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Nicotine & Tobacco Research Advance Access published online on April 24, 2009
Nicotine & Tobacco Research, doi:10.1093/ntr/ntp048
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© The Author 2009. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Evaluation of the accuracy of self-reported smoking in pregnancy when the biomarker level in an active smoker is uncertain

Igor Burstyn, Nitin Kapur, Carol Shalapay, Fiona Bamforth, T.Cameron Wild, Juxin Liu and Don LeGatt

Igor Burstyn, Ph.D., Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
Nitin Kapur, M.D., Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
Carol Shalapay, M.L.T., Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
Fiona Bamforth, F.R.C.P.C., Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
T. Cameron Wild, Ph.D., Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
Juxin Liu, Ph.D., Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
Don LeGatt, Ph.D., Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada

Corresponding Author:Igor Burstyn, Ph.D., Community and Occupational Medicine Program, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 13-103E Clinical Sciences Building, Edmonton, Alberta, T6G 2G3, Canada. Telephone: 780-492-3240; Fax: 780-492-9677; E-mail: iburstyn{at}ualberta.ca


  Abstract

Introduction: Our main objective was to estimate smoking prevalence as well as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of self-reported smoking among pregnant women in Edmonton, Canada, at 15–16 weeks of gestation.

Methods: We used serum samples to assemble a cohort of pregnant women who underwent an optional second-trimester screening for chromosomal and developmental anomalies. We determined cotinine concentrations for 92 self-reported smokers (11% of the cohort) and for 285 self-reported nonsmoking mothers, using adapted urinary cotinine assay. Self-reports were collected at the time of delivery. In a validation study, serum cotinine was determined for known smokers and nonsmokers and used, within a Bayesian statistical framework, to define the distribution of cutoffs that differentiate true smokers from nonsmokers. This distribution of cutoffs was used to construct multiple two-by-two tables to obtain the distribution of sensitivity, specificity, PPV, NPV, and prevalence.

Results: Sensitivity was poor (M = 47.4%, SD = 17.3%), but specificity was nearly perfect (M = 94.9%, SD = 1.1%). PPV (M = 66.6%, SD = 11.7%) was smaller than NPV (M = 84.7%, SD = 14.3%). In our sample, the prevalence of true smoking at 15–16 weeks of gestation was described by a skewed distribution with a mean of 21.6% (SD = 13.8%) and a median of 16.6%.

Discussion: The strength of the present study includes blinding of subjects to the intention to test their sera for a biomarker of smoking. A limitation was the use of a nonrandom sample restricted to pregnancies that resulted in live births. We discuss data collection methods that would elicit more accurate smoking histories from pregnant women.

Received: April 11, 2008; Accepted: January 30, 2009
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