Worksite Nicotine Testing: Is it Worth it?

Posted by Lisa Stovall on Mon, Oct, 01, 2012

addictionMore employers are encouraging employees to quit smoking with incentives (or penalties!) According to the Society for Human Resource Management’s (SHRM’s) 2018 Employee Benefits survey report, 16% of employers provide a discount on health insurance premiums to people who do not use tobacco products, 10% offer a discount for participating in a program to quit smoking and 18% impose a smoking surcharge.

Given the often high-valued health care discounts, many employers are turning to nicotine testing to discourage dishonesty and ensure incentives are appropriately distributed. 

But is it worth it to add a testing element to smoking cessation efforts? As incentives around tobacco usage become larger, ensuring employees are tobacco-free may be worth the fight. The economic benefit of having non-smokers on the payroll is huge. The Centers for Disease Control and Prevention (CDC) puts a $3,391 price tag on each employee who smokes: $1,760 in lost productivity and $1,623 in excess medical expenditures.

What types of tests are available?

TotalWellness offers a variety of nicotine testing options for employers who want to verify tobacco user status. We offer an oral swab, an on-site saliva test, a fingerstick blood test, or a venipuncture lab draw. All samples are collected on-site by trained staff and measure cotinine, a biomarker of tobacco exposure.

Oral Swab

For the oral swab, a small collection strip is placed in the participants' mouth and rubbed gently on the cheek to collect a sample. We utilize a product called OraSure. The sample is placed in a collection vial, labeled, and sent to the lab for processing. Participants receive results in the mail approximately two weeks after sample collection. Results are also electronically transferred to TotalWellness.

Saliva Test

For the saliva test participants provide a saliva sample on-site by depositing a sample through a funnel into a saliva tube. The saliva is then applied to a testing card and results are available in approximately 20 minutes. We utilize a product called Accutest NicAlert. Sample results are provided to participants and recorded on their consent form. TotalWellness receives the consent forms and uploads the data.


For the fingerstick blood test, staff collects a small blood sample from participants. We then use the PTS Detect™ cotinine system, which is a handheld device that offers specific, reliable, accurate and fast results at the point of care. It measures exact blood cotinine levels from 25 ng/mL to 200 ng/mL in 5 minutes.

Venipuncture Lab Draw

For the venipuncture lab draw, staff collects a blood sample from the participant on-site. The samples are mailed to the lab, Clinical Reference Lab, for processing. Participants receive results in the mail approximately two weeks after sample collection. Results are also electronically transferred to TotalWellness.

How long does nicotine stay in the system?

When people smoke, the body processes nicotine and it will get rid of the substance over time. The length of time that nicotine stays in the body depends on the amount the person smokes and the number of years they have been smoking. 

Cotinine is an alkaloid found in tobacco and is produced when the body metabolizes nicotine after ingestion. Cotinine can be used as a biomarker for exposure to tobacco and is typically detectable for several days after the use of tobacco.

Legal Limitations 

Laws protecting tobacco users vary by state, so if you are considering implementing
tobacco-free policies or nicotine testing, it is best to consult with legal counsel to avoid potential pitfalls.

*This post was updated July 2019 for accuracy. 

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Topics: Biometric Health Screenings, Wellness at Work


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