cotinine testing

Debunking the myths: the facts about cotinine

by Betsy Sears on September 21, 2017

cotinine-testingAccording to the Foundation for a Smokefree America, smoking is the single most preventable cause of death and disease causing more fatalities than cocaine, auto accidents, AIDS, alcohol, heroin, fire, suicide and homicide combined.

The relationship between nicotine and cotinine

Cigarettes are made up of tar, carbon monoxide, acetaldehyde, nitrosamines, nicotine and 4,000 different carcinogenic chemicals. Nicotine – a highly abused, highly toxic alkaloid found in tobacco products such as cigars, cigarettes and chewing tobacco – is metabolized into cotinine by the liver, which is then excreted in the urine. When an applicant applies for life insurance and provides a urine sample, that sample is tested for cotinine at the laboratory. If the result is positive, the applicant will be rated as a smoker during the underwriting process and receive a much higher premium than a non-smoker.

In general, cotinine can probably be detected between a few days and a week after smoking cessation. The concentration of cotinine in an applicant’s body is dependent upon several variables, including:

  • Low vs. high nicotine cigarettes
  • Time of last tobacco use
  • Amount of tobacco used
  • Hydration level of applicant
  • Individual metabolic differences

ExamOne research consistently shows that using the laboratory recommended cotinine threshold of .30 all but eliminates the possibility of a false positive test result.

“Smoker’s amnesia”

Some applicants deny their tobacco use during the life insurance application process. Cotinine testing analysis* shows that 28% of applicants (age 35+) tested positive for tobacco but said they did not smoke on the application (this is called nondisclosure). While there is nondisclosure among all age groups, rates of nondisclosure in younger applicants are higher continue to rise. Laboratory testing is the only way to discover who has “smoker’s amnesia.”

Smoking non-disclosure rates for applicants 18 to 34 years old are up from 25% in 2005 to 30% in 2015. 

Cotinine myths

You may have encountered an applicant with a positive cotinine result who said things like:

  • “I’ve never had a cigarette in my life.”
  • “I was at a concert/bar last night and everyone around me was smoking.”
  • “I smoked one cigar to celebrate my new grandchild and I have never smoked before.”

The truth is that those types of explanations do not generally hold true. Indulging in a rare cigar or being around people who smoke is most likely not going to result in a positive cotinine result. A positive cotinine test is usually the result of someone who smokes, chews tobacco or wears a nicotine patch.

There will always be myths about smoking, but a laboratory test can see through the smoke and get the real results.

*2015 ExamOne cotinine testing

It is important to know the cotinine positivity rates of a life insurance applicant during a typical life insurance underwriting process. An applicant’s cotinine positivity rate, when correctly captured, is useful in classifying smoking and non-smoking premium rates. In most cases, smokers pay rates as high as three times the premium of non-smokers and this has become a very strong motivation for more and more life insurance applicants to lie about their smoking status during application process. Determining the correctness of reported tobacco usage by applicants therefore continues to attract attention within the life insurance industry. Cotinine positivity distribution maps as shown below, provides a quick reference to underwriters and life insurance risk assessors on the trends and distribution patterns of tobacco usage among life insurance applicants across the United States. The report also notes the states where to potentially expect relatively higher cotinine positivity rates among life insurance applicants across the country.


The results for cotinine positivity rates across the United States as analyzed from ExamOne life insurance applications data from years 2000 – 2012 are summarized as follows:

– ExamOne life insurance applicant data for the 12 year period downscaled to a 3-digit zip code level were analyzed.

– The data shows significant increase in number of life insurance applications processed at ExamOne from about 300, 000 in  year 2000 to about 1.5 million in year 2012.

– On average, analysis shows a generally decreasing trend over those 12 years in cotinine positivity rates across the United States. Average nationwide cotinine positivity rate was shown to be about 11-12% per year and gradually decreased to about 8% in 2012.

– Over the 12 year period – East central Kentucky recorded the highest cotinine positivity rates of about 70% (in the year 2000); Oklahoma Panhandle recorded highest cotinine positivity rates of about 50% also in the year 2000.

– Texas, New Mexico, eastern Wyoming, Arizona, Nevada, Missouri, Iowa, Louisiana, Alabama, Virginia and West Virginia, Montana all recorded relatively higher cotinine positivity rates ranging from 20 – 50% during this timeframe. When compared with other states, Pennsylvania and Nebraska recorded a relatively lower cotinine positivity rate of about 18 and 15% respectively during the same period.

Our record shows a generally decreasing trend in cotinine positivity rates among life insurance applicants – those who were tested for cotinine positivity by ExamOne between 2000 – 2012. Eastern Kentucky, Oklahoma Panhandle and New Mexico recorded relatively higher cotinine positivity rates when compared with the rest of the states during the 12 year period. This information provides an overview of where to expect a higher likelihood of tobacco using life insurance applicants’ across the United States.