Tobacco smoke exposure prevalent in urban public hospital patients
NEW YORK – Based on cotinine screening, 80% of patients in an urban public hospital were either active or second-hand smokers, according to a report in the October 1st American Journal of Epidemiology.
“If serum cotinine measurement became part of routine screening at urban public hospitals, cotinine levels would be abnormal in many patients and would provide objective evidence of tobacco smoke exposure, probably resulting in more intensive intervention to encourage patients to stop smoking and avoid secondhand smoke,” Dr. Neal L. Benowitz from University of California, San Francisco, and his colleagues maintain.
At the San Francisco General Hospital, the researchers screened 948 hospitalized adults. Using standard cotinine cutoff points, 40% were classified as current smokers and 15% as recent smokers or heavily exposed passive smokers. An additional 25% had low-level exposure.
More Native Americans (80%) and African Americans (77%) had significant smoke exposure than did whites (66%), Latinos (35%), and Asians (22%), the researchers note.
Smoke exposure was more common among the unemployed (55%) than among the employed (32%). Rates of significant exposure also differed by insurance status, ranging from 29% of privately insured patients to 52% of MediCal recipients and 65% of those with no insurance.
“Most patients admitted to hospitals are asked whether they smoke cigarettes,” the authors point out, but “misreporting of smoking status is common.”
The levels of smoke exposure in this study were “extraordinarily high” and “similar to national smoking levels in the 1950s, when cigarette smoking was at its peak in the United States,” they say.
These levels of smoke exposure, they add, contrast with the relatively low prevalence of significant smoke exposure in the general population of California (14%).
As their results prove, however, “smoking behavior in a state or city as a whole does not reflect smoking behavior in persons of lower economic status and in vulnerable populations.”
Am J Epidemiol 2009;170:885-891.
