title: Assessing the accuracy of self-reported smoking status and impact of passive smoke exposure among pregnant Aboriginal and Torres Strait Islander women using cotinine biochemical validation.
abstract: OBJECTIVE
  A significant level of misreport or error occurs during questionnaire-based assessment of smoking behaviour. Failure to measure environmental tobacco smoke, and participant's inclination to under-report their smoking raise questions as to the accuracy of assessment. In order to establish an estimation of the possible error associated with such assessment, the accuracy of self-reported smoking status among a group of pregnant Aboriginal and Torres Strait Islander women was examined.
  
  
  METHODS
  Women attending two Aboriginal Medical services in Far North Queensland for antenatal care were invited to participate. Women completed an interviewer assisted questionnaire relating to their smoking status and a 24 h diary of their exposure to nicotine and consumption of alcohol. Urine samples were analysed for cotinine using an Enzyme Linked Immunosorbent Assay.
  
  
  RESULTS
  Cotinine analysis indicated that 17% of women who reported that they were non-smokers were likely to have misreported this status, or be exposed to high levels of passive smoke. The only significant predictors of cotinine level were self-reported nicotine exposure (including passive smoke) and number of cigarettes smoked in the previous 24 h. Other individual and environmental variables had no significant influence on cotinine level using this analysis technique.
  
  
  CONCLUSIONS
  The level of potential error in smoking assessment among this group was substantial. Exposure to environmental tobacco smoke might explain part of this error, but the reasons for misreport can only be speculated. This rate of misclassification should be taken into consideration in routine screening of antenatal women in primary health care.
authors.affiliation: Wuchopperen Health Service, Cairns and Townsville Aboriginal and Torres Strait Islander Health Service. conor.gilligan@newcastle.edu.au
authors.forename: Conor
authors.initials: C
authors.lastname: Gilligan
authors.forename: Robert
authors.initials: R
authors.lastname: Sanson-Fisher
authors.forename: Sandra
authors.initials: S
authors.lastname: Eades
authors.forename: Mark
authors.initials: M
authors.lastname: Wenitong
authors.forename: Kathryn
authors.initials: K
authors.lastname: Panaretto
authors.forename: Catherine
authors.initials: C
authors.lastname: D'Este
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D003367:Cotinine / Q000652:urine*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D018811:Maternal Exposure; D009538:Nicotine / Q000378:metabolism; D011247:Pregnancy; D015203:Reproducibility of Results; D012650:Self Disclosure; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000032:analysis*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution; D009538:Nicotine; D003367:Cotinine