Smoking behavior among casino employees: self-report validation using plasma cotinine

Towards the Objective Speech Assessment of Smoking Status based on Voice Features: A Review of the Literature

BACKGROUND AND OBJECTIVE

In smoking cessation clinical research and practice, objective validation of self-reported smoking status is crucial for ensuring the reliability of the primary outcome, that is, smoking abstinence. Speech signals convey important information about a speaker, such as age, gender, body size, emotional state, and health state. We investigated (1) if smoking could measurably alter voice features, (2) if smoking cessation could lead to changes in voice, and therefore (3) if the voice-based smoking status assessment has the potential to be used as an objective smoking cessation validation method.

METHODS

A systematic review of the scientific literature was conducted to compile studies on smoking status assessment based on voice features. We searched nine scientific databases for original studies involving the effects of smoking on voice features, the effects of smoking cessation on voice features.

RESULTS

A total of 34 studies were identified for review. We found that fundamental frequency, jitter, shimmer, harmonics to noise ratio, and other voice features are affected by smoking and could be used to assess smoking status.

CONCLUSION

Speech assessment of smoking status based on voice features has potential as a smoking status validation method, as it is simple, reliable, and less time-consuming. Furthermore, this study provides recommendations for future research on the objective speech assessment of smoking status based on voice features.

Review and Prospect of the Research on Occupational Health Psychology of Casino Employees

The occupational specialty of casino employees brings about the problem of long-standing severe emotional exhaustion and stress management challenges. Therefore, it is of great significance to pay attention to their occupational health psychology (Du & Li, in Psych Res 7(1):46-50, 2014). Based on the relevant researches on occupational health psychology of casino employees at home and abroad in recent years, this paper reviews and outlines the previous research results in a systematic way from environmental and occupational, organizational as well as individual dimensions, and figures out the factors that may affect the occupational health psychology of casino employees, and further expounds the psychological and behavioral effects of these factors on employees (including job burnout, organizational commitment, job satisfaction, employees' problematic gambling behavior, etc.), with the purpose of getting a deeper understanding of why occupational health psychology of casino employees can affect customer satisfaction, loyalty and casino profits ultimately. On this basis, three suggestions are put forward for the optimization of human resource management in casinos through the lens of occupational health psychology. In the end, the paper points out some shortcomings of existing studies and the trend for future study that can expand and deepen relevant variables and research subjects that affect the occupational health psychology of casino employees on the basis of comprehensive review.

Linking birth records to hospital admission records enhances the identification of women who smoke during pregnancy

OBJECTIVE

Birth records and hospital admission records are valuable for research on maternal smoking, but individually are known to under-estimate smokers. This study investigated the extent to which combining data from these records enhances the identification of pregnant smokers, and whether this affects research findings such as estimates of maternal smoking prevalence and risk of adverse pregnancy outcomes associated with smoking.

METHODS

A total of 846,039 birth records in New South Wales, Australia, (2001-2010) were linked to hospital admission records (delivery and antenatal). Algorithm 1 combined data from birth and delivery admission records, whereas algorithm 2 combined data from birth record, delivery and antenatal admission records. Associations between smoking and placental abruption, preterm birth, stillbirth, and low birthweight were assessed using multivariable logistic regression.

RESULTS

Algorithm 1 identified 127,612 smokers (smoking prevalence 15.1%), which was a 9.6% and 54.6% increase over the unenhanced identification from birth records alone (prevalence 13.8%), and delivery admission records alone (prevalence 9.8%), respectively. Algorithm 2 identified a further 2,408 smokers from antenatal admission records. The enhancement varied by maternal socio-demographic characteristics (age, marital status, country of birth, socioeconomic status); obstetric factors (multi-fetal pregnancy, diabetes, hypertension); and maternity hospital. Enhanced and unenhanced identification methods yielded similar odds ratios for placental abruption, preterm birth, stillbirth and low birthweight.

CONCLUSIONS

Use of linked data improved the identification of pregnant smokers. Studies relying on a single data source should adjust for the under-ascertainment of smokers among certain obstetric populations.

Parental smoking cessation and child daily smoking: A 9-year longitudinal study of mediation by child cognitions about smoking

OBJECTIVE

This study investigated to what extent the prospective relationship between parental smoking cessation and child daily smoking is mediated by child cognitions about smoking.

DESIGN

The study drew its sample from the 40 Washington State school districts involved in the Hutchinson Smoking Prevention Project. The predictor variable of parental smoking cessation was measured during third grade. The mediator measures, consistent with the Theory of Planned Behavior and Social Cognitive Theory, were measured during ninth grade, and the smoking status outcome was measured during twelfth grade.

MAIN OUTCOME MEASURES

Smoking status at twelfth grade.

RESULTS

Negative general attitudes toward smoking, attitude that cigarette smoke is bothersome, and tobacco refusal self-efficacy together significantly mediated 49% of the prospective relationship between parental smoking cessation and child daily smoking.

CONCLUSION

Parental smoking cessation before children reach third grade may lead children to develop more negative cognitions about smoking, and, in turn, reduce their risk of smoking.

The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status

INTRODUCTION

Smoking is a leading cause of premature mortality and preventable morbidity. Surveillance is most often based on self-reported data, but studies have shown that self-reports tend to underestimate smoking status.

METHODS

This study systematically reviewed the literature to measure the concordance between self-reported smoking status and smoking status determined through measures of cotinine in biological fluids. Four electronic databases were searched to identify observational and experimental studies on adult populations over the age of 18 years.

RESULTS

Searching identified 67 studies that met the eligibility criteria and examined the relationship between self-reported smoking and smoking confirmed by cotinine measurement. Overall, the data show trends of underestimation when smoking prevalence is based on self-report and varying sensitivity levels for self-reported estimates depending on the population studied and the medium in which the biological sample is measured. Sensitivity values were consistently higher when cotinine was measured in saliva instead of urine or blood. Meta-analysis was not appropriate because of the substantial heterogeneity among the cutpoints used to define smokers and the poor reporting on outcomes of interest.

DISCUSSION

Further research in this field would benefit from the standardization of cutpoints to define current smokers and the implementation of standard reporting guidelines to enhance comparability across studies. Accurate estimation of smoking status is important as data from population studies such as those included in this review are used to generate regional and national estimates of smoking status and in turn are used to allocate resources and set health priorities.

Prenatal smoking prevalence ascertained from two population-based data sources: birth certificates and PRAMS questionnaires, 2004

OBJECTIVES

This study provided a population-based estimate of the prevalence of smoking during pregnancy by combining information from two data sources: birth certificates (BCs) and a self-administered questionnaire.

METHODS

We analyzed data from 39,345 women who delivered live births in one of 24 states and responded to a questionnaire from the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing, state- and population-based surveillance system. We compared prevalence of smoking during pregnancy based on the BC, the PRAMS questionnaire, and the two data sources combined. Data were weighted to represent all women delivering live births in each of the 24 states during 2004.

RESULTS

The combined estimate indicated that 15.1% of women reported smoking during pregnancy, whereas the BCs alone reported 10.4% and the PRAMS questionnaires alone reported 13.4%.

CONCLUSIONS

Based on the combined BC and PRAMS questionnaire data, the number of infants exposed to tobacco in-utero may be 31% higher than is currently reported on the BCs. Combining the data from the two different sources led to higher ascertainment of prenatal smoking.

Stability and progression of disordered gambling: lessons from longitudinal studies

OBJECTIVE

Few studies have explicitly examined the stability (that is, the tendency for individuals to stay at one diagnostic level as opposed to moving to another improved or worsened level) or progression of disordered gambling; however, conventional wisdom holds that disordered gambling is intractable and escalating. The objective of this study was to examine these assumptions.

METHOD

We reviewed 5 recent prospective studies of gambling behaviour among nontreatment samples for evidence related to the stability and progression of disordered gambling.

RESULTS

Our review found no evidence to support the assumption that individuals cannot recover from disordered gambling (that is, the persistence assumption), no evidence to support the assumption that individuals who have more severe gambling problems are less likely to improve than individuals who have less severe gambling problems (that is, the selective-stability assumption), and no evidence to support the assumption that individuals who have some gambling problems are more likely to worsen than individuals who do not have gambling problems (that is, the progression assumption).

CONCLUSION

Contrary to professional and conventional wisdom suggesting that gambling problems are always progressive and enduring, this review demonstrates instability and multidirectional courses in disordered gambling.

Validation of self-reported cigarette smoking in a remote Australian Aboriginal community

OBJECTIVE

To examine the relationship between self-reported tobacco smoking and urinary cotinine concentrations in the setting of a remote Aboriginal community.

METHODS

In a remote Northern Territory (NT) Aboriginal community the relationship between self-reported tobacco smoking and urinary cotinine concentrations was examined as part of a cross-sectional survey of cardiovascular risk factors. Current tobacco smoking was assessed as part of a questionnaire. The concentration of cotinine and cotinine/creatinine ratio (CCR) in a spot urine sample were used as a biochemical marker of nicotine exposure.

RESULTS

A total of 237 people took part in the survey, although completed questionnaires and urine results were available for 184 people. Current tobacco smoking was reported by 161 (69 [95% CI 63 to 75]%) people, with higher rates among males (84/104, 81 [95% CI 72 to 88]%) than females (77/129, 60 [95% CI 51 to 68]%, p < 0.001). There was good agreement of self report with current tobacco smoking using categories based on urinary cotinine (agreement 94%, kappa = 0.84) and urinary CCR (agreement 94%, kappa = 0.86). Quantitative agreement between cotinine measures and self-reported number of cigarettes per day was better for CCR than cotinine, but the correlation was relatively weak for both.

CONCLUSIONS

Self-reported cigarette smoking is a valid qualitative measure in this environment. The relatively weak correlation between the biomarker and number of reported cigarettes smoked illustrates problems both with questionnaire and urinary markers of nicotine exposure.

IMPLICATIONS

As a qualitative measure of tobacco smoking in this setting, self-report appears adequate but the validity of quantitative self-report is unclear.

Long term success of short smoking cessation seminars supported by occupational health care

The objective of this longitudinal (3 year) study was to determine predictors of abstinence in 515 employees of a steel plant (28% female, age 18-67 years) after participation in Allen Carr seminars (intensive group counselling in a single session of 6 h). Answers given in computer aided phone interviews were analysed by stepwise and Cox regression. Of 510 responding persons 262 (51.4%) reported continuing abstinence. In a random sample of 61 respondents cotinine concentration in urine was measured, showing high agreement with smoking history. Social support increased abstinence, which was more persistent in males and office workers. Also in female participants the non-smoking spouse was a significant predictor for abstinence while a higher body weight predicted relapse. Relapsed female smokers did not show a sustainable reduction of cigarette consumption. Compared to cessation clinics higher population coverage would be achievable by workplace seminars. Every second smoker motivated to participate seems to be able to quit even without medication and to stay abstinent. Especially in females these seminars should be followed by physical exercise and continued support of gender specific occupational health care.

Changes in the influence of parents' and close friends' smoking on adolescent smoking transitions

This paper examined changes in the influence of parents' and close friends' smoking on smoking transitions occurring over the course of adolescence, using a large (N=6,006) longitudinal study. The three grade periods were 5th to 7th (ages 10-12), 7th to 9th (ages 12-14), and 9th to 12th grade (ages 14-17). Smoking transitions examined were: (1) never to trying, (2) trying to monthly, and (3) monthly to daily. Results showed that the influence of parents' smoking was substantial for all three transitions during most of the grade periods and, for the transition from monthly to daily smoking, increased (p=.006) during adolescence. In contrast, the influence of close friends' smoking was strongest for the transition to trying smoking and did not significantly change (all p>.05) for any of the smoking transitions as the adolescent became older. In conclusion, the influence of close friends' smoking on smoking transitions might be stable during adolescence whereas the influence of parents' smoking on the transition to daily smoking might markedly increase across adolescence.

Close friends', parents', and older siblings' smoking: reevaluating their influence on children's smoking

A number of longitudinal studies have explored the role of friends', parents', and older siblings' smoking in children's smoking acquisition. A reasonable implication of this previous research is that intervention efforts could be beneficially directed toward countering the potential influence of friends' and possibly older siblings' smoking but not parents' smoking. However, methodological limitations of this previous research motivated our reevaluation of the role of friends', parents', and older siblings' smoking in children's smoking. Close friends' smoking status was assessed when children were in 5th grade, whereas parents' and older siblings' smoking status was assessed when children were in 3rd grade. The outcome, children's daily smoking status, was assessed in 12th grade. The setting was 40 Washington state school districts that participated in the long-term Hutchinson Smoking Prevention Project. Participants were the 4,576 families for whom close friends', parents', and older siblings' smoking status as well as children's smoking status were available. The probability that each close friend's smoking influenced the child to smoke daily was 9% (95% CI = 6%-12%), the probability that each parent's smoking influenced the child to smoke daily was 11% (95% CI = 9%-14%), and the probability that each older sibling's smoking influenced the child to smoke daily was 7% (95% CI = 1%-13%). These results suggest that close friends', parents', and siblings' smoking were similarly important influences on children's smoking. Family-focused interventions could be a valuable future direction of prevention research.

Smoking as a complex but critical covariate in neurobiological studies of posttraumatic stress disorders: a review

As smoking rates in the general population continue to fall in response to new information and changing social values, the continued high rate of smoking among persons with psychiatric disorders has caught the attention of society at many levels: public health officials, medical and mental health care providers, and concerned family members alike. As a consequence, research studies aimed at quantifying the problem and understanding its cause have increased dramatically over the past several years. The following review first examines epidemiological studies that have revealed a bidirectional causal relationship between tobacco dependence and posttraumatic stress disorder (PTSD), one of several mental health disorders in which tobacco dependence remains prevalent and resistant to intervention. Second, we use a translational neuroscience perspective to discuss possible neurobiological mediators of the relationship between PTSD and tobacco dependence, hoping to spur further human and animal research that will elucidate pathogenetic mechanisms involved and inspire novel treatment interventions. Finally, to enable more effective clinical research in this area, we provide an overview of effective scientific methods for assessing and managing 'smoking status' as an experimental variable in clinical research studies of PTSD as well as other mental health disorders.

Environmental tobacco smoke exposure in school children: parent report and urine cotinine measures

BACKGROUND

Environmental tobacco smoke (ETS) in the home continues to be a major health risk for children around the world. Measuring ETS is a central feature of clinical and epidemiological studies, with children's exposure often assessed through parental estimates. The authors examined the relationship between parent-reported estimates of children's exposure to ETS and children's urinary cotinine levels and evaluated the ETS exposure and its effect on respiratory health in children.

METHODS

A total of 188 school children were included in the study. Parents were asked to complete a questionnaire about their smoking habits, their children's respiratory morbidity status and housing conditions. Urinary cotinine levels were measured in children.

RESULTS

According to the responses, 72.3% of the children came from households with smokers, and 34.6% had daily exposure to ETS. When urine cotinine levels of >10 ng/mL were used as the yardstick of exposure, 76% of the children were identified as ETS exposed. No relation was detected between the symptoms of respiratory tract diseases and ETS exposure. To determine the amount of ETS exposure, the contribution of parental reports was low.

CONCLUSION

To evaluate the level of ETS exposure of children, the parents' reports were not reliable. The addition of a biological measure results in a more informative estimate of ETS exposure in children.

Childhood friends who smoke: do they influence adolescents to make smoking transitions?

This study investigated longitudinally the extent to which childhood friends who smoke influence adolescents' smoking transitions, and compared that influence with that of parents who smoke. In a sample of 4744 children, results showed that the probability, per close friend, that a smoking close friend influenced the adolescent to make the first transition to trying smoking was 38% (95% CI: 28%, 46%); to make the second transition from trying to monthly smoking, 10% (95% CI: 5%, 15%); and to make the third transition from monthly to daily smoking, 11% (95% CI: 5%, 17%). Compared to parents' smoking, close friends' smoking was 12% (p=0.03) more influential for the first transition, no different for the second transition (p=0.53), and 16% (p=0.01) less influential for the third transition. Results provide new evidence suggesting that childhood close friends who smoke influence not only initiation but also escalation of adolescents' smoking. Results also confirmed the important role of parents' smoking. Targeting both childhood close friends' and parents' smoking would be valuable in prevention research.

Prospective prediction of children's smoking transitions: role of parents' and older siblings' smoking

AIMS

To use a novel social epidemic probability model to investigate longitudinally the extent to which parents' and older siblings' smoking predict children's smoking transitions.

DESIGN

Parents' and older siblings' smoking status was assessed when children were in 3rd grade (baseline). Three smoking transitions were assessed over the period of child/adolescent smoking acquisition (up to 12th grade): (1) transition from never smoking to trying smoking, (2) transition from trying to monthly smoking and (3) transition from monthly to daily smoking.

SETTING

Forty Washington State school districts participating in the long term Hutchinson Smoking Prevention Project (HSPP).

PARTICIPANTS AND MEASUREMENTS

Participants were the 5520 families for whom data on both parents' and older siblings' baseline smoking status, as well as on children's smoking transitions, were available.

FINDINGS

The probability that a smoking parent influenced their child to make the first transition to trying smoking was 32% (95% CI: 27%, 36%); to make the second transition from trying to monthly smoking, 15% (95% CI: 10%, 19%); and to make the third transition from monthly to daily smoking, 28% (95% CI: 21%, 34%). The probability that an older sibling influenced a child to make the first transition to trying smoking was 29% (95% CI: 17%, 39%); to make the second transition from trying to monthly smoking, 0% (95% CI: 0%, 8%); and to make the third transition from monthly to daily smoking, 20% (95% CI: 4%, 33%).

CONCLUSIONS

In contrast to previous research, the results provide new evidence suggesting that family smoking influences both initiation and escalation of children's smoking. Results also quantify, in terms of probabilities, the importance of parents' and older siblings' smoking on children's three major smoking transitions. Parents' smoking, as well as older siblings' smoking, are important behaviors to target in preventing adolescents from making smoking transitions.

Parental smoking cessation and children's smoking: Mediation by antismoking actions

The present study investigated whether parents' antismoking actions mediated the prospective relationship between parental smoking cessation and children's smoking. Smoking status of parents (predictor) was assessed when their children were in 3rd grade, parental antismoking actions (mediators) were assessed when their children were in 11th grade, and children's smoking status (outcome) was assessed when they were in 12th grade. In 20 Washington state school districts, data were collected from 1,600 children (49% female, 91% White) and from their parents. Results showed that children's odds of daily smoking were reduced by 39% (95% CI = 24%-51%) for those whose parents had quit smoking, compared with those whose parents were current smokers. Asking to sit in nonsmoking sections of public establishments was a significant (p<.01) mediator that explained 64% of the association between parental smoking cessation and children's smoking. However, not allowing smoking in the home and asking others not to smoke around them were not significant mediators (p = .10, and p = .06, respectively). In conclusion, asking to sit in a nonsmoking section of a public establishment substantially mediates the relationship between parental smoking cessation and children's smoking.

Does parental smoking cessation encourage their young adult children to quit smoking? A prospective study

AIMS

To investigate the extent to which parental early and late smoking cessation predicts their young adult children's smoking cessation.

DESIGN

Parental early smoking cessation status was assessed when children were in 3rd grade, parental late smoking cessation was assessed when children were in 11th grade, and young adult children's smoking cessation was assessed 2 years after high school.

SETTING

Forty Washington State school districts participated in the Hutchinson Smoking Prevention Project.

PARTICIPANTS AND MEASUREMENTS

Participants were the 1553 families in which parents were ever regular smokers who had a young adult child smoking at least weekly at 12th grade who also reported their smoking status 2 years later. Questionnaire data were gathered on parents and their young adult children (49% female and 91% Caucasian) in a cohort with a 94% retention rate.

FINDINGS

Parents who quit early had children with 1.8 (OR = 1.80; 95% CI = 1.22, 2.64) times higher odds of quitting smoking for at least 1 month in young adulthood compared to those whose parents did not quit early. In contrast, there was no association (OR = 0.84; 95% CI = 0.47, 1.51) between parents quitting late and their young adult children's smoking cessation.

CONCLUSIONS

Parental early smoking cessation is associated with increased odds of their young adult children's smoking cessation. Parents who smoke should be encouraged to quit when their children are young.

Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures

OBJECTIVES

Current data show smoking is associated with a number of complications of the fracture healing process. A concern, however, is the potential confounding effect of covariates associated with smoking. The present study is the first to prospectively examine time to union, as well as major complications of the fracture healing process, while adjusting for potential confounders.

SETTING

Eight Level I trauma centers.

PATIENTS

Patients with unilateral open tibia fractures were divided into 3 baseline smoking categories: never smoked (n = 81), previous smoker (n = 82), and current smoker (n = 105).

OUTCOME MEASURE

Time to fracture healing, diagnosis of infection, and osteomyelitis.

METHODS

Survival and logistic analyses were used to study differences in time to fracture healing and the likelihood of developing complications, respectively. Multivariate models were used to adjust for injury severity, treatment variations, and patient characteristics.

RESULTS

After adjusting for covariates, current and previous smokers were 37% (P = 0.01) and 32% (P = 0.04) less likely to achieve union than nonsmokers, respectively. Current smokers were more than twice as likely to develop an infection (P = 0.05) and 3.7 times as likely to develop osteomyelitis (P = 0.01). Previous smokers were 2.8 times as likely to develop osteomyelitis (P = 0.07), but were at no greater risk for other types of infection.

CONCLUSION

Smoking places the patient at risk for increased time to union and complications. Previous smoking history also appears to increase the risk of osteomyelitis and increased time to union. The results highlight the need for orthopaedic surgeons to encourage their patients to enter a smoking cessation programs.

A science-based framework for responsible gambling: the Reno model

As social observers increasingly identify gambling-related problems as a public health issue, key stakeholders need to join together to reduce both the incidence and prevalence of gambling-related harm in the community. This position paper describes a strategic framework that sets out principles to guide industry operators, health service and other welfare providers, interested community groups, consumers and governments and their related agencies in the adoption and implementation of responsible gambling and harm minimization initiatives.

Comparison of self-reported smoking and urinary cotinine levels in a rural pregnant population

OBJECTIVES

(a) to assess the accuracy of self-reported smoking status in pregnant women from rural and small metropolitan statistical areas who stated they were smokers at the onset of pregnancy, (b) to compare the characteristics of these women who self-reported a nonsmoker status at the first prenatal visit with those who reported a smoker status, and (c) to determine the characteristics that predict self-reported smoking status and positive/negative urinary cotinine assays.

SETTING

Seven private obstetric offices serving rural and small metropolitan statistical areas in upstate New York.

PARTICIPANTS

A convenience sample of 94 pregnant women who stated they were smokers at the onset of their pregnancies. Their mean age was 23 years and mean level of education was 11.9 years; 95% were White, 65% were single, and 65% were Medicaid-funded.

DESIGN

Descriptive correlational design. At the first prenatal visit, the sensitivity and specificity of smoking and nonsmoking status were determined by comparing self-reports of smoking status with urinary cotinine assays. Data were also analyzed for relationships among demographic variables and for predictors of smoking status and urinary cotinine.

RESULTS

The discordance rate between self-reports of smoking status and urinary cotinine assays at the first prenatal visit for the total sample was 16.6%, significant at p < .001, chi-square = 27.80, df = 1. Based on biochemical assays of >200 ng/ml of cotinine indicating active smoking, 34.7% of women who denied smoking (specificity of 65.3%) and 10.4% of women who stated that they smoked (sensitivity of 89.5%) inaccurately reported their status (significant at p < .001). The number of cigarettes smoked per day was positively correlated with age, gravidity, parity, and number of smokers in the household. Gravidity and the number of smokers in the household were significant predictors of positive self-report of smoking status and of positive urinary cotinine assay.

CONCLUSION

These results substantiate the unreliability of self-report on smoking status in the pregnant population and in women who are recent quitters. Such findings have implications for clinical practice, such as (a) changes are necessary in how the prenatal interview assesses past and present tobacco use, (b) pregnant smokers who are multigravidae and who live with other smokers need more tailored interventions, and (c) more research is needed on how self-report can be ethically and efficiently validated.

How to assess epidemiological studies

Assessing the quality of an epidemiological study equates to assessing whether the inferences drawn from it are warranted when account is taken of the methods, the representativeness of the study sample, and the nature of the population from which it is drawn. Bias, confounding, and chance can threaten the quality of an epidemiological study at all its phases. Nevertheless, their presence does not necessarily imply that a study should be disregarded. The reader must first balance any of these threats or missing information with their potential impact on the conclusions of the report.

Laying the foundation for quantifying regional exposure to social phenomena: considering the case of legalized gambling as a public health toxin

Exposure and adaptation models provide competing perspectives of the environmental influence on the development of addictive disorders. Exposure theory suggests that the presence of environmental toxins (e.g., casinos) increases the likelihood of related disease (e.g., gambling-related disorders). Adaptation theory proposes that new environmental toxins initially increase adverse reactions; subsequently, symptoms diminish as individuals adapt to such toxins and acquire resistance. The authors describe a new public health regional exposure model (REM) that provides a tool to gather empirical evidence in support of either model. This article demonstrates how the strategic REM, modified to examine gambling exposure, uses standardized indices of exposure to social phenomena at the regional level to quantify social constructs.

Accuracy of self-reported smoking status among participants in a chemoprevention trial

BACKGROUND

Exposure to tobacco products is readily assessed through self- or interview-administered questionnaires. Degree of misreporting among participants in chemoprevention trials is unknown. We assessed the level of discrepancy between self-reported smoking exposure and plasma cotinine among participants in a chemoprevention trial.

METHODS

Analyses were conducted among 824 men and women who participated in a dietary trial of adenoma recurrence. Smoking exposure was ascertained through self-administered questionnaires at three time-points. Plasma cotinine was measured by gas chromatography among 283 never, 446 former and 95 current self-reported smokers. Sensitivity and specificity were assessed using various plasma cotinine cut-points.

RESULTS

Degree of misclassification for self-reported current smokers was minor (0-3%), regardless of cotinine cut-point used. Using a cut-point of 20 ng/ml, which takes into account exposure to environmental tobacco smoke among nonsmokers, sensitivity and specificity were 98.9% and 80.2%, respectively.

CONCLUSIONS

These data indicate that degree of misreport for current smokers is extremely low; however, approximately 20% of self-reported never smokers misreport their exposure, suggesting that validation of self-report is needed for these individuals.

The validity of self-reports in a follow-up study with drug addicts

Self-reports continue to be the most commonly used method in studies on the effectiveness of treatments for drug addiction. Nevertheless, the validity of this procedure has been called into question, so that subjects' reports are often compared with data from other sources. This study compares the data collected from the self-reports of 207 subjects that had participated in a drug-free treatment program with information from the family and with official records from the main assistance units for drug addicts in the region (Asturias, Spain). As regards misuse of illegal drugs and alcohol, the results show a high level of agreement (91.3% and 90.35%, respectively) between self-reports and information from the family. The data are similar for the other variables studied (work and educational activity, leisure activities, and family relationships). Agreement between self-reports and data collected from the assistance units is very high, reaching 91.19%. These results support the hypothesis that self-reports may constitute a valid instrument for assessing the results of drug-addiction treatment programs.

Smoking behavior among casino employees: self-report validation using plasma cotinine

The veracity of behavioral self-reports is often challenged, particularly when the motivation to avoid stigma and win social approval holds potential to introduce bias into the data collected. This study employed plasma cotinine tests to validate the self-reports of tobacco use collected from 3,841 casino employees as part of a comprehensive health survey. Rates of discordance were calculated by comparing employee self-reports with results from plasma colinine tests. This study provides evidence that casino employees can provide valid self-report data. Further, discordance rates of self-reported tobacco use vary according to operational definitions of tobacco use. These findings highlight the methodological importance of recognizing the inherent heterogeneity of smoking behavior.