Prevalence of Smoking Assessed Biochemically in an Urban Public Hospital: A Rationale for Routine Cotinine Screening
Prevalence of Smoking Assessed Biochemically in an Urban Public Hospital: A Rationale for Routine Cotinine Screening
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DOI：
10.1093/aje/kwp215
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发表时间：
2009-10-01
影响因子：
5
通讯作者：
Jacob, Peyton, III
中科院分区：
文献类型：
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作者：
Benowitz, Neal L.;Schultz, Katherine E.;Jacob, Peyton, III
可替宁是尼古丁的一种代谢产物，在人群研究中已被用于研究烟草烟雾暴露情况，但作者并不知晓其在住院患者筛查中的应用。作者测量了2005年9月至2006年7月期间在加利福尼亚州旧金山一家城市公立医院收治的948名患者的血清可替宁水平。根据可替宁水平，他们将患者分为主动吸烟者（可替宁≥14纳克/毫升）、近期吸烟者或明显暴露于二手烟者（0.5 - 13.9纳克/毫升）、轻度暴露于二手烟者（0.05 - 0.49纳克/毫升）以及未暴露者（<0.05纳克/毫升）。与旧金山普通人群中13%的吸烟率相比，40%的患者为主动吸烟者；15%为近期吸烟者或重度暴露于二手烟；25%有低水平的二手烟暴露；20%未暴露。在非裔美国人（77%）、无保险者（65%）、自称饮酒者（77%）和非法药物使用者（90%）中，主动吸烟或重度二手烟暴露的比例特别高。在否认吸烟的人群中，32%被发现有明显暴露。如果血清可替宁测量成为城市公立医院常规筛查的一部分，许多患者的可替宁水平将会异常，并将提供烟草烟雾暴露的客观证据，可能会导致更积极的干预措施，以鼓励患者戒烟并避免二手烟。
Cotinine, a metabolite of nicotine, has been used to study tobacco smoke exposure in population studies, but the authors are unaware of its use to screen hospitalized patients. The authors measured serum cotinine levels in 948 patients admitted to an urban public hospital in San Francisco, California, between September 2005 and July 2006. On the basis of cotinine levels, they classified patients as active smokers (cotinine >= 14 ng/mL), recent smokers or significantly exposed to secondhand smoke (SHS) (0.5-13.9 ng/mL), lightly exposed to SHS (0.05-0.49 ng/mL), or unexposed (< 0.05 ng/mL). In contrast to the 13% prevalence of smoking in the general population of San Francisco, 40% of patients were active smokers; 15% were recent smokers or heavily exposed to SHS; 25% had low-level exposure to SHS; and 20% were unexposed. Active smoking or heavy SHS exposure was particularly high among African Americans (77%), the uninsured (65%), self-reported alcohol drinkers (77%), and illicit drug users (90%). Of people who denied smoking, 32% were found to have had significant exposure. 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 SHS.