评估瑞典年轻成年人的烟草使用情况：使用 BAMSE 出生队列进行的自我报告和尿液可替宁验证研究。
Assessing tobacco use in Swedish young adults from self-report and urinary cotinine: a validation study using the BAMSE birth cohort.
机构信息
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
出版信息
BMJ Open. 2023 Jul 12;13(7):e072582. doi: 10.1136/bmjopen-2023-072582.
OBJECTIVES
Studies on health effects of tobacco often rely on self-reported exposure data, which is subjective and can lead to misclassification. The aim of this study was to describe the prevalence of cigarette smoking, snus and e-cigarette use, as well as to validate self-reported tobacco use among young adults in Sweden.
METHOD
Participants of a population-based Swedish cohort (n=3052), aged 22-25 years, assessed their tobacco use in a web questionnaire. Urinary cotinine was analysed in a subsample of the study population (n=998). The agreement between self-reported tobacco use and urinary cotinine was assessed using Cohen's Kappa coefficient (κ) at a cut-off level of 50 ng/mL.
RESULTS
Patterns of tobacco use differed between men and women. Among men, 20.0% reported daily snus use, 5.8% daily cigarette smoking and 5.6% any e-cigarette use. In contrast, 3.2% of the women reported daily snus use, 9.0% daily cigarette smoking and 2.4% any e-cigarette use. Among the tobacco use categories, daily snus users had the highest levels of cotinine. Of reported non-tobacco users, 3.5% had cotinine levels above the cut-off, compared with 68.0% among both occasional cigarette smokers and snus users, 67.5% among all e-cigarette users and 94.7% and 97.8% among daily cigarette smokers and snus users, respectively. Agreement between self-reported tobacco use and urinary cotinine was classified as strong for daily use of cigarettes (κ=0.824) and snus (κ=0.861), while moderate to weak for occasional smoking (κ=0.618), occasional snus use (κ=0.573) and any e-cigarette use (κ=0.576).
CONCLUSIONS
We found high validity of self-reported tobacco use in our study population, particularly for daily tobacco use. Further, we found that daily snus users were exposed to high levels of cotinine. Together with previous findings, our results indicate good validity of self-reported tobacco use among young adults.
目的
关于烟草对健康影响的研究通常依赖于自我报告的暴露数据，而这些数据是主观的，可能导致分类错误。本研究的目的是描述瑞典年轻成年人的香烟、鼻烟和电子烟使用情况，并验证自我报告的烟草使用情况。
方法
在一项基于人群的瑞典队列研究中，年龄在 22-25 岁的参与者在网络问卷中评估了他们的烟草使用情况。在研究人群的一个子样本中分析了尿液可替宁（n=998）。使用 Cohen's Kappa 系数（κ）评估自我报告的烟草使用情况与尿液可替宁之间的一致性，以 50ng/mL 为截断值。
结果
男性和女性的烟草使用模式不同。在男性中，20.0%报告每日使用鼻烟，5.8%报告每日吸烟，5.6%报告使用任何电子烟。相比之下，3.2%的女性报告每日使用鼻烟，9.0%报告每日吸烟，2.4%报告使用任何电子烟。在所有烟草使用类别中，每日使用鼻烟者的可替宁水平最高。在报告的非烟草使用者中，有 3.5%的可替宁水平高于截断值，而偶尔吸烟者和鼻烟使用者的这一比例分别为 68.0%、所有电子烟使用者的这一比例为 67.5%、每日吸烟者和鼻烟使用者的这一比例分别为 94.7%和 97.8%。自我报告的烟草使用与尿液可替宁之间的一致性被归类为每日使用香烟（κ=0.824）和鼻烟（κ=0.861）的强一致性，而偶尔吸烟（κ=0.618）、偶尔使用鼻烟（κ=0.573）和使用任何电子烟（κ=0.576）的一致性为中等到弱。
结论
我们发现，在我们的研究人群中，自我报告的烟草使用情况具有很高的有效性，特别是对于每日烟草使用情况。此外，我们发现，每日使用鼻烟者接触到的可替宁水平较高。结合以往的研究结果，我们的研究结果表明，在年轻成年人中，自我报告的烟草使用具有较好的有效性。
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