Measurements for active cigarette smoke exposure in prevalence and cessation studies: Why simply asking pregnant women isn't enough

Abstract

Tobacco smoke exposure during and after pregnancy may cause maternal, fetal, and infant morbidity and mortality. The purpose of this review is to (a). describe existing methods of measuring active tobacco exposure among pregnant women and (b). illustrate the usefulness of these measures in validating self-reported smoking status among these women. Medline, PsycINFO, and Academic Search Elite were used to identify measures of cigarette smoking exposure, prevalence reports, cessation and validity studies, and research on deception about smoking during pregnancy. Review of the research on smoking cessation among pregnant women since 1966 revealed that 36% of studies (9 out of 25) located used only self-report to assess smoking status. The remaining 16 studies used either significant other reports or at least one type of biochemical test to confirm self-report. Deception rates were reported at baseline only, follow-up only, or both in 15 studies. Three federal agencies in the United States collect data on self-reported smoking during pregnancy. Smoking prevalence rates are inconsistent among these agencies. This article demonstrates that measuring smoking status during pregnancy via self-report alone leads to discrepancies in national prevalence rates, deceptions in clinical practice disclosure, and inconsistencies in research study results. Evaluation studies that confirm smoking status among pregnant women by biochemical methods provide more accurate prevalence rates and lead to the most effective behavioral interventions to achieve cessation. National statistics should carry a disclaimer indicating the likelihood of underestimation. Researchers and clinicians should be trained in best-practice, evidence-based behavioral methods to assess prenatal smoking status and to assist those who desire to quit.

Biochemically-verified Smoking Rate Trends and Factors Associated with Inaccurate Self-reporting of Smoking Habits in Korean Women

“…In England,15% of Bangladeshi female immigrants underreport their personal tobacco use, while in Iran, where female self-reported smoking prevalence is 1.3%, serum cotinine-verified prevalence is 6.7% (SarrafZadegan et al, 2004;Roth, 2009). Female under-reporting has also been documented in Tunisia and Canada and so on (Russell et al, 2004;Fakhfakh et al, 2011;Wong et al, 2012).…”

Maternal Smoking During Pregnancy and Offspring Brain Structure and Function: Review and Agenda for Future Research

“…Validated biochemical measures of tobacco exposure over gestation can be measured in maternal saliva, urine, hair, nails, and plasma or serum nicotine/cotinine (Benowitz, Hukkanen, & Jacob, 2009). Previous research has shown salivary cotinine to be the most sensitive test of MSDP (Russell, Crawford, & Woodby, 2004). Of note, metabolism of nicotine/cotinine is increased in pregnancy due to increased circulating sex hormones (Benowitz et al, 2009).…”

Measurement of Tobacco Smoke Exposure: Comparison of Toenail Nicotine Biomarkers and Self-Reports

“…However, it has been shown that variation in smoking habits, such as the length or frequency of puffs (known as smoking topography), can lead to different levels of exposure even when smoking the same amount of cigarettes (7). Furthermore, in certain situations, such as during pregnancy or among adolescents, smokers may deliberately or unconsciously underreport smoking status or the number of cigarettes smoked (3,(8)(9)(10)(11) because of growing awareness of health risks and social rejection of smoking. Another important source of variability of exposure to tobacco smoke that cannot be quantified by self-report of smoking are differences in metabolism of tobacco, which varies by race, gender, and age, and leads to different levels of internal exposure from smoking a similar number of cigarettes (12).…”

“…The lack of accurate and reliable methods for measurement of long-term exposure to tobacco smoke leads to measurement error, which results in an underestimation of the health risks (2). Questionnaires are still the most common method of measuring exposure to tobacco smoke, although biomarkers and other environmental and personal monitors are being frequently used (3)(4)(5)(6). Nevertheless, there is no ''gold standard'' method for measurement of the overall exposure to tobacco smoke.…”