Validation of Self-Reported Smokeless Tobacco Use by Measurement of Serum Cotinine Concentration Among US Adults

Abstract

Although investigators have assessed the relationship between self-reported cigarette smoking and biomarker levels, the validity of self-reported information on smokeless tobacco (SLT) use is uncertain. We used aggregated data from the 2003–2004, 2005–2006, 2007–2008, and 2009–2010 administrations of the National Health and Nutrition Examination Survey (NHANES) to compare self-reported SLT use with serum concentrations of cotinine, a metabolite of nicotine, among US adults aged ≥18 years. Receiver operating characteristic analysis was used to determine the optimal serum cotinine cutpoint for discriminating SLT users from nonusers of tobacco, and concordance analysis was used to compare self-reported SLT use with cotinine levels. Among the 30,298 adult respondents who completed the NHANES during 2003–2010, 418 reported having exclusively used SLT and no other type of tobacco (cigarettes, cigars, or pipes) during the past 5 days, while 23,457 reported not using any tobacco. The optimal cotinine cutpoint for discriminating SLT users from non–tobacco users was 3.0 ng/mL (sensitivity = 97.0%, specificity = 93.0%), which was comparable to a revised cutpoint recommended for identifying adult cigarette smokers. Concordance with cotinine was 96.4% and 93.7% for self-reported SLT use and tobacco nonuse, respectively. These findings indicate that self-reported SLT use among adults correlates highly with serum cotinine levels and that the optimal cutpoint for minimizing misclassification of self-reported use is a serum cotinine concentration of 3.0 ng/mL.

Tobacco product use among workers in the construction industry, United States, 2014‐2016

“…First, information on the type of tobacco product used was self-reported and may be subject to reporting bias; however, previous studies have indicated that self-reported estimates of cigarettes and smokeless tobacco are valid. 36,37 Second, self-reported secondhand smoke exposure was used, which could have resulted in misclassification of exposure. However, self-reported secondhand smoke exposure has been previously validated and was significantly correlated with measured cotinine levels.…”

Nicotine and Toxicant Exposure among U.S. Smokeless Tobacco Users: Results from 1999 to 2012 National Health and Nutrition Examination Survey Data

“…They also did not find significant differences between smokeless tobacco users and nonusers with the exception of NNAL and some polyaromatic hydrocarbons. More recently, Agaku and King (18) used 2003-2010 NHANES data to assess the relationship between self-reported smokeless tobacco use and serum cotinine concentrations and identify the optimal cutpoint for identifying smokeless tobacco users based on cotinine concentrations. Agaku, Vardavas, and Connolly (19) conducted a similar analysis for NNAL using 2007-2010 data.…”

Prevalence and Factors Associated with Smokeless Tobacco Use, 2014-2016

“…However, a previous study by Agaku et al found a high level (>95%) of concordance between self-reported STP use and serum cotinine levels in US adults. 67 It is also important to note that STP use was assessed differently in 2014 compared to 2015/2016. In 2014, assessment of current STP use was preceded by questions related to STP awareness and ever use, whereas the 2015/2016 surveys only assessed past 30-day use of STPs.…”