Instruments to Assess Secondhand Smoke Exposure in Large Cohorts of Never Smokers: The Smoke Scales

The objectives of this study were to: (i) to develop questionnaires that can identify never-smoking children and adults experiencing increased exposure to secondhand smoke (SHS+), (ii) to determine their validity against hair nicotine, and (iii) assess their reliability. A sample of 191 children (85 males; 106 females; 7–18 years) and 95 adult (23 males; 72 females; 18– 62 years) never-smokers consented to hair nicotine analysis and answered a large number of questions assessing all sources of SHS. A randomly-selected 30 % answered the questions again after 20–30 days. Prevalence of SHS+ in children and adults was 0.5260.07 and 0.6760.10, respectively (p,0.05). The Smoke Scale for Children (SS-C) and the Smoke Scale for Adults (SS-A) were developed via factor analysis and included nine questions each. Positivity criteria for SS-C and SS-A via receiver operating characteristics curve analysis were identified at.16.5 and.16, respectively. Significant Kappa agreement (p,0.05) was confirmed when comparing the SS-C and SS-A to hair nicotine concentration. Reliability analyses demonstrated that the SS-C and SS-A scores obtained on two different days are highly correlated (p,0.001) and not significantly different (p.0.05). Area under the curve and McNemar’s Chi-square showed no pair-wise differences in sensitivity and specificity at the cutoff point between the two different days for SS-C and SS-A (p.0.05). We conclude tha