title: Does South Korea have hidden female smokers: discrepancies in smoking rates between self-reports and urinary cotinine level.
abstract: BACKGROUND
  Female smoking is perceived very negatively in East Asian countries such as South Korea, Japan, and China, as well as in Islamic countries. These countries' self-reported surveys (SRs) tend to produce results that underestimate the number of smokers, owing to the social desirability response bias. The present study seeks to assess South Korea, Europe, and the Americas, by comparing data from SRs with those from urinary cotinine samples.
  
  
  METHODS
  Current smoking rates were calculated using the SRs and the urinary cotinine concentration (UCC) methods according to socioeconomic factors. In order to examine response accuracy regarding current smoking status in the SRs, participants who both completed the SRs and acquired UCC results were subject to analyses of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and difference ratio (DR) with respect to gender, age, region, economic level, household status, and the presence of chronic disease.
  
  
  RESULTS
  Based on self-reports, the current smoking rate among women was 7.1% (official smoking rates), while that according to the UCC was 18.2%; the rates for men were 47.8% and 55.1%, respectively. The sensitivity of males was 0.8553, the specificity 0.9768, PPV 0.9783, NPV 0.8465, and the difference ratio (DR) was 1.143. The sensitivity for females was 0.3670, the specificity 0.9956, PPV 0.9486, NPV 0.8761, and the DR was 2.6. These results exhibit a very low response alignment rate compared to males.
  
  
  CONCLUSIONS
  This study shows that the actual female smoking rate is significantly higher than that reported officially, but also that the gap is decreasing steadily. Females exhibited a higher rate of false responses, which resulted in an underestimation of the female smoking rate.
authors.affiliation: Department of Health Administration, Yonsei University, Gangwon-Do, Republic of Korea. parklove5004@naver.com.|Department of Preventive Medicine, Yonsei University Wonju College of Medicine, 162 Ilsan-Dong, Wonju-City, Gangwon-Do, 220-701, Republic of Korea. parklove5004@naver.com.|Yonsei University Institute for Poverty Alleviation and International Development, Gangwon-Do, Republic of Korea. parklove5004@naver.com.|Healthy City Research Center, Institute of Health and Welfare, Yonsei University, Gangwon-Do, Republic of Korea. parklove5004@naver.com.
authors.forename: Myung Bae
authors.initials: MB
authors.lastname: Park
authors.affiliation: Department of Preventive Medicine, Yonsei University Wonju College of Medicine, 162 Ilsan-Dong, Wonju-City, Gangwon-Do, 220-701, Republic of Korea. kimcb@yonsei.ac.kr.|Yonsei University Institute for Poverty Alleviation and International Development, Gangwon-Do, Republic of Korea. kimcb@yonsei.ac.kr.
authors.forename: Chun-Bae
authors.initials: CB
authors.lastname: Kim
authors.affiliation: Department of Health Administration, Yonsei University, Gangwon-Do, Republic of Korea. ewnam@yonsei.ac.kr.|Yonsei University Institute for Poverty Alleviation and International Development, Gangwon-Do, Republic of Korea. ewnam@yonsei.ac.kr.|Healthy City Research Center, Institute of Health and Welfare, Yonsei University, Gangwon-Do, Republic of Korea. ewnam@yonsei.ac.kr.
authors.forename: Eun Woo
authors.initials: EW
authors.lastname: Nam
authors.affiliation: Korea Health Promotion Foundation, Seoul, Republic of Korea. suyaa@khealth.or.kr.
authors.forename: Kyeong Soo
authors.initials: KS
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000652:urine; D003367:Cotinine / Q000652:urine*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D057566:Self Report; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology / Q000652:urine*; D014342:Truth Disclosure; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003367:Cotinine