Reliability Of Self-reported Smoking Status Research Articles

Comparing cotinine and NNAL verification of self-reported smoking status among lung cancer screening eligible population from the 2007–2014 National Health and Nutrition Examination Survey (NHANES)

Background: Biochemical verification of self-reported smoking status is not common among the population eligible for lung cancer screening (LCS). Methods: We used urinary NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides) and serum cotinine as the gold standard to determine the validity and reliability of self-reported smoking status from the 2007–2014 National Health and Nutrition Examination Survey (NHANES). Results: We found 2.3% (n = 652, equivalent to 5.3 million weighted population) of adults eligible for LCS according to the current United States Preventive Services Task Force guideline. Self-reported current smoking status performed similarly against NNAL and cotinine: sensitivity [89.7% (95%CI: 84.9%–94.5%) vs. 89.5% (95%CI: 84.8%–94.3%)]; specificity [99.7% (95%CI: 99.2%–100.0%) vs. 100% (95%CI:100%–100%)]; positive predictive value (PPV) and negative predictive value (NPV) were 99.8% (95%CI:99.4%–100.0%) versus 100% (95%CI:100%–100%) and 85.3% (95%CI: 79.1%–91.5%) versus 85.1% (95%CI: 79.1%–1.0%), respectively; and Kappa [86.5% (95%CI:80.5%–92.5%) vs. 86.5% (95%CI:80.6%–92.3%)]. Performance measures were better among females than males; worst among the non-Hispanic white and best among other race/ethnicity group. The validity and reliability of self-reported smoking status increased with increasing cutpoint levels of both NNAL and cotinine. Conclusions: Self-reported smoking status among people who are at high risk of lung cancer is reasonably reliable. The difference between using NNAL and cotinine appears to be minimal.

Can You Believe Your Patients If They Say They Have Quit Smoking?

To determine the reliability of self-reported smoking status in the orthopaedic trauma population and determine if certain patient factors might predispose inaccurate self-reported smoking cessation. Prospective. Level I trauma center. Two hundred forty-seven orthopaedic trauma patients were included in the study. In-office measurement of exhaled carbon monoxide (CO). Self-reported smoking cessation with exhaled CO measurements. A total of 906 self-reported surveys were completed over 4 follow-up visits. Of the responses indicating smoking cessation (n = 174), 12.6% [95% confidence interval (CI), 0.081-0.185] reported smoking cessation with positive CO readings, suggesting inaccurate self-reporting of smoking status. Over 20% of those patients inaccurately reporting abstinence did so more than once. The odds of inaccurate self-reporting was 3 times higher in patients with no insurance or government insurance [odds ratio (OR), 3.5; 95% CI, 1.1-11.0; P = 0.043] and in the unemployed (OR, 3.3; 95% CI, 0.97-8.57; P = 0.049). Self-reported smoking status in the orthopaedic population is fairly reliable, with 13% of patient's inaccurately self-reporting smoking cessation despite knowing their smoking status was being measured. Clinicians should be aware of the potential for inaccuracy in self-reported smoking cessation, particularly in patients with the identified socioeconomic factors. Point-of-care testing before elective trauma procedures to confirm smoking status might have a role if the procedure outcome is highly dependent on smoking status. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Validation of self-reported tobacco use with urinary NNAL among LCS-eligible population from the 2007-2014 National Health and Nutrition Examination Survey (NHANES)

Background As a major metabolite of tobacco-specific carcinogen, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) has been used as a biomarker for tobacco smoking exposure. Among current or former smokers, accurate self-reported smoking status is critical for determining the eligibility for lung cancer screening (LCS). This study used NNAL to verify self-reported smoking status among LCS-eligible population from a nationally representative sample in the National Health and Nutrition Examination Survey (NHANES). Methods We utilized NHANES data from 2007-2014 that included both urine total NNAL and self-reported smoking behavior to select the LCS-eligible population. We applied four cutpoints of NNAL (10pg/ml, 20pg/ml, 30pg/ml, 40pg/ml) as the gold standard to assess the performance of self-reported smoking status. To determine the validity and reliability of self-reported smoking status, we calculated the sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), accuracy, and reliability (Kappa). Results We found approximately 3.7% (n=985, equivalent to 8.5 million weighted population) of adults eligible for LCS according to the United States Preventive Services Task Force guideline. Validity and reliability of self-reported smoking status increased with increasing cutpoints of NNAL. Against NNAL-based smoking status with a cutpoint of 40pg/ml, self-reported smoking status showed the highest Se (88.8%), lowest Sp (99.4%); the corresponding PPV and NPV, respectively, was 99.5% and 85.5%; the accuracy was 93.0% and kappa was 0.86. The self-reported smoking status tended to be more valid and reliable among females than males across all NNAL cutpoints evaluated. Using the established 40pg/ml cutpoint as the gold standard, we found the accuracy was lowest among the non-Hispanic black (90.1%) and highest among the other race/ethnicity groups (93.9%). Conclusion Utilizing urine NNAL as the biochemical verification reference, we found that self-reported smoking status among people who are at risk of lung cancer is reasonably reliable.

Biochemical verification of the self-reported smoking status of screened male smokers of the Dutch–Belgian randomized controlled lung cancer screening trial

BackgroundSmoking is the main cause of lung cancer, so data linked to smoking behaviour are important in lung cancer screening trials. However, self-reporting data concerning smoking behaviour are mainly used. The aim of this study was to biochemically determine the validity and reliability of self-reported smoking status among smokers at high risk for developing lung cancer participating in the Dutch-Belgian lung cancer screening (NELSON) trial. MethodFor this sub study, a random sample of 475 men was selected who were scheduled for the fourth screening round in the NELSON trial. They were asked to complete a short questionnaire to verify the smoking behaviour for the previous seven days and a blood sample was collected to measure the cotinine level. The validity (sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV)) and reliability (Kappa) of the self-reported smoking status compared to the cotinine level (as golden standard) were determined. ResultsBoth a completed questionnaire as well as a cotinine level were available for 199 (41.9%) participants. Based on these data, Se and Sp were respectively 98% (95%-Confidence Interval (CI): 91–99) and 98% (95%-CI: 93–100). PPV and NPV were 98% and 96% and Kappa was 0.96. ConclusionIn conclusion, the validity of the self-reported smoking status turned out to be reliable amongst men at high risk for developing lung cancer who participate in the NELSON lung cancer screening trial.

The clinical significance and reliability of self-reported smoking status in patients with intracranial aneurysms: A review

ObjectiveHere we present a review of the pathophysiology of tobacco smoking on intracranial aneurysms, self-reported smoking status in these patients, screening tools and assays available for assessing active nicotine use, means of impacting smoking cessation rates, and the potential impact of smoking cessation on risk of rupture and recurrence of treated intracranial aneurysms. MethodsA literature search using PubMed was done to identify all English language studies relating to tobacco use and intracranial aneurysms, smoking and subarachnoid hemorrhage, nicotine breakdown products, and smoking cessation in neurosurgery. Results from the studies were reviewed and summarized. ResultsTobacco use is an independent risk factor for formation, growth, and rupture of intracranial aneurysms. The pathogenesis of aneurysm formation is complex, and related to increased wall shear stress, endothelial dysfunction, atherosclerosis, and altered gene regulation. Furthermore 80% of all aneurysmal ruptures occur in patients who have used tobacco products. It is suboptimal to rely on self-reported smoking status in order to determine patient risk. Use of objective metrics for ongoing tobacco use may be indicated in selected patients, and may increase smoking cessation rates in these patients. A variety of laboratory and point-of-care tests are available for measurement of nicotine and nicotine breakdown products. Most assays in clinical practice measure the nicotine breakdown product cotinine, which constitutes 75% of nicotine metabolites excreted in the urine and has a substantial half-life of 16h, compared to nicotine's 2-h half-life. With proper identification, an astute physician may be able to assist in smoking cessation and foster improved patient care. By following recommended guidelines and prescribing pharmaceutical aid, a patient has a 2.5 times greater chance of smoking cessation compared with attempting to stop without physician assistance. ConclusionsSmoking increases risk for intracranial aneurysm formation, rupture, re-rupture and need for re-treatment. Measurement of nicotine breakdown products may have clinical utility in the management of patients with intracranial aneurysms. Smoking cessation interventions may be effective, and use of established smoking cessation tools use may lead to improved clinical outcomes in these patients. The effects of smoking cessation efforts on smoking cessation and intracranial aneurysm outcomes is a fertile field for future investigation.

Smoking Status over Two Years in Patients with Multiple Sclerosis

Background: Smoking increases the risk of multiple sclerosis (MS) and possibly disease progression. The reliability of self-reported smoking status is unknown in MS. We assessed the reliability of self-reported smoking status among participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Methods: In 2004 and 2006, NARCOMS participants reported smoking status using Behavioral Risk Factor Surveillance Survey questions. We compared responses from 5,458 participants answering both questionnaires. We measured agreement regarding smoking status (ever/current) using a κ coefficient, and agreement for ages of starting and quitting smoking, and number of cigarettes smoked using an intraclass correlation coefficient (ICC). Results: In 2004, 2,885 (53.4%) participants reported ever smoking. The κ coefficient for ever smoking was 0.90 (95% confidence interval, CI: 0.89–0.92) and for current smoking 0.92 (95% CI: 0.90–0.94). The ICC for age at starting smoking was 0.73 (95% CI: 0.71–0.75) and for age at quitting smoking 0.90 (95% CI: 0.89–0.91). African-Americans, younger participants and those of lower socioeconomic status were less reliable. Depressed participants reported current smoking status less consistently (odds ratio: 0.51; 95% CI: 0.39–0.67). Conclusions: NARCOMS participants reliably report smoking status. The impact of depression on reliability of self-reported smoking status needs re-evaluation.