Tobacco Documents Online

Table 11. Age-adjusted prevalence* of current, former, and never cigarette smoking, CPS II and NHIS-83 Current Former Never CPS H HIS CPS HIS CPS HIS II H Men White 30.1 31.1 44.4 43.5 25.5 25.4 Black 42.5 41.8 31.6 32.1 25.9 26. i Women White 20.4 26.0 22.5 19.7 57.1 54.3 Black 26.2 27.4 I5.8 14.4 58.0 58.2 *(Percent). Standard population: CPS H 62 I i I I I I I I I I I I I I I I I

I I I- I I I I I I I I I I I I I I I 63 Chapter 5: Validity and Completeness Information I On the Outcome Variable i. Follow-up Procedures of the A validation study of the CPs II automated follow-up procedure has been conducted previously using the National Death Index (ND1) (Calle, 1993). In a linkage of over 15,000 persons whose vital status through 1988 had been traced through manual follow-up, 4,686 out of 5,046 (or 92.9 percent) of all deaths known to ACS volunteers were identified by the National Death Index. Since the use of automated foliow-up in CPS rr started in 1988, when there were 340 deaths from lung cancer ascertained by volunteers, another 22 have been ascertained by the use of the NDI. At a false-negative rate of 7% for the automated procedure, less thad two deaths would have been missed in our study (i.e. 0.07"22=1.54), by using the automated procedure instead of ascertaining deaths by ACS volunteers . As noted earlier, follow-up of vital status is complete for 99.8 % of all enrolled subjects, and of those 101,541 deceased subjects only 3,258 (3.2%) did not have a death certificate (ACS: Update of the CPS-II Master Index Vital Status report, April 12, 1993). ii. Results of Validation Study of Death Certificate Diagnoses of Lung Cancer '~ For 30 deaths for which lung cancer was considered the underlying cause of death in CPS II nonsmoking participants who resided in SEER registry areas, SEER diagnosis was compardd with the underlying cause of death on death certificates. In 29 subjects classified as primary lung cancer by death certificates, SEER Cancer Registries also diagnosed primary lung cancer in 27, and for two, the primary site was listed unknown in the SEER database. For no cases was the

disease known to be metastatic from other sites to the lung. I.n 25 of these 29 I lung cancers (86.2 percent), the specific histologic type was known to the SEER Cancer Registries, and in 64 percent they were adenocarcinomas. From this small validation study we conclude that lung cancers coded from death certificates generally correctly classify deaths fro~ primary lung cancer. The confirmation rate was 93. I percent (27/29), similar to that found in the TNCS study (Percy I981). Even in the two instances in our validation study in which the primary site of cancer was unknown, the diagnosis of lung cancer was not ruled out. Main Exposure Variables i. Self Reported ETS Exposure in CPS II and NI=IIS As mentioned above, because the CPS II questionnaires did not require respondents to complete all fields, many questionnaires contained blanks (Table 12). Twenty-three percent of the questionnaires filled by men and thirteen percent of those f'Llled by women were left blank in the three spaces provided for self-reported number of hours exposed to ETS (i.e., at home, work and other places). Table 13 displays in detail the patterns of answers from CPS II enrollees to the questions: " Whether or not you smoke, on the average, how many hours a day are you exposed to cigarette smoke of others? At home? (hours); At work (hours); In other areas? (hours)". As shown in this table, most times a space was left blank when valid answers were provided for at least one of the three environments. 0 0~ 0'~ 0 0'~ 0 I I I I I I I I I I I I I i I I

I I I 65 I I I I I I I I I I I I I I Table 12. Answers to question in CPS II on reported hours of ETS exposure at different settings a. All Men in CPS II Hours Home % Work % Other % Places 0 196,031 38.5 I24,114 24.4 101,533 20.0 I I5,107 3.0 52,856 10.4 71,040 14.0 2 12,258 2.4 24,834 4.9 26,533 5.2 3 8,649 1.71 9,089 1.8 6,979 1.4 4 18,363 3.6 13,359 2.6 6,240 1.2 5 8,678 1.7 5,059 1.0 1,714 0.3 6 11,904 2.3 8,527 1.7 1,384 0.3 7 2,621 0.51 3,985 0.8 280 0.1 8+ 37,827 7.4 80,478 15.8 4,710 0.9 Blank 180,924 35.6 163,357 32. i 261,885 51.5 Unclass 16,232 3.2 22,936 4.5 26,296 5.2 Total 508,594 100.(~ 508,594 100.0 508,594 100.0 All three fields left blank 65,999 (13.0%) All three fields with unclassifiabIe data 5,006 (1.0%) ~0 0 O~ 0~ 0 I

66 I I I I b. All Women in CPS II 'i:Iours Home % Work -% Other % ' Places 0 208,404 30.8 [54,373 22.8 99,953 14.8 1 16,103 2.4 40,117 5.9 46,088 6.8 2 14,029 2. I 16,636 2.5 20,148 3.0 3 10,952 1.6 6,243 0.9 7,06 [ 1.0 4 20,430 3.0 8,937 1.3 4,726 0.7 5 13,642 2.0 4,766 0.7 1,385 0.2 6 15,753 2.3 7,204 1.1 928 0.1 7 4,097 0.6 6,630 1.0 181 0.0 8+ 59,412 8.8 59,133 8.7 4,393 0.6 Blank 282,326 41.7 345,165 51.0 433,178 64.0 Unclass 31,382 4.6 27,326 4.0 58,489 8.6 Total 676,530 100.0 676,530 i00.0 676,530 100.0 . All three fields left blank 156,249 (23.1%) All three fields with unclass data 6,285 (0.9%) 0 0 0 I I I I I I i I I

! I I I- I I I I I I I I I I I I I I I Table 13. Patterns of answers given by CPS [I participants to self- assessment of number of hours exposed,, to ETS ~.i.~ Men w~m~fi -' ' Home Work Other hours hours hours , • 65,999 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 I to 1 to 1 to 1 to 1 to I to 0 5,732 1 to 8' 26,097 9 * 8,993 0 l 4,422 0 0 186 0 1 to 8 130 0 9 30 1 to 8 50,206 1 to 8 0 319 I to 8 1 to 8 7,361 I to 8 9 373 9 . 9,208 9 0 25 9 1 to 8 110 9 9 1,733 7,704 0 2,334 1 to 8 2,216 9 431 11,190 65,314 28,323 4,791 1 21,994 1 19,818 I 28,225 1 1,284 654 522 299 932 31,703 0 145 1 to 8 5,311 9 167 0 2,244 0 0 4,146 0 0 0 0 I to8 0 9 to 8 to 8 0 to 8 I to 8 to 8 9 9 9 0 9 Ito8 9 9 12.98 156,249 23.10 l. 13 8,565 1.27 5.13 24,543 3.63 1.77 22,486 3.32 0.87 5,434 0.80 0.04 173 0.03 0.03 100 0.01 0.01 80 0.01 9.87 47,135 6.97 0.06 186 0.03 1.45 4,265 0.63 0.07 745 O. I 1 1.81 9,946 1.47 0.00 18 0.00 0.02 l I9 0.02 0.34 2,282 0.34 1.51 18,908 2.79 0.46 4,372 0.65 0.44 3,743 0.55 0.08 2,613 0.39 2.20 27,148 4.01 12.84 72,162 I0.67 5.57 22,997 3.40 0.94 13,632 2.01 4.32 19,751 2.92 3.90 8,292 1.23 5.55 10,249 1.51 0.25 1,871 0.28 0.13 841 0.12 O. 10 354 0.05 0.06 265 0.04 0.18 1,206 0.18 6.23 77,326 11.43 0.03 142 0.02 1.04 6,890 1.02 0.03 876 O. 13 0.44 5,009 0.74 0.82 4,022 0.59 67 o o~ 0~ 0~ o o~ o

68 I I to 8 0 1 to 8 3,050 0.60 2,810 0.42 1 to 8 0 9 174 0.03 505 0.07 1 to 8 1 to 8 . 46,980 9.24 44,622 6.60 1 to 8 1 to 8 0 2,897 0.57 1,518 0.22 i to 8 1 to 8 1 to 8 17,191 3.38 8,415 1.24 1 to 8 1 to 8 9 791 0.16 1,316 0.19 1 to 8 9 . 206 0.04 432 0.06 1 to 8 9 0 t7 0.00 19 0.00 1 to 8 9 1 to 8 123 0.02 96 0.01 1 to 8 9 9 262 0.05 420 0.06 9 . 5,362 1.05 14,569 2.15 9 0 15 0.00 15 0.00 9 1 to 8 69 0.01 133 0.02 9 . 9 1,079 0.21 3,735 0.55 9 0 37 0.01 71 0.01 9 0 0 27 0.01 76 0.01 9 0 1 to 8 11 0.00 23 0.130 9 0 9 39 0.01 131 0.02 9 1 to 8 390 0.08 922 0.14 9 1 to 8 0 I0 0.00 II 0.00 9 1 to 8 I to 8 137 0.03 62 0.01 9 I to 8 9 211 0.04 306 0.05 9 9 3,586 0.71 4,815 0.71 9 9 0 26 0.01 28 0.00 9 9 1 to 8 227 0.04 200 0.03 9 9 9 5,006 0.98 6,285 0.93 Total 508,594 100.130 676,530 100.00 *a 9 code means that unquantifiable answ~rs(~vor~g like a ,,10t,,or "little"), as well as question marks, were answered. The comparisons of CPS-II data on ETS exposure at home, with data from the 1988 National Health Interview Survey (NCHS NHIS 1988) is presented in table 14, stratified by age, race and gender. If spaces left blank for number of hours exposed to ETS at home in CPS II are considered.to represent zero hours (i.e., unexposed), and persons with "unclassifiable" ETS information are excluded, then the prevalence figures from self reported data on ETS exposure at home in CPS rr resemble the prevalence in NHIS. Indeed, all age-adjusted comparisons of gender and racial specific prevalence figures agree within 3.3 percent. The category of "unclassifiable" ETS represent vague wording (e.g., a question mark, 'Iittle') that could not be converted into hours during coding of questionnaires. We concluded that when self-reported ETS exposure in CPS II o 0~ o 0~ o o~ I I I ,|

I I- I I I I I I I I I I I I I I 69 I was left blank, persons should be considered unexposed, and that "unclassifiable" data on ETS exposure in the three blanks should be excluded from the analyses. Table 14. Percentage of nons~aokers reportedly exposed to ETS at home* in CPS II ** and NI:IIS *** by age, race and gender. White Men Black Men White Black Women Women Age CPS NI-IIS :kDiff CPS NHISI :k CPS NHIS :k CPS NHIS _.+ lI lI Diff lI Diff II Diff 30-34 12.8 10.2 2.6 12.9 II.6 1.3 21.2 15.9 5.3 22.9 21.8 1.I 35-39 10.5 9.2 1.3 12.7 I2.4 0.3 I9.9 14.9 5.0 20.1 18.1 2.0 40-44 8.7 7.7 45-49 9.1 7.3 t.0 t4.4 9.4 1 5.0 1.8 9.6 18.1 -8.5 19.3 15.3 4.0 22.4 20.7 1.7 18.9 17.6 1.3 21.1 18.4 2.7 50-54 8.7 15.5 -6.8 I1.0 14.2 -3.2 18.3 18.6 -0.3 19.4 30.0 -10.6 55-59 8.3 14.4 -6.1 12.0 17.9 -5.9 16.4 11.5 4.9 17.1 22.8 -5.7 60-64 7.3 11.4 -4.1 10.3 25.01 -14.7 13.1 13.0 0.1 15.5 24.0 -8.5 65+ 5.2 5.9 -0.7 5.4 12.0 -6.6 8.4 7.2 1.2 11.7 11.7 0.0 Total 7.8 9.4 -1.6 9.9 13.4 -3.5 14.7 12.8 1.9 17.0 19.2 -2.2 8.8§ 9.8 -t.0 t0.9 14.2 -3.3 15.8 13.2 2.6 18.5 19.9 -t.4 ETS exposure as self-repoSed'- ~umb~ oi"h~'~'~f'~xt~osurc to ETS at home in CPS IL m~d as living with a smoking person who smokc~ at home in NHIS. ** Excludes "unelassifiable" ETS exposure at home. Considers I-8 hours as exposed, and blanks in spaces provided to write ETS exposure at home, as well as O's as unexposed. *** Weighted percentages (i.e., weights are inverse of selection probabilities) §Age adjusted prevalence figures using the 1980 US Census sub-populations as standards I

7O Comparisons of CPS II participants in the analytic cohort for self-reported ETS analyses were conducted to contrast characteristics such as age, schooling and 'race', for individuals who filled all three spaces and those who left spaces blank. Those who left any space blank were more likely to be older, and less educated, and more likely to be non-whites than those who f'ti1ed the three spaces (Table 15). However, persons who f'tlled all three fields for hours of exposure at home, work and other places and who reportedly had zero hours of exposure to ETS, were similar to those who left any blank space for ETS in CPS II questionnaires. As will be discussed in Chapter 8, a possible implication of this distribution of missing data is that perhaps blanks might not represent ETS unexposed subjects. Table 15. Characteristics of CPS II nonsmokers in analytic cohort for self-reported ETS by completeness of the information provided for ETS Characteristic Left any ETS field Completed all ETS blank fields Cross-product (Column percent) (Column percent) . rati~ Age group 65 + 30-64 Schooling <12 years 12+ 'Race' Non-whites Whites 25.4 20.5 74.6 79.5 15.6 8.1 84.4 91.9 8.3 5.5 91.7 94.5 1.4 2.1 1.7 ! !

I I I I I I I I I I I I I I I I I 71 ii. CPS II Self-reported Exposure to ETS and Spousal Smoking Habits Results of the second validationlstudy that compared self-reported ETS exposure with the smoking status of cohabitees and spouses are presented in tablel6. Table 16.a. and 16.b show that seE-reported exposure to ETS at home by CPS nonsmoking women and men, respectively, agreed with having at least one current smoker among cohabi~ees: the observed agreement was 88.4% for. women, and 94.5% of men (k=56.0%; 95% CI=55.6-56.45 for women, and k=63.5%; 95% CI=62.7-64.3 for men). Self reported ETS (hours of exposure at home) agreed better with the smoking status of spouses (Table 16.c. and 16.d.) than with the number of ~moking cohabitees (Table 16.a. and I6.b.); the observed agreement was 87.8% and 95.4% for wives (Table 16.c.) and husbands, respectively (k=62.6%; 95% CI=62.2-62.9 for nonsmoking wives, and k=69.8%; CI=69.0-70.6, for nonsmoking husbands). We concluded that self-reported ETS exposure in CPS II was internally consistent with the smoking habits reported by spouses. We also concluded that self-reported ETS is closer to spousal ETS than to smoking of cohabitees. Using current smoking status of spouses as standard, self-reported ETS would misclassify 4.6% of the subjects, with a specificity of 98%. Table 16.a. Comparison of self-reported exposure to ETS at home by CPS II nonsmoking women and the number of ........ _current smokers among cohabitees. I Cohabitees status Self-reported At least one Nonsmoker and Total ETS current smoker former smokers .................... only, Yes 33,951 (9.8) 17,250 (5.0) 51,201(14.8) No 22,850 (6.6) 271,947 (78.6) 294,797 (85.2) Total 56,801 (16.4) 289,197 (83.6) 345,998 (100.0) kL-~6~0% (¢5% CI=55.6-56.4) .......... I 0 0 ~0