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Posted: February 26, 2008

Elderly Smokers Tend to Keep Their Habit a Secret

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.
The findings bring into question the validity of using self-reported tobacco use in research projects, reporting tobacco use by the general public, or caring for individuals with chronic diseases related to smoking, according to researchers at the Case Western Reserve University School of Dental Medicine and other university collaborators. The study has been published in the current Journal of Health Care for the Poor and Underserved.
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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 grouped 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, Dr. Monica Fisher, Ph.D., DDS, MS, MPH, an associate professor at Case Western’s dental school.
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.
However, denial can have deadly consequences. For example, researchers said an earlier study by other researchers showed cotinine – a byproduct of nicotine use that stays in the blood for several days after smoking – was found in smokers who did not admit smoking and had significantly higher mortality rates (36%) than self-reported true non-smokers (15%).
Fisher and other researchers from Case Western, 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, the study noted.
Researchers concluded that caution is needed when relying on smokers to self-identify as part of survey data and that additional measures are needed to validate who does or doesn't smoke.

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