Self-reported Smoking Behavior Research Articles

Descriptions and Correlates of Salivary Cotinine in Individuals with Schizophrenia Spectrum Disorders

The purpose of this study was to describe the procedure and results of salivary cotinine testing and to examine correlations between cotinine levels, self-reported smoking behavior, and other demographic variables in outpatients with schizophrenia spectrum disorders (SSDs). Twenty-one participants completed salivary cotinine measures. Sixteen reported smoking cigarettes (mean = 1.2 packs per day; SD = 0.8; range = 0.25 to 3.0) for a mean of 27.4 years (SD = 16.3 years, range = 1 to 46 years). Age was significantly positively correlated with self-report of packs smoked per day (r = 0.52; p = 0.04) and years smoked (r = 0.63; p = 0.02). There was no clear pattern of relationship between salivary cotinine level and self-reported smoking behavior. This pilot study adds to a small body of literature describing salivary cotinine measures in individuals with SSDs, yet further investigation is warranted to definitively determine the utility of this objective measure of nicotine use.

Perioperative Smoking Behavior of Chinese Surgical Patients

Surveys suggest that, consistent with a high smoking prevalence, Chinese smokers in the general population report little interest in quitting. In other cultures, surgery is a powerful teachable moment for smoking cessation, increasing the rate of spontaneous quitting. We determined the perioperative tobacco use behavior of Chinese patients scheduled for elective surgery who smoke cigarettes and factors associated with both preoperative intent to abstain and self-reported smoking behavior at 30 days postoperatively. Specifically, we tested the hypothesis that perception of the health risks of smoking would be independently associated with both preoperative intent to abstain and self-reported abstinence at 30 days postoperatively. Patients ≥18 years of age scheduled for elective noncardiovascular surgery at Peking Union Medical College Hospital in Beijing, China, were assessed preoperatively and up to 30 days postoperatively for factors associated with smoking behavior, including indices measuring knowledge of smoking-related health risks. Of the 227 patients surveyed at baseline, most (164, 72%) intended to remain abstinent after hospital discharge. For the 204 patients contacted at 30 days postoperatively, 126 (62%) self-reported abstinence. In multivariate analysis, factors associated with preoperative intent to abstain after surgery included older age, self-efficacy for abstaining, and undergoing major surgery; factors associated with abstinence included older age, self-efficacy, major surgery, and preoperative intent to abstain. Higher perception of benefits from quitting was associated with intent, but not abstinence. Knowledge of the health risks caused by smoking was not found to be associated with either intent or abstinence, so that the hypothesis was not supported. Both intent to quit and self-efficacy for maintaining abstinence appear to be much higher in Chinese surgical patients than in prior surveys of the general Chinese population, and the majority of surgical patients maintained abstinence for at least 30 days. These findings suggest that surgery can serve as a powerful teachable moment for smoking cessation in China.

Smoking behaviour, former quit attempts and intention to quit in urban adolescents and young adults: A five-year longitudinal study

To examine smoking behaviour, former quit attempts and intention to quit among Swiss adolescents and young adults over five year's time. five-year longitudinal study (2003, 2005 and 2008) based on a random urban community sample (N=1345 complete cases). Data were collected by computer-assisted telephone interviews with adolescents (16-17) and young adults (18-24). Main outcome measures included self-reported smoking behaviour, former quit attempts, smoking cessation methods and current intentions to quit smoking. Adolescents were more often non-smokers and less often daily smokers when compared to young adults at baseline (χ(2)(4)=28.68, P<.001). Their smoking behaviour increased significantly from baseline to follow-up (T=1445.50, r=.20, P<.001) in contrast to the stable smoking behaviour in young adults (χ(2)(2)=.12, n.s.). In longitudinal analyses young adults were also more stable in their smoking status at the later measurement points. In comparison adolescents changed their smoking status more often being non-smokers at baseline and smokers later on. Independently of the age group, the majority of smokers already had previously attempted to quit (65%) or intended to give up smoking at some point (72%). However only 17% were motivated to make the quit attempt within the next 6 months. Self-quitting was the preferred method, and 25% of the self-quitters had been successful. This study illustrates that different developments in smoking behaviour exist in adolescents and young adults. Our study reveals that a majority of smokers are willing to quit but often fail. Furthermore, the data indicates that for adolescents the focus should lie on primary prevention.

Peer Influence and Selection Processes in Adolescent Smoking Behavior: A Comparative Study

Adolescent smoking studies find evidence of active peer influence and selection processes. However, studies have shown that these processes operate differently depending on context. This study uses SIENA to model coevolutionary processes between smoking and changes in friendship ties, comparing two high schools in which data were collected in identical fashion to explore influence and selection mechanisms with respect to current smoking, and smoking levels. This is a longitudinal survey with 2 waves of data. In-home surveys were conducted with students from 2 large high schools in the United States: a West Coast school, and a Midwestern school. Participants were consented students in 10th and 11th grades at the first wave of data collection. The primary measures were self-reported smoking behavior and friendship nominations. There is evidence of influence and selection in both schools for adolescents' smoking status (1 = any smoking) and for level of smoking. These models reflect great similarities in influence and selection processes across schools for different smoking behaviors. However, smoking prevalence may impact the exact mechanisms by which influence and selection operate. Researchers should consider smoking interventions with independent modules addressing different selection and influence processes, implemented based on contextual factors such as the prevalence of smoking.

Assessment of serum cotinine in patients with chronic heart failure: self-reported versus objective smoking behaviour

Smoking is a major risk factor in the development of coronary artery disease and thus chronic heart failure (HF). The value of self-reported smoking behaviour has not been validated in patients with HF. We sought to assess serum cotinine levels, a marker of recent tobacco exposure, in a cohort of clinically stable patients with chronic HF. We analysed serum cotinine values in 75 patients with chronic HF [mean age ± SD 64 ± 16 years, 85 % male, left ventricular ejection fraction 30 ± 1 %, New York Heart Association class (I/II vs. III/IV) 73 %/27 %, haemoglobin (Hb) 13.4 ± 1.5 g/dL, serum creatinine 1.21 ± 0.51 mg/dL] and 30 control subjects of similar age (63 ± 11 years, 43 % male, Hb 14.1 ± 1.5 g/dL, creatinine 1.12 ± 0.92 mg/dL) using a chemiluminescence immunoassay. Patients were interviewed about their smoking habits, and routine laboratory parameters were analysed. In patients with HF, cotinine values ranged from undetectable to 829 μg/L (mean 110 ± 208 μg/L). Similar findings were evident in healthy subjects with cotinine ranging from undetectable to 860 μg/L (mean 105 ± 208 μg/L). Serum cotinine levels correlated with leukocyte count and haemoglobin concentration (both p < 0.05). Self-reported smoking behaviour did not correspond to serum cotinine level in serum in 16.9 % of the patients with chronic HF. No such finding was evident in control subjects. Serum cotinine measurement provides an easily applicable means to analyse smoking behaviour in patients with chronic HF. Its assessment may permit analysis of smoking deception in daily clinical routine.

Association Between Genetic Variants on Chromosome 15q25 Locus and Objective Measures of Tobacco Exposure

BackgroundTwo single-nucleotide polymorphisms, rs1051730 and rs16969968, located within the nicotinic acetylcholine receptor gene cluster on chromosome 15q25 locus, are associated with heaviness of smoking, risk for lung cancer, and other smoking-related health outcomes. Previous studies have typically relied on self-reported smoking behavior, which may not fully capture interindividual variation in tobacco exposure.MethodsWe investigated the association of rs1051730 and rs16969968 genotype (referred to as rs1051730–rs16969968, because these are in perfect linkage disequilibrium and interchangeable) with both self-reported daily cigarette consumption and biochemically measured plasma or serum cotinine levels among cigarette smokers. Summary estimates and descriptive statistical data for 12 364 subjects were obtained from six independent studies, and 2932 smokers were included in the analyses. Linear regression was used to calculate the per-allele association of rs1051730–rs16969968 genotype with cigarette consumption and cotinine levels in current smokers for each study. Meta-analysis of per-allele associations was conducted using a random effects method. The likely resulting association between genotype and lung cancer risk was assessed using published data on the association between cotinine levels and lung cancer risk. All statistical tests were two-sided.ResultsPooled per-allele associations showed that current smokers with one or two copies of the rs1051730–rs16969968 risk allele had increased self-reported cigarette consumption (mean increase in unadjusted number of cigarettes per day per allele = 1.0 cigarette, 95% confidence interval [CI] = 0.57 to 1.43 cigarettes, P = 5.22 × 10−6) and cotinine levels (mean increase in unadjusted cotinine levels per allele = 138.72 nmol/L, 95% CI = 97.91 to 179.53 nmol/L, P = 2.71 × 10−11). The increase in cotinine levels indicated an increased risk of lung cancer with each additional copy of the rs1051730–rs16969968 risk allele (per-allele odds ratio = 1.31, 95% CI = 1.21 to 1.42).ConclusionsOur data show a stronger association of rs1051730–rs16969968 genotype with objective measures of tobacco exposure compared with self-reported cigarette consumption. The association of these variants with lung cancer risk is likely to be mediated largely, if not wholly, via tobacco exposure.

Factors associated with antenatal smoking among Aboriginal and Torres Strait Islander women in two jurisdictions.

Smoking rates are three times as high for pregnant Indigenous women relative to non-Indigenous women, in Australia. This paper describes Indigenous women's self-reported antenatal smoking behaviour and compares knowledge and attitudes of those who: (i) smoke and don't smoke during pregnancy; and (ii) quit or continued to smoke since the beginning of pregnancy. Cross-sectional surveys with 264 pregnant Indigenous women in two states collected data on smoking status, antenatal changes, risk knowledge, attitudes to smoking and sociodemographic characteristics. Multivariable logistic regression analyses assessed associations between knowledge and attitude variables and smoking status and antenatal changes in smoking status. Forty-six per cent of the women (n = 121) reported currently smoking. The majority (68%) who smoked at the beginning of pregnancy reported quitting (21%) or reducing (47%). Relative to smokers, non-smokers had more schooling (P = 0.002), more post-secondary education (P = 0.023), lower parity (P = 0.003), better understanding of smoking-related risks (miscarriage P = 0.01; low birth weight P = 0.003; infant illness P < 0.001; childhood behavioural problems P = 0.007), and less frequently expressed attitudes indicating that quitting was very difficult given other problems they faced. Similar patterns were found for women who quit during pregnancy compared to those who continued smoking. Increasing awareness of antenatal smoking risks and the benefits of quitting may motivate women to attempt to quit. However, knowledge alone is unlikely to be sufficient considering the life circumstances of many Indigenous women. Addressing the social environment and daily stressors, particularly those exacerbated by pregnancy, may be critical to supporting quit attempts.

Nonmedication Smoking Reduction Program for Inpatients With Chronic Schizophrenia

People with schizophrenia are more likely to smoke, and to smoke more frequently, than those without schizophrenia. Furthermore, inpatients smoke even more frequently compared with those living in the community. In light of this, we implemented and assessed a smoking reduction intervention using a wide array of behavioral group techniques and methods in chronic hospitalized schizophrenic clients. Using a controlled design, we randomly assigned chronic schizophrenic clients to either a five-session smoking reduction intervention (n = 35) or a waiting list (WL; n = 18). We assessed self-reported smoking behavior, clinical status (Positive and Negative Syndrome Scale, Hamilton Rating Scale for Depression; Clinical Global Impression Scale for Psychosis), subjective quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire-abbreviated version), and weight before and 3 months after the intervention. The intervention successfully reduced the number of cigarettes smoked compared with nonintervention. No clinical worsening or weight gain was observed. Behavioral group-oriented smoking reduction interventions can significantly reduce smoking behavior in hospitalized chronic clients with schizophrenia.

Beyond fear appeals: Contradicting positive smoking outcome expectancies to influence smokers' implicit attitudes, perception, and behavior

Smokers often have (implicit or explicit) positive smoking outcome expectancies that motivate them to smoke. For instance, they may feel that smoking is relaxing, that it improves concentration, or that it is seen as cool and attractive by peers. These expectations are, for the most part, illusory. In order to counteract these expectations, we designed cigarette package warning labels that contradicted common positive outcome expectancies. We investigated the effectiveness of our new warning labels in two experiments. We first measured smokers' implicit attitudes toward smoking using an affective priming method and found that our new warning labels changed positive attitudes into ambivalent attitudes. We then tested whether our warning labels changed smokers' self-reported positive outcome expectancies and smoking behavior. Smokers presented with the new warning labels immediately associated positive outcome expectancies less strongly with smoking and reported smoking fewer cigarettes in the 24hours following the experiment. Explicitly taking the reasons for unhealthy behavior into account when trying to change people's habits could offer a valuable contribution to effective health campaigns.

Reliability and validity of self-reported smoking in an anonymous online survey with young adults.

The Internet offers many potential benefits to conducting smoking and other health behavior research with young adults. Questions, however, remain regarding the psychometric properties of online self-reported smoking behaviors. The purpose of this study was to examine the reliability and validity of self-reported smoking and smoking-related cognitions obtained from an online survey. Young adults (N = 248) age 18 to 25 who had smoked at least 1 cigarette in the past 30 days were recruited online and completed a survey of tobacco and other substance use. Measures of smoking behavior (quantity and frequency) and smoking-related expectancies demonstrated high internal consistency reliability. Measures of smoking behavior and smoking stage of change demonstrated strong concurrent criterion and divergent validity. Results for convergent validity varied by specific constructs measured. Estimates of smoking quantity, but not frequency, were comparable to those obtained from a nationally representative household interview among young adults. These findings generally support the reliability and validity of online surveys of young adult smokers. Identified limitations may reflect issues specific to the measures rather than the online data collection methodology. Strategies to maximize the psychometric properties of online surveys with young adult smokers are discussed.

Emotional intelligence and smoking: Protective and risk factors among Canadian young adults

A sample of 20 and 21 year old participants ( n = 2699) of the Canadian National Longitudinal Survey of Children and Youth (NLSCY) was used to investigate the association between emotional intelligence and smoking in young adulthood. Emotional intelligence was measured with a short-form of the original EQ-i ( Statistics Canada, 2008), which assessed overall emotional intelligence and five dimensions: interpersonal competencies, intrapersonal competencies, stress management competencies, adaptability competencies and general mood. Using self-reported smoking behaviors, participants were classified as daily, occasional or non-smokers. Multinomial logistic regression analyses were conducted to test the association between emotional intelligence (and its dimensions) with daily and occasional smoking (compared to non-smoking – the reference category). Analyses were conducted on the total sample and were also stratified across gender. Stress management emerged as a protective factor against occasional and daily smoking among both males and females. Unexpectedly, a higher score on interpersonal competencies was associated with occasional smoking (compared to non-smoking) among males, suggesting that this group may consist of several social smokers. Our results suggest that emotional intelligence may comprise gender-specific protective and risk factors for occasional and daily smoking, which in turn should be considered in the development of smoking prevention programs.

Impact of enhanced secondary prevention on health behaviour in patients following minor stroke and transient ischaemic attack: a randomized controlled trial

Objective: To evaluate whether enhanced secondary prevention more significantly influences readiness to change health behaviour after minor stroke/transient ischaemic attack, compared with conventional stroke secondary prevention. Design: Single-blind randomized control trial. Setting: Rural district general hospital outpatient clinic. Subjects: Fifteen women and 37 men with a mean age of 68.3 years with first minor stroke or transient ischaemic attack. Interventions: The intervention group received ‘enhanced secondary prevention’ (additional advice, motivational interviewing and telephone support) to change health behaviour. Both groups received ‘conventional care’ which included advice given during routine care. Main measures: The primary outcome was ‘readiness to change behaviour’ measured using a validated stroke specific score based on the transtheoretical model. Secondary outcomes were the Hospital Anxiety and Depression Scale, and self-reported alcohol consumption, smoking behaviour, exercise frequency, and fruit and vegetable consumption. Results: Analysis of the data for the 52 participants showed no statistical difference in the groups for the primary outcome of readiness to change behaviour. Statistically significant improvements for change in self-reported exercise were demonstrated (P = 0.007); to 2—3 times per week in the intervention group compared to 0—1 times per week in the control group, and in fruit and vegetable consumption (P = 0.033); to 10 portions of fruit and vegetables consumed per week in the intervention group compared to 1 or 2 portions a week for the control group. No evidence of a difference between groups was seen for alcohol consumption or Hospital Anxiety and Depression Scale. Conclusions: While no difference was demonstrated between the groups for readiness to change behaviour, a clinically significant effect in reported exercise behaviour and diet were demonstrated in the intervention group. This interesting finding indicates a dissonance between the behaviour scale and actual behaviour change, potentially indicating a lack of sensitivity of the scale to detect a change in this patient group.

A descriptive analysis of relations between parents' self-reported smoking behavior and infants' daily exposure to environmental tobacco smoke

BackgroundThe aims of the present study were to examine relations between parents' self-reported smoking behavior and infants' daily exposure to environmental tobacco smoke, as assessed by urinary cotinine-to-creatinine ratio (CCR), and to describe the CCR over seven days among infants at home.MethodsA convenience sample of 27 households was drawn. Each household had to have at least one daily tobacco smoker and one child up to three years of age. Over a seven-day period, urine samples were obtained from the child daily. To examine relations between parents' self-reported smoking and infants' daily CCR, generalized estimating equation (GEE) analysis was used.ResultsThe data revealed that infants from households with indoor smoking had higher CCRs than infants in households with outdoor smoking. CCRs were higher in girls than in boys. Older infants had lower CCRs than younger infants. Smoking outside the home versus inside the home, infant's gender, and infants' age accounted for 68% of the variance in CCR in a GEE data analysis model. No increase or decrease of CCR over time was found.ConclusionThe findings suggest that parents' self-reported smoking indoors at home versus outdoors is predictive of CCR among infants three and younger. Higher CCR concentrations in girls' urine need further examination. Furthermore, significant fluctuations in daily CCR were not apparent in infants over a seven-day time period.

Association Between Trauma Exposure and Smoking in a Population-Based Sample of Young Adults

Purpose To evaluate the relation between smoking and trauma exposure in a population-based, longitudinal sample. Contrary to current smoking trends in the general population, recent findings indicate continued high smoking rates in trauma-exposed samples. Methods A nationally representative sample of 15,197 adolescents was followed from 1995 (mean age, 15.6 years) to 2002 (mean age, 22 years) as part of three waves of The National Longitudinal Study of Adolescent Health (Add Health). We examined the relation between self-reported trauma exposure and smoking behaviors (lifetime regular, current regular), nicotine dependence based on the Fagerström Test of Nicotine Dependence (FTND), number of cigarettes smoked per day, and age of onset of regular smoking. Results Controlling for demographics and depressive symptoms, exposure to traumatic events yielded a significant increase in the odds of lifetime regular smoking. Nicotine dependence and cigarettes smoked per day was also significantly related to exposure to childhood physical and sexual abuse. Decreased age of regular smoking onset was seen for those reporting childhood physical abuse and childhood sexual abuse. Conclusions Exposure to traumatic life events during childhood and young adulthood increases the risk of smoking, highlighting the need to prevent and treat tobacco use in this vulnerable population.

Disparities in Diabetes Care Between Smokers and Nonsmokers

Smoking is a known risk factor for both macro- and microvascular complications of diabetes, contributing to higher medical costs, lower quality of life, and premature deaths in adults with diabetes who smoke (1–3). Although the prevalence of smoking has decreased over the last decade in the U.S., (4,5) one in six adults with diabetes still smokes (6). Diabetes experts recommend that diabetic smokers be advised about smoking cessation and closely monitored for signs of complications by health care professionals, (7) but diabetic smokers are reportedly less likely to receive the recommended care. A survey of health plan members reported that diabetic smokers were likely to have fewer diabetes care visits and receive less frequent preventive care than diabetic nonsmokers (8). Using data from community-based, statewide diabetes intervention programs, the present study compares five major diabetes care indicators between diabetic smokers and age-, sex-, and race-matched diabetic nonsmokers while controlling for the effects of insurance status. The data were collected from participants of the New York State Diabetes Coalitions community-based intervention programs, 1999–2004, which were designed to reach the medically underserved (9). All participants were required to complete standardized forms at program registration. The data contained self-reported health status, smoking behavior, diabetes care, and insurance status of >16,000 adults (aged ≥18 years) with diagnosed diabetes. Participants with <13 months of duration since diagnosis of diabetes were excluded from the study. Then, all current …

Western media's influence on Egyptian adolescents' smoking behavior: The mediating role of positive beliefs about smoking

Western media has been implicated as an adolescent smoking risk factor in numerous Western studies, but little research has investigated that influence on adolescents from developing Arab countries. One such country is Egypt, which has the highest rate of smoking in the Arab world. An estimated 34% of Egyptians are daily smokers, 4% of whom are under the age 15 years and 0.6% of whom are under the age 10. The present study investigated the association between exposure and receptivity to Western media, positive beliefs about smoking, and Egyptian adolescents' smoking behavior. A school-based cross-sectional survey of 1,930 Egyptian adolescents in 7th, 9th, and 12th grades, from randomly selected schools in Alexandria, Egypt, was conducted in May 2003. Self-reported smoking behaviors, demographics, psychosocial factors, and exposure to Western and pro-tobacco media were assessed. Controlling for demographics, psychosocial smoking risk factors, and pro-tobacco media exposure, we found that Western media exposure was positively associated with ever-smoking across genders and 30-day smoking among adolescent males only. Positive beliefs about smoking partially mediated this association among ever-smokers and completely mediated it among 30-day male smokers. The results indicate that the influence of Western media on Egyptian adolescents' smoking behavior is at least partially mediated by its influence in increasing adolescents' positive beliefs about smoking and consequently their smoking behavior. Regulation of the glamorization of smoking behavior in Western media and correction of the erroneous perception of positive beliefs about smoking among adolescents is necessary to help curb the rising smoking epidemic in Egypt.

Environmental Tobacco Smoke Exposure and Respiratory Morbidity in Children

Environmental tobacco smoke (ETS) contains carcinogenic and toxic agents. Smoking might have a more serious effect on children than adults. We aimed to examine the effects of passive smoking on pulmonary function and respiratory health in children and to assess the concordance between parental self-reported smoking habits and urinary cotinine levels in their children. This cross-sectional study was conducted in the winter with the participation of 131 children (9–12 yr old). The procedure for each subject consisted of administration of a questionnaire to the parents, and collection of a urine sample and measurement of lung function in each child. Cotinine level excreted into urine was analyzed with respect to parental self-reported smoking behavior. Working mothers and mothers with higher level of education tended to smoke more at home (p values, respectively, .002 and.005). There was a statistical difference between the urinary cotinine levels of children when divided into two groups according to their fathers' smoking behavior at home (p = .0001). No statistically significant difference was determined in the mean episodes of respiratory infections treated during the last 12 mo among the groups formed according to daily number of cigarettes smoked by the parents at home (1: not exposed; 2: < 5 cigarettes; 3: 5–10 cigarettes; 4: > 10 cigarettes), or among the groups formed according to urinary cotinine levels (1: < 10 ng/ml; 2: ≥10 ng/ml). No significant difference was demonstrated in any of the respiratory function parameters investigated between the groups considered. The reliability of the declarations of the parents in the estimation of ETS exposure of children was low. Children are unable to remove themselves from ETS exposure. It is better to reduce the percentage of parents who smoke rather than to isolate smokers or increase ventilation.

Web-based support as an adjunct to group-based smoking cessation for adolescents

Although group-based programs remain the most common treatment approach for adolescent smoking cessation, success rates for these programs have been relatively modest, and their reach may be limited. Web-based adjuncts may be one way to boost the efficacy and reach of group-based approaches. The purpose of this study was to evaluate the effectiveness of enhancing the American Lung Association's Not on Tobacco program (NOT) with a Web-based adjunct (NOT Plus). Twenty-nine high schools were randomly assigned to either the NOT program alone or to the NOT Plus condition, which included access to a specially designed Web site for teens, along with proactive phone calls from the group facilitator to the participant. Self-reported smoking behavior was obtained at end-of-program and at a 3-month follow-up. Using hierarchical linear modeling, accounting for the clustering of students in schools, and controlling for student gender, grade, race, and baseline smoking rate, there was a marginally significant (p=.06) condition effect at end-of-treatment and a significant effect at 3-month follow-up (p<.05) favoring the NOT Plus condition. Approximately 57% of adolescents reported visiting the Web site, and among the NOT Plus condition, use of the Web site was associated with cessation significantly at end-of-program (p<.05), but not at 3 months. Adolescents in urban schools were more likely to access the Web site than those in rural schools. Participants who visited the Web site rated it positively on several dimensions. Reasons for not using the Web site will be discussed, as well as its value as an adjunct.

Validity of Self-reported Smoking Status among Participants in a Lung Cancer Screening Trial

Lung cancer remains a devastating disease associated with substantial morbidity and mortality. Recent research has suggested that lung cancer screening with spiral computed tomography scans might reduce lung cancer mortality. Studies of lung cancer screening have also suggested that significant numbers of participants quit smoking after screening. However, most have relied solely on self-reported smoking behavior, which may be less accurate among participants in lung cancer screening. To assess the validity of self-reported smoking status among participants in a lung cancer screening trial, this study compared self-reported smoking status against urinary cotinine levels. The sample included 55 consecutive participants enrolled in a randomized clinical trial comparing annual spiral computed tomography and chest X-ray for lung cancer screening. Participants were a mean of 59 years of age and predominantly Caucasian (96%) and male (55%). Self-reported smoking status was assessed before and after participants learned of the purpose of the biochemical verification study. Using urinary cotinine as the "gold standard," the sensitivity and specificity of self-reported smoking status were 91% and 95%, respectively (kappa = 0.85, P < 0.001, 95% confidence interval = 0.71-0.99). Total misclassification rate was 7%. However, three of the four misclassified participants reported concurrent use of nicotine replacement strategies. Eliminating these cases from the analysis revealed sensitivity of 100% and specificity of 95% (kappa = 0.96, P < 0.001, 95% confidence interval = 0.88-1.00). In conclusion, self-reported smoking status among participants in a lung cancer screening trial was highly consistent with urinary cotinine test results.

Self-reported smoking and related health behaviors in South Carolina: A geographic analysis of incidence rates of smoking-attributed cancers

Smoking is associated with increased risk of adverse health effects, including increased risk of cancer, stroke, heart disease and premature mortality. Smoking cessation is touted as the best method to prevent these negative health outcomes. However, the rate of current smokers has not significantly declined in the last fifteen years in South Carolina. This study assesses current smoking and related health behaviors and investigates any possible association with incidence rates of smoking-attributed cancers in South Carolina. Responses regarding current smoking behavior and voluntary seeking of medical care to the 2003 Behavior Risk Factor Surveillance System (BRFSS) survey conducted in South Carolina were obtained through the South Carolina Department of Health and Environmental Control (SC-DHEC) website. Incidence rates of all cancers for 1996 through 2000 were also obtained through the SC-DHEC website. Smoking-attributed cancers were classified based upon Centers for Disease Control (CDC) classification. Both smoking attributed and nonsmoking attributed cancer incidence rates were categorized according to counties. An analysis was conducted using Arc View Geographical Information System software. Geographic analysis identified Marlboro and Dillon counties has having the highest age-adjusted lung cancer incidence rates in South Carolina (Dillon – 118.9 and Marlboro – 135.0 per 100,000) while also having the largest percentage of current smokers (69.3%) and the largest percentage of smokers not seeking medical care (30.7%). These counties had the third and fourth highest rate differences between total 1996 to 2000 incidence rates of smoking-attributed cancers and the incidence rates of cancers not attributable to smoking. Marlboro and Dillon counties have high smoking-attributable cancer incidence rates and the largest percentage of current smokers not seeking medical care. Ongoing surveillance such as BRFSS should be combined with health education in these at-risk counties.