Do adolescents response to surveys about tobacco consumption mean what we think they do

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Do adolescents response to surveys about tobacco
consumption mean what we think they do?

• Rashid Ahmed, Paul McDonald,
• Cheryl Madill, Karen Pieters,
• Stephanie Filsinger

University of Waterloo, Canada
www.phr.uwaterloo.ca
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Facts Youth Smoking

• The majority of smokers begin tobacco use before
  they reach adulthood
• The younger a person begins to smoke, the greater
  the risk of eventually contracting smoking caused
  diseases such as cancer or heart disease

Sources http//www.who.int/tobacco/statistics/tob
acco_atlas/en
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Challenges in Measuring Youth Tobacco Consumption

• Responses depend on context of where surveys
  completed
• Due to irregular consumption, its difficult for
  youth to be accurate
• Questions may not be valid or reliable
• Time periods such as 30 days may not have
  practical significance to youth
• Reliability lowest for 30 day recall (i.e., lt.70)
• Confusion between whole or part cigarettes
• Confusion/confound between stopping and quitting

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Smoking Rate (Age15-18)
Source CTUMS, NPHS, and Survey of Smoking Habits
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Smoking Definition (CTUMS)

• At the present time, do you smoke cigarettes
  every day, occasionally or not at all?
• Daily
• Occasional
• Not at all
• Daily smokers and smoked in last 30 days
• So, thinking back over the past 7 days, starting
  with yesterday, how many cigarettes did you
  smoke?

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Discrepancies
Source School Smoking Project (SSP)
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Study Purpose

• To compare the reliability and validity of paper
  survey with daily self report tobacco consumption
  using electronic daily diaries, such as
  Blackberry
• To capture the irregular smoking patterns of
  adolescent cigarette consumption

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Study Design
Visit schools, recruit participants,
give/receive consent forms Administer self
report survey T1 provide Blackberry ) )
Collect daily reports from Blackberry (B1) ) 30
days after T1, administer survey T2 provide
cessation intervention Quit date (1 to 3 weeks
after T2) ) ) Collect daily reports from
Blackberry (B2) ) 30 days after quit date,
administer survey T3 CO and Cotinine ) )
Collect daily reports from Blackberry (B2) ) 60
days after quit date administer survey T4, CO and
Cotinine Students entered into a draw for 20
gift certificate odds of winning related to
compliance
T1
T2
T3
T4
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Recruitment

• 27 schools contacted
• 19 schools from London, Waterloo, and Brantford
  participated
• 135 students returned consent forms
• 88 students attended first session/received
  Blackberry

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Characteristics of Participants at Baseline

• 59 female
• Age
• mean 17 years
• 14 - 15 (13)
• 16 - 17 (47)
• 18 - 19 (40)
• Reported smoked 14/day
• This is higher than the Ontario average of 12.7
  for this age group

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Compliance With Protocol

• Completion of self report surveys (and bio-chem,
  where applicable)
• T1 88/88 (100)
• T2 77/88 (88)
• T3 62/88 (70)
• T4 64/88 (73)
• Blackberry compliance
• 44 completed more than 75 of all daily reports
• 26 completed 50-74 of daily reports
• 2 completed less than 50 of daily reports
• 27 of participants were lost due to withdrawal
  of consent missed intervention session lost
  contact for more than 1 week

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Example of a 30-day smoking history as reported
on a pager
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Correlation between 7- and 30-day paper responses
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Mean Cigarette Consumption for Youth Last 24
hours
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Mean Cigarette Consumption for Youth Last 30 days
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Conclusions

• Students over-reported their smoking behaviour on
  the paper questionnaire
• Consumption patterns can vary enormously, even
  among relatively heavy youth smokers

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Conclusion

• Without some correction for biases in paper
  surveys, estimates of youth smoking consumption
  may not clearly reflect their true smoking
  behavior
• Research into a series of smoking behaviour
  questions that can accurately portray actual
  cigarette consumption among individual
  adolescents is key to developing valid and
  reliable instruments on which to base health
  policy

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Thanks Any Question?