Volume 12, Issue 3 (Autumn 2025)
J Prevent Med 2025, 12(3): 301-310 |
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Research code: 4030065
Ethics code: IR.HUMS.REC.1403.068
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Zare F, Behjati Ardakani M, Eshaghi Sani Kakhaki H, Ghanbarnejad A, Zamani Rarani M, salehikhah R et al . Validity Assessment of Self-Reported Cigarette Use: Concordance between Questionnaire Responses and Urinary Cotinine Levels. J Prevent Med 2025; 12 (3) :301-310
URL: http://jpm.hums.ac.ir/article-1-853-en.html
URL: http://jpm.hums.ac.ir/article-1-853-en.html
Fatemeh Zare1 
, Mehdi Behjati Ardakani2 , Hadi Eshaghi Sani Kakhaki *3 , Amin Ghanbarnejad4 , Mohammad Zamani Rarani5 , Reza Salehikhah6 , Abdolhossain Madani4
, Mehdi Behjati Ardakani2 , Hadi Eshaghi Sani Kakhaki *3 , Amin Ghanbarnejad4 , Mohammad Zamani Rarani5 , Reza Salehikhah6 , Abdolhossain Madani4
1- Department of Public Health, School of Health, Larestan University of Medical Sciences, Larestan, Iran
2- Department of Occupational Health Engineering, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. & Department of Occupational Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3- Department of Occupational Medicine, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
4- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
5- Department of Anatomy, School of Medicine, Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences
6- School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
2- Department of Occupational Health Engineering, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. & Department of Occupational Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3- Department of Occupational Medicine, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
4- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
5- Department of Anatomy, School of Medicine, Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences
6- School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Abstract: (373 Views)
Introduction: Self-reported smoking status is widely used in epidemiological studies because of its simplicity and cost-effectiveness. However, its validity may be affected by social desirability bias, fear of judgment, or workplace-related concerns. This study aimed to evaluate the validity of self-reported cigarette smoking by comparing questionnaire-based responses with urinary cotinine levels among aluminum industry workers.
Methods: In this cross-sectional study, 88 workers participated. Data were collected using a demographic and smoking status questionnaire. Urinary cotinine levels were measured using an enzyme-linked immunosorbent assay method with a Bio Quant kit. A cut-off value of 500 ng/mL was used to classify participants as active smokers. Data were analyzed using the Chi-square test, Cohen’s kappa coefficient, sensitivity, and specificity indices.
Results: Only 4.5% of participants self-identified as smokers, whereas 33% were classified as active smokers based on urinary cotinine analysis. The discrepancy between self-reported smoking status and cotinine-based classification was statistically significant, with a p-value of 0.002. The sensitivity and specificity of self-reported smoking were 10.3% and 98.3%, respectively, and Cohen’s kappa coefficient was 0.308, indicating fair agreement. Urinary cotinine levels were significantly higher among anode production workers compared with office staff, with a p-value of 0.001.
Conclusion: Self-reported smoking status showed low validity and substantially underestimated the true prevalence of cigarette smoking among workers. Biochemical assessment using urinary cotinine is recommended as a complementary method to improve the accuracy of smoking status classification in occupational and public health studies.
Methods: In this cross-sectional study, 88 workers participated. Data were collected using a demographic and smoking status questionnaire. Urinary cotinine levels were measured using an enzyme-linked immunosorbent assay method with a Bio Quant kit. A cut-off value of 500 ng/mL was used to classify participants as active smokers. Data were analyzed using the Chi-square test, Cohen’s kappa coefficient, sensitivity, and specificity indices.
Results: Only 4.5% of participants self-identified as smokers, whereas 33% were classified as active smokers based on urinary cotinine analysis. The discrepancy between self-reported smoking status and cotinine-based classification was statistically significant, with a p-value of 0.002. The sensitivity and specificity of self-reported smoking were 10.3% and 98.3%, respectively, and Cohen’s kappa coefficient was 0.308, indicating fair agreement. Urinary cotinine levels were significantly higher among anode production workers compared with office staff, with a p-value of 0.001.
Conclusion: Self-reported smoking status showed low validity and substantially underestimated the true prevalence of cigarette smoking among workers. Biochemical assessment using urinary cotinine is recommended as a complementary method to improve the accuracy of smoking status classification in occupational and public health studies.
Type of Study: Orginal |
Subject:
Health Professional
Received: 2025/10/18 | Accepted: 2025/12/18 | Published: 2026/08/11
Received: 2025/10/18 | Accepted: 2025/12/18 | Published: 2026/08/11
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