Smoking among hospitalized patients: A multi-hospital cross-sectional study of a widely neglected problem

Cristina Martínez, Marcela Fu, Yolanda Castellano, Anna Riccobene, Paz Fernández, Sandra Cabrera, Eva Gavilan, Ariadna Feliu, Montse Puig-Llobet, Pilar Fuster, Jose María Martínez-Sánchez, Javier Montes, Joan Maria Estrada, Carmen Moreno, Anna Falcó-Pegueroles, Jordi Galimany, Cecilia Brando, Rosa Suñer-Soler, Anna Capsada, Esteve Fernández, y Grupo de Coordinadores de la Red Catalana de Hospitales sin Humo (XCHsF), Cristina Martínez, Marcela Fu, Yolanda Castellano, Anna Riccobene, Paz Fernández, Sandra Cabrera, Eva Gavilan, Ariadna Feliu, Montse Puig-Llobet, Pilar Fuster, Jose María Martínez-Sánchez, Javier Montes, Joan Maria Estrada, Carmen Moreno, Anna Falcó-Pegueroles, Jordi Galimany, Cecilia Brando, Rosa Suñer-Soler, Anna Capsada, Esteve Fernández, y Grupo de Coordinadores de la Red Catalana de Hospitales sin Humo (XCHsF)

Abstract

Introduction: A comprehensive smoking ban was recently enacted for acute-care hospital campuses in Spain. The aim of this study was to assess the prevalence and patterns of smoking among inpatients before and during hospitalization.

Methods: Multi-center cross-sectional study was conducted in 13 hospitals in the province of Barcelona, Spain from May 2014 to May 2015. Participants were adults who provided informed consent. The sample size was calculated to be representative of each hospital (prevalence 29.4%, precision ± 5%, error 5%). We approached 1228 subjects, 888 accepted to participate and 170 were replaced (were not available or declined to participate). Final sample comprised 1047 subjects. We used a computer-assisted personal interview system to collect data, including sociodemographic variables and use of tobacco before and during hospitalization. Smoking status was validated with exhaled carbon monoxide. We calculated overall tobacco prevalence and investigated associations with participant and center characteristics. We performed multiple polytomous and multilevel logistic regression analyses to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with adjustments for potential confounders.

Results: In all, 20.5% (95% CI: 18.1-23.0) of hospitalized patients were smokers. Smoking was most common among men (aOR=7.47; 95% CI: 4.88-11.43), young age groups (18-64 years), and individuals with primary or less than primary education (aOR=2.76; 95% CI: 1.44-5.28). Of the smokers, 97.2% were daily consumers of whom 44.9% had medium nicotine dependence. Of all smokers, three-quarters expressed a wish to quit, and one-quarter admitted to consuming tobacco during hospitalization.

Conclusions: Our findings indicate the need to offer smoking cessation interventions among hospitalized patients in all units and service areas, to avoid infringements and increase patient safety, hospital efficiency, and improve clinical outcomes. Hospitalization represents a promising window for initiating smoking interventions addressed to all patients admitted to smoke-free hospitals, specially after applying a smoke-free campus ban.

Keywords: epidemiology; health services; policy; smoking; tobacco.

Conflict of interest statement

Authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.

Figures

Figure 1
Figure 1
Flowchart of the recruitment process
Figure 2
Figure 2
Age-standardized prevalence (%) of smoking, in participant hospitals of Barcelona Province, 2014–2015 (The area of each dot represents the relative weighting of the hospital, in terms of the proportion of participants among the total, bars represent 95% CI, the diamond and the dotted line represent the overall weighted prevalence and 95% CI)

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Source: PubMed

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