Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older - Third National Health and Nutrition Examination Survey, 1988-1994

The discrepancy between cigarette smoking status reported during an intervi ew and measured level of serum cotinine, a nicotine biomarker, was investig ated in a representative sample of the US population aged greater than or e qual to 17 years (N = 15,357). Data were collected from participants in the Third National Health and Nutrition Examination Survey (1988-1994). Among self-reported smokers, 7.5% (95% confidence interval: 6.3, 8.7) had a serum cotinine level less than or equal to 15.0 ng/ml, the selected cutoff point for identifying nonsmokers. Age (p < 0.01), race/ethnicity (p < 0.01), and average number of cigarettes smoked per day (p < 0.01) were associated wit h these discrepant findings. Among self-reported nonsmokers, 1.4% (95% conf idence interval: 1.1, 1.7) had a serum cotinine level greater than 15.0 ng/ ml, the selected cutoff point for identifying smokers. Race/ethnicity (p < 0.01), education (p < 0.01), number of household members who smoked in the home (p = 0.03), and self-reported smoking status from an earlier home inte rview (p < 0.01) were associated with these discrepant findings. Difference s in smoking patterns, including the extent of nicotine dosing, may explain most of the discrepancy observed among self-reported smokers, whereas dece ption regarding smoking status may explain most of the discrepancy among se lf-reported nonsmokers. This study provides evidence that self-reported smo king status among adult respondents to a population-based survey conducted in a private medical setting is accurate.