Abstract
Objective. The objectives of this paper were to determine the rate of misclassification of smoking and nonsmoking status by self-reports and saliva cotinine of pregnant women participating in a smoking cessation trial, determine the relationship of the number of cigarettes smoked per day and saliva cotinine, and examine whether misclassification was due to an inappropriate saliva cotinine cutoff point. Methods. End of pregnancy self-reports of smoking status and saliva cotinine were used to calculate misclassification rates. Results. The findings revealed that 61 of 441 self-reported smokers had biochemical values inconsistent with smoking status for a smoking misclassification rate of 13.8%. The results also revealed that 28 of 107 self-reported quitters had cotinine values consistent with smoking status for a nonsmoking misclassification rate of 26.2%. Receiver Operating Characteristic (ROC) curves were then plotted to determine whether misclassification resulted from an inappropriate cutoff point. The cotinine cutoff point that maximized sensitivity and specificity for all women was 24 ng/ml. Racial ROC comparisons indicated a higher cutoff point for blacks than whites. Use of any of the ROC indicated cutoff points would not change the misclassification rates. Conclusions. These findings suggest that underreporting of smoking status during pregnancy is high and that social desirability of nonsmoking status may have contributed to the lack of precision in saliva cotinine to distinguish smoking status in this study.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Simpson WJ: A preliminary report on cigarette smoking and the incidence of prematurity. Am J Obstet Gynecol 1957;73:808–15.
Macmahon B, Alpert B, Salver, E: Infant weight and parental smoking habits. Am J Epidemiol 1966;82:247–61.
Butler N, Goldstein H, Ross E: Cigarette smoking in pregnancy: Its influence on birth weight and prenatal mortality. Br Med J 1972;2:127–30.
Hasselmayer EG, Meyer MB, Catz C, Longo LD: Pregnancy and infant health. In: Smoking and Health, A Report of the Surgeon General, U.S. Department of Health, Education and Welfare Public Health Service, 1979: chap. 8. Washington, DC: DHEW Publication No. (PHS) 79–50066.
Li CQ, Windsor RA, Perkins L, Goldenberg RL, Lowe JB: The impact of infant birth weight and gestational age of cotinine-validated smoking reduction during pregnancy. JAMA 1993;269:1519–24.
Kendrick JC, Zahniser C, Miller N, Salas N, Stine J, Garguillo PM, Floyd RL, Spierto FW, Sexton M, Metzger RW, Stockbauer JW, Hannon WH, Dalmut ME: Integrating smoking cessation into routine public health prenatal care: The smoking cessation in pregnancy project. Am J Public Health 1995;85:217–22.
Windsor RA, Orleans CT: Guidelines and methodological standards for smoking cessation intervention research among pregnant women: Improving the science and art. Health Educ Q 1986;13:131–61.
Ershoff DH, Mullen PD, Quinn VP: A randomized trial of a serialized self-help smoking cessation program for pregnant women in an HMO. Am J Public Health 1989;79:182–7.
Hjalmarson AIM, Hahn L, Svanberg B: Stopping smoking in pregnancy: Effect of a self-help manual in a controlled trial. Br J Obstet Gynaecol 1991;98:260–4.
Haddow JW, Knight GJ, Kloza EM, Palomaki GE, Wald NJ: Cotinine-assisted intervention in pregnancy to reduce smoking and low-birthweight delivery. Br J Obstet Gynaecol 1991;98:859–65.
Windsor RA, Lowe JB, Perkins LL, Smith DY, Artz L, Amburgy K, Crawford M, Contreras L, Boyd NR: Behavioral impact and cost benefit of health education methods for pregnant smokers in public health maternity clinics: The Birmingham Trail II. Am J Public Health 1993;83:201–6.
Pechacek T, Fox B, Murray D, Luepker R: Review of techniques for measurement of smoking behavior. In: J Matarazzo, S Weiss, J Herd, N Miller, S Weiss, editors. Behavioral health: A handbook of health enhancement and disease prevention. New York: Wiley, 1984.
Van Vunakis H, Tashkin DP, Rigas B, Simmons M, et al: Relative sensitivity and specificity of salivary and serum cotinine in identifying tobacco-smoking status of self-reported nonsmokers and smokers of tobacco and/or marijuana. Arch Environ Health 1989;44:53–8.
Langone JJ, Gijika HB, Van Vunakis H: Nicotine and its metabolites: Radioimmunoassays for nicotine and cotinine. Biochemistry 1973;12:5025–30.
Haley NJ, Axelrad CM, Tilton KA: Validation of self-reported smoking behavior: Biochemical analyses of cotinine and thiocyanate. Am J Public Health 1983;73:1204–7.
Lee PN: Lung cancer and passive smoking: Association an artefact due to misclassification of smoking habits? Toxicol Lett 1987;35:157–62.
Etzel, RA: A review of the use of saliva cotinine as a marker of tobacco smoke exposure. Prev Med 1990;19:190–7.
Metz CE: Basic principles of ROC analysis. Semin Nucl Med 1978;8:283–98.
Swan GE, Habina K, Means B, Jobe JB, Esposito JL: Saliva cotinine and recent smoking: Evidence for a nonlinear relationship. Public Heal Rep. 1993; 108: 779–783.
Pierce JP, Dwyer T, Di Guisto E, Carpenter T, et al: Cotinine validation of self-reported smoking in commercially run community surveys. J Chron Dis 1987;40:689–95.
Jarvis MJ, Tunstall-Pedoe H, Feyerabend C, Vesey C, Saloojee Y: Comparison of tests used to distinguish smokers from nonsmokers. Am J Public Health 1987;77:1435–8.
Abrams DB, Follick MJ, Biener L, Carey KB, Hitti J: Saliva cotinine as a measure of smoking status in field settings. Am J Public Health 1987;77:846–8.
Windsor RA, Boyd NR, Orleans CT: A meta-evaluation of smoking cessation intervention research among pregnant women: Improving the science and art. Health Educ Res 1998;13:419–38.
Windsor RA, Cutter G, Morris J, Reese Y, Adams B, Bartlett E: Effectiveness of self-help smoking cessation interventions for pregnant women in public health maternity clinics: A randomized trial. Am J Public Health 1985;76:1389–92.
Perez-Stable EJ, Herrera B, Jacob P, Benewitz NL: Nicotine metabolism and intake in black and white smokers. JAMA 1998;280:152–6.
English PB, Eskenazi B, Christianson RE: Black-white differences in serum cotinine levels among pregnant women and subsequent effects on infant birthweight. Am J Public Health 1994;84:1439–43.
Wagenknecht LE, Burke GL, Perkins LL, Haley NJ, Friedman GD: Misclassification of smoking status in the CARDIA study: A comparison of self-report with serum cotinine levels. Am J Public Health 1992;82:33–6.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Boyd, N.R., Windsor, R.A., Perkins, L.L. et al. Quality of Measurement of Smoking Status by Self-Report and Saliva Cotinine Among Pregnant Women. Matern Child Health J 2, 77–83 (1998). https://doi.org/10.1023/A:1022936705438
Issue Date:
DOI: https://doi.org/10.1023/A:1022936705438