The validity of self-reported nicotine product use in the 2001-2008 National Health and Nutrition Examination Survey

Med Care. 2010 Dec;48(12):1128-32. doi: 10.1097/MLR.0b013e3181ef9948.


Background: 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.

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

Research design: 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.

Subjects: 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.

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

Results: 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.

Conclusions: 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.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Bias
  • Cotinine / analysis*
  • Cross-Sectional Studies
  • Deception*
  • Environmental Exposure / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Reproducibility of Results
  • Saliva / chemistry*
  • Smoking / epidemiology*
  • Smoking / psychology
  • Social Desirability*
  • Surveys and Questionnaires / standards*
  • Tobacco Smoke Pollution / statistics & numerical data
  • Truth Disclosure
  • United States / epidemiology
  • Young Adult


  • Tobacco Smoke Pollution
  • Cotinine