Elsevier

Addictive Behaviors

Volume 29, Issue 2, February 2004, Pages 405-411
Addictive Behaviors

Short communication
Verification of adolescent self-reported smoking

https://doi.org/10.1016/j.addbeh.2003.08.012Get rights and content

Abstract

Smoking and the validity of information obtained on it is often questioned in view of the widespread belief that adolescents tend to under- or overreport the habit. The aim here was to verify smoking habits as reported in a questionnaire given in conjunction with dental examinations by asking participants directly whether they smoked or not and performing biochemical measurements of thiocyanate in the saliva and carbon monoxide in the expired air. The series consisted of 150 pupils in the ninth grade (age 15 years). The reports in the questionnaires seemed to provide a reliable estimate of adolescent smoking, the sensitivity of the method being 81–96%, specificity 77–95%. Biochemical verification or control of smoking proved needless in normal dental practice. Accepting information offered by the patient provides a good starting point for health education and work motivating and supporting of self-directed breaking of the habit.

Introduction

Prevention programmes on smoking and its effects are frequently evaluated on the basis of reports given by subjects themselves. This means in effect that the validity of information obtained is often questioned in the widespread belief that smokers tend to underestimate the amount that they smoke Haley & Hoffman, 1985, U.S. Department of Health and Human Services, 1990 or deny smoking at all Luepker et al., 1989, Murray et al., 1987.

Biochemical methods are frequently used to substantiate such reports, for example, by the measurement of cotidine in blood, urine or saliva samples, analysis of thiocyanate in saliva, or blood samples or monitoring of CO levels samples of expired air Etzel, 1990, Jarvis et al., 1987, Ruth & Neaton, 1991, Schwartz, 1987. Carbon monoxide displaces oxygen in the blood to form carboxyhaemoglobin (COHb), the level of which may be measured in blood or more easily in the breath, especially using modern CO analyzers (Ecolyzer, Nikomed EC-50). The alveolar carbon monoxide level is directly related to COHb, which is in turn related to smoking. The disadvantages of the method are the short half-life (3–4 h) and the fact that the analysis is sensitive to environmental influences, for example, second-hand smoking because of working conditions or traffic pollution, while its advantages lie in its low costs, the ease of performing the test, and the immediate feedback provided for the patient.

Measurement of thiocyanate is based on the presence of trace amounts of cyanide in tobacco. The analysis can be performed on urine or saliva samples, and it has the advantage of a long half-life (about two weeks), whereas the disadvantage is the possibility of error because fruits, nuts, and certain other foodstuffs may raise the thiocyanate level even in nonsmokers.

Nicotine and its derivate cotidine can be measured in blood, urine, or saliva samples. The weakness of nicotine is its short half-life (only about 30 min), so that cotidine, with a longer half-life, is a better marker of smoking. On the other hand, the measurement of cotidine is expensive, which argues against its extensive use.

Estimates of the reliability of self-reports on adolescent smoking have generally been quite high, 88–100% Barnea et al., 1987, Needle et al., 1983, O'Malley et al., 1983, and hence no correction is usually made for under- or overreporting.

It is highly valuable for a dentist to obtain reliable information on adolescent smoking by reason of the obvious and well-documented connection between smoking status and oral health Gupta et al., 1995, Johnson & Bain, 2000, McCann, 1989, Offenbacher & Weathers, 1985. Smoking prevention efforts in connection with dental examinations have in fact proved effective (Kentala, Utriainen, Pahkala, & Mattila, 1999).

The aim of this study was to verify adolescents' own reports on their smoking given in a questionnaire administered prior to their routine dental examinations and to test the associations between the various validation systems available.

Section snippets

Participants

The series consisted of 150 young people in the ninth grade (6 randomly chosen classes) in the county of Vaasa, Finland. The pupils were aged of 15; 48% were girls.

Procedure

They were asked to complete a self-administered questionnaire on smoking before attending their annual dental examination. Smoking status was then ascertained by the dentist by asking whether the pupil smoked or not (standardized procedure). Prior to this question, they were informed of the verification procedures and their consent

Results

According to questionnaire responses, there were 32% smokers among the subjects (Table 1). The proportion was lowest measured by saliva and highest by the CO method.

The sensitivity and specificity values of the self-administered questionnaire verified somewhat when using different gold standards. When choosing the dentist's question about smoking as gold standard, very high sensitivity (0.96) and specificity (0.95) were reached. Taking biochemical measures as gold standard, a sensitivity of

Discussion

Finnish adolescents stand poorly in European comparisons: Smoking rates for 15- to 16-year-old boys and girls are among the highest. The self-reported frequency of smoking in the study population was also in relation to the Finland's results in cross-national surveys and national health behaviour analysis (King, Wold, Tudor-Smith, & Harel, 1996).

When comparing the biochemical test results with adolescent's reports on their smoking, it is possible to point to two major sources of disagreement:

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