April 11, 2013
Qualitative Nicotine Test Kits Compared
"An informed decision is a wise decision"
By: Victor E. Battles, M.D.
Instant quantitative nicotine test kits for
testing of urine and saliva specimens are convenient and economical. They provide rapid on-the-spot test results.
The two products currently on the market have many features in common, but there are some important differences to
NicAlert and TobacAlert, both produced by Nymox Pharmaceutical Corp, are the two available products on the market
today. Because they provide on-the-spot readings which can determine one's exposure to nicotine they are also
referred to as rapid or instantaneous testing kits. The kits consist of testing strips, instructions, accessories
for collecting urine or saliva, depending on whether a kit is for urine or saliva testing, and a test
result interpretation chart. The same NicAlert test strip can be used for urine or saliva and the same is true for
the TobacAlert test strips. Therefore, the only difference in the respective kits is the accompanying instructions
and specimen collection accessories.
Both types of strips measure cotinine, which is a byproduct of nicotine resulting from its metabolism or breakdown
by the body. Cotinine is measured instead of nicotine because it stays in the body between eight and ten times
longer than nicotine and is thus more measurable and easily detected.
Both strips have seven reading levels ranging from 0 to 6. Each level represents an equivalent cotinine level that
would be measured if testing of the same specimen were performed by a laboratory. The cotinine level equivalent for
a given test strip level is the same for NicAlert and TobacAlert as expressed in the interpretation charts included
in the kits, but there are some differences in the interpretation of the measurements at the lower levels as will
be discussed below. A strip level of 0 is equivalent to an actual cotinine level of between 0 and 10 ng/ml and the
higher strip levels are equivalent to higher actual cotinine levels. The strips can be read within 10 to 30 minutes
of applying a specimen depending on whether it is a TobacAlert or NicAlert strip and depending on whether urine or
saliva is tested.
The window of detection, which is the time frame from the last use of tobacco during which cotinine can be
detected, generally ranges from 2-3 days for NicAlert and TobacAlert, but factors such as a person’s genetic
makeup, the pattern of nicotine inhalation, the type of cigarettes smoked, body mass, physical activity, medical
disease(s) and medications can cause some variation between individuals. Studies have shown that both products
provide accurate measurements of cotinine but there have been more accuracy studies performed for NicAlert than for
Both testing systems can detect cotinine from various sources of tobacco exposure including cigarettes, cigars,
pipes, chewing tobacco and snuff but they cannot specifically identify the source of the exposure. Both strips will
detect cotinine caused by the use of nicotine replacement products but will not distinguish between tobacco
exposure and the use of nicotine replacement products.
NicAlert is intended for professional use, particularly in the healthcare field. TobacAlert is intended primarily
for home testing, particularly if there are concerns about exposure to secondhand tobacco smoke. Both systems can
be used interchangeably however as long as you aware of the pros and cons of each testing method. Rapid
quantitative nicotine test kits can be used for testing in doctors’ offices, hospitals and other healthcare
settings. They can also be used by insurance companies to verify information on applications for health and life
insurance. Other uses include testing of students at school, testing of athletes by coaches and testing of underage
family members by parents who suspect unauthorized tobacco use. Some smoking counselors also use the kits to test
clients enrolled in their quit smoking programs.
There is a significant difference between the instant quantitative test kits when urine is tested and when saliva
is tested with respect to the detection of secondhand tobacco smoke exposure and the distinction between passive
tobacco smoke exposure and actual tobacco use. Since cotinine is concentrated by the kidneys and excreted in the
urine, the measuring of cotinine in the urine with either strip yields a higher reading for a given amount of
cotinine in the body than the measuring of cotinine in saliva.
Consequently, the lower strip readings of 1 and 2 for tests performed on urine indicate passive tobacco smoke
exposure, but for the same level readings to be obtained with the testing of saliva the amount of cotinine in the
body would have to be significantly higher and at levels achievable only through actual tobacco use. Therefore, the
test kits which measure cotinine in urine can distinguish between secondhand tobacco smoke exposure and actual
tobacco use, but the kits which measure cotinine in saliva can only determine actual tobacco use and should not be
used for determining if there has been passive exposure to tobacco smoke.
Another factor to consider in testing with either strip is that urine can be adulterated so as to alter the test
result, but there is no way to alter cotinine measurement in saliva other than to quit smoking. Therefore, if there
is any concern about the honesty of the person who is to be tested, a test kit for measuring cotinine in saliva
would be preferred over a urine kit.
The use of rapid quantitative nicotine test kits is a convenient and affordable
alternative to laboratory nicotine testing. Several factors should be considered however, including the reason for
testing, the conditions and circumstances of the testing and how the test results will be used, in deciding which
testing method best meets your needs.
Source: Proactive Health Outlet
Victor E. Battles, M.D. is a board-certified internist with 30 + years of patient contact. Dr. Battles has been a
principal investigator in several clinical research trials and is the founder of Proactive Health Outlet, a
resource providing self-help for improving health.
To view NicAlert and TobacAlert Comparison Matrix click
here. To purchase nicotine test kits click here.