title: Estimates of nondisclosure of cigarette smoking among pregnant and nonpregnant women of reproductive age in the United States.
abstract: Although clinic-based studies have used biochemical validation to estimate the percentage of pregnant women who deny smoking but are actually smokers, a population-based estimate of nondisclosure of smoking status in US pregnant women has not been calculated. The authors analyzed data from the 1999-2006 National Health and Nutrition Examination Survey and estimated the percentage of 994 pregnant and 3,203 nonpregnant women 20-44 years of age who did not report smoking but had serum cotinine levels that exceeded the defined cut point for active smoking (nondisclosure). Active smoking was defined as self-reporting smoking or having a serum cotinine concentration that exceeded the cut point for active smoking. Overall, 13.0% (95% confidence interval (CI): 8.8, 17.1) of pregnant women and 29.7% (95% CI: 27.3, 32.1) of nonpregnant women were active smokers. Nondisclosure was higher among pregnant active smokers (22.9%, 95% CI: 11.8, 34.6) than among nonpregnant smokers (9.2%, 95% CI: 7.1, 11.2). Among pregnant active smokers, nondisclosure was associated with younger age (20-24 years). Among nonpregnant active smokers, nondisclosure was associated with Mexican-American and non-Hispanic black race/ethnicity. Studies and surveillance systems that rely on self-reported smoking status are subject to underestimation of smoking prevalence, especially among pregnant women, and underreporting may vary by demographic characteristics.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. pdietz@cdc.gov
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Dietz
authors.forename: David
authors.initials: D
authors.lastname: Homa
authors.forename: Lucinda J
authors.initials: LJ
authors.lastname: England
authors.forename: Kim
authors.initials: K
authors.lastname: Burley
authors.forename: Van T
authors.initials: VT
authors.lastname: Tong
authors.forename: Shanta R
authors.initials: SR
authors.lastname: Dube
authors.forename: John T
authors.initials: JT
authors.lastname: Bernert
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D015982:Bias; D003367:Cotinine / Q000097:blood; D005260:Female; D006801:Humans; D016015:Logistic Models; D017058:Mexican Americans / Q000706:statistics & numerical data; D009749:Nutrition Surveys; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D012907:Smoking / Q000097:blood / Q000453:epidemiology* / Q000523:psychology*; D014342:Truth Disclosure; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003367:Cotinine