Lung cancer remains a devastating disease associated with substantial morbidity and mortality. Recent research has suggested that lung cancer screening with spiral computed tomography scans might reduce lung cancer mortality. Studies of lung cancer screening have also suggested that significant numbers of participants quit smoking after screening. However, most have relied solely on selfreported smoking behavior, which may be less accurate among participants in lung cancer screening. To assess the validity of self-reported smoking status among participants in a lung cancer screening trial, this study compared selfreported smoking status against urinary cotinine levels. The sample included 55 consecutive participants enrolled in a randomized clinical trial comparing annual spiral computed tomography and chest X-ray for lung cancer screening. Participants were a mean of 59 years of age and predominantly Caucasian (96%) and male (55%). Self-reported smoking status was assessed before and after participants learned of the purpose of the biochemical verification study. Using urinary cotinine as the ''gold standard,'' the sensitivity and specificity of self-reported smoking status were 91% and 95%, respectively (k = 0.85, P < 0.001, 95% confidence interval = 0.71-0.99). Total misclassification rate was 7%. However, three of the four misclassified participants reported concurrent use of nicotine replacement strategies. Eliminating these cases from the analysis revealed sensitivity of 100% and specificity of 95% (k = 0.96, P < 0.001, 95% confidence interval = 0.88-1.00). In conclusion, self-reported smoking status among participants in a lung cancer screening trial was highly consistent with urinary cotinine test results. Validity of Self-reported Smoking Status among Participants in a Lung Cancer Screening TrialLung cancer is a devastating illness associated with substantial morbidity and mortality. In 2006, f174,470 Americans will be diagnosed with lung cancer, and another 162,460 will die from the disease (1). Improved survival with early diagnosis has prompted exploration of lung cancer screening technologies (2-5). In addition to the medical implications of early detection, participation in screening programs may be associated with decreased smoking rates (6-9), although some have suggested that negative screening results may actually lead to continuation of or return to smoking (6).Most studies exploring changes in smoking status associated with screening have relied solely on participant self-report of smoking status. The veracity of self-reports is often questionable in situations involving social pressure or medical disapproval (10-13). In these high-demand situations, studies have consistently suggested that smoking behavior is underreported (12-18). Although inaccurate self-reported smoking status in the general population occurs relatively infrequently (15,19), the lung cancer screening context may constitute a high-demand situation, a condition under which biochemical verification is recommended (1...