Cited by 276Smoking Behavior and CessationPrenatal Substance Exposure EffectsSurvey Methodology and Nonresponse

Estimates of nondisclosure of cigarette smoking among pregnant and nonpregnant women of reproductive age in the United States

Dietz, P. M., Homa, D., England, L. J., Burley, K., Tong, V. T., Dube, S. R., Bernert, J. T.·2011·American Journal of Epidemiology

Abstract

Although clinic-based studies have used biochemical validation to estimate the percentage of pregnant women who deny smoking but are actually smokers, a population-based estimate of nondisclosure of smoking status in US pregnant women has not been calculated. The authors analyzed data from the 1999-2006 National Health and Nutrition Examination Survey and estimated the percentage of 994 pregnant and 3,203 nonpregnant women 20-44 years of age who did not report smoking but had serum cotinine levels that exceeded the defined cut point for active smoking (nondisclosure). Active smoking was defined as self-reporting smoking or having a serum cotinine concentration that exceeded the cut point for active smoking. Overall, 13.0% (95% confidence interval (CI): 8.8, 17.1) of pregnant women and 29.7% (95% CI: 27.3, 32.1) of nonpregnant women were active smokers. Nondisclosure was higher among pregnant active smokers (22.9%, 95% CI: 11.8, 34.6) than among nonpregnant smokers (9.2%, 95% CI: 7.1, 11.2). Among pregnant active smokers, nondisclosure was associated with younger age (20-24 years). Among nonpregnant active smokers, nondisclosure was associated with Mexican-American and non-Hispanic black race/ethnicity. Studies and surveillance systems that rely on self-reported smoking status are subject to underestimation of smoking prevalence, especially among pregnant women, and underreporting may vary by demographic characteristics.

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  • The majority of primary research summarized in the 2015 smoking meta-analyses failed to adjust for relevant confounders such as birth weight and employed self-report data collection likely biased by social desirability.

    “the majority of the primary research summarized in these meta-analyses failed to be adjusted for relevant confounders such as birth weight and employed self-report data collection methods likely biased by social desirability [147].”
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    “Tobacco use in pregnancy was measured by parent recall, which is subject to some degree of under-reporting because of stigma, and by medical data (e.g., birth certificates) that was collected prospectively and considered reasonably valid for measuring in utero tobacco exposure,50 but was still subject to under-reporting.36”

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Authors
Dietz, P. M., Homa, D., England, L. J., Burley, K., Tong, V. T., Dube, S. R., & Bernert, J. T.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Dietz, P. M.
Venue
American Journal of Epidemiology
Published
2010-12-22
Volume
173
Issue
3
Pages
355-359
ISSN
  • 0002-9262 (ISSN-L)
  • 1476-6256
OpenAlex
W2139614200
Cited by
276
References
15
Citations by year
2026: 8 · 2025: 9 · 2024: 14 · 2023: 13 · 2022: 9 · 2021: 15 · 2020: 22 · 2019: 26 · 2018: 21 · 2017: 16 · 2016: 21 · 2015: 21 · 2014: 30 · 2013: 23 · 2012: 20
FWCI
10.82
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Centers for Disease Control and Prevention
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
  • Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
Keywords
cigarette smoking, non-disclosure, pregnant women, self-reported smoking status, serum cotinine, women of reproductive age, Mexican American women, non-Hispanic Black women, age differences, NHANES
MeSH terms
Adult, Black or African American, Cotinine, Female, Humans, Nutrition Surveys, Pregnancy, Smoking, Truth Disclosure, United States, Bias, Logistic Models, Mexican Americans, Age Distribution, Pregnant People, Young Adult

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