title: An intervention to address secondhand tobacco smoke exposure among nonsmokers hospitalized with coronary heart disease.
abstract: Secondhand tobacco smoke (SHS) exposure increases nonsmokers' risk of coronary heart disease and worsens outcomes after hospitalization for acute coronary syndrome, but it is rarely addressed in inpatient cardiac care. We developed and assessed a hospital-based intervention to increase nonsmokers' awareness of SHS as a cardiovascular risk factor. Nonsmokers admitted to 2 cardiac units of a large Boston, Massachusetts, hospital were surveyed before (May 2010 to January 2011) and after (November 2011 to March 2012) a system-level nurse-delivered intervention was implemented in October 2011. It consisted of a revised admission form that prompted nurses to document SHS exposure at admission, provide a pamphlet about SHS risks, and advise nonsmokers to make their home and car smoke free. The primary outcome was patients' short-term recall of advice to keep their home and car smoke free. The secondary outcome was patients' awareness of the cardiovascular risk of SHS exposure. We enrolled 190 nonsmokers before and 142 nonsmokers after implementation. Adjusting for group differences, patients admitted after the system change were more likely to recall being asked if a household member smokes (24% vs 10%, adjusted odds ratio [AOR] 3.6, 95% confidence interval [CI] 1.8 to 7.1, p=0.0002) and being advised to keep their home and car smoke free (28% vs 2%, AOR 27.3, 95% CI 7.8 to 95.7, p<0.0001). After the intervention, more patients believed that SHS exposure increased cardiovascular risk for nonsmokers (42% vs 21%, AOR 2.6, 95% CI 1.6 to 4.4) and for themselves (39% vs 22%, AOR 2.2, 95% CI 1.3 to 3.8). In conclusion, a system-level intervention in cardiac units successfully increased hospitalized nonsmokers' awareness of the cardiovascular risk of SHS exposure.
authors.affiliation: Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts. Electronic address: nrigotti@partners.org.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
authors.affiliation: Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
authors.affiliation: Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Joanna
authors.initials: J
authors.lastname: Streck
authors.affiliation: Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Michele
authors.initials: M
authors.lastname: Reyen
authors.affiliation: Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Kathleen
authors.initials: K
authors.lastname: McKool
authors.affiliation: Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Winickoff
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000517:prevention & control / Q000706:statistics & numerical data
chemical_list: D014028:Tobacco Smoke Pollution