title: Validity of self-reported smoking status among participants in a lung cancer screening trial.
abstract: 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 self-reported 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 self-reported 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 (kappa = 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% (kappa = 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.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Louisville School of Medicine, KY, USA. jamie.studts@louisville.edu
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Studts
authors.forename: Sameer R
authors.initials: SR
authors.lastname: Ghate
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Gill
authors.forename: Christina R
authors.initials: CR
authors.lastname: Studts
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Barnes
authors.forename: A Scott
authors.initials: AS
authors.lastname: LaJoie
authors.forename: Michael A
authors.initials: MA
authors.lastname: Andrykowski
authors.forename: Renato V
authors.initials: RV
authors.lastname: LaRocca
mesh_terms: D000328:Adult; D000368:Aged; D016739:Behavior, Addictive; D015415:Biomarkers / Q000652:urine; D015986:Confounding Factors, Epidemiologic; D003367:Cotinine / Q000652:urine; D005260:Female; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000652:urine; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012650:Self Disclosure; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000652:urine; D016540:Smoking Cessation; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D003367:Cotinine