Smoking prevalence in early pregnancy: comparison of self-report and anonymous urine cotinine testing.
OBJECTIVE
Societal pressures against smoking during pregnancy may lead to a reduction in disclosure of smoking status. The objective of this study was to compare prevalence of smoking at prenatal intake by self-report with anonymous biochemical validation.


METHODS
Women receiving care at the Duke Obstetrics Clinic from February 2005 through January 2006 were eligible for evaluation. Self-reported smoking and urine samples were obtained anonymously at prenatal intake. The NicCheck™ I semi-quantitative dipstick was used to detect urinary nicotine, cotinine, and 3-hydroxycotinine. The difference, with 95% confidence interval, between the proportions of smokers by self-report and urine testing was calculated for (1) high-positive vs. low-positive and negative results combined and (2) any positive vs. negative results.


RESULTS
Among 297 subjects, self-reported smoking was 18.2 vs. 14.8% for low-positive and negative results combined with an absolute difference of 3.4%, [-2.9%, 9.6%]. When comparing self-report with any positive result (43.1%), the absolute difference was 24.9%, [17.4%, 32.1%].


CONCLUSIONS
Our findings suggest that most pregnant women disclose their smoking and many nonsmokers may have significant second-hand exposure. Universal urinary cotinine screening of pregnant women could aid in appropriately counseling women about second-hand exposure as well as monitoring women at high risk for adverse pregnancy outcomes.
Swamy
Geeta K
GK
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
Reddick
Keisha L B
KL
Brouwer
Rebecca J N
RJ
Pollak
Kathryn I
KI
Myers
Evan R
ER
D000293:Adolescent; D000328:Adult; D035041:Anonymous Testing; D003367:Cotinine / Q000652:urine*; D005260:Female; D006801:Humans; D011247:Pregnancy / Q000706:statistics & numerical data* / Q000652:urine; D015995:Prevalence; D057566:Self Report; D012907:Smoking / Q000453:epidemiology*; D014028:Tobacco Smoke Pollution; D055815:Young Adult
D014028:Tobacco Smoke Pollution; D003367:Cotinine
Yonsei Med J. 2009 Jun 30;50(3):345-51
19568595
Nicotine Tob Res. 2004 Apr;6 Suppl 2:S253-7
15203825
Forensic Sci Int. 2004 Oct 29;145(2-3):191-4
15451092
Pharmacology. 2004 Dec;72(4):254-9
15539886
Am J Epidemiol. 1998 Aug 1;148(3):259-62
9690362
J Expo Anal Environ Epidemiol. 2004;14 Suppl 1:S65-70
15118747
Environ Health Perspect. 1999 May;107 Suppl 2:329-40
10350518
Am J Prev Med. 1999 Apr;16(3):208-15
10198660
JAMA. 1995 Mar 8;273(10):795-8
7861574
Nicotine Tob Res. 2006 Aug;8(4):547-54
16920652
Addiction. 2001 Jul;96(7):1001-6
11440610
N C Med J. 1997 Sep-Oct;58(5):356-60
9313360
BMC Public Health. 2007 May 16;7:81
17506887
J Pharmacol Exp Ther. 2002 May;301(2):594-8
11961061
Environ Health Perspect. 1999 Dec;107 Suppl 6:897-904
10592147
MMWR Surveill Summ. 2009 May 29;58(4):1-29
19478726
J Public Health Manag Pract. 2003 Jul-Aug;9(4):322-5
12836515
Paediatr Perinat Epidemiol. 2002 Jul;16(3):246-8
12123437
Addict Behav. 1996 Sep-Oct;21(5):675-9
8876767
JAMA. 2000 Jan 19;283(3):361-6
10647799
Acta Obstet Gynecol Scand. 2002 Mar;81(3):240-4
11966481
Matern Child Health J. 1998 Jun;2(2):77-83
10728263