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American Journal of Epidemiology Advance Access originally published online on August 27, 2009
American Journal of Epidemiology 2009 170(7):885-891; doi:10.1093/aje/kwp215
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Prevalence of Smoking Assessed Biochemically in an Urban Public Hospital: A Rationale for Routine Cotinine Screening

Neal L. Benowitz, Katherine E. Schultz, Christine A. Haller, Alan H. B. Wu, Katherine M. Dains and Peyton Jacob, III

Correspondence to Dr. Neal L. Benowitz, Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, Box 1220, San Francisco, CA 94143-1220 (e-mail: nbenowitz{at}medsfgh.ucsf.edu).

Received for publication March 31, 2009. Accepted for publication June 24, 2009.

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.

biological markers; cotinine; ethnic groups; hospitalization; smoking; tobacco; tobacco smoke pollution; vulnerable populations

Abbreviations: NHANES, National Health and Nutrition Examination Survey; SHS, secondhand smoke


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