Park Myung-Bae
1Department of Health and Welfare, Pai Chai University, Daejeon, Republic of Korea.
Tob Induc Dis. 2023 Feb 6;21:20. doi: 10.18332/tid/156458. eCollection 2023.
There is a paucity of studies evaluating passive smoking (PS) by comparing self-report (SR) and biomarkers. Our study aimed to confirm whether SR could accurately reflect PS compared to biomarkers, a golden standard for assessing the exposure of non-smokers.
We used the 2014-2020 Korea National Health and Nutrition Examination Survey data and selected 29622 non-smokers aged >19 years as the study participants. The PS rate by SR was assessed during the last 7 days, and participants were interviewed to investigate their exposure at home, work, indoors, and in public places. In addition, participants having a limit of detection ≥0.5 ng/mL in urine cotinine (UC) was defined as the exposure group. All analyses reflected the weights of complex sampling. We first compared the rates of PS using biomarkers and SR, and then the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated based on biomarkers.
PS exposure by UC was the highest (44.4%), and the exposure by SR was significantly lower (5.1-29.5%). Kappa and sensitivity in PS in the indoor home (HPS) were lower than those in indoor workplaces (WPS) and indoor public places (PPS). Moreover, overall sensitivity and PPV were lower, and specificity and NPV were relatively higher in accuracy. Lastly, the sensitivity was poor, and the specificity was relatively good, which means that measurement by SR would identify people who were actually exposed to PS as non-exposed.
Despite exposure to PS, the use of the SR method is more likely to classify participants in the non-exposed group. Hence, to overcome measurement error in SR and reflect exposure in any place and setting, biomonitoring and SR should be performed.
通过比较自我报告（SR）和生物标志物来评估被动吸烟（PS）的研究较少。我们的研究旨在确认与生物标志物相比，SR能否准确反映PS，生物标志物是评估非吸烟者暴露情况的金标准。
我们使用了2014 - 2020年韩国国家健康与营养检查调查数据，选取了29622名年龄大于19岁的非吸烟者作为研究参与者。通过SR评估过去7天内的PS率，并对参与者进行访谈以调查他们在家中、工作场所、室内和公共场所的暴露情况。此外，将尿可替宁（UC）检测限≥0.5 ng/mL的参与者定义为暴露组。所有分析均反映了复杂抽样的权重。我们首先比较了使用生物标志物和SR得出的PS率，然后基于生物标志物计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
UC检测出的PS暴露率最高（44.4%），而SR得出的暴露率显著较低（5.1 - 29.5%）。室内家庭环境中的PS（HPS）的kappa值和敏感性低于室内工作场所（WPS）和室内公共场所（PPS）。此外，总体敏感性和PPV较低，特异性和NPV在准确性方面相对较高。最后，敏感性较差，特异性相对较好，这意味着通过SR测量会将实际暴露于PS的人归类为未暴露者。
尽管存在PS暴露，但使用SR方法更有可能将参与者归类为未暴露组。因此，为了克服SR中的测量误差并反映任何场所和环境下 的暴露情况，应同时进行生物监测和SR。
