PubMed · 3974645
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1985-03-14. Passive smoking.. https://doi.org/10.1056/nejm198503143121111
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Because of a lack of representative data on smoking status misclassification among U.S. married females, a two-part study was conducted. Part I was conducted to obtain nationally representative estimates of the percentage of U.S. women who report themselves to be current, former, and never smokers, to determine the concordance of smoking habits among spouse pairs, and to establish field quotas and probability weightings for Part II. Part II was conducted to determine smoker misclassification rates using salivary cotinine as an indication of active smoking. Part I, conducted in January 25-29, 1992, utilized random-digit dialing telephone interviewing throughout the 48 contiguous United States. Part II, conducted from February 19, 1992 to March 7, 1992, was a mall-intercept study in nine geographically disperse U.S. cities and it involved interviewing and saliva collection. Among married U.S. women, 25% reported they were current smokers, 22% reported they were former smokers, and 53% reported they were never smokers. Using a cotinine concentration of either > 35 ng/ml or > 106 ng/ml to indicate regular smoking, 3.61% and 2.55% of regular smokers, respectively, reported themselves to be never smokers. The concordance ratio, an important parameter in correcting for non-differential misclassification bias, was found to be 5.52. In addition, an indication of substantial differential misclassification was found between exposed and unexposed populations. This type of misclassification bias has previously not been accounted for in the adjustment of epidemiology-based risk assessments of tobacco smoke exposure and lung cancer. Taken together, these data suggest that misclassification bias alone is likely to explain any lung cancer risk elevation observed in the U.S. epidemiology of environmental tobacco smoke exposure among nonsmoking women.
Exposure to environmental tobacco smoke is an important variable in many pediatric epidemiologic studies. We measured urinary cotinine, a specific metabolite of nicotine, in a population-based cohort of children every other month from birth through two years of age. Extensive data regarding exposure to smokers (people in the home, in home and away from home day care, home visitors, visits to smokers) were collected monthly by way of home interviews. We evaluated, with multiple cotinine measurements as the gold standard, other measures of exposure that are more feasible to obtain in large-scale studies. Comparing one cotinine to the average of multiple measurements, we found that 33.7% were in error in excess of 100 ng/mg, but 84% of the infants could be correctly classified into categories of low versus high. Parental smoking patterns had the highest predictive accuracy (fathers 67.0% and mothers 64.1%). Combining selected smoker categories (either parent, other home residents outside day care workers) resulted in improved accuracy of 79.3%.
OBJECTIVE: To determine the reliability of self reports of smoking during pregnancy. METHODS: Residual sera from early and late antenatal blood samples were tested for cotinine for all pregnancies over a six month period. Over an overlapping 12 month period, a postal questionnaire on smoking was also sent to all new mothers (n = 4857) when their baby was 4-8 weeks old. Smoking status from obstetric booking notes was also obtained. RESULTS: The cotinine-validated smoking prevalence was 31.3% for the first trimester and 27.7% for the third trimester. Questionnaire self reported prevalences were 19.2% and 15.7% for the first and third trimesters respectively, and 18.9% for obstetric booking. Of cotinine-validated smokers, 22% denied smoking-self deceivers. Of mothers who replied to the questionnaire, a half appeared to systematically under report the amount they smoked. CONCLUSIONS: Nearly a quarter of smoking pregnant women did not report smoking. Moreover, of those who did, the amount smoked was often under reported. This tendency to under report may rise as pressures to stop smoking increase. Accurate measures of smoking prevalence in pregnant women will require objective testing.