Comparison of parental reports of smoking and residential air nicotine concentrations in children

Ulrike Gehring ^1*, Brian P. Leaderer ², Joachim Heinrich ³, Marieke Oldenwening ¹, Mariella ECA Giovannangelo ¹, Emma Nordling ⁴, Guenter Merkel ⁵, Gerard Hoek ⁶, Tom Bellander ⁷ and Bert Brunekreef ¹

¹ Utrecht University, Netherlands
² Yale University, United States
³ GSF-National Research Centre for Environment and Health, Germany
⁴ Karolinska Institute and Stockholm County Council, Sweden
⁵ University of Rostock, Germany
⁶ IRAS, Netherlands
⁷ Karolinska Institute and Stockholm County Council, Netherlands

^* To whom correspondence should be addressed. E-mail: u.gehring{at}iras.uu.nl.

Accepted 29 June 2006

Abstract

Background: Using questionnaires to assess children’s residential exposure to environmental tobacco smoke (ETS) may result in misclassification from recall and response bias. Questionnaire data has frequently been validated against urinary cotinine measurements, but rarely against actual measurements of residential air nicotine. Objective: To compare questionnaire-reported smoking with air nicotine concentrations in a large population of children and with urinary cotinine levels in a sub-population, and to assess the potential impact of the symptom status of the children on the agreement between different measures of exposure. Methods: We assessed residential exposure to ETS in 347 German, 335 Dutch, and 354 Swedish pre-school and schoolchildren by questionnaire and by air nicotine measurements, and in a subset of 307 German children by urinary cotinine measurements. We then compared the different measures of ETS exposure. Results: In all countries, air nicotine concentrations increased with increasing questionnaire-reported smoking in a dose-response fashion. Specificity and negative predictive values of questionnaire reports for nicotine concentrations were excellent. Sensitivity and positive predictive values were moderate to good. Excluding occasional smokers, the overall percentage of homes misclassified was 6.9, 6.7 and 5.1% in Germany, The Netherlands, and Sweden, respectively. Similar results were found for the agreement of urinary cotinine concentrations with questionnaire-reports and air nicotine levels. There was no indication of an underreporting by parents of symptomatic children. Conclusion: Despite some misclassification, questionnaire-reports are an inexpensive and valid estimate of residential ETS exposure among pre-school and school children.

Keywords: air nicotine, environmental tobacco smoke, questionnaire, urinary cotinine

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