Assessing adolescent tobacco use in a substance use treatment program with self-report and biological measures

Amy L. Meadows, Gregory Guenthner, Lucas S. Broster, Alice Y. Luo, Catherine A. Martin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Tobacco use in adolescents can alter their lifetime health outcomes. Despite the importance of early identification and treatment, adolescent tobacco use, including that of electronic vapor products (e.g., e-cigarettes), is often missed. In a state-funded substance use treatment program, we added biological measures, including urinary cotinine and exhaled carbon monoxide to self-report measures to assess recent and lifetime tobacco use. We conducted a retrospective review of the de-identified charts to examine the feasibility of screening for self-report and biological measures of tobacco use. Self-report, urinary cotinine, and exhaled carbon monoxide samples were obtained at every visit, including intake and follow-up. There were 52 adolescents with a total of 400 clinic visits to the program. Of those 400 visits, 258 included self-reported tobacco use and 142 included a denial of using any form of tobacco. However, of those 142 visits with a negative self-report of tobacco, 31 tested positive for cotinine and 6 had positive exhaled carbon monoxide. Although 111 of the 142 had negative cotinine, 5 had positive carbon monoxide, but all of those self-reported recent cannabis use. Despite using a sensitive measure of self-report of tobacco use, almost 22% of visits had a discordant self-report with a biological measure that indicated tobacco use. Considering the lifelong impact of adolescent tobacco use, clinicians should consider augmenting self-report with biological measures of tobacco use. Identification of tobacco use in adolescents with substance use can assist clinicians in providing education about tobacco use, such as electronic vapor products, and individualizing treatments.

Original languageEnglish
Article number106424
JournalAddictive Behaviors
StatePublished - Aug 2020

Bibliographical note

Funding Information:
Funding for this study was provided by the Kentucky Cabinet for Health and Family Services (CHFS) for Adolescent Health and Recovery Treatment and Training. CHFS had no role in the study design, collection, analysis, or interpretation of data, writing the manuscript, or decision to submit the paper for publication.

Publisher Copyright:
© 2020 Elsevier Ltd


  • Adolescent
  • Carbon Monoxide
  • Cotinine
  • Electronic Cigarette
  • Nicotine
  • Tobacco

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Toxicology
  • Psychiatry and Mental health


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