The Validity of Self-Reported Nicotine Product Use in the 2001–2008 National Health and Nutrition Examination Survey

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.