collected for all Australians in the 2011-12 National Health Measures Survey (NHMS) and information about comparisons between the NHMS results and those of non-ABS surveys is available from the Comparisons with other Australian surveys section of the Biomedical Results for Chronic Diseases, 2011-12 publication.


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 08/09/2014.

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