Skip to main content
Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 1999 Dec;107(Suppl 6):873–877. doi: 10.1289/ehp.99107s6873

Exposure misclassification bias in studies of environmental tobacco smoke and lung cancer.

A H Wu 1
PMCID: PMC1566193  PMID: 10592145

Abstract

It is now recognized that exposure to environmental tobacco smoke (ETS) in the workplace and other settings outside the home may be equally as important as residential ETS exposure. This review examines the sources of misclassification in the assessment of workplace ETS exposure in questionnaire-based epidemiologic studies. Cogent to this discussion is the role of misclassification of ever smokers as never smokers, which is important in studies of both workplace and residential ETS exposure and lung cancer and is discussed first. The collective evidence from studies that have used direct or indirect approaches to estimate smoker misclassification shows that although some misclassification of ever smokers as never smokers exists in studies of ETS and lung cancer, the potential bias from the misclassification of smokers is unlikely to explain the observed increased risk of lung cancer associated with ETS exposure.

Full text

PDF
873

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akiba S., Kato H., Blot W. J. Passive smoking and lung cancer among Japanese women. Cancer Res. 1986 Sep;46(9):4804–4807. [PubMed] [Google Scholar]
  2. Benowitz N. L. Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiol Rev. 1996;18(2):188–204. doi: 10.1093/oxfordjournals.epirev.a017925. [DOI] [PubMed] [Google Scholar]
  3. Boffetta P., Agudo A., Ahrens W., Benhamou E., Benhamou S., Darby S. C., Ferro G., Fortes C., Gonzalez C. A., Jöckel K. H. Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe. J Natl Cancer Inst. 1998 Oct 7;90(19):1440–1450. doi: 10.1093/jnci/90.19.1440. [DOI] [PubMed] [Google Scholar]
  4. Britten N. Validity of claims to lifelong non-smoking at age 36 in a longitudinal study. Int J Epidemiol. 1988 Sep;17(3):525–529. doi: 10.1093/ije/17.3.525. [DOI] [PubMed] [Google Scholar]
  5. Brownson R. C., Alavanja M. C., Hock E. T., Loy T. S. Passive smoking and lung cancer in nonsmoking women. Am J Public Health. 1992 Nov;82(11):1525–1530. doi: 10.2105/ajph.82.11.1525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Brownson R. C., Alavanja M. C., Hock E. T. Reliability of passive smoke exposure histories in a case-control study of lung cancer. Int J Epidemiol. 1993 Oct;22(5):804–808. doi: 10.1093/ije/22.5.804. [DOI] [PubMed] [Google Scholar]
  7. Coultas D. B., Howard C. A., Peake G. T., Skipper B. J., Samet J. M. Discrepancies between self-reported and validated cigarette smoking in a community survey of New Mexico Hispanics. Am Rev Respir Dis. 1988 Apr;137(4):810–814. doi: 10.1164/ajrccm/137.4.810. [DOI] [PubMed] [Google Scholar]
  8. Coultas D. B., Peake G. T., Samet J. M. Questionnaire assessment of lifetime and recent exposure to environmental tobacco smoke. Am J Epidemiol. 1989 Aug;130(2):338–347. doi: 10.1093/oxfordjournals.aje.a115340. [DOI] [PubMed] [Google Scholar]
  9. Cummings K. M., Markello S. J., Mahoney M., Bhargava A. K., McElroy P. D., Marshall J. R. Measurement of current exposure to environmental tobacco smoke. Arch Environ Health. 1990 Mar-Apr;45(2):74–79. doi: 10.1080/00039896.1990.9935929. [DOI] [PubMed] [Google Scholar]
  10. Feyerabend C., Higenbottam T., Russell M. A. Nicotine concentrations in urine and saliva of smokers and non-smokers. Br Med J (Clin Res Ed) 1982 Apr 3;284(6321):1002–1004. doi: 10.1136/bmj.284.6321.1002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fontham E. T., Correa P., Reynolds P., Wu-Williams A., Buffler P. A., Greenberg R. S., Chen V. W., Alterman T., Boyd P., Austin D. F. Environmental tobacco smoke and lung cancer in nonsmoking women. A multicenter study. JAMA. 1994 Jun 8;271(22):1752–1759. [PubMed] [Google Scholar]
  12. Garfinkel L., Auerbach O., Joubert L. Involuntary smoking and lung cancer: a case-control study. J Natl Cancer Inst. 1985 Sep;75(3):463–469. [PubMed] [Google Scholar]
  13. Ger L. P., Hsu W. L., Chen K. T., Chen C. J. Risk factors of lung cancer by histological category in Taiwan. Anticancer Res. 1993 Sep-Oct;13(5A):1491–1500. [PubMed] [Google Scholar]
  14. Hackshaw A. K., Law M. R., Wald N. J. The accumulated evidence on lung cancer and environmental tobacco smoke. BMJ. 1997 Oct 18;315(7114):980–988. doi: 10.1136/bmj.315.7114.980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Haddow J. E., Palomaki G. E., Knight G. J. Use of serum cotinine to assess the accuracy of self reported non-smoking. Br Med J (Clin Res Ed) 1986 Nov 15;293(6557):1306–1306. doi: 10.1136/bmj.293.6557.1306-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hammond S. K. Exposure of U.S. workers to environmental tobacco smoke. Environ Health Perspect. 1999 May;107 (Suppl 2):329–340. doi: 10.1289/ehp.99107s2329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Janerich D. T., Thompson W. D., Varela L. R., Greenwald P., Chorost S., Tucci C., Zaman M. B., Melamed M. R., Kiely M., McKneally M. F. Lung cancer and exposure to tobacco smoke in the household. N Engl J Med. 1990 Sep 6;323(10):632–636. doi: 10.1056/NEJM199009063231003. [DOI] [PubMed] [Google Scholar]
  18. Kabat G. C., Stellman S. D., Wynder E. L. Relation between exposure to environmental tobacco smoke and lung cancer in lifetime nonsmokers. Am J Epidemiol. 1995 Jul 15;142(2):141–148. doi: 10.1093/oxfordjournals.aje.a117612. [DOI] [PubMed] [Google Scholar]
  19. Kabat G. C., Wynder E. L. Lung cancer in nonsmokers. Cancer. 1984 Mar 1;53(5):1214–1221. doi: 10.1002/1097-0142(19840301)53:5<1214::aid-cncr2820530532>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  20. Kalandidi A., Katsouyanni K., Voropoulou N., Bastas G., Saracci R., Trichopoulos D. Passive smoking and diet in the etiology of lung cancer among non-smokers. Cancer Causes Control. 1990 Jul;1(1):15–21. doi: 10.1007/BF00053179. [DOI] [PubMed] [Google Scholar]
  21. Ko Y. C., Lee C. H., Chen M. J., Huang C. C., Chang W. Y., Lin H. J., Wang H. Z., Chang P. Y. Risk factors for primary lung cancer among non-smoking women in Taiwan. Int J Epidemiol. 1997 Feb;26(1):24–31. doi: 10.1093/ije/26.1.24. [DOI] [PubMed] [Google Scholar]
  22. Koo L. C., Ho J. H., Saw D., Ho C. Y. Measurements of passive smoking and estimates of lung cancer risk among non-smoking Chinese females. Int J Cancer. 1987 Feb 15;39(2):162–169. doi: 10.1002/ijc.2910390207. [DOI] [PubMed] [Google Scholar]
  23. Lee P. N., Chamberlain J., Alderson M. R. Relationship of passive smoking to risk of lung cancer and other smoking-associated diseases. Br J Cancer. 1986 Jul;54(1):97–105. doi: 10.1038/bjc.1986.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Lee P. N., Forey B. A. Misclassification of smoking habits as a source of bias in the study of environmental tobacco smoke and lung cancer. Stat Med. 1996 Mar 30;15(6):581–605. doi: 10.1002/(SICI)1097-0258(19960330)15:6<581::AID-SIM182>3.0.CO;2-B. [DOI] [PubMed] [Google Scholar]
  25. Lee P. N. Passive smoking and lung cancer association: a result of bias? Hum Toxicol. 1987 Nov;6(6):517–524. doi: 10.1177/096032718700600612. [DOI] [PubMed] [Google Scholar]
  26. Levois M., Switzer P. Differential exposure misclassification in case-control studies of environmental tobacco smoke and lung cancer. J Clin Epidemiol. 1998 Jan;51(1):37–54. doi: 10.1016/s0895-4356(97)00224-2. [DOI] [PubMed] [Google Scholar]
  27. McLaughlin J. K., Dietz M. S., Mehl E. S., Blot W. J. Reliability of surrogate information on cigarette smoking by type of informant. Am J Epidemiol. 1987 Jul;126(1):144–146. doi: 10.1093/oxfordjournals.aje.a114647. [DOI] [PubMed] [Google Scholar]
  28. Nyberg F., Agudo A., Boffetta P., Fortes C., González C. A., Pershagen G. A European validation study of smoking and environmental tobacco smoke exposure in nonsmoking lung cancer cases and controls. Cancer Causes Control. 1998 Mar;9(2):173–182. doi: 10.1023/a:1008882227444. [DOI] [PubMed] [Google Scholar]
  29. Nyberg F., Isaksson I., Harris J. R., Pershagen G. Misclassification of smoking status and lung cancer risk from environmental tobacco smoke in never-smokers. Epidemiology. 1997 May;8(3):304–309. doi: 10.1097/00001648-199705000-00013. [DOI] [PubMed] [Google Scholar]
  30. Ott W. R. Mathematical models for predicting indoor air quality from smoking activity. Environ Health Perspect. 1999 May;107 (Suppl 2):375–381. doi: 10.1289/ehp.99107s2375. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Pierce J. P., Dwyer T., DiGiusto E., Carpenter T., Hannam C., Amin A., Yong C., Sarfaty G., Shaw J., Burke N. Cotinine validation of self-reported smoking in commercially run community surveys. J Chronic Dis. 1987;40(7):689–695. doi: 10.1016/0021-9681(87)90105-6. [DOI] [PubMed] [Google Scholar]
  32. Pirkle J. L., Flegal K. M., Bernert J. T., Brody D. J., Etzel R. A., Maurer K. R. Exposure of the US population to environmental tobacco smoke: the Third National Health and Nutrition Examination Survey, 1988 to 1991. JAMA. 1996 Apr 24;275(16):1233–1240. [PubMed] [Google Scholar]
  33. Pojer R., Whitfield J. B., Poulos V., Eckhard I. F., Richmond R., Hensley W. J. Carboxyhemoglobin, cotinine, and thiocyanate assay compared for distinguishing smokers from non-smokers. Clin Chem. 1984 Aug;30(8):1377–1380. [PubMed] [Google Scholar]
  34. Pron G. E., Burch J. D., Howe G. R., Miller A. B. The reliability of passive smoking histories reported in a case-control study of lung cancer. Am J Epidemiol. 1988 Feb;127(2):267–273. doi: 10.1093/oxfordjournals.aje.a114802. [DOI] [PubMed] [Google Scholar]
  35. Riboli E., Preston-Martin S., Saracci R., Haley N. J., Trichopoulos D., Becher H., Burch J. D., Fontham E. T., Gao Y. T., Jindal S. K. Exposure of nonsmoking women to environmental tobacco smoke: a 10-country collaborative study. Cancer Causes Control. 1990 Nov;1(3):243–252. doi: 10.1007/BF00117476. [DOI] [PubMed] [Google Scholar]
  36. Samet J. M. Workshop summary: assessing exposure to environmental tobacco smoke in the workplace. Environ Health Perspect. 1999 May;107 (Suppl 2):309–312. doi: 10.1289/ehp.99107s2309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Schwartz A. G., Yang P., Swanson G. M. Familial risk of lung cancer among nonsmokers and their relatives. Am J Epidemiol. 1996 Sep 15;144(6):554–562. doi: 10.1093/oxfordjournals.aje.a008965. [DOI] [PubMed] [Google Scholar]
  38. Shimizu H., Morishita M., Mizuno K., Masuda T., Ogura Y., Santo M., Nishimura M., Kunishima K., Karasawa K., Nishiwaki K. A case-control study of lung cancer in nonsmoking women. Tohoku J Exp Med. 1988 Apr;154(4):389–397. doi: 10.1620/tjem.154.389. [DOI] [PubMed] [Google Scholar]
  39. Stockwell H. G., Goldman A. L., Lyman G. H., Noss C. I., Armstrong A. W., Pinkham P. A., Candelora E. C., Brusa M. R. Environmental tobacco smoke and lung cancer risk in nonsmoking women. J Natl Cancer Inst. 1992 Sep 16;84(18):1417–1422. doi: 10.1093/jnci/84.18.1417. [DOI] [PubMed] [Google Scholar]
  40. Thompson S. G., Stone R., Nanchahal K., Wald N. J. Relation of urinary cotinine concentrations to cigarette smoking and to exposure to other people's smoke. Thorax. 1990 May;45(5):356–361. doi: 10.1136/thx.45.5.356. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Tweedie R. L., Mengersen K. L. Lung cancer and passive smoking: reconciling the biochemical and epidemiological approaches. Br J Cancer. 1992 Oct;66(4):700–705. doi: 10.1038/bjc.1992.341. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Wald N. J., Nanchahal K., Thompson S. G., Cuckle H. S. Does breathing other people's tobacco smoke cause lung cancer? Br Med J (Clin Res Ed) 1986 Nov 8;293(6556):1217–1222. doi: 10.1136/bmj.293.6556.1217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Wald N., Ritchie C. Validation of studies on lung cancer in non-smokers married to smokers. Lancet. 1984 May 12;1(8385):1067–1067. doi: 10.1016/s0140-6736(84)91467-3. [DOI] [PubMed] [Google Scholar]
  44. Wu-Williams A. H., Dai X. D., Blot W., Xu Z. Y., Sun X. W., Xiao H. P., Stone B. J., Yu S. F., Feng Y. P., Ershow A. G. Lung cancer among women in north-east China. Br J Cancer. 1990 Dec;62(6):982–987. doi: 10.1038/bjc.1990.421. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Wu A. H., Henderson B. E., Pike M. C., Yu M. C. Smoking and other risk factors for lung cancer in women. J Natl Cancer Inst. 1985 Apr;74(4):747–751. [PubMed] [Google Scholar]
  46. Zaridze D., Maximovitch D., Zemlyanaya G., Aitakov Z. N., Boffetta P. Exposure to environmental tobacco smoke and risk of lung cancer in non-smoking women from Moscow, Russia. Int J Cancer. 1998 Jan 30;75(3):335–338. doi: 10.1002/(sici)1097-0215(19980130)75:3<335::aid-ijc1>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Sciences

RESOURCES