Smoking Status Confirmation by Proxy: Validation in a Smoking Cessation Trial
Susan Regan1, Zachary Z Reid2, Jennifer H K Kelley3
1Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; sregan@partners.org.
Summary
Proxy confirmation (PC) is a feasible method for assessing smoking cessation in trials but is not superior to self-report (SR). Biochemical confirmation (BC) remains the gold standard for verifying abstinence in smoking cessation research.
Area of Science:
- Clinical Research
- Public Health
- Addiction Medicine
Background:
- Biochemical confirmation (BC) is the gold standard for verifying smoking abstinence in cessation research.
- Difficulty in obtaining samples for BC can bias quit rate estimates.
- Proxy confirmation (PC) has not been previously validated in smoking cessation trials.
Purpose of the Study:
- To assess the feasibility and validity of proxy confirmation (PC) in a smoking cessation trial.
- To compare the effectiveness of PC against self-report (SR) and biochemical confirmation (BC).
Main Methods:
- 402 hospitalized smokers were enrolled and provided demographics and smoking history.
- Participants reported 7-day tobacco abstinence at 6 months post-discharge via telephone.
- Proxies were contacted for PC, and saliva samples were collected for BC.
Main Results:
- Response rates were 82% for SR, 84% for PC, and 69% for BC.
- Quit rates varied: 35% for SR, 27% for SR + PC, 21% for SR + BC, and 27% for SR + BC or PC.
- PC sensitivity was 73% (vs. 77% for SR), and specificity was 84% (vs. 100% for SR).
Conclusions:
- Proxy confirmation (PC) is feasible for use in smoking cessation trials.
- PC is not superior to self-report (SR) for verifying smoking abstinence.
- Biochemical confirmation (BC) remains the most accurate method for assessing smoking cessation.
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