WHO European Office for Prevention and Control of Noncommunicable Diseases, Division of Noncommunicable Diseases and Health Through the Lifecourse, WHO Regional Office for Europe, Moscow, Russian Federation.
Noncommunicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia.
Eur J Public Health. 2020 Oct 1;30(5):1007-1012. doi: 10.1093/eurpub/ckaa093.
Self-reported measures of tobacco use may have limited validity, particularly among some populations. This study aims to validate self-reported smoking measures among Georgian adults participating in the 2016 STEPS survey using cotinine biomarker measurements, and to explore potential differences according to sociodemographic characteristics. Additionally, this paper examines how the estimated prevalence of smoking in the population varies according to measurement type.
Using the WHO standardized STEPS methodology, adults self-reported their smoking status. In a later stage of the survey, a subset of participants provided a urine sample, which was tested for cotinine. Using each participant's objective cotinine measurement and their self-reported smoking status, we calculated the sensitivity, specificity and positive predictive value of self-reported smoking. Next, we calculated the estimated prevalence of smokers according to the type of measurement.
Results indicated high sensitivity (83.37%, 95% CI: 76.79-88.37%) among males and relatively low sensitivity (38.60% CI: 29.23-48.90%) among females. According to self-report, the prevalence of smokers was 26.44% (23.61-29.48%), while according to cotinine detection, the prevalence of smokers was 32.27% (29.16-35.55%). Among all subgroups, the self-reported prevalence of smoking was significantly lower than the cotinine-detected prevalence.
To the best of our knowledge, this is the first time that the validity of the STEPS self-reported tobacco indicator has been tested. Self-reported measures of smoking status may lead to an under-estimation of smoking prevalence among Georgian adults, especially women. These findings suggest that integration of biochemical measures of smoking into tobacco use studies may be an important investment.
自我报告的烟草使用情况可能存在一定的局限性，尤其是在某些人群中。本研究旨在通过可替宁生物标志物测量来验证参与 2016 年 STEPS 调查的格鲁吉亚成年人的自我报告吸烟测量，同时探索根据社会人口特征可能存在的差异。此外，本文还研究了根据测量类型，人群中吸烟的估计流行率如何变化。
使用世界卫生组织（WHO）标准化的 STEPS 方法学，成年人自我报告他们的吸烟状况。在调查的后期阶段，参与者的一部分提供了尿液样本，用于检测可替宁。根据每个参与者的客观可替宁测量值及其自我报告的吸烟状况，我们计算了自我报告吸烟的敏感性、特异性和阳性预测值。接下来，我们根据测量类型计算了吸烟者的估计流行率。
结果表明，男性的敏感性较高（83.37%，95%CI：76.79-88.37%），而女性的敏感性相对较低（38.60%，95%CI：29.23-48.90%）。根据自我报告，吸烟者的流行率为 26.44%（23.61-29.48%），而根据可替宁检测，吸烟者的流行率为 32.27%（29.16-35.55%）。在所有亚组中，自我报告的吸烟流行率明显低于可替宁检测的吸烟流行率。
据我们所知，这是首次对 STEPS 自我报告的烟草指标的有效性进行检验。自我报告的吸烟状况可能导致格鲁吉亚成年人吸烟流行率的低估，尤其是女性。这些发现表明，将吸烟的生物化学测量纳入烟草使用研究可能是一项重要的投资。
