An iterative technique for identifying smoking deceivers with application to the Scottish heart health study

doi:10.1016/0091-7435(92)90008-6

Preventive Medicine

Volume 21, Issue 1, January 1992, Pages 88-97

https://doi.org/10.1016/0091-7435(92)90008-6 Get rights and content

Abstract

Background. The study population consists of 3,977 self-declared nonsmokers for whom complete data on smoking biochemistry were available. Data were obtained from the Scottish Heart Health Study, a random cross-sectional population sample of 40- to 59-year-old men and women.

Methods. Three biochemical markers of smoking (expired-air carbon monoxide, serum thiocyanate, and serum cotinine) are used together to derive optimum cut-points for distinguishing true nonsmokers from self-declared nonsmokers who are smoking deceivers, using an iterative procedure via a computer program.

Results. The cut-points derived are, for carbon monoxide, 6 ppm (sensitivity, 0.81, and specificity, 0.94, when compared with the other two biochemical markers combined), for thiocyanate, 63.4 μmol/liter (sensitivity, 0.75; specificity, 0.92), and, for cotinine, 17.5 ng/ml (sensitivity, 0.77; specificity, 0.98). These cut-points are generally lower than those reported previously, primarily because other studies have taken self-reported smoking status to be the truth. The presence of deceivers among declared nonsmokers would tend to raise the biochemical levels of this group and hence of the cut-points.

Conclusion. The prevalence of smoking deception in the Scottish population is low: the frequency of those at or above all three cut-points is 1.2%, at or above two or more (the preferred definition of a smoking deceiver) is 2.2%, and at or above at least one is 16.4%.

References (26)

MJ Jarvis et al.
An evaluation of the intervention against smoking in the Multiple Risk Factor Intervention Trial
Prev Med
(1984)
P Hill et al.
Cigarette smoking: Carboxyhaemoglobin, plasma nicotine, cotinine and thiocyanate vs self-reported smoking data and cardiovascular disease
J Chronic Dis
(1983)
JP Pierce et al.
Cotinine validation of self-reported smoking in commercially run community surveys
J Chronic Dis
(1987)
JM Irving et al.
Evaluation of a portable measure of expired-air carbon monoxide
Prev Med
(1988)
DM Prue et al.
A critical evaluation of thiocyanate as a biochemical index of smoking exposure
Behav Ther
(1980)
JR Idle
Titrating exposure to tobacco smoke using cotinine—A minefield of misunderstandings
J Clin Epidemiol
(1990)
Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results
JAMA
(1982)
R Stepney
Are smokers' self-reports of inhalation a useful measure of smoke exposure?
J Epidemiol Community Health
(1982)
TM Vogt et al.
Expired air carbon monoxide and serum thiocyanate as objective measures of cigarette exposure
Am J Public Health
(1977)
R Richmond et al.
Blood cotinine, carboxyhaemoglobin and thiocyanate concentration and cigarette consumption
Br Med J
(1986)

M Kornitzer et al.

Belgian heart disease prevention project: Comparison of self-reported smoking behaviour with serum thiocyanate concentrations

J Epidemiol Community Health

(1983)

R Pojer et al.

Carboxyhaemoglobin, cotinine and thiocyanate assay compared for distinguishing smokers from non-smokers

Clin Chem

(1984)

MJ Jarvis et al.

Biochemical markers of smoke absorption and self-reported exposure to passive smoking

J Epidemiol Community Health

(1984)

Cited by (41)

Deception in clinical trials and its impact on recruitment and adherence of study participants
2018, Contemporary Clinical Trials
Citation Excerpt :
Concealment of medical/medication histories have also led to serious and sometimes fatal consequences for research participants [19,32,33]. In general population surveys, concealment of smoking status is generally <5% [34–38]. However, concealment of smoking status is one of the most prevalent forms of deceit by trial participants; in clinical trials involving various patient groups (surgical, cardiac, smoking cessation, asthma and healthy volunteers), the prevalence of concealment of smoking status ranged from 2 to 24% [9,39–44].
Deceptive practices by participants in clinical research are prevalent. It has been shown that as high as 75% of participants withheld information to avoid exclusion from studies. Self-reported adherence has been found to be largely inaccurate. Overcoming deception is a critical issue, since the safety of study participants, the integrity of research data and research resources are at risk. In this review article, we examine deception from the perspective of investigators conducting clinical trials; we describe the types (concealment, fabrication, drug holidays and collusion), prevalence, risks, and predictors of deception, and propose an approach to reduce the impact of deception, especially on adherence, in clinical trials.
Cross-sectional and longitudinal association of cigarette smoking with carotid atherosclerosis in Chinese adults
2009, Preventive Medicine
Citation Excerpt :
Second, within the context of anti-smoking environment in the world, there is a possibility that under reporting of smoking exists for those who reported no or less amount of smoking, especially in men. In fact, men smokers were more likely to report not smoking or less amount of smoking than women smokers (Woodward and Tunstall-Pedoe, 1992). This kind of misclassification of smoking status and pack-year categories among men should attenuate the association of smoking with carotid atherosclerosis.
To assess the cross-sectional and longitudinal association of cigarette smoking with carotid atherosclerosis in middle-aged and older Chinese adults.
The study population consisted of 1132 residents in Beijing (748 women and 384 men) aged 35 to 64 years. Information on baseline smoking characteristics, including smoking status and pack-years was collected in 1993–1994. The cohort was resurveyed in 2002 and common carotid artery intima–media thickness (CCA-IMT) and carotid plaques were measured by B-mode ultrasound.
The multivariable-adjusted mean CCA-IMT at resurvey was significantly associated with smoking status at both resurvey and baseline, and was 0.72 mm for consistent current smokers, 0.71 mm for former and inconsistent smokers, and 0.70 mm for consistent never smokers at both surveys, respectively (p-trend < 0.01). The multivariable-adjusted odds ratio [OR, 95% confidence interval (CI)] of having carotid plaques was 1.5 (1.0–2.1) for consistent current smokers vs consistent never smokers. In addition, there was a significant dose-response relationship between baseline smoking pack-years and multivariable-adjusted mean CCA-IMT and risk of having carotid plaques at resurvey.
Smoking is associated with carotid atherosclerosis in middle-aged and older Chinese adults both cross-sectionally and longitudinally. Smoking cessation may play a significant role in prevention and control of cardiovascular diseases in China.
Is compulsory restriction of tar yield of cigarettes a worthwhile public health policy?
2001, American Journal of Preventive Medicine
Background: Although the notion of a “safe cigarette” has proved an illusion, while people continue to smoke, an issue remains of whether compulsory restriction of tar yield is a worthwhile public health policy.
Methods: The study group was comprised of a random population sample of middle-aged Scottish men and women—3464 smokers of cigarettes with known tar yield at baseline. Tar yields were classified into low (<10 mg), low/middle (10–14.99 mg), and middle or high (≥15 mg), according to standard groupings. Deaths within the study cohort were recorded over a period of 13 years.
Results: Among low, low/middle, and middle or high tar smokers, 55 (10%), 178 (16%), and 276 (16%), respectively, died. In a comparison group of lifetime never-smokers, 178 (6%) died. After adjustment for daily cigarette dose, duration of smoking, age, gender, social class, type A personality, body mass index, urinary potassium, and antioxidant vitamin consumption, hazard ratios (95% confidence intervals) for all-cause mortality comparing low-tar smokers to low/middle-tar smokers and to middle- or high-tar smokers were 1.64 (1.04–2.58) and 1.46 (0.95–2.26), respectively. Corresponding results for cardiovascular disease were 1.48 (0.74–2.96) and 1.35 (0.79–2.60). For lung cancer, after adjusting for known confounding factors, corresponding hazard ratios were 2.82 (0.98–8.15) and 2.30 (0.81–6.49).
Conclusions: Smoking any type of cigarette is far more risky than abstaining altogether. Although the results obtained comparing tar levels are limited because of lack of repeat measures of smoking during follow-up, potential residual confounding factors, statistical imprecision, and failure to show a dose-response relationship, results do support the hypothesis that persistent smokers will reduce their tobacco-induced health risk if they smoke cigarettes with <10 mg of tar. However, the data do not permit quantification of the benefits of switching to lower-tar cigarettes. Worldwide legislation to limit tar levels to 10 mg as an absolute maximum is recommended, while recognizing that this must be part of an integrated approach to tobacco control.
Chronic obstructive pulmonary disease in the general population. An epidemiological study in Guipúzcoa (Spain)
1998, Archivos de Bronconeumologia
El objetivo de este trabajo ha sido la realización de un estudio transversal descriptivo sobre la enfermedad pulmonar obstructiva crónica en la población general.
Se estudiaron 600 varones con edades comprendidas entre los 40 y 60 años extraídos de una muestra seleccionada aleatoriamente (el 69,9% de la totalidad; el 76,6% de los sujetos elegibles). Se realizó a cada sujeto un cuestionario, una espirometría y una medición de CO en aire espirado.
El 50,8% eran fumadores si bien sólo el 24,8% de la población total tenía niveles de CO en aire espirado superiores a 10 ppm. La prevalencia de bronquitis crónica (BC) fue del 9,2%. Un total de 40 sujetos (6,8%), de los que sólo un 25% tenían espirometría previa, cumplían criterios de obstrucción al flujo aéreo (OFA). La OFA se asoció a la presencia de BC y al consumo acumulado de tabaco, el cual a su vez también se relacionó con la BC.
Estos datos refuerzan la necesidad, por un lado, de combatir el tabaco, por su relación con la BC y la OFA y, por otro lado, de realizar un mayor número de espirometrías, principalmente entre sujetos fumadores o con síntomas de BC.
To perform a cross-sectional descriptive study of chronic obstructive pulmonary disease in the general population.
We studied 600 men aged between 40 and 60 from a random sample (69.9% of the total, 76.6% eligible subjects). Each subject answered a questionnaire, underwent spirometric testing and measurement of CO in expired air.
Smokers accounted for 50.8% of the sample, although only 24.8% of the population had CO levels in expired air greater than 10 ppm. The prevalence of chronic bronchitis was 9.2%. Forty subjects (6.8%), only 25% of whom had previously undergone spirometry, met the criteria for air flow limitation. Air flow limitation was associated with chronic bronchitis and smoking, which were also mutually associated.
Our data underline the need to combat smoking, given its relation with chronic bronchitis and airflow limitation, as well as to perform spirometry more routinely, mainly in smokers or patients with symptoms of chronic bronchitis.
Multimodal smoking cessation treatment combining transcranial magnetic stimulation, cognitive behavioral therapy, and nicotine replacement therapy in veterans with posttraumatic stress disorder: A feasibility randomized controlled trial protocol
2023, medRxiv
Twenty-year predictors of peripheral arterial disease compared with coronary heart disease in the scottish heart health extended cohort (SHHEC)
2017, Journal of the American Heart Association

View all citing articles on Scopus

¹: Present address: Department of Applied Statistics, Reading University, P.O. Box 217, Reading, RG6 2AN, United Kingdom.

View full text

An iterative technique for identifying smoking deceivers with application to the Scottish heart health study

Abstract

Prev Med

J Chronic Dis

J Chronic Dis

Prev Med

Behav Ther

J Clin Epidemiol

Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results

JAMA

Are smokers' self-reports of inhalation a useful measure of smoke exposure?

J Epidemiol Community Health

Expired air carbon monoxide and serum thiocyanate as objective measures of cigarette exposure

Am J Public Health

Blood cotinine, carboxyhaemoglobin and thiocyanate concentration and cigarette consumption

Br Med J

Belgian heart disease prevention project: Comparison of self-reported smoking behaviour with serum thiocyanate concentrations

J Epidemiol Community Health

Carboxyhaemoglobin, cotinine and thiocyanate assay compared for distinguishing smokers from non-smokers

Clin Chem

Biochemical markers of smoke absorption and self-reported exposure to passive smoking

J Epidemiol Community Health