Determinants of self-reported smoking and misclassification during pregnancy, and analysis of optimal cut-off points for urinary cotinine : a cross-sectional study
OBJECTIVES: To estimate the prevalence and factors associated with smoking and misclassification in pregnant women from INMA (INfancia y Medio Ambiente, Environment and Childhood) project, Spain, and to assess the optimal cut-offs for urinary cotinine (UC) that best distinguish daily and occasional smokers with varying levels of second-hand smoke (SHS) exposure.
DESIGN: We used logistic regression models to study the relationship between sociodemographic variables and self-reported smoking and misclassification (self-reported non-smokers with UC >50 ng/ml). Receiver operating characteristic (ROC) curves were used to calculate the optimal cut-off point for discriminating smokers. The cut-offs were also calculated after stratification among non-smokers by the number of sources of SHS exposure. The cut-off points used to discriminate smoking status were the level of UC given by Youden's index and for 50 and 100 ng/ml for daily smokers, or 25 and 50 ng/ml for occasional smokers.
PARTICIPANTS: At the third trimester of pregnancy, 2263 pregnant women of the INMA Project were interviewed between 2004 and 2008 and a urine sample was collected.
RESULTS: Prevalence of self-reported smokers at the third trimester of pregnancy was 18.5%, and another 3.9% misreported their smoking status. Variables associated with self-reported smoking and misreporting were similar, including born in Europe, educational level and exposure to SHS. The optimal cut-off was 82 ng/ml (95% CI 42 to 133), sensitivity 95.2% and specificity 96.6%. The area under the ROC curve was 0.986 (95% CI 0.982 to 0.990). The cut-offs varied according to the SHS exposure level being 42 (95% CI 27 to 57), 82 (95% CI 46 to 136) and 106 ng/ml (95% CI 58 to 227) for not being SHS exposed, exposed to one, and to two or more sources of SHS, respectively. The optimal cut-off for discriminating occasional smokers from non-smokers was 27 ng/ml (95% CI 11 to 43).
CONCLUSIONS: Prevalence of smoking during pregnancy in Spain remains high. UC is a reliable biomarker for classifying pregnant women according to their smoking status. However, cut-offs would differ based on baseline exposure to SHS.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2013 |
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| Erschienen: |
2013 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:3 |
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| Enthalten in: |
BMJ open - 3(2013), 1 vom: 24. Jan. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Aurrekoetxea, Juan J [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 29.01.2013 Date Revised 21.10.2021 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1136/bmjopen-2012-002034 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM224514415 |
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| 100 | 1 | |a Aurrekoetxea, Juan J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Determinants of self-reported smoking and misclassification during pregnancy, and analysis of optimal cut-off points for urinary cotinine |b a cross-sectional study |
| 264 | 1 | |c 2013 | |
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| 500 | |a Date Revised 21.10.2021 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a OBJECTIVES: To estimate the prevalence and factors associated with smoking and misclassification in pregnant women from INMA (INfancia y Medio Ambiente, Environment and Childhood) project, Spain, and to assess the optimal cut-offs for urinary cotinine (UC) that best distinguish daily and occasional smokers with varying levels of second-hand smoke (SHS) exposure | ||
| 520 | |a DESIGN: We used logistic regression models to study the relationship between sociodemographic variables and self-reported smoking and misclassification (self-reported non-smokers with UC >50 ng/ml). Receiver operating characteristic (ROC) curves were used to calculate the optimal cut-off point for discriminating smokers. The cut-offs were also calculated after stratification among non-smokers by the number of sources of SHS exposure. The cut-off points used to discriminate smoking status were the level of UC given by Youden's index and for 50 and 100 ng/ml for daily smokers, or 25 and 50 ng/ml for occasional smokers | ||
| 520 | |a PARTICIPANTS: At the third trimester of pregnancy, 2263 pregnant women of the INMA Project were interviewed between 2004 and 2008 and a urine sample was collected | ||
| 520 | |a RESULTS: Prevalence of self-reported smokers at the third trimester of pregnancy was 18.5%, and another 3.9% misreported their smoking status. Variables associated with self-reported smoking and misreporting were similar, including born in Europe, educational level and exposure to SHS. The optimal cut-off was 82 ng/ml (95% CI 42 to 133), sensitivity 95.2% and specificity 96.6%. The area under the ROC curve was 0.986 (95% CI 0.982 to 0.990). The cut-offs varied according to the SHS exposure level being 42 (95% CI 27 to 57), 82 (95% CI 46 to 136) and 106 ng/ml (95% CI 58 to 227) for not being SHS exposed, exposed to one, and to two or more sources of SHS, respectively. The optimal cut-off for discriminating occasional smokers from non-smokers was 27 ng/ml (95% CI 11 to 43) | ||
| 520 | |a CONCLUSIONS: Prevalence of smoking during pregnancy in Spain remains high. UC is a reliable biomarker for classifying pregnant women according to their smoking status. However, cut-offs would differ based on baseline exposure to SHS | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Murcia, Mario |e verfasserin |4 aut | |
| 700 | 1 | |a Rebagliato, Marisa |e verfasserin |4 aut | |
| 700 | 1 | |a López, María José |e verfasserin |4 aut | |
| 700 | 1 | |a Castilla, Ane Miren |e verfasserin |4 aut | |
| 700 | 1 | |a Santa-Marina, Loreto |e verfasserin |4 aut | |
| 700 | 1 | |a Guxens, Mónica |e verfasserin |4 aut | |
| 700 | 1 | |a Fernández-Somoano, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Espada, Mercedes |e verfasserin |4 aut | |
| 700 | 1 | |a Lertxundi, Aitana |e verfasserin |4 aut | |
| 700 | 1 | |a Tardón, Adonina |e verfasserin |4 aut | |
| 700 | 1 | |a Ballester, Ferran |e verfasserin |4 aut | |
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