The Validity of Self-reported Smoking: a Review and Meta-analysis

Overview

Journal Am J Public Health

Specialty Public Health

Date 1994 Jul 1

PMID 8017530

Citations 568

Authors

D L Patrick

A Cheadle

D C Thompson

P Diehr

T Koepsell

S Kinne

Affiliations

Soon will be listed here.

Abstract

Objectives: The purpose of this study was to identify circumstances in which biochemical assessments of smoking produce systematically higher or lower estimates of smoking than self-reports. A secondary aim was to evaluate different statistical approaches to analyzing variation in validity estimates.

Methods: Literature searches and personal inquiries identified 26 published reports containing 51 comparisons between self-reported behavior and biochemical measures. The sensitivity and specificity of self-reports of smoking were calculated for each study as measures of accuracy.

Results: Sensitivity ranged from 6% to 100% (mean = 87.5%), and specificity ranged from 33% to 100% (mean = 89.2%). Interviewer-administered questionnaires, observational studies, reports by adults, and biochemical validation with cotinine plasma were associated with higher estimates of sensitivity and specificity.

Conclusions: Self-reports of smoking are accurate in most studies. To improve accuracy, biochemical assessment, preferably with cotinine plasma, should be considered in intervention studies and student populations.

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References

Luepker R, Pechacek T, Murray D, Johnson C, Hund F, Jacobs D . Saliva thiocyanate: a chemical indicator of cigarette smoking in adolescents. Am J Public Health. 1981; 71(12):1320-4. PMC: 1619960. DOI: 10.2105/ajph.71.12.1320. View

JENICEK M . Meta-analysis in medicine. Where we are and where we want to go. J Clin Epidemiol. 1989; 42(1):35-44. DOI: 10.1016/0895-4356(89)90023-1. View

Bauman K, Dent C . Influence of an objective measure on self-reports of behavior. J Appl Psychol. 1982; 67(5):623-8. View

Gillies P, Wilcox B, Coates C, Kristmundsdottir F, Reid D . Use of objective measurement in the validation of self-reported smoking in children aged 10 and 11 years: saliva thiocyanate. J Epidemiol Community Health. 1982; 36(3):205-8. PMC: 1052212. DOI: 10.1136/jech.36.3.205. View

Bauman K, Koch G, Bryan E . Validity of self-reports of adolescent cigarette smoking. Int J Addict. 1982; 17(7):1131-6. DOI: 10.3109/10826088209056345. View

Pechacek T, Murray D, Luepker R, Mittelmark M, Johnson C, Shutz J . Measurement of adolescent smoking behavior: rationale and methods. J Behav Med. 1984; 7(1):123-40. DOI: 10.1007/BF00845351. View

Fortmann S, Rogers T, Vranizan K, Haskell W, Solomon D, Farquhar J . Indirect measures of cigarette use: expired-air carbon monoxide versus plasma thiocyanate. Prev Med. 1984; 13(1):127-35. DOI: 10.1016/0091-7435(84)90045-8. View

Pojer R, Whitfield J, Poulos V, Eckhard I, Richmond R, HENSLEY W . Carboxyhemoglobin, cotinine, and thiocyanate assay compared for distinguishing smokers from non-smokers. Clin Chem. 1984; 30(8):1377-80. View

Haley N, Hoffmann D . Analysis for nicotine and cotinine in hair to determine cigarette smoker status. Clin Chem. 1985; 31(10):1598-600. View

10.

Luepker R, Pallonen U, Murray D, Pirie P . Validity of telephone surveys in assessing cigarette smoking in young adults. Am J Public Health. 1989; 79(2):202-4. PMC: 1349936. DOI: 10.2105/ajph.79.2.202. View

11.

Van Vunakis H, Tashkin D, Rigas B, Simmons M, Gjika H, Clark V . Relative sensitivity and specificity of salivary and serum cotinine in identifying tobacco-smoking status of self-reported nonsmokers and smokers of tobacco and/or marijuana. Arch Environ Health. 1989; 44(1):53-8. DOI: 10.1080/00039896.1989.9935873. View

12.

Noland M, Kryscio R, Riggs R, Linville L, Perritt L, Tucker T . Saliva cotinine and thiocyanate: chemical indicators of smokeless tobacco and cigarette use in adolescents. J Behav Med. 1988; 11(5):423-33. DOI: 10.1007/BF00844836. View

13.

Slattery M, Hunt S, French T, Ford M, Williams R . Validity of cigarette smoking habits in three epidemiologic studies in Utah. Prev Med. 1989; 18(1):11-9. DOI: 10.1016/0091-7435(89)90050-9. View

14.

Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, Colombo A . Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989; 80(1):87-98. DOI: 10.1161/01.cir.80.1.87. View

15.

Windsor R, Morris J, Cutter G, Lowe J, Higginbotham J, Perkins L . Sensitivity, specificity and predictive value of saliva thiocyanate among pregnant women. Addict Behav. 1989; 14(4):447-52. DOI: 10.1016/0306-4603(89)90032-4. View

16.

Laird N, Mosteller F . Some statistical methods for combining experimental results. Int J Technol Assess Health Care. 1990; 6(1):5-30. DOI: 10.1017/s0266462300008916. View

17.

Wagenknecht L, Cutter G, Haley N, Sidney S, Manolio T, Hughes G . Racial differences in serum cotinine levels among smokers in the Coronary Artery Risk Development in (Young) Adults study. Am J Public Health. 1990; 80(9):1053-6. PMC: 1404871. DOI: 10.2105/ajph.80.9.1053. View

18.

Fleiss J, Gross A . Meta-analysis in epidemiology, with special reference to studies of the association between exposure to environmental tobacco smoke and lung cancer: a critique. J Clin Epidemiol. 1991; 44(2):127-39. DOI: 10.1016/0895-4356(91)90261-7. View

19.

Vogt T, Selvin S, WIDDOWSON G, Hulley S . Expired air carbon monoxide and serum thiocyanate as objective measures of cigarette exposure. Am J Public Health. 1977; 67(6):545-9. PMC: 1653665. DOI: 10.2105/ajph.67.6.545. View

20.

Sillett R, Wilson M, Malcolm R, Ball K . Deception among smokers. Br Med J. 1978; 2(6146):1185-6. PMC: 1608315. DOI: 10.1136/bmj.2.6146.1185. View