Instruments to assess secondhand smoke exposure in large cohorts of never smokers: the smoke scales

PLoS One. 2014 Jan 21;9(1):e85809. doi: 10.1371/journal.pone.0085809. eCollection 2014.

Abstract

(i) to develop questionnaires that can identify never-smoking children and adults experiencing increased exposure to secondhand smoke (SHS+), (ii) to determine their validity against hair nicotine, and (iii) assess their reliability. A sample of 191 children (85 males; 106 females; 7-18 years) and 95 adult (23 males; 72 females; 18-62 years) never-smokers consented to hair nicotine analysis and answered a large number of questions assessing all sources of SHS. A randomly-selected 30% answered the questions again after 20-30 days. Prevalence of SHS+ in children and adults was 0.52±0.07 and 0.67±0.10, respectively (p<0.05). The Smoke Scale for Children (SS-C) and the Smoke Scale for Adults (SS-A) were developed via factor analysis and included nine questions each. Positivity criteria for SS-C and SS-A via receiver operating characteristics curve analysis were identified at >16.5 and >16, respectively. Significant Kappa agreement (p<0.05) was confirmed when comparing the SS-C and SS-A to hair nicotine concentration. Reliability analyses demonstrated that the SS-C and SS-A scores obtained on two different days are highly correlated (p<0.001) and not significantly different (p>0.05). Area under the curve and McNemar's Chi-square showed no pair-wise differences in sensitivity and specificity at the cutoff point between the two different days for SS-C and SS-A (p>0.05). We conclude that the SS-C and the SS-A represent valid, reliable, practical, and inexpensive instruments to identify children and adult never-smokers exposed to increased SHS. Future research should aim to further increase the validity of the two questionnaires.

MeSH terms

  • Adolescent
  • Adult
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Greece / epidemiology
  • Hair / chemistry
  • Humans
  • Male
  • Middle Aged
  • Nicotine / analysis
  • Prevalence
  • ROC Curve
  • Reproducibility of Results
  • Smoking / epidemiology*
  • Surveys and Questionnaires*
  • Tobacco Smoke Pollution / analysis*
  • Tobacco Smoke Pollution / statistics & numerical data
  • Young Adult

Substances

  • Tobacco Smoke Pollution
  • Nicotine

Grants and funding

These authors have no support or funding to report.