Comparison of parental reports of smoking and residential air nicotine concentrations in children

Abstract

Background: Using questionnaires to assess children's residential exposure to environmental tobacco smoke (ETS) may result in misclassification from recall and response bias. Questionnaire data have frequently been validated against urinary cotinine measurements, but rarely against actual measurements of residential air nicotine. Objective: To compare questionnaire reported smoking with air nicotine concentrations in a large population of children and with urinary cotinine levels in a subpopulation; and to assess the potential impact of the symptom status of the children on the agreement between different measures of exposure. Methods: The authors assessed residential exposure to ETS in 347 German, 335 Dutch, and 354 Swedish preschool and schoolchildren by questionnaire and air nicotine measurements, and in a subset of 307 German children by urinary cotinine measurements. They then compared the different measures of ETS exposure. Results: In all countries, air nicotine concentrations increased with increasing questionnaire reported smoking in a dose-response fashion. Specificity and negative predictive values of questionnaire reports for nicotine concentrations were excellent. Sensitivity and positive predictive values were moderate to good. Excluding occasional smokers, the overall percentage of homes misclassified was 6.9%, 6.7%, and 5.1% in Germany, the Netherlands, and Sweden, respectively. Similar results were found for the agreement of urinary cotinine concentrations with questionnaire reports and air nicotine levels. There was no indication of underreporting by parents of symptomatic children. Conclusion: Despite some misclassification, questionnaire reports are an inexpensive and valid estimate of residential ETS exposure among preschool and school children.

Effects of In Utero and Childhood Tobacco Smoke Exposure and β2-Adrenergic Receptor Genotype on Childhood Asthma and Wheezing

“…Several studies found that maternal recall of smoking during pregnancy is reliable even 10 to 30 years later. [27][28][29][30] Parental report of SHS has been found to be reliable in some [31][32][33] and was found to be underreported in children with asthma 34 ; therefore, although recall bias is possible for in utero and SHS exposures, this may have attenuated the risk estimates because children with asthma were more likely to be in the unexposed group. This potential bias could account for the lack of significant modification of the association between Arg16Gly and asthma by smoking exposures.…”

Transforming Growth Factor-β1 C-509T Polymorphism, Oxidant Stress, and Early-Onset Childhood Asthma

“…Parental report of smoking has been found to be reliable in some (42)(43)(44) and was found to be underreported in children with asthma (45).Therefore, although recall bias is possible for in utero and secondhand smoke exposures, this may have attenuated the risk estimates because children with asthma were more likely to be in the unexposed group. Because genotyping for the TGF-b1 SNPs is not used in diagnosing asthma, diagnostic bias or recall bias in reporting age at asthma onset and persistence of symptoms by first grade (used to determine asthma phenotypes) with respect to the studied SNPs is unlikely.…”

Pre- and Postnatal Exposure to Parental Smoking and Allergic Disease Through Adolescence

“…However, selfreported data are comparable with cord blood, urinary cotinine, or indoor air nicotine measurements. 22,23 Additionally, exposure information was collected at baseline, before onset of disease symptoms. Thus, any misclassification is likely to be nondifferential and would tend to underestimate the true association.…”