Tobacco Smoking Status as Assessed by Oral Questionnaire Results 30% Under-reporting by Adult Males in Rural India: A Confirmatory Comparison by Exhaled Breath Carbon Monoxide Analysis

BACKGROUND: The authenticity and true status of tobacco use, especially in the form of smoking among the patient clientele is always a matter of concern for their physicians. OBJECTIVES: The purpose of this study was to assess the authenticity of self-reported habit of tobacco smoking among a population sample of male respondents in rural India. Methods: Respondents were asked to complete oral questionnaires that assessed their status of tobacco smoking (if any) as well as duration of tobacco smoking, type of tobacco smoking, and frequency of tobacco smoking. Subsequently, exhaled breath carbon monoxide analysis was performed to detect their amounts of exhaled carbon monoxide. RESULTS: In 175 respondents, the Smoke Check color indicators were significantly different (P < 0.0001) in the respondents who were diagnosed smokers per oral questionnaires (n = 92) versus diagnosed nonsmokers per oral questionnaires (n = 83). The probability statistics of authenticity of oral questionnaires for assessing smoking status showed that self-reporting was only 75% sensitive and 76% specific with 80% positive predictive value and 70% negative predictive value. CONCLUSION: True status of tobacco smoking with exhaled breath carbon monoxide analysis can be an easy clinical maneuver with community health screening and health promotion implications among patient populations in rural India.