Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL.
Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.
Nicotine Tob Res. 2019 Mar 30;21(4):551-556. doi: 10.1093/ntr/nty060.
Patients with cancer, cardiovascular disease (CVD), and respiratory disease are susceptible to health consequences related to secondhand smoke (SHS) exposure. This study examined the prevalence, time trends, and correlates of SHS exposure among these patients compared with individuals without these diseases (control).
Data were obtained from the 2001-2012 National Health and Nutrition Examination Survey. All adults (≥20 years old) who were nonsmokers and exposed to SHS (serum cotinine level 0.015-10 ng/mL), had cancer (n = 1,440), CVD (congestive heart failure, coronary heart disease, angina, heart attack, or stroke; n = 1,754), respiratory disease (asthma, chronic bronchitis, emphysema; n = 1,444), or none of these diseases (control; n = 11,615) were included in the analysis. Weighted prevalence, weighted second-degree polynomial linear regression of prevalence on year for trend analysis, and multivariable logistic regression analyses were performed with adjustments to the complex survey design.
SHS exposure was the highest among patients with respiratory disease (72.1%), followed by patients with CVD (70.6%), controls (70.4%), and patients with cancer (65.4%). From 2001 to 2012, exposure decreased the most among CVD patients (19.6%), followed by controls (16.0%), cancer patients (14.7%), and respiratory patients (10.0%). Exposed individuals in all groups were more likely to be younger, Black, and less educated. Exposed patients with respiratory disease were more likely to be former smokers (p < .05 for all).
SHS exposure among these patients is high and comparable to the general population. Strengthening smoke-free policies in all settings is critical. More efforts are needed to address SHS exposure more effectively in clinical care settings.
Despite the negative health effect of SHS exposure among patients with cancer, CVD, and respiratory disease, modest progress has been made in reducing their exposure. Continued efforts to strengthen smoke-free policies in workplaces, public place, and multiunit housing is critical. In addition, exposure to SHS among these patients seems to be overlooked in clinical care settings. More efforts are needed to address this problem more effectively in health care settings and investigate specific interventions directed at increasing patients' awareness about the risk of exposure to SHS and helping them to reducing their exposure.
患有癌症、心血管疾病（CVD）和呼吸系统疾病的患者易受到与二手烟（SHS）暴露相关的健康后果的影响。本研究比较了这些患者与无此类疾病的个体（对照）之间 SHS 暴露的流行率、时间趋势和相关因素。
数据来自 2001-2012 年全国健康与营养调查。所有非吸烟者（血清可替宁水平为 0.015-10ng/ml）且暴露于 SHS（血清可替宁水平为 0.015-10ng/ml）、患有癌症（n=1440）、CVD（充血性心力衰竭、冠心病、心绞痛、心脏病发作或中风；n=1754）、呼吸系统疾病（哮喘、慢性支气管炎、肺气肿；n=1444）或无这些疾病（对照；n=11615）的成年人均纳入分析。采用加权流行率、流行率的二次多项式线性回归进行趋势分析，并对复杂的调查设计进行调整，进行多变量逻辑回归分析。
患有呼吸系统疾病的患者 SHS 暴露率最高（72.1%），其次是 CVD 患者（70.6%）、对照组（70.4%）和癌症患者（65.4%）。从 2001 年到 2012 年，CVD 患者的暴露量下降最多（19.6%），其次是对照组（16.0%）、癌症患者（14.7%）和呼吸系统患者（10.0%）。所有组的暴露个体更年轻、黑人且受教育程度更低。患有呼吸系统疾病的暴露者更有可能是前吸烟者（p<.05）。
这些患者的 SHS 暴露率较高，与一般人群相当。在所有环境中加强无烟政策至关重要。需要更多努力在临床护理环境中更有效地解决 SHS 暴露问题。
尽管癌症、心血管疾病和呼吸系统疾病患者接触 SHS 会带来负面健康影响，但在减少他们的接触方面已取得了适度进展。继续努力加强工作场所、公共场所和多单元住房的无烟政策至关重要。此外，这些患者接触 SHS 的情况在临床护理环境中似乎被忽视了。需要更多努力在医疗保健环境中更有效地解决这个问题，并调查针对提高患者对接触 SHS 风险的认识和帮助他们减少接触的具体干预措施。
