Part of the workshop discussions focused on the ongoing methodological challenges of monitoring tobacco use. The main three are listed below.
Underreporting of Smoking: As the marginalization and associated stigma of smoking intensifies, it is becoming increasingly unpopular to identify oneself as a smoker. Underreporting may be particularly relevant among pregnant women, youth, parents of small children, and young adults.
Increasing Use of Cellular Phones: The increasing use of cellular phones has wide-reaching implications for telephone-based survey methodology. Reaching those individuals who have a cellular phone but no land line presents a particular challenge, as established methods for sampling banks of phone numbers do not apply to cellular phones, and surveying on cellular phones is problematic if respondents pay for air time. The workshop group recommended further work to identify possible ways in which new technologies could be turned into a surveillance advantage, such as through the possible use of text messaging.
Sample Size Limitations: As smoking prevalence rates drop, monitoring efforts may need to focus on subgroups of smokers to evaluate specific target groups. The workshop group expressed concern about the increasing challenge of obtaining sufficient sample sizes and of justifying the larger samples necessary to obtain sufficient statistical power. For example, a targeted survey of non-daily smokers would be a difficult and expensive undertaking to obtain a sufficiently robust sample size.
Our increased understanding of the mechanisms and trajectories of smoking behaviour coupled with observed trends in smoking behaviour suggests a need for a five- to ten-year plan to sustain state-of-the-art monitoring tools. These monitoring tools will then continue to serve all aspects of tobacco control on an ongoing basis. A strategic plan is required for attempting to determine and anticipate what is needed and for developing the measures to meet those needs. There is also a need to investigate ways in which the identified methodological challenges can be addressed. See Appendix B for a detailed summary of the workshop group's discussions and recommendations on issues for future research.
There was consensus among the workshop participants that the 1994 recommendations were continuing to meet our current tobacco use surveillance needs and would continue to do so in the future. In the discussions, it was clear that one distinct set of recommended core questions would not meet all applications. As a result, three levels of question sets were recommended for use in various surveillance and research applications, depending on the depth of information needed on tobacco use behaviours.