Self-report Of Smoking Status Research Articles

Accuracy of self-reported smoking status in adult survivors of childhood cancer: A report from St. Jude Lifetime Cohort study.

10570 Background: Although clinicians often evaluate smoking behavior in cancer survivors via self-report, the validity of this approach is unknown. We validated self-reported smoking status by serum cotinine data in clinically assessed adult survivors of childhood cancer and identified factors contributing to misclassification. Methods: The study sample consists of 287 randomly selected adult survivors of childhood cancers participating in the St. Jude Lifetime Cohort Study and undergoing a risk-based clinical assessment in a survivorship clinic. Self-reported smoking status was classified as never (N = 105), past (N = 111), and current (N = 71) smokers. Age, sex, and race/ethnicity were balanced among the three groups (p’s > 0.05). Blood samples were obtained and serum cotinine levels were quantified by liquid chromatography tandem mass spectrometry. Misclassification was determined by the discrepancies between self-reported smoking status and race/ethnicity-specific serum cotinine thresholds (Benowitz et al. Am J Epidemiol 2009). Multiple logistic regression model was used to identify factors related to misclassification. Results: Of the 287 survivors (mean age = 34 years [range = 19-61]; mean time from diagnosis = 24 years [range = 11-46]), 55.4% were male and 84.0% non-Hispanic white. Cotinine levels consistent with recent active smoking were present in 39.4% compared to 24.7% who self-reported as being a current smoker (X2= 14.1; p = 0.0002). Rates of misclassification were 36.9%, 8.4%, and 6.7% in survivors who reported themselves as past, current, and never smokers, respectively. Among self-reported past smokers, 18-30 years of age at survey, male, and current marijuana use increased the risk of misclassification: RR = 3.0 (95%CI = 1.2-7.6), 2.5 (95%CI = 1.1-5.4) and 3.2 (95%CI = 1.1-9.3), respectively. Conclusions: Within a clinical setting, reliance on self-report of smoking status by survivors results in a high misclassification rate. For research, serum cotinine levels should be utilized to assign smoking status. For clinical care and health promotion, clinicians need to be aware of the high rate of misclassification when relying upon self-reported smoking status.

The Effect of Different Case Definitions of Current Smoking on the Discovery of Smoking-Related Blood Gene Expression Signatures in Chronic Obstructive Pulmonary Disease.

Smoking is the number one modifiable environmental risk factor for chronic obstructive pulmonary disease (COPD). Clinical, epidemiological and increasingly "omics" studies assess or adjust for current smoking status using only self-report, which may be inaccurate. Objective measures such as exhaled carbon monoxide (eCO) may also be problematic owing to limitations in the measurements and the relatively short half life of the molecule. In this study, we determined the impact of different case definitions of current cigarette smoking on gene expression in peripheral blood of patients with COPD. Peripheral blood gene expression from 573 former- and current-smokers with COPD in the ECLIPSE study was used to find genes whose expression was associated with smoking status. Current smoking was defined using self-report, eCO concentrations, or both. Linear regression was used to determine the association of current smoking status with gene expression adjusting for age, sex and propensity score. Pathway enrichment analyses were performed on genes with P < .001. Using self-report or eCO, only two genes were differentially expressed between current and ex-smokers, with no enrichment in biological processes. When current smoking was defined using both eCO and self-report, four genes were differentially expressed (LRRN3, PID1, FUCA1, GPR15) with enrichment in 40 biological pathways related to metabolic processes, response to hypoxia and hormonal stimulus. Additionally, the combined definition provided better distributions of test statistics for differential gene expression. A combined phenotype of eCO and self report allows for better discovery of genes and pathways related to current smoking. Studies relying only on self report of smoking status to assess or adjust for the impact of smoking may not fully capture its effect and will lead to residual confounding of results.

Efficacy of a tobacco quitline among adult survivors of childhood cancer.

The purpose of this investigation was to determine the efficacy of two evidence-based tobacco quitlines in adult survivors of childhood cancer who regularly smoke cigarettes. A total of 519 adult survivors of childhood cancer were randomized to either Proactive + 4 weeks of medication (Counselor-initiated intervention, n = 260) or a Reactive + 2 weeks of medication (Participant-initiated intervention, n = 259) condition. Both conditions received telephone counseling to quit smoking as well as nicotine replacement therapy. The primary outcome was biochemically verified (i.e. cotinine) point prevalence smoking cessation at 12 months follow-up. Participants randomized to the Proactive + 4 weeks of medication condition self-reported a higher rate of cessation than those survivors in the Reactive + 2 weeks of medication condition at 8 weeks (33.2% vs. 17.0%, p < .001), but cessation rates were not significantly different at 12 months (23.0% vs. 18.7%, p = .29). However, 80% of participants claiming abstinence failed biochemical verification, indicating marked falsification of self-reported smoking status. Adjusted cessation rates were less than 2% in both intervention conditions. Our results indicate that neither a Proactive + 4 weeks of medication or Reactive + 2 weeks of medication quitline significantly impacted long-term smoking cessation rates. Our results further indicate that self-reports of smoking status are unreliable in survivors of childhood cancer, a population in considerable need of tobacco abstinence. Rates of smoking cessation may be markedly overestimated in studies of childhood cancer survivors that rely on self-reports of tobacco abstinence, and future studies need to include biochemical verification of tobacco status in this population.

Progression of Periodontal Disease in a Maintenance Population of Smokers and Non‐Smokers: A 3‐Year Longitudinal Study

Cigarette smoking is accepted as an important factor that increases the risk for the initiation and progress of chronic periodontitis. However, the effect of cigarette smoking on the recurrence of disease in patients undergoing regular maintenance therapy is less understood. Therefore, we set out to assess disease progression longitudinally in smoking and non-smoking subjects with chronic periodontitis undergoing periodontal maintenance therapy every 3 to 4 months. A total of 108 subjects undergoing regular maintenance therapy for chronic periodontitis were followed over a 3-year period. Self-reports of smoking status were confirmed by analysis of exhaled carbon monoxide concentrations. Clinical parameters (plaque index [PI], bleeding on probing [BOP], clinical attachment loss [CAL], probing depth [PD], and tooth loss) were recorded at yearly reevaluation visits. The study was carried out in a university hospital setting. Longitudinal measurements were obtained from 81 (75%) subjects. There were no differences in inflammatory indices at baseline or over time (PI and BOP; both P >0.05) between smokers (N = 16; age: 54 +/- 6 years) and non-smokers (N = 65; age: 59 +/- 14 years). Likewise, there was no difference between the smoking groups with respect to disease progression (measured as changes in prevalence [number] and proportion [percentage] of progressing sites and as mean CAL, PD, and tooth loss; all P >0.05). In this small population, regular maintenance treatment in a cross-section of highly motivated subjects with chronic periodontitis seemed to be equally successful in preventing progressive periodontal tissue destruction in current smokers and current non-smokers.

Concordance of Self-Reported Abstinence and Measurement of Expired Air Carbon Monoxide in a Self-Help Smoking Cessation Treatment

Some self-help programmes for smoking cessation obtain abstinence data entirely from participants' self-reports. This may lead to overestimation of efficacy. In the present study, the relationship between self-reported abstinence and expired-air carbon monoxide was evaluated at the 12-mo. follow-up in 200 smokers who had participated in a self-help programme for smoking cessation conducted by mail. Analysis indicated a close relationship between carbon monoxide levels and self-reports of smoking status; concordance was about 90%. Studies of the efficacy of self-help programmes for smoking cessation should include some sort of objective verification of self-reported abstinence.

Tobacco smoking in Tanzania, East Africa: population based smoking prevalence using expired alveolar carbon monoxide as a validation tool

Objectives: To describe the prevalence of tobacco smoking in an urban East African population while using a simple validation procedure to examine the degree of under reporting in men and...

Smoking status by proxy and self report: rate of agreement in different ethnic groups

OBJECTIVETo examine the rate of agreement between proxy and self report of smoking status in Hispanics compared with other ethnic groups.DESIGNData source is the 1990 California Tobacco Survey (CTS) which...

Quality of measurement of smoking status by self-report and saliva cotinine among pregnant women.

The objectives of this paper were to determine the rate of misclassification of smoking and nonsmoking status by self-reports and saliva continine of pregnant women participating in a smoking cessation trial, determine the relationship of the number of cigarettes smoked per day and saliva continine, and examine whether misclassification was due to an inappropriate saliva continine cutoff point. End of pregnancy self-reports of smoking status and saliva continine were used to calculate misclassification rates. The findings revealed that 61 of 441 self-reported smokers had biochemical values inconsistent with smoking status for a smoking misclassification rate of 13.8%. The results also revealed that 28 of 107 self-reported quitters had continine values consistent with smoking status for a nonsmoking misclassification rate of 26.2%. Receiver Operating Characteristic (ROC) curves were then plotted to determine whether misclassification resulted from an inappropriate cutoff point. The continine cutoff point that maximized sensitivity and specificity for all women was 24 ng/ml. Racial ROC comparisons indicated a higher cutoff point for blacks than whites. Use of any of the ROC indicated cutoff points would not change the misclassification rates. These findings suggest that underreporting of smoking status during pregnancy is high and that social desirability of nonsmoking status may have contributed to the lack of precision in saliva continine to distinguish smoking status in this study.

Doxorubicin-induced cardiotoxicity

<b>Objectives: </b>Despite the well-documented link between high rates of smoking and schizophrenia, there have been no longitudinal studies that have looked at rates of smoking and associated factors over time. This prospective study examined the longitudinal rates of smoking in a schizophrenia clinic sample over a decade. <b>Design: </b>Longitudinal survey research. <b>Setting:</b> A well-established community-based psychiatric rehabilitation program in Hamilton, Ontario, Canada providing long-term intensive case management and rehabilitation skills training. <b>Participants: </b>Stable community outpatients diagnosed with schizophrenia were surveyed initially in 1995 (N = 102) and then re-surveyed eleven years later in 2006 (N = 76). <b>Main Outcome Measures: </b>Self-report of smoking status. <b>Results:</b>Smoking rates dropped significantly over time, with evidence that the number of ‘quitters’ tripled over the past decade and the number of ‘everyday’ smokers decreased by almost a third from 63.2% down to 43.3% (p &lt; .001). <b>Conclusions: </b> The findings from the present study suggest that it is possible to obtain reduced smoking prevalence over time in a selected schizophrenia outpatient sample, though further research is required to better understand the factors related to quitting smoking in individuals with schizophrenia.

Passive smoking amongst asthmatic children. Questionnaire or objective assessment?

An increasing number of studies have implicated passive smoking as a definite threat to non-smokers' health. Self-reports of smoking status may not always be reliable, particularly in situations where the smoker feels under pressure to give up smoking. In this study questionnaire and salivary cotinine, an objective measure of nicotine exposure, were studied in asthmatic and age-matched control children. We have consequently developed a sensitive assay for cotinine using high performance liquid chromatography (HPLC) to quantitate environmental tobacco smoke (ETS) exposure in a group of 5- to 7-year-old asthmatic and control children. We chose to use mixed unstimulated saliva collected by absorption into dental rolls in the mouth for 5 min. Our modified extraction procedure was highly reproducible with a > 90% retrieval rate of cotinine from spiked saliva. The parents were asked to fill in a questionnaire on atmospheric pollutants to obtain an estimate of declared ETS exposure in the home. Results showed that 31% of the asthmatic patients were exposed to ETS, according to the parents, but by HPLC 69% had been so exposed (n = 19). From the control group the figures were 40% and 50% of patients, respectively. Therefore, an objective assessment is essential as ETS is more ubiquitous than is apparent from the questionnaire alone. Finally, in this small number of individuals our objective assessment demonstrates that ETS exposure is more prevalent in asthmatic children (69%) than age-matched controls (51%).

Methodological note: Corroboration of self-reported smoking status using significant other reports

Significant other reports (SORs) are commonly used in smoking cessation studies to verify self-reports of smoking status. This report focuses on factors related to the smoker and significant other, which can affect self-reported classification of smoking status when using SORs. Data used in this analysis were collected from a cohort of 107 smokers who participated in a smoking cessation program. Participants were contacted at 1, 3, and 6 months after quitting to obtain self-reports of smoking status. SORs also were obtained at each assessment period. The highest discrepancy rate between self-report and SOR was observed among slippers, followed by relapsers, and abstainers, respectively. In addition, corroboration of smoking status was influenced by the social context in which the significant other was likely to see the smoker.

The Effects of Counseling on Smoking Cessation Among Patients Hospitalized with Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial

Seventy-four cigarette-smoking patients admitted with COPD to the Chest Unit of a 600-bed teaching hospital served as subjects for a randomized trial of smoking cessation counseling. All patients were advised to quit smoking and smoking in the unit was not allowed. One-half of the patients were, in addition, provided with a self-help manual and three to eight 15- to 20-min counseling sessions on alternate days while in hospital. Self-reports of smoking status were obtained at 3 and 6 months, a sample of which were validated with serum COHb. The results were disappointing. Differences between the counseled group and the controls both in rates of cessation at 6 months (33.3% vs 21.4%) and, for patients still smoking, reductions in amount smoked would have lacked practical significance even if statistical significance had been obtained. Some alternative treatment approaches are suggested for this group of patients.

Adding spirometry, carbon monoxide, and pulmonary symptom results to smoking cessation counseling

Smokers are often advised to quit in a discussion of future health risks. The authors tested whether adding information about personal effects of smoking would motivate hospital outpatients to stop smoking more than advice about potential hazards would. Ninety smokers in a general screening clinic were randomized to receive education alone or education plus an additional motivational intervention that contained immediate feedback about the smoker's exhaled carbon monoxide (CO) values, spirometry results, and pulmonary symptoms. A self-report of smoking status was obtained one, four, and 12 months after the intervention. In addition, at 12 months, exhaled CO measurements were made. Smokers who received the additional motivational intervention were more than twice as likely to report quitting some time during the 12-month follow-up (40% vs. 16%, p = 0.015). At 12 months, 33% of the intervention group and 10% of the control group smokers tested had achieved CO-validated cessation (p = 0.03). Counting all patients not contacted as continuing to smoke, the percentages were 20% vs. 7% (p = 0.06). These practical feedback methods to motivate cessation deserve testing in other settings.

Smoking and carbon monoxide levels during pregnancy

Self-reports of smoking status and breath tests for carbon monoxide were collected in prenatal outpatients. The breath test for carbon monoxide appeared to be a valid and specific measure of smoking status during pregnancy. Of the 179 patients surveyed, 99 reported they had smoked during the present pregnancy. Nineteen of the smokers reported they had quit during the present pregnancy and 46 reported that they smoked fewer cigarettes than at the beginning of their pregnancy. Most of the quitters and reducers stated that they had stopped or reduced their intake early in pregnancy and for pregnancy-related reasons; however, neither parity, nausea or vomiting, marital status, nor requests of physicians or family were associated with higher rates of smoking cessation or reduction. Most of the pregnant smokers were interested in stopping smoking, but few attended a free treatment program.