title: Association of Secondhand Smoke With Stroke Outcomes.
abstract: Approximately half of never smokers are exposed to secondhand smoke (SHS). Smoking is a well-established stroke risk factor, yet associations between SHS, stroke, and poststroke mortality remain uncertain. We aimed to determine the prevalence of exposure to SHS among those with and without stroke and its impact on mortality.
  
  
  
  Data were obtained from the US National Health and Nutrition Examination Surveys for 27 836 never smokers with/without self-reported stroke aged ≥18 years, sampled from 1988 to 1994 and 1999 to 2012, with linked mortality through 2010. Household exposure to SHS was determined by self-report; exposure severity was quantified by serum cotinine level. Independent relationships between SHS and all-cause mortality were assessed using Cox regression models, before and after adjusting for sociodemographics and comorbidities.
  
  
  
  From 1988 to 1994 to 1999 to 2012, age-adjusted prevalence of exposure to SHS declined from 11.5% to 6.6% among survivors of stroke (P=0.08), and 14.6% to 5.9% among persons without stroke (P<0.01). Factors associated with high exposure to SHS were male sex, black race, ≤12th-grade education, poverty income ratio ≤200%, high alcohol intake, and history of myocardial infarction (all P<0.05). High exposure to SHS was associated with higher odds of previous stroke (odds ratio, 1.46; P=0.026). There was a dose-dependent relationship between exposure to SHS and all-cause mortality after stroke.
  
  
  
  Individuals with previous stroke have 50% greater odds to have been exposed to SHS; SHS is associated with a 2-fold increase in mortality after stroke. This study highlights the importance of obtaining exposure to SHS history and counseling patients and their families on the potential impact of SHS on poststroke outcomes.
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (M.P.L.); Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Biomathematics, University of California at Los Angeles (D.M.); Department of Neurology, University of Southern California (A.T.); and Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.). michelle.py.lin@gmail.com.
authors.forename: Michelle P
authors.initials: MP
authors.lastname: Lin
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (M.P.L.); Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Biomathematics, University of California at Los Angeles (D.M.); Department of Neurology, University of Southern California (A.T.); and Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.).
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (M.P.L.); Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Biomathematics, University of California at Los Angeles (D.M.); Department of Neurology, University of Southern California (A.T.); and Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.).
authors.forename: Daniela
authors.initials: D
authors.lastname: Markovic
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (M.P.L.); Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Biomathematics, University of California at Los Angeles (D.M.); Department of Neurology, University of Southern California (A.T.); and Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.).
authors.forename: Amytis
authors.initials: A
authors.lastname: Towfighi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000139:chemically induced* / Q000401:mortality*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution
keywords: cardiovascular disease; prevalence; risk factor; secondhand smoke; stroke