176911 Accuracy of self-reported secondhand smoke exposure in NHANES 1988-2002

Sunday, October 26, 2008

Kristopher L. Arheart, EdD , Department of Epidemiology & Public Health, University of Miami, Miller School of Medicine - NIOSH Research Group, Miami, FL
David J. Lee, PhD , Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, FL
Lora E. Fleming, MD, PhD , Department of Epidemiology & Public Health, University of Miami, Miller School of Medicine - OHH Center and NIOSH Research Group, Miami, FL
William G. LeBlanc, PhD , Department of Epidemiology & Public Health, University of Miami, Miller School of Medicine - NIOSH Research Group, Miami, FL
Noella Dietz, PhD , Department of Epidemiology and Public Health, University of Miami, Leonard Miller School of Medicine, Miami, FL
Kathryn E. McCollister, PhD , Department of Epidemiology & Public Health, University of Miami, Miller School of Medicine, Miami, FL
James Wilkinson, MD, MPH , Graduate Programs In Public Health, University of Miami, Miami, FL
John E. Lewis, PhD , Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL
John D. Clark III, PhD , Department of Epidemiology and Public Health, University of Miami, Miami, FL
Evelyn P. Davila, MPH , Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL
Frank C. Bandiera, MPH , Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, FL
Background: The workplace remains a significant source of secondhand smoke (SHS) exposure. Occupational health studies often rely on self-reported SHS exposure; the accuracy of self-reports is unknown. This study examines the accuracy of self-reported tobacco use and exposure to SHS validated against serum cotinine levels, a nicotine metabolite.

Methods: Nationally representative data on serum cotinine and self-reported tobacco use and SHS exposure for US workers were extracted from the National Health and Nutrition Examination Surveys (NHANES). NHANES III, 1999-2000, and 2001-2002 surveys were used (n= 13,870). Serum cotinine was categorized into tobacco user (>15 ng/ml), SHS exposed (above the detectable limit but ≤15 ng/ml), and SHS unexposed (undetectable). The percent agreement between the self-reported and cotinine categories was calculated.

Results: Workers reporting tobacco use were 88% accurate while workers reporting work, home, or combination home/work exposures were 92-93% accurate. Workers reporting no SHS exposure were only 30% accurate. Accuracy levels did not vary much among worker groups (e.g. blue/white collar).

Conclusions: Workers accurately report their smoking status; positive reports of workplace and/or home SHS exposures are also accurate. However, large proportions of workers reporting "no exposures" have detectable levels of cotinine in their blood consistent with unreported SHS exposures which extend beyond home and workplace settings and/or reflect a worker inability to detect low-level workplace SHS exposure. Occupational health studies that rely on abbreviated self-reported SHS exposure instruments should be aware of some misclassification, and may consider more comprehensive assessment of these exposures both in and out of the worksite.

Learning Objectives:
1. Describe the use of the NHANES databases as a source of nationally representative data to examine tobacco use and exposure to SHS 2. Explore the accuracy of using self-reported tobacco use/SHS exposure using serum cotinine levels

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have the necessary academic background and experience
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.