title: Validating Use of Internet-Submitted Carbon Monoxide Values by Video to Determine Quit Status.
abstract: BACKGROUND
  Daily visits to biochemically verify continuous smoking abstinence via expired-air carbon monoxide (CO) may deter participation in cessation trials. One way to reduce need for daily visits while continuing to monitor abstinence success may be use of a recent procedure to verify abstinence from daily CO values via the Internet. This method requires participants submit to study staff video recordings of themselves correctly using a CO monitor. However, it has not been clearly demonstrated that those classified quit via Internet-submitted videos of CO would be reliably classified quit when assessed in lab.
  
  
  METHODS
  Our study examined agreement in quit status from Internet-submitted CO values with quit status via CO collected in later same-day lab visits. Participants (n = 23) were from a short-term cessation study who agreed to record and submit videos of offsite CO testing, in addition to attending daily lab visits. All CO values were obtained via Bedfont pico+ Smokerlyzer monitors, with CO < 8 ppm indicating quit. During two 4-day practice quit attempts, a video was submitted before daily lab visits, up to eight videos each.
  
  
  RESULTS
  Of the total of 150 videos submitted, 97 videos indicated "not quit" and 53 "quit." Cohen's Kappa indicated substantial agreement in quit status between assessments, 0.70, p < .001, as 85% of the videos indicating "quit" CO were also "quit" CO in lab.
  
  
  CONCLUSIONS
  To our knowledge, these results are the first validation of daily Internet-submitted CO values to confirm daily quit status, supporting the utility of this approach for close monitoring of continuous abstinence.
  
  
  CONCLUSIONS
  This study compared consistency between quit status from CO values submitted over the Internet and quit status via CO collected in later same-day lab visits. Findings indicate substantial agreement in quit status between these two methods of CO assessment. Our results validate the use of Internet-submitted CO values to verify daily quit status. This method can be used in future cessation trials as a means to biochemically validate continuous abstinence without the burden of daily lab visits or relying on self-report of recent smoking lapses.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Karelitz
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Valerie C
authors.initials: VC
authors.lastname: Michael
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Boldry
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Perkins
mesh_terms: D001944:Breath Tests; D002248:Carbon Monoxide / Q000032:analysis*; D006801:Humans; D020407:Internet; D015203:Reproducibility of Results; D057566:Self Report / Q000592:standards*; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D017216:Telemedicine; D014741:Video Recording
chemical_list: D002248:Carbon Monoxide