Smoking is a major risk factor for many chronic diseases. Nearly all studies collecting smoking data use self-reports, which are very rarely validated. We identified 15,182 adults 18 years or older in the Third National Health and Nutrition Examination Survey. Denying smoking, the main outcome, was defined as cotinine-determined smokers self-reporting non-smoking. Multiple logistic regression modeling took into account the complex survey design and sample weights. Age and race/ethnicity-gender categories predicted denying smoking. Smokers denying smoking ranged from 0.0% for elderly (75 years and older) Mexican-American women to 67.8% for elderly non-Hispanic Black women. Among elderly smokers, non-Hispanic Black women were more likely to deny smoking than both non-Hispanic White women (odds ratio (OR) = 8.9, 95% confidence interval (CI): 2.1–38.3) and non-Hispanic Black men (OR=21.4 95% CI: 4.3–107.2). This U.S. population-based study of age-specific race/ethnicity-gender predictors of denying smoking suggests caution in interpreting smoking-related survey data.


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