The Validity of Self-Reported Nicotine Product Use in the 2001–2008 National Health and Nutrition Examination Survey

Abstract

Many researchers rely on high-quality face-to-face national surveys conducted by the federal government to estimate the prevalence of nicotine product use, but some scholars have suggested that adults' self-reports in such surveys are intentionally distorted by social desirability response bias, thus raising questions about the validity of those data.

To assess the validity of face-to-face survey self-reports by comparing them with physiological tests.

Respondents in the National Health and Nutrition Examination Survey provided self-reports of nicotine product use and gave blood samples that were analyzed for levels of serum cotinine, an indicator of nicotine exposure.

Nationally representative samples of thousands of American adults in National Health and Nutrition Examination Survey surveys conducted in 2001–2002, 2003–2004, 2005–2006, and 2007–2008.

Serum cotinine levels and self-reports of nicotine product use.

On average, only 1.17% to 1.25% of adult respondents said that they did not use a product containing nicotine, but had elevated cotinine levels. After eliminating the potential influence of passive smoking, these figures dropped to 0.89% to 0.94%. This small discrepancy between the 2 assessments could be due to measurement error in the cotinine test results or to recent use of cotinine-elevating medication.

These data do not support the claim that a substantial number of adult respondents intentionally under-report nicotine consumption in face-to-face interviews. The remarkable accuracy of self-reports of nicotine consumption seen here justifies confidence in self-reports of this behavior in such surveys.