title: Smoking prevalence in early pregnancy: comparison of self-report and anonymous urine cotinine testing.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Geeta K
authors.initials: GK
authors.lastname: Swamy
authors.forename: Keisha L B
authors.initials: KL
authors.lastname: Reddick
authors.forename: Rebecca J N
authors.initials: RJ
authors.lastname: Brouwer
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
mesh_terms: 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
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine
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