Instruments to assess secondhand smoke exposure in large cohorts of never smokers: the smoke scales.
(i) to develop questionnaires that can identify never-smoking children and adults experiencing increased exposure to secondhand smoke (SHS+), (ii) to determine their validity against hair nicotine, and (iii) assess their reliability. A sample of 191 children (85 males; 106 females; 7-18 years) and 95 adult (23 males; 72 females; 18-62 years) never-smokers consented to hair nicotine analysis and answered a large number of questions assessing all sources of SHS. A randomly-selected 30% answered the questions again after 20-30 days. Prevalence of SHS+ in children and adults was 0.52±0.07 and 0.67±0.10, respectively (p<0.05). The Smoke Scale for Children (SS-C) and the Smoke Scale for Adults (SS-A) were developed via factor analysis and included nine questions each. Positivity criteria for SS-C and SS-A via receiver operating characteristics curve analysis were identified at >16.5 and >16, respectively. Significant Kappa agreement (p<0.05) was confirmed when comparing the SS-C and SS-A to hair nicotine concentration. Reliability analyses demonstrated that the SS-C and SS-A scores obtained on two different days are highly correlated (p<0.001) and not significantly different (p>0.05). Area under the curve and McNemar's Chi-square showed no pair-wise differences in sensitivity and specificity at the cutoff point between the two different days for SS-C and SS-A (p>0.05). We conclude that the SS-C and the SS-A represent valid, reliable, practical, and inexpensive instruments to identify children and adult never-smokers exposed to increased SHS. Future research should aim to further increase the validity of the two questionnaires.
FAME Laboratory, Centre for Research and Technology Hellas, Trikala, Greece ; Department of Exercise Sciences, University of Thessaly, Trikala, Greece ; Regional Directorate of Primary and Secondary Education of Western Greece, Patras, Greece.
Maria
M
Misailidi
Centre of Toxicology Science and Research, Medical School, University of Crete, Iraklio, Greece.
Manolis N
MN
Tzatzarakis
Centre of Toxicology Science and Research, Medical School, University of Crete, Iraklio, Greece.
Mathaios P
MP
Kavvalakis
Department of Exercise Sciences, University of Thessaly, Trikala, Greece ; School of Sports, Performing Arts and Leisure, University of Wolverhampton, Walsall, United Kingdom.
Yiannis
Y
Koutedakis
Centre of Toxicology Science and Research, Medical School, University of Crete, Iraklio, Greece.
Aristidis M
AM
Tsatsakis
FAME Laboratory, Centre for Research and Technology Hellas, Trikala, Greece.
Andreas D
AD
Flouris
D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006115:Greece / Q000453:epidemiology; D006197:Hair / Q000737:chemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000032:analysis; D015995:Prevalence; D012372:ROC Curve; D015203:Reproducibility of Results; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000032:analysis* / Q000706:statistics & numerical data; D055815:Young Adult
D014028:Tobacco Smoke Pollution; D009538:Nicotine