UPDATE: Debunking the myths: the facts about cotinine

by Betsy Sears on September 21, 2017

We are continually getting more data around smoking and life insurance. This popular post from 2012 has been updated with recent research.

According 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 cotinine result comes back 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”
A portion of 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 application (this is called non disclosure). While there is non-disclosure rates among all age groups, younger age groups have higher non-disclosure rates and continue to rise. Cotinine laboratory testing is the only way to discover who has “smoker’s amnesia”.

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

Cotinine Myths
As a life insurance agent, you may have had an applicant with a positive cotinine result tell you things like this:

  • “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

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