Abstract
The objective of this study was to evaluate the validity of self-reported smoking prevalence in Korean adolescents by using an improved gold standard by a combined method. Using a stratified sampling method, we selected 13 schools from among 397 high schools that participated in the 2015 Korean Youth Health Risk Behavior Web-Based Survey (KYRBS). A second survey (repeated self-reporting questionnaire and urinary cotinine test) was conducted on 1058 students who completed the KYRBS. The gold standard of current smoker was defined as those either self-reporting as a smoker in the second survey or having a urinary cotinine concentration ≥50 ng/mL. The current smoking prevalence in the first survey (KYRBS) was 7.9% (boys 16.5% and girls 1.8%), which was lower than the results based on gold standard (11.3% total, boys 21.9% and girls 3.7%). The sensitivity and specificity of self-reported smoking status was 62.5% and 99.0%, respectively. In particular, the sensitivity of girls (43.5%) was lower than that of boys (67.0%). The self-reported smoking prevalence in Korean adolescents was underestimated, particularly among girls. Careful attention should be paid to interpreting adolescents’ smoking prevalence, and supplementary surveys or periodic validity tests need to be considered in Asian countries.
Highlights
Self-reported questionnaires, which are generally used for computing smoking statistics, provide underestimated outcomes compared to the actual smoking prevalence [1]
When only a biochemical test is used as the gold standard to assess the validity of self-reported smoking surveys, a misclassification error may arise, where passive smokers are classified as smokers while occasional smokers are classified as nonsmokers [1,7]
The prevalence of current cigarette smoking in the first survey using a self-reported questionnaire was 7.9%, which was lower than those of 9.0–11.3% in the second survey using the self-reported questionnaire, urinary cotinine concentration of ≥50 ng/mL, or the estimated prevalence based on the mode value of the number of smoking classmates
Summary
Self-reported questionnaires, which are generally used for computing smoking statistics, provide underestimated outcomes compared to the actual smoking prevalence [1]. This is because smoking is perceived as a socially undesirable behavior; some individuals, women and adolescents, tend to hide their smoking status in self-reported questionnaires [2,3,4,5,6]. When only a biochemical test is used as the gold standard to assess the validity of self-reported smoking surveys, a misclassification error may arise, where passive smokers are classified as smokers while occasional smokers are classified as nonsmokers [1,7].
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