Misclassification rates for current smokers misclassified as nonsmokers

Am J Public Health. 1998 Oct;88(10):1503-9. doi: 10.2105/ajph.88.10.1503.


Objectives: This paper provides misclassification rates for current cigarette smokers who report themselves as nonsmokers. Such rates are important in determining smoker misclassification bias in the estimation of relative risks in passive smoking studies.

Methods: True smoking status, either occasional or regular, was determined for individual current smokers in 3 existing studies of nonsmokers by inspecting the cotinine levels of body fluids. The new data, combined with an approximately equal amount in the 1992 Environmental Protection Agency (EPA) report on passive smoking and lung cancer, yielded misclassification rates that not only had lower standard errors but also were stratified by sex and US minority majority status.

Results: The misclassification rates for the important category of female smokers misclassified as never smokers were, respectively, 0.8%, 6.0%, 2.8%, and 15.3% for majority regular, majority occasional, US minority regular, and US minority occasional smokers. Misclassification rates for males were mostly somewhat higher.

Conclusions: The new information supports EPA's conclusion that smoker misclassification bias is small. Also, investigators are advised to pay attention to minority/majority status of cohorts when correcting for smoker misclassification bias.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Bias
  • Biomarkers
  • Cotinine / blood
  • Cotinine / metabolism*
  • Cotinine / pharmacokinetics
  • Cotinine / urine
  • Diagnostic Errors
  • Female
  • Humans
  • Male
  • Smoking* / metabolism
  • Tobacco Smoke Pollution
  • United States


  • Biomarkers
  • Tobacco Smoke Pollution
  • Cotinine