Secondhand smoke exposure and validity of self-report in low-income women and children in India

Jessica L. Elf, Aarti Kinikar, Sandhya Khadse, Vidya Mave, Nikhil Gupte, Vaishali Kulkarni, Sunita Patekar, Priyanka Raichur, Joanna E Cohen, Patrick N Breysse, Amita Gupta, Jonathan E Golub

Research output: Contribution to journalArticle

Abstract

Background: There is limited validation of self-reported measures for secondhand smoke (SHS) exposure in low- and middle-income countries. We evaluated the validity of standard self-reported measures among women and children in urban India. Methods: Structured questionnaires were administered, and household air and hair samples were analyzed for nicotine concentration. Results: In total, 141 households of 70 child and 71 adult participants were included. Air nicotine was detected in 72 (51%) homes, and 35 (75%) child and 12 (56%) adult participants had detectable hair nicotine. Correlation between air and hair nicotine was significant in children (r = 0.5; P = .0002) but not in adults (r = -0.1; P = .57). Poor correlation was found between self-reported measures of exposure and both air and hair nicotine. No questions were significantly correlated with hair nicotine, and the highest-magnitude correlation with air nicotine was for how often someone smoked inside for adults (r = 0.4; P = .10) and for home preparation of mishri (a smokeless tobacco product prepared for consumption by roasting) for children (r = 0.4; P = .39). The highest value for sensitivity by using air nicotine as the gold standard was for whether people smelled other families preparing mishri (47%; 95% confidence interval: 31-62) and prepared mishri in their own homes (50%; 95% confidence interval: 19-81). Conclusions: These results raise caution in using or evaluating self-reported SHS exposure in these communities. More appropriate questions for this population are needed, including mishri preparation as a source of SHS exposure.

Original languageEnglish (US)
Pages (from-to)S118-S129
JournalPediatrics
Volume141
DOIs
StatePublished - Jan 1 2018

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Tobacco Smoke Pollution
Nicotine
Self Report
India
Hair
Air
Confidence Intervals
Smokeless Tobacco
Tobacco Products

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Secondhand smoke exposure and validity of self-report in low-income women and children in India. / Elf, Jessica L.; Kinikar, Aarti; Khadse, Sandhya; Mave, Vidya; Gupte, Nikhil; Kulkarni, Vaishali; Patekar, Sunita; Raichur, Priyanka; Cohen, Joanna E; Breysse, Patrick N; Gupta, Amita; Golub, Jonathan E.

In: Pediatrics, Vol. 141, 01.01.2018, p. S118-S129.

Research output: Contribution to journalArticle

Elf, Jessica L. ; Kinikar, Aarti ; Khadse, Sandhya ; Mave, Vidya ; Gupte, Nikhil ; Kulkarni, Vaishali ; Patekar, Sunita ; Raichur, Priyanka ; Cohen, Joanna E ; Breysse, Patrick N ; Gupta, Amita ; Golub, Jonathan E. / Secondhand smoke exposure and validity of self-report in low-income women and children in India. In: Pediatrics. 2018 ; Vol. 141. pp. S118-S129.
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AU - Elf, Jessica L.

AU - Kinikar, Aarti

AU - Khadse, Sandhya

AU - Mave, Vidya

AU - Gupte, Nikhil

AU - Kulkarni, Vaishali

AU - Patekar, Sunita

AU - Raichur, Priyanka

AU - Cohen, Joanna E

AU - Breysse, Patrick N

AU - Gupta, Amita

AU - Golub, Jonathan E

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N2 - Background: There is limited validation of self-reported measures for secondhand smoke (SHS) exposure in low- and middle-income countries. We evaluated the validity of standard self-reported measures among women and children in urban India. Methods: Structured questionnaires were administered, and household air and hair samples were analyzed for nicotine concentration. Results: In total, 141 households of 70 child and 71 adult participants were included. Air nicotine was detected in 72 (51%) homes, and 35 (75%) child and 12 (56%) adult participants had detectable hair nicotine. Correlation between air and hair nicotine was significant in children (r = 0.5; P = .0002) but not in adults (r = -0.1; P = .57). Poor correlation was found between self-reported measures of exposure and both air and hair nicotine. No questions were significantly correlated with hair nicotine, and the highest-magnitude correlation with air nicotine was for how often someone smoked inside for adults (r = 0.4; P = .10) and for home preparation of mishri (a smokeless tobacco product prepared for consumption by roasting) for children (r = 0.4; P = .39). The highest value for sensitivity by using air nicotine as the gold standard was for whether people smelled other families preparing mishri (47%; 95% confidence interval: 31-62) and prepared mishri in their own homes (50%; 95% confidence interval: 19-81). Conclusions: These results raise caution in using or evaluating self-reported SHS exposure in these communities. More appropriate questions for this population are needed, including mishri preparation as a source of SHS exposure.

AB - Background: There is limited validation of self-reported measures for secondhand smoke (SHS) exposure in low- and middle-income countries. We evaluated the validity of standard self-reported measures among women and children in urban India. Methods: Structured questionnaires were administered, and household air and hair samples were analyzed for nicotine concentration. Results: In total, 141 households of 70 child and 71 adult participants were included. Air nicotine was detected in 72 (51%) homes, and 35 (75%) child and 12 (56%) adult participants had detectable hair nicotine. Correlation between air and hair nicotine was significant in children (r = 0.5; P = .0002) but not in adults (r = -0.1; P = .57). Poor correlation was found between self-reported measures of exposure and both air and hair nicotine. No questions were significantly correlated with hair nicotine, and the highest-magnitude correlation with air nicotine was for how often someone smoked inside for adults (r = 0.4; P = .10) and for home preparation of mishri (a smokeless tobacco product prepared for consumption by roasting) for children (r = 0.4; P = .39). The highest value for sensitivity by using air nicotine as the gold standard was for whether people smelled other families preparing mishri (47%; 95% confidence interval: 31-62) and prepared mishri in their own homes (50%; 95% confidence interval: 19-81). Conclusions: These results raise caution in using or evaluating self-reported SHS exposure in these communities. More appropriate questions for this population are needed, including mishri preparation as a source of SHS exposure.

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