Sensitivity and specificity of a self-administered questionnaire of tobacco use; including the Fagerstrom test

Area of Preventive Medicine and Public Health, Department of Biomedical Sciences, University of León, Altos de la Nava s/n
International journal of nursing studies (Impact Factor: 2.9). 07/2009; 47(2):181-9. DOI: 10.1016/j.ijnurstu.2009.05.022
Source: PubMed


Preventing tobacco consumption and promoting cessation among health professionals are of great significance as their habits can influence their patients' attitudes. Knowledge of the prevalence and characteristics of tobacco use in a specific population is important for the design of efficient strategies for preventing people from acquiring the habit and persuading them to stop. Self-administered questionnaires are a very common method for determining tobacco use, but assessment is needed of their validity for specific groups, such as occasional smokers or students of health sciences.
The aim of this study was to determine the sensitivity and specificity of a self-administered questionnaire for determining tobacco use among a population of young female students of health sciences. As a gold standard, we used a measure of the concentration of cotinine in saliva with different cut-off points. We also analysed the influence on sensitivity and specificity of the questionnaire of nicotine dependence and exposure to secondary smoke.
This is an internal validity study (sensitivity and specificity) of a self-administered questionnaire.
The study was carried out in the School of Health Sciences of the University of León, at its centres in León and Ponferrada.
Data were collected on 432 of a total of 480 women aged under 25 who were studying Health Sciences at the University of León in 2007.
The self-administered questionnaire included data concerning demography, education, tobacco habits and exposure to environmental smoke. Saliva cotinine concentration was determined with an EIA kit.
The questionnaire used showed high values of sensitivity and specificity (85.3% and 95.3%) and a very good correlation (Kappa=81.0%) with cotinine values of 10ng/ml or higher. Discrepancies in the test results for those who declared themselves to be smokers only occurred in women with a low nicotine dependency. Among those who did not declare themselves smokers, those exposed to second-hand smoke were 7 times more frequently classified erroneously as smokers than those who had not been exposed.
The self-administered questionnaire used showed a very good internal validity and a good correlation with cotinine levels of 10ng/mg, and therefore seems to be a good instrument for measuring tobacco use in this population. The availability of information on passive smoking and nicotine dependence is essential for the correct interpretation of the discrepancies.

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    • "The study has certain limitations, such as those arising from the use of questionnaires self-completed, which can lead to social desirability bias. To reduce these limitations, the questionnaire was based on other previously used in similar populations (Gil López et al., 2000; Insalud, 1998; Molina et al., 2010). Another weakness is the existence of losses, although participation at 83% can be considered good. "
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    ABSTRACT: PURPOSE: To examine the effectiveness of a tobacco control course on the improvement of knowledge, attitudes and beliefs about smoking among health sciences' students. METHODS: This was a quasi-experimental study of community intervention carried out during the years 2005-2008, at 2 university health science centres in northwest Spain. A total of 290 students on the intervention and 256 on the control campus took part in the study. The intervention consisted of a course on the prevention and control of tobacco use offered only on the intervention campus. Data were collected before the intervention and 6months afterwards. RESULTS: After the course, significant differences between groups were observed in the improvement of knowledge, attitudes and perceived ability to act in tobacco control. CONCLUSIONS: The introduction of training concerning smoking through active methodologies had a positive impact on the knowledge, attitudes and beliefs about tobacco of students.
    Nurse education today 12/2011; 32(8). DOI:10.1016/j.nedt.2011.11.007 · 1.36 Impact Factor
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    • "However, our baseline surveys only used 'past 30 days use' as current use (Post et al., 2005; Kandel et al., 2006). Also, no information was available regarding exposure to environmental tobacco smoke and nicotine dependence levels, which would help in interpreting discrepancies in self-reports (Molina et al.,2010). "
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    ABSTRACT: Self-reported tobacco use among young people can underestimate the actual prevalence of tobacco use. Biochemical validation of self-reports is particularly recommended for intervention studies where cessation outcomes are to be measured. Literature on biochemical validation of self-reports of multiple forms of tobacco use in India is sparse, particularly among young people. The study was conducted during the baseline household survey of a community-based tobacco prevention and cessation intervention trial for youth (10-19 years old) residing in slum communities in Delhi, India in 2009. Salivary cotinine measurement on 1,224 samples showed that youth were under-reporting use of chewing and smoking tobacco. Self-reports had a low sensitivity (36.3%) and a positive predictive value of 72.6%. No statistically significant difference in under- reporting was found between youth in the control and intervention conditions of the trial, which will be taken into consideration in assessing intervention outcomes at a later time point. Biochemical validation of self-reported tobacco use should be considered during prevention and cessation studies among youth living in low-income settings in developing countries like India. Impact: The future results of biochemical validation from Project ACTIVITY (Advancing Cessation of Tobacco in Vulnerable Indian Tobacco Consuming Youth) will be useful to design validation studies in resource-poor settings.
    Asian Pacific journal of cancer prevention: APJCP 01/2011; 12(10):2551-4. · 2.51 Impact Factor
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    • "Data were collected during practical classes with the greatest attendance levels, to minimize losses. A questionnaire of proven sensitivity and specificity (Molina et al. 2010), was used to gather personal information on each student, including age, year of study, qualifications, campus and academic background, together with details of their smoking habits and exposure to environmental smoke. To assess tobacco consumption, participants were asked: 'Which of the following best describes your current status as a smoker or non-smoker?' with four possible answers: 'Non-smoker who has never smoked', 'Ex-smoker', 'Smoker who does not want to give up' and 'Smoker who is willing to try to give up'. "
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    ABSTRACT: This paper is a report of the effectiveness of a tobacco use prevention and control course on health sciences students' smoking prevalence and incidence. Although it is known that the intervention of health professionals in their patients' tobacco use can be affected by their own habit, very few studies have analysed the effect of specific tobacco-oriented training on smoking among health science students. This study is a quasi-experimental study of community intervention. During the years 2005-2008, a total of 290 health science students on the intervention campus and 256 on the control campus took part in the study. In the former, the intervention consisted of a course on the prevention and control of tobacco use for students, which was not offered on the control campus. Data about tobacco use and socio-demographic variables were collected by means of a questionnaire before and 6 months after the intervention. Prevalence of tobacco use decreased in the intervention group (-1.1%) and increased in the control group (1.5%). The risk of acquiring the habit was almost three times higher in the control group than in the intervention group and the probability of cessation was 40% higher in the intervention group and correlated with nicotine dependence. The intervention suggests the effect on habit acquisition was slight but not so on cessation. Preventive interventions should be carried out before students go to university, while more specific cessation programmes are required to reduce tobacco use among students.
    Journal of Advanced Nursing 12/2010; 67(4):747-55. DOI:10.1111/j.1365-2648.2010.05532.x · 1.74 Impact Factor
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