Effects of biochemical validation of self-reported cigarette smoking on treatment success and on misreporting abstinence.

Abstract

Many investigators have reported that cigarette smokers who are trying to quit often falsely report being abstinent at the end of treatment. Unfortunately, much of the previous research designed to investigate this problem has been flawed, making the results difficult to interpret. We attempted to avoid these flaws and to investigate the measurement of alveolar carbon monoxide (CO) levels to validate self-reported smoking rates at the end of treatment. Participants in behavioral cessation clinics were randomly assigned to one of three conditions that varied in timing of exposure to information regarding CO measurement: at the beginning of treatment (demonstration of CO measurement, discussion of smoking effects on CO levels, and notification that individual CO levels would be measured at the conclusion of the clinic), at the end of treatment (demonstration, discussion, and notification of CO measurement prior to self-reports of smoking levels), or at the end of treatment (demonstration and discussion of CO measurement subsequent to self-reports of smoking levels). CO levels of all participants were measured at the end of treatment after they reported their current smoking levels. Only 16% of self-reports of abstinence were not verified by CO measurement. Smokers who observed the CO demonstration at the beginning of treatment were significantly more likely than the other two groups to achieve abstinence at the end of treatment and significantly less likely to misreport abstinence. Clinical and research implications of these results are discussed.

Error in smoking measures: effects of intervention on relations of cotinine and carbon monoxide to self-reported smoking. The Lung Health Study Research Group.

“…17 One would eXpWct in our data that despite a self-report bias toward claiming smoking cessation from within a cessation intervention program, there should also be an opposed bias in the case of carbon monoxide measurement toward looking honest in the eyes of the clinic interviewer, in whose presence the results are obtained. We found that, consistentwith this interpretation, thebias evident when cotinine was used as the biochemical marker was signifcantly greater than when carbon monoxide was used.…”

Dissemination of an effective inpatient tobacco use cessation program

“…The use of self-report rather than objective measures (including biochemical measures and hospital records) is another limitation of the study. Studies comparing self-report and biochemical measures of tobacco use have found misclassification rates (percentage of smokers or other tobacco users who say they quit who have biochemical evidence of continued tobacco use) of about 5%-16%, depending on the population studied (e.g., Atterbring et al, 2001;Glynn, Gruder, & Jergerski, 1986;Miller et al, 1997). The method of measurement for tobacco use cessation is an important issue for health care facilities wishing to set performance goals.…”

One-year evaluation results from CableQuit: A community cable television smoking cessation pilot program

“…Past studies have indicated that asking participants to provide saliva samples for validation increases the number of accurate self-reported quitting statuses received (Glynn et al, 1986).…”