Abstract
This study aimed to measure the percent agreement between Exhaled Breath Carbon Monoxide (eBCO) measure using a piCO+ smokerlyzer® and self-reported cigarette smoking status and to determine the optimal thresholds for definite identification of cigarette smokers of male school students in Jordan. A descriptive, cross sectional, study of a random sample of male adolescents in grades 7 and 8 from four public high schools in Irbid, completed an adaptation of a standardized Arabic-language tobacco smoking questionnaire and an eBCO measure. Sensitivity and specificity of the eBCO were calculated against self-reported cigarette smoking. Participants (n = 439) had a mean age of 12.5 years (SD = 0.50) and 174 (39.9%) reported being an ever smoker of whom 59 (33.9%) reported being a recent (30-day) smoker. The optimal eBCO cut-off point for recent smoking was 4.5 ppm with a sensitivity of 84.7% and specificity of 65.5%. Overall, eBCO can accurately identify recent smokers and distinguish them from non-smokers. The eBCO use enables healthcare professionals and researchers to assess efficacy of smoking cessation and prevention programs without necessarily relying on self-report. Further research is indicated to validate our findings and should be expanded to include females, detailed characteristics of cigarette and waterpipe smoking.
Highlights
Despite the decline in tobacco consumption in Western societies, it remains a serious public health concern in the Eastern Mediterranean Region (EMR), especially among adolescents [1,2]
A similar percentage of participants reported having their first cigarette by the time they were 14 years old, a third (27.3%) commencing at or before the age of 10 years and another third starting at the ages of 13 and 14 years (30.0%)
The study results demonstrate that low-cost Exhaled Breath Carbon Monoxide (eBCO) devices may be used to accurately determine smoking in male adolescents and that these devices offer a sound alternative to self-report in dual smoking populations [30]
Summary
Despite the decline in tobacco consumption in Western societies, it remains a serious public health concern in the Eastern Mediterranean Region (EMR), especially among adolescents [1,2]. An alarming increase in the rate of adolescents’ waterpipe smoking (WPS), a major tobacco consumption method in the EMR [2,5,6], suggests that the current public health focus on cigarette smoking is vastly under-estimating the rates of tobacco consumption. Recent evidence suggests that dual (WPS and cigarette) smoking rates are increasing amongst adolescents [2,5,6]. Adolescents’ WPS usage rates are more prevalent than cigarette smoking alone and dual use rates are on the rise among both genders [2,5,6]. Failure to include WPS usage when measuring tobacco-use prevalence rates or evaluating the efficacy and effectiveness of tobacco use cessation interventions [7] may be confounding evaluations
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