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Enquiry into smoking status and recommendations for smoking cessation is an essential preventive service. However, there are few studies comparing self-reported (SR) and cotinine-verified (CV) smoking statuses, using medical check-up data. The rates of discrepancy and under-reporting are unknown.
We performed a cross-sectional study using health examination data from Healthcare System Gangnam Center, Seoul National University Hospital in 2013. We analyzed SR and CV smoking statuses and discrepancies between the two in relation to sociodemographic variables. We also attempted to ascertain the factors associated with a discrepant smoking status among current smokers.
In the sample of 3,477 men, CV smoking rate was 11.1% higher than the SR rate. About 1 in 3 participants either omitted the smoking questionnaire or gave a false reply. The ratio of CV to SR smoking rates was 1.49 (95% confidence interval [CI], 1.38–1.61). After adjusting for confounding factors, older adults (≥60 years) showed an increased adjusted odds ratio (aOR) for discrepancy between SR and CV when compared to those in their twenties and thirties (aOR, 5.43; 95% CI, 2.69–10.96). Educational levels of high school graduation or lower (aOR, 2.33; 95% CI, 1.36–4.01), repeated health check-ups (aOR, 1.45; 95% CI, 1.03–2.06), and low cotinine levels of <500 ng/mL (aOR, 2.03; 95% CI, 1.33–3.09), were also associated with discordance between SR and CV smoking status.
Omissions and false responses impede the accurate assessment of smoking status in health check-up participants. In order to improve accuracy, it is suggested that researcher pay attention to participants with greater discrepancy between SR and CV smoking status, and formulate interventions to improve response rates.
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Korean women are known to have a very low smoking rate. However, the actual smoking rate among Korean women is higher than 10% and may continue to increase gradually. In addition, some Korean women use extreme weight control methods that have potentially harmful effects. This study was conducted to elucidate weight control methods related to cotinine-verified smoking among Korean adult women.
This cross-sectional study involved 4,189 women aged ≥19 years who had attempted weight control during the past 1 year from the Korea National Health and Nutrition Examination Survey, 2008-2011. Smoking status was assessed using both self-report questionnaires and assays of urinary cotinine, and weight control methods were investigated using self-report questionnaires.
The smoking rate based on the measurement of urinary cotinine was 12.4% ± 0.8% among Korean women. Cotinine-verified smokers were more likely to attempt fasting (odds ratio, 2.19; 95% confidence intervals, 1.03 to 4.67), taking prescription diet-pills (odds ratio, 2.37; 95% confidence intervals, 1.47 to 3.82), and taking nonprescription diet-pills (odds ratio, 3.46; 95% confidence intervals, 1.71 to 6.98), and were less likely to attempt eating less food or modifying dietary patterns (odds ratio, 0.71; 95% confidence intervals, 0.51 to 0.99) compared to non-smokers.
Korean adult women's smoking is independently related to a high likelihood of using weight control methods with potentially harmful effects, such as fasting and taking diet-pills, and a low likelihood of choosing weight control methods, including dietary modification, that require constant effort for a prolonged time.
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Previous studies have shown that self-reports tend to underestimate smoking status, especially among women in Korea. We therefore assessed the characteristics of Korean women smokers who falsely described themselves as non-smokers.
The subjects were 4,135 adult women aged ≥19 years who participated in the 2008 Korean National Health and Nutrition Examination Survey. Of these, 3,151 subjects answered questions about their smoking status on self-reported questionnaires and underwent assays of urinary cotinine concentration. Subgroups of false respondents (n = 131) and true respondents (n = 198) regarding smoking were determined by comparing their responses on questionnaires with their urinary cotinine levels.
Among adult Korean women, the self-reported smoking rate was 7.4% (95% confidence interval [CI], 6.4% to 8.4%); however, using urinary cotinine >100 ng/mL as a marker of smoking, the smoking rate was 11.8% (95% CI, 10.5% to 13.3%). In multivariate analysis, after adjusting for type of household, family income, and suicidal ideation, the odds ratios (ORs) of false respondents were 3.49 (95% CI, 1.41 to 8.63) for college-educated women and 2.47 (95% CI, 1.22 to 5.01) for women with high school education, relative to women with elementary school education. Married women with living spouses (OR, 2.80; 95% CI, 1.33 to 5.90) were more likely to respond falsely than unmarried women. Women who reported trying to reduce weight within 1 year (OR, 2.70; 95% CI, 1.47 to 4.93) and those who reported being less stressed (OR, 1.82; 95% CI, 1.08 to 3.07) were more likely to be false respondents.
The smoking rate determined using urinary cotinine concentration was higher than the self-reported rate among Korean women. Among smokers, those who were more educated, married, living with a husband, trying to reduce weight, and less stressed tended to describe themselves falsely as non-smokers.
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