Validation of self-reported smokeless tobacco use by measurement of serum cotinine concentration among US adults.
Open Access
- 13 August 2014
- journal article
- research article
- Published by Oxford University Press (OUP) in American Journal of Epidemiology
- Vol. 180 (7), 749-54
- https://doi.org/10.1093/aje/kwu182
Abstract
Although investigators have assessed the relationship between self-reported cigarette smoking and biomarker levels, the validity of self-reported information on smokeless tobacco (SLT) use is uncertain. We used aggregated data from the 2003-2004, 2005-2006, 2007-2008, and 2009-2010 administrations of the National Health and Nutrition Examination Survey (NHANES) to compare self-reported SLT use with serum concentrations of cotinine, a metabolite of nicotine, among US adults aged ≥18 years. Receiver operating characteristic analysis was used to determine the optimal serum cotinine cutpoint for discriminating SLT users from nonusers of tobacco, and concordance analysis was used to compare self-reported SLT use with cotinine levels. Among the 30,298 adult respondents who completed the NHANES during 2003-2010, 418 reported having exclusively used SLT and no other type of tobacco (cigarettes, cigars, or pipes) during the past 5 days, while 23,457 reported not using any tobacco. The optimal cotinine cutpoint for discriminating SLT users from non-tobacco users was 3.0 ng/mL (sensitivity=97.0%, specificity=93.0%), which was comparable to a revised cutpoint recommended for identifying adult cigarette smokers. Concordance with cotinine was 96.4% and 93.7% for self-reported SLT use and tobacco nonuse, respectively. These findings indicate that self-reported SLT use among adults correlates highly with serum cotinine levels and that the optimal cutpoint for minimizing misclassification of self-reported use is a serum cotinine concentration of 3.0 ng/mL.Keywords
This publication has 32 references indexed in Scilit:
- Use of Conventional and Novel Smokeless Tobacco Products Among US AdolescentsPEDIATRICS, 2013
- Biomarker Measurements of Concurrent Exposure to Multiple Environmental Chemicals and Chemical Classes in ChildrenJournal of Toxicology and Environmental Health, Part A, 2011
- Comparison of Urine Cotinine and the Tobacco-Specific Nitrosamine Metabolite 4-(Methylnitrosamino)-1-(3-Pyridyl)-1-Butanol (NNAL) and Their Ratio to Discriminate Active From Passive SmokingNicotine & Tobacco Research, 2011
- Self-reported smoking habits and serum cotinine levels in women with placental abruptionActa Obstetricia et Gynecologica Scandinavica, 2010
- Global surveillance of oral tobacco products: total nicotine, unionised nicotine and tobacco-specific N-nitrosaminesTobacco Control, 2010
- Receptivity to Taboka and Camel Snus in a U.S. test marketNicotine & Tobacco Research, 2009
- Validity of Self-reported Smoking Using Urinary Cotinine among Vocational High School StudentsJournal of Preventive Medicine & Public Health, 2009
- Optimal Serum Cotinine Levels for Distinguishing Cigarette Smokers and Nonsmokers Within Different Racial/Ethnic Groups in the United States Between 1999 and 2004American Journal of Epidemiology, 2008
- Salivary cotinine concentration versus self-reported cigarette smoking: Three patterns of inconsistency in adolescenceNicotine & Tobacco Research, 2006
- Comparison of Self‐Reported Smoking and Urinary Cotinine Levels in a Rural Pregnant PopulationJournal of Obstetric, Gynecologic & Neonatal Nursing, 2004