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Estimates of Nondisclosure of Cigarette Smoking Among Pregnant and Nonpregnant Women of Reproductive Age in the United States
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 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].”
From The contribution of environmental exposure to the etiology of autism spectrum disorder (2019) · cites this paper as [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”
From Environmental Chemical Exposures and Autism Spectrum Disorders: A Review of the Epidemiological Evidence (2014) · cites this paper as [36]
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Metadata
- 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
- Publisher
- Oxford University Press (OUP)
- 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 › Public Health, Environmental and Occupational Health › 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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