Nonsmokers hospitalized for CHD rarely screened for secondhand smoke

Nonsmokers hospitalized for CHD were usually neither advised about nor screened for secondhand smoke exposure, according to a research letter published in JAMA Internal Medicine.

“The findings of this study make a strong case for the need to address [secondhand smoke] exposure more effectively in inpatient cardiology practice,” Sandra J. Japuntich, PhD, and colleagues wrote. “… It is likely that [secondhand smoke] exposure is similarly overlooked in outpatient cardiology practice. Hospitals and health care systems are missing an opportunity to identify and intervene in this major modifiable [CV] risk factor.”

Japuntich, from the National Center for Posttraumatic Stress Disorder at the Veterans Affairs Boston Healthcare System, and colleagues interviewed 214 nonsmokers hospitalized for CHD at Massachusetts General Hospital and tested their saliva for exposure to secondhand smoke.

Secondhand smoke exposure

The patients were asked about exposure to secondhand smoke at home, at work and in their cars; whether they maintained any rules about smoking at home or in the car; their beliefs about the health risks of secondhand smoke exposure; and interventions by health care professionals regarding secondhand smoke exposure. Their saliva samples were tested for levels of cotinine, a nicotine metabolite with a 16-hour half-life.

Twenty-two percent of patients reported secondhand smoke exposure in the 30 days before hospital admission, and 15.4% reported exposure in the 7 days before admission, according to the researchers.

Japuntich and colleagues wrote that 13.6% of patients reported living with a smoker, 67.8% reported maintaining a household smoking ban and 72.3% of car owners reported maintaining a smoking ban in their cars.

Of the 184 patients with evaluable saliva samples, 8.2% had detectable cotinine levels of ≥0.2 ng/mL. Among 72 patients whose samples were tested with a more sensitive assay, 40.3% had detectable cotinine levels of ≥0.05 ng/mL, according to the researchers.

Although 89.7% of patients believed that secondhand smoke is harmful to the health of nonsmokers and 56.5% believed that secondhand smoke exposure increased nonsmokers’ risk for “heart attack,” 22% disagreed that secondhand smoke exposure increased nonsmokers’ heart attack risk and 21.5% said they did not know whether it did or not. Approximately half of responders (50.5%) said they were “not at all worried” about their current secondhand smoke exposure, the researchers wrote.

“Nonsmokers who were hospitalized with CHD were rarely screened for [secondhand smoke] exposure or advised to avoid it,” Japuntich and colleagues wrote. They also noted that only 17.3% of patients reported having been asked by a hospital physician or nurse about their secondhand smoke exposure since admission, 9.8% recalled being asked if they lived with a smoker and only 1.4% recalled having received advice on how to keep their home or car smoke-free.

Failure to translate

“This study is important because it clearly demonstrates where the health care community has failed to translate research into action,” R. William Vandivier, MD, from the Chronic Obstructive Pulmonary Disease Center at the division of pulmonary sciences and critical care medicine at the University of Colorado, wrote in an invited commentary. “… This is a case in which the electronic health record could make a big difference in both the inpatient and outpatient settings through the development of ‘prompts’ to inquire about [secondhand smoke] exposure and ‘hard stops’ to encourage counseling during what may be a prime teachable moment.”

For more information:

Japuntich SJ. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.5476.

Vandivier RW. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.4046.

Disclosure: The study was supported by grants from the Flight Attendant Medical Research Institute and the Department of Veterans Affairs Clinical Services Research and Development Service. See the full study for a list of the researchers’ relevant financial disclosures. Vandivier reports no relevant financial disclosures.