The accuracy of self-reported smoking: A systematic review of the relationship between self-reported and cotinine-assessed smoking status
Abstract
Introduction Smoking is a leading cause of premature mortality and preventable morbidity. Surveillance is most often based on self-reported data, but studies have shown that self-reports tend to underestimate smoking status. Methods This study systematically reviewed the literature to measure the concordance between self-reported smoking status and smoking status determined through measures of cotinine in biological fluids. Four electronic databases were searched to identify observational and experimental studies on adult populations over the age of 18 years. Results Searching identified 67 studies that met the eligibility criteria and examined the relationship between self-reported smoking and smoking confirmed by cotinine measurement. Overall, the data show trends of underestimation when smoking prevalence is based on self-report and varying sensitivity levels for self-reported estimates depending on the population studied and the medium in which the biological sample is measured. Sensitivity values were consistently higher when cotinine was measured in saliva instead of urine or blood. Meta-analysis was not appropriate because of the substantial heterogeneity among the cutpoints used to define smokers and the poor reporting on outcomes of interest. Discussion Further research in this field would benefit from the standardization of cutpoints to define current smokers and the implementation of standard reporting guidelines to enhance comparability across studies. Accurate es…
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Self-reported smoking prevalence is believed to be severely underestimating true smoking prevalence, especially in population subgroups or places where tobacco use may not be culturally acceptable.
“self-reported smoking prevalence is believed to be severely underestimating true smoking prevalence,72, 73, 74, 75 especially in population subgroups or places where tobacco use may not be culturally acceptable.”
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- Authors
- Gorber, S. C., Schofield-Hurwitz, S., Hardt, J., Levasseur, G., & Tremblay, M.
- Affiliations
- Statistics Canada (CA)
- Venue
- Nicotine & Tobacco Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-01
- Volume
- 11
- Issue
- 1
- Pages
- 12-24
- ISSN
- 1462-2203 (ISSN-L)
- 1469-994X
- OpenAlex
- W2016893440
- Cited by
- 1,079
- References
- 5
- Citations by year
- 2026: 47 · 2025: 63 · 2024: 48 · 2023: 47 · 2022: 56 · 2021: 69 · 2020: 81 · 2019: 67 · 2018: 86 · 2017: 84 · 2016: 85 · 2015: 81 · 2014: 72 · 2013: 63 · 2012: 39
- FWCI
- 4.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nicotine & Tobacco Research (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- self-reported smoking, cotinine, smoking status, measurement accuracy, saliva cotinine, urinary cotinine, sensitivity, tobacco surveillance
- MeSH terms
- Adult, Aged, Cotinine, Female, Humans, Male, Mass Screening, Middle Aged, Surveys and Questionnaires, Saliva, Self Disclosure, Sensitivity and Specificity, Smoking, Truth Disclosure, Biomarkers, Prevalence, Smoking Cessation
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