Validation of Self-Reported Smoking Status by Simultaneous Measurement of Carbon Monoxide and Salivary Thiocyanate

doi:10.1006/pmed.2000.0779

Preventive Medicine

Volume 32, Issue 1, January 2001, Pages 82-88

https://doi.org/10.1006/pmed.2000.0779 Get rights and content

Abstract

Objective. The objective of this study was to determine the validity of tobacco questionnaires when using as gold standard either a single biomarker or a combination of two biomarkers.

Methods. The methods were self-reported smoking compared with salivary thiocyanate and expired carbon monoxide in a 1996, population-based, Swiss survey of 552 men and 565 women.

Results. Sensitivity of self-reported smoking relative to salivary thiocynate or carbon monoxide alone was low (38.2% for salivary thiocyanate ≥ 100 mg/L, 56.4% for salivary thiocyanate ≥ 150 mg/L and 62.6% for carbon monoxide ≥ 9 ppm). When defining true positive smokers as people with high concentration of both salivary thiocyanate and carbon monoxide, overall, sensitivity was 88.6% and specificity was 87.2%. In women, sensitivity increased from 85 to 89% when removing subjects exposed to passive smoking. When excluding heavy smokers, sensitivity decreased to 63% in men and to 71% in women. Older women had tendency to misreport smoking.

Conclusions. This comparison of questionnaire data with the simultaneous measurement of salivary thiocyanate and expired carbon monoxide indicates that valid responses can be obtained for self-reported, current smoking in population-based surveys. However, the validity of questionnaires can be underestimated if the gold standard (of exposure to tobacco smoke) is either high levels of carbon monoxide or high levels of salivary thiocyanate.

References (22)

KJ Ruth et al.
Evaluation of two biological markers of tobacco exposure
MRFIT Research Group. Prev Med
(1991)
A Morabia et al.
Community-based surveillance of cardiovascular risk factors in Geneva: methods, resulting distributions, and comparisons with other populations
Prev Med
(1997)
MM Gerkovich et al.
Measurement of SCN during the process of smoking cessation
J Subst Abuse
(1990)
F Curtin et al.
Smoking behavior in a Swiss urban population: the role of gender and education
Prev Med
(1997)
AK Elkind
The social definition of women's smoking behaviour
Soc Sci Med
(1985)
H Waage et al.
Discrimination of smoking status by thiocyanate and cotinine in serum, and CO in expired air
Int J Epidemiol
(1992)
DL Patrick et al.
The validity of self-reported smoking: a review and meta-analysis
Am J Public Health
(1994)
F Curtin et al.
Lifetime exposure to environmental tobacco smoke among urban women: differences by socioeconomic class
Am J Epidemiol
(1998)
GK Stookey et al.
Evaluation of biochemical validation measures in determination of smoking status
J Dent Res
(1987)

There are more references available in the full text version of this article.

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^☆: The present study was supported by a grant from the Swiss National Scientific Foundation (No, 32–37986.93) and the State Health Department (Département de l'Action Sociale et de la Santé) of the Canton of Geneva.

²: To whom correspondence and reprint requests should be addressed. Fax: ++41 22 372 95 65. E-mail: [email protected].

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Regular ArticleValidation of Self-Reported Smoking Status by Simultaneous Measurement of Carbon Monoxide and Salivary Thiocyanate☆

Abstract

MRFIT Research Group. Prev Med

Prev Med

J Subst Abuse

Prev Med

Soc Sci Med

Discrimination of smoking status by thiocyanate and cotinine in serum, and CO in expired air

Int J Epidemiol

The validity of self-reported smoking: a review and meta-analysis

Am J Public Health

Lifetime exposure to environmental tobacco smoke among urban women: differences by socioeconomic class

Am J Epidemiol

Evaluation of biochemical validation measures in determination of smoking status

J Dent Res

Regular Article
Validation of Self-Reported Smoking Status by Simultaneous Measurement of Carbon Monoxide and Salivary Thiocyanate☆