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Elderly
more likely to deny smoking when asked, says
Case Western Reserve University researcher
CLEVELAND—More elderly adults are lighting
up cigarettes and not reporting their
nicotine habits to doctors and others,
according to findings from one of the first
studies to examine the accuracy of
self-reported smoking habits by age, race
and gender of adults 18 years and older by
researchers at the Case Western Reserve
University School of Dental Medicine and
other university collaborators.
A combined total of 8 percent of people from
all age and race groups studied were true
smokers but had denied it.
The findings bring into question the
validity of using self-reported tobacco use
when conducting research projects, reporting
tobacco use by the general public or caring
for individuals with chronic diseases
related to smoking, according to researchers
of the study, “Age and Race/Ethnicity-Gender
Predictors of Denying Smoking, United
States.”
The study has been published in the
current Journal of Health Care for the Poor
and Underserved.
The researchers conducted their study by
identifying self-reported non-smokers from
15, 182 adults in the third National Health
and Nutrition Examination Survey. They
examined usage by age groups of 18-34,
35-54, 55-74, and 75-90. Groups of men and
women were broken down by race and ethnicity
into Mexican American, non-Hispanic White
and non-Hispanic Black groups. The age group
of 60 and older was also broken down into
cognitively competent.
“Denying smoking overall increased with age
from 6% of 18-34 year olds to 25% of the
elderly over the age of 75,” said the
article’s lead author, Monica Fisher, Ph.D.,
DDS, MS, MPH, an associate professor at the
Case Western Reserve University School of
Dental Medicine.
Non-Hispanic white men and women followed
the pattern of the overall study and
increased denial with age. However denial of
smoking decreased for older Mexican American
women, but the denial rate basically
remained stable over age for non-Hispanic
black men and women and Mexican American
men.
Social taboos against smoking among the
older groups may drive some elderly to deny
smoking, said Fisher.
But the consequences can be deadly. For
example, researchers reported that an
earlier study by other researchers showed
cotinine—by-product of nicotine use that
stays in the blood for several days after
smoking -based smokers who self-reported as
non smokers—had significantly higher
mortality rates (36%) than self-reported
true non-smokers (15%).
Fisher and other researchers from Case
Western Reserve, the University of Michigan
and the University of Kentucky called for
the use of biomarkers, such as cotinine, as
a more accurate measure of smoking when
smoking is an important factor in the
outcomes of research or health issues.
They compared the participant’s
self-reported smoking habits to blood levels
of cotinine, to see if self-reported smoking
habits matched the blood test. The
researchers also used cotinine levels of
15ng/ml or greater to rule out individuals
exposed to second-hand smoke. They also
eliminated cigar, pipe or smokeless tobacco
users from the study.
While researchers detected true smokers, the
segment that occasionally smokes was
potentially missed, which could raise the
number of people who smoke.
Researchers concluded that caution is needed
when using self-reported nicotine use as
part of survey data and that additional
measures are needed to validate who does or
doesn’t smoke.
About Case Western Reserve University
Case is among the nation's leading research
institutions. Founded in 1826 and shaped by
the unique merger of the Case Institute of
Technology and Western Reserve University,
Case is distinguished by its strengths in
education, research, service, and
experiential learning. Located in Cleveland,
Case offers nationally recognized programs
in the Arts and Sciences, Dental Medicine,
Engineering, Law, Management, Medicine,
Nursing, and Social Work.
http://www.case.edu.
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