Self-reports of smoking status are generally believed to be accurate in most epidemiological studies (Patrick et al., 1994). Studies of clinical populations, such as those undergoing smoking cessation interventions, cancer inhibitor 17-DMAG patients, pregnant women, and persons with asthma, suggest that certain groups of smokers underreport their smoking status (e.g., Eisner, Yelin, Trupin, & Blanc, 2001; Martinez, Reid, Jiang, Einspahr, & Alberts, 2004; Murray, Connett, Lauger, & Voelker, 1993; Webb, Boyd, Messing, & Windsor, 2003). Other than a public opinion survey conducted in the United Kingdom that found that three out of 10 smokers concealed their smoking from general practitioners (BBC News, 2007), little is known at a population level about the extent to which smokers conceal their smoking status from health care providers.
To address this gap, the present study reports the prevalence of keeping one’s smoking status a secret from health care providers based on data collected among smokers in a general population survey of New York City residents. We also examined whether discernible patterns exist in terms of who keeps their smoking status a secret, hypothesizing that persons who perceive their smoking to be more socially unacceptable will be more likely to keep their smoking status a secret from health care providers. The social unacceptability of smoking takes many possible forms. Such perceptions may be driven by one’s normative environment, such as rules prohibiting smoking in one’s home or by values about smoking expressed by close friends or family members.
It also may be a function of feeling devalued by others because one smokes, what we term ��smoker-related stigma,�� or to experiences of differential treatment because one smokes, such as being turned down for a job. The central motivation behind the present analysis is the concern that individuals who conceal their smoking status are deprived of guidance from health care providers that may help them to quit, making it important to explore who conceals their smoking status as well as potential explanations for why some smokers may conceal their smoking status. Methods Sample The data for the present analysis come from the New York Social Environment Study (NYSES). The NYSES is a cross-sectional random-digit�Cdialed telephone survey of 4,000 New York City residents aged 18 or older that was administered between June and December 2005.
It was designed to assess the relationship between neighborhoods and drug use behavior, including tobacco use. To reduce misclassification bias resulting from the underreporting of tobacco use and illicit drugs (Cowling, Johnson, Holbrook, Warnecke, & Tang, 2003), the NYSES was introduced to respondents as a ��survey about neighborhoods where New Yorkers Drug_discovery live and what people think about their neighborhoods.