Impact of Secondhand Smoke Exposure on Smoking Cessation in Cardiac Patients

Social Smoking Environment and Associations With Cardiac Rehabilitation Attendance

PURPOSE

Continued cigarette smoking after a major cardiac event predicts worse health outcomes and leads to reduced participation in cardiac rehabilitation (CR). Understanding which characteristics of current smokers are associated with CR attendance and smoking cessation will help improve care for these high-risk patients. We examined whether smoking among social connections was associated with CR participation and continued smoking in cardiac patients.

METHODS

Participants included 149 patients hospitalized with an acute cardiac event who self-reported smoking prior to the hospitalization and were eligible for outpatient CR. Participants completed a survey on their smoking habits prior to hospitalization and 3 mo later. Participants were dichotomized into two groups by the proportion of friends or family currently smoking ("None-Few" vs "Some-Most"). Sociodemographic, health, secondhand smoke exposure, and smoking measures were compared using t tests and χ2 tests (P < .05). ORs were calculated to compare self-reported rates of CR attendance and smoking cessation at 3-mo follow-up.

RESULTS

Compared with the "None-Few" group, participants in the "Some-Most" group experienced more secondhand smoke exposure (P < .01) and were less likely to attend CR at follow-up (OR = 0.40; 95% CI, 0.17-0.93). Participants in the "Some-Most" group tended to be less likely to quit smoking, but this difference was not statistically significant.

CONCLUSION

Social environments with more smokers predicted worse outpatient CR attendance. Clinicians should consider smoking within the social network of the patient as an important potential barrier to pro-health behavior change.

Associations Between Secondhand Tobacco Smoke Exposure and Nicotine Dependence and Smoking Cessation Attempts Among Adult Tobacco Users With a Psychiatric Disorder

INTRODUCTION

Secondhand smoke exposure (SHSe) is predictive of greater nicotine dependence (ND) and poor smoking cessation (SC) outcomes. SHSe and its impact on ND and SC attempts in people with psychiatric disorders (PD) remain poorly understood. Hence, the objectives of this study were to (1) quantify SHSe, (2) examine the association of SHSe with ND, and (3) assess the association between SHSe and SC among tobacco users with PD.

METHOD

A cross-sectional survey of 118 tobacco users in an inpatient psychiatric facility was conducted. Data on demographics, tobacco use and SHSe history, motivation to quit smoking, ND, and SC attempts were obtained. Participants' environmental and psychosocial sources of and perceived SHSe were described. Multivariate linear regression analyses were used to examine the associations between SHSe and ND, while logistic regression analyses were used to assess the associations between SHSe and SC.

RESULTS

The primary sources of environmental SHSe were from the car (63.6%) and home (51.7%); primary sources of psychosocial SHSe were close friends (67.8%) and parents/grandparents (65.3%); and mean perceived SHSe was 6.2 ( SD = 3.5). Although perceived SHSe was significantly associated with ND (β = .39, p < .0001) in multivariate analyses, no SHSe variable was associated with SC. However, scores on items measuring motivation to quit smoking were associated with SC attempts.

DISCUSSION

Patients with PD reported high levels of SHSe, which was associated with higher ND. Routine screening for SHSe should be implemented as part of health assessments in this population to address ND treatment options. Moreover, targeted interventions and policies should be considered toward reducing SHSe in this vulnerable population.

Living with Smoker(s) and Smoking Cessation in Chinese Adult Smokers: Cross-Sectional and Prospective Evidence from Hong Kong Population Health Survey

Background: Results on the environmental influence on unassisted quitting are scarce. We investigated the associations of living with smoker(s) with quitting in Chinese adult smokers. Methods: We examined both cross-sectional and prospective data in the Hong Kong Population Health Survey recruited participants in 2003/04, and followed up to 2006. Unconditional logistic regression yielded adjusted odds ratios (AORs) of (i) planning to quit, (ii) ex-smoking (cross-sectional), and quitting (prospective) for living with smoker(s). 1679 ever smokers aged 18+ years at baseline, and 323 of them who were successfully followed-up were included in the cross-sectional, and prospective analysis. Results: At baseline, living with smoker(s) was significantly associated with lower odds of planning to quit in current smokers (AOR 0.41, 95% CI 0.25–0.68), and lower odds of ex-smoking (AOR 0.45, 95% CI 0.34–0.58), particularly if the smoker(s) smoked inside home (AOR 0.35, 95% CI 0.26–0.47). Prospectively, living with smoker(s) non-significantly predicted lower odds of new quitting (AOR 0.48, 95% CI 0.13–1.78). Conclusions: Our study has provided the first evidence in a Chinese general population that living with smoker(s) is an important barrier against smoking cessation. To boost quit rate in nonusers of smoking cessation services, smoking at home should be banned, especially for populations living in crowed urban environments that are typical of economically developed cities in China.