Study Sheds Light on Second Hand Smoke Exposure in CHD Patients

The majority of congenital heart disease (CHD) patients are not screened by a health care worker for their exposure to second hand smoke during hospitalization, according to results of a survey of 214 nonsmokers with CHD published Nov. 10 in JAMA Internal Medicine. Furthermore, 40 percent of the patients had a detectible level of cotinine (≥0.05 ng/mL) in their system at the time of their admission.

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The study, led by Sandra J. Japuntich, PhD, measured the biochemical and self-reported second hand smoke exposures of CHD patients, also taking into account the patients’ beliefs and the clinicians’ actions regarding second hand smoke. Of the 2,192 nonsmokers with CHD who were admitted to the cardiac service at the Massachusetts General Hospital, Boston, 214 were enrolled in the study. Eligibility was determined by a hospital admission of 48 hours of less, with no reported tobacco or nicotine replacement use and a diagnosis of ischemic CHD.  In addition to the patients’ beliefs about second hand smoke, researchers recorded patients’ second hand smoke exposure in their home, car and work, and collected a saliva sample for an assay of cotinine, a nicotine metabolite with a 16-hour half-life.

Two-thirds of patients (68 percent) reported a smoking ban in their household and 72 percent reported a ban on smoking in their car. While 90 percent of the patients agreed that second hand smoke is harmful to nonsmokers’ health, half of the patients were “not at all” worried about their own second hand smoke exposure. Of the patients participating in the study, only 17 percent reported that a hospital physician or nurse asked about their second hand smoke exposure since admission to the hospital.

The authors conclude that “the findings of this study make a strong case for the need to address second hand smoke exposure more effectively in inpatient cardiology practice.” The authors add that second hand smoke exposure is most likely overlooked in outpatient cardiology, as well.

In an accompanying editorial, R. Williams Vandivier, MD, explains that the study “clearly demonstrates where the health care community has failed to translate research into action… The present study emphasizes the need to allocate energy and resources to uncover the effects of second hand smoke exposure and learn how to maximally implement these findings in patients to improve their health.”

Keywords: Heart Diseases, Cotinine, Health Personnel, Nicotine, Tobacco Smoke Pollution, Boston, Data Collection, Saliva, Hospitalization, Smoking, Hospitals, General

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