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American Journal of Public Health, Vol. 84, Issue 7 1086-1093, Copyright © 1994 by American Public Health Association

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The validity of self-reported smoking: a review and meta-analysis.

D L Patrick, A Cheadle, D C Thompson, P Diehr, T Koepsell and S Kinne

Department of Health Services, University of Washington, Seattle 98195.

OBJECTIVES. The purpose of this study was to identify circumstances in which biochemical assessments of smoking produce systematically higher or lower estimates of smoking than self-reports. A secondary aim was to evaluate different statistical approaches to analyzing variation in validity estimates. METHODS. Literature searches and personal inquiries identified 26 published reports containing 51 comparisons between self-reported behavior and biochemical measures. The sensitivity and specificity of self-reports of smoking were calculated for each study as measures of accuracy. RESULTS. Sensitivity ranged from 6% to 100% (mean = 87.5%), and specificity ranged from 33% to 100% (mean = 89.2%). Interviewer-administered questionnaires, observational studies, reports by adults, and biochemical validation with cotinine plasma were associated with higher estimates of sensitivity and specificity. CONCLUSIONS. Self-reports of smoking are accurate in most studies. To improve accuracy, biochemical assessment, preferably with cotinine plasma, should be considered in intervention studies and student populations.




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