National Centre for Epidemiology and Population Health, Australian National University, 54 Mills Road, Acton ACT 2601, Australia.
BMC Med Res Methodol. 2022 Apr 11;22(1):108. doi: 10.1186/s12874-022-01594-w.
Smoking remains a leading cause of disease burden globally. Declining youth smoking prevalence is an essential feature of effective tobacco control; however, accurate data are required to assess progress. This study investigates bias in youth smoking prevalence estimates by respondent type (proxy-reported, self-report with parent present, or self-report independently) for Aboriginal and Torres Strait Islander and total populations of Australia.
Repeated cross-sectional analysis of representative Aboriginal and Torres Strait Islander Health and National Health Surveys, 2007-2019. Data were restricted to participants aged 15-17 years. Prevalence ratios (PR) and 95% Confidence Intervals (CI) for ever-smoking by respondent type were calculated using Poisson regression with robust standard errors. National youth current-smoking prevalence was estimated if all data were collected by youth self-report; estimates and trends were compared to observed estimates.
Over 75% of all smoking status data were reported by proxy or with parent present. Ever-smoking prevalence among youth self-reporting independently versus proxy-reported was 1.29 (95% CI:0.96-1.73) to 1.99 (95% CI:1.39-2.85) times as high for Aboriginal and Torres Strait Islander youth, and 1.83 (95% CI:0.92-3.63) to 2.72 (95% CI:1.68-4.41) times as high for total population youth. Across surveys, predicted national current-smoking prevalence if all youth self-reported independently was generally higher than observed estimate.
Estimates of youth smoking prevalence are likely inaccurate and underestimated if data are collected by proxy or with parent present. Increased reliance on data reported by youth independently is crucial to improve data accuracy, including to enable accurate assessment of national prevalence.
吸烟仍然是全球疾病负担的主要原因。青少年吸烟率的下降是有效控烟的一个重要特征；然而，需要准确的数据来评估进展情况。本研究调查了澳大利亚原住民和托雷斯海峡岛民以及总人口中按应答者类型（代理报告、有父母在场的自我报告或独立自我报告）对青少年吸烟流行率估计的偏倚。
对 2007-2019 年具有代表性的原住民和托雷斯海峡岛民健康和国家健康调查进行重复横断面分析。数据仅限于 15-17 岁的参与者。使用泊松回归和稳健标准误差计算按应答者类型的曾经吸烟的患病率比（PR）和 95%置信区间（CI）。如果所有数据均由青少年自我报告收集，则估计并比较了全国青少年当前吸烟流行率的估计值和趋势；如果所有数据均由青少年自我报告收集，则估计并比较了全国青少年当前吸烟流行率的估计值和趋势。
超过 75%的所有吸烟状况数据均由代理或有父母在场的报告。独立于代理报告或有父母在场的青少年自我报告的曾经吸烟率，原住民和托雷斯海峡岛民青少年为 1.29（95%CI：0.96-1.73）至 1.99（95%CI：1.39-2.85）倍，总人口青少年为 1.83（95%CI：0.92-3.63）至 2.72（95%CI：1.68-4.41）倍。在整个调查中，如果所有青少年都独立自我报告，预测的全国当前吸烟流行率通常高于观察到的估计值。
如果数据是由代理或有父母在场的报告收集的，则青少年吸烟流行率的估计值可能不准确且被低估。增加对青少年独立报告的数据的依赖对于提高数据准确性至关重要，包括能够准确评估全国流行率。
