Assessing secondhand smoke exposure with reported measures

Abstract

Non-smokers are exposed to tobacco smoke from the burning cigarette and the exhaled smoke from smokers. In spite of decades of development of approaches to assess secondhand smoke exposure (SHSe), there are still unresolved methodological issues. This manuscript summarises the scientific evidence on the use of SHSe reported measures and their methods, objectives, strengths and limitations; and discusses best practices for assessing behaviour leading to SHSe for lifetime and immediate or current SHSe. Recommendations for advancing measurement science of SHSe are provided. Behavioural measures of SHSe commonly rely on self-reports from children and adults. Most commonly, the methodology includes self, proxy and interview-based reporting styles using retrospective recall or diary-style reporting formats. The reporting method used will vary based upon the subject of interest, assessment objectives and cultural context. Appropriately implemented, reported measures of SHSe provide an accurate, timely and cost-effective method for assessing exposure time, location and quantity in a wide variety of populations.

Secondhand Smoke Exposure and Validity of Self-Report in Low-Income Women and Children in India

“…1 An accurate assessment of SHS exposure is needed for population-based prevalence estimates, epidemiologic studies in which researchers investigate associations with disease, and clinicians during patient examinations. 2 Self-reported measures and questionnaires are the most commonly used methods for assessing SHS exposure levels in populations of interest. These methods are noninvasive, inexpensive, and easy to administer, providing a useful resource to a wide range of professionals for a variety of purposes.…”

“…These methods are noninvasive, inexpensive, and easy to administer, providing a useful resource to a wide range of professionals for a variety of purposes. 2 Additionally, clinicians and health care professionals often use questionnaire methods for ascertaining exposure among their patients. 3 Of importance, however, is ensuring that the questions included in reported measurement tools are valid for the target population.…”

“…Misclassification of SHS exposure may lead to incorrect prevalence estimates in surveillance studies and biased or confounded estimates of risk in epidemiologic studies, and it is frequently cited as a major limitation of studies in which researchers evaluate SHS exposure. 2 In the clinic setting, patients who are not identified as being exposed to SHS may miss out on important interventions from their providers.…”

“…7 A variety of self-report methods have been used to collect SHS exposure information, from daily diaries to directly observed methods. 2 In children, caregivers are often responsible for reporting exposure, which is a challenge if children are not in the presence of their caregivers full-time or if the caregivers are the source and reluctant to accurately report. 8 Children are a particularly vulnerable population, elevating the importance of accurate classification in this group.…”

“…Valid questions may be especially important for lowincome individuals, providing value to researchers and clinicians evaluating tobacco use and associated morbidities in this particularly vulnerable population. 2,9 Questions used in the Global Tobacco Surveillance System surveys, which have been administered in India, are validated for understanding and comprehension of questions, but routine validation with biomarkers is not conducted (as is the case with the NHANES in the United States). 10,11 The purpose of this present study is to evaluate the validity of reported measures of exposure to tobacco use in India, specifically women's ability to report personal SHS exposure and caregiver ability to report SHS exposure for children <5 years of age.…”