Risk Factors for Continued Cigarette Use After Subarachnoid Hemorrhage

Abstract

Background and Purpose-Cigarette smoking is a risk factor for the formation and rupture of intracranial aneurysms. Few studies have examined predictors of resumption of cigarette smoking after a first episode of subarachnoid hemorrhage (SAH). Methods-Of 620 SAH patients treated between July 1996 and November 2002, we prospectively evaluated continued cigarette use in 152 smokers alive at 3 months. Univariate and multivariate logistic regression analyses were used to identify potential demographic, social, and clinical predictors of continued cigarette use, defined as smoking Ն1 cigarette per week in the month before follow-up. Results-Thirty-seven percent (56 of 152) resumed smoking after their SAH. Patients who continued smoking were younger, were more often black, had begun smoking at an earlier age, and had a higher frequency of prior alcohol or cocaine use and self-reported depression or anxiety than those who quit (all PϽ0.05 Key Words: alcohol drinking Ⅲ cerebral aneurysm Ⅲ cigarette smoking Ⅲ subarachnoid hemorrhage S ubarachnoid hemorrhage (SAH) affects Ϸ21 000 adults in North America each year. 1 Even with significant improvements in the medical and surgical management of SAH, case fatality rates remain between 30% and 50%, 2-5 and those who survive frequently report impaired quality of life (QOL) characterized by disruptive cognitive and emotional symptoms. 3 A recurrent episode of SAH occurs in Ϸ2% to 3% of patients each year after surgical or endovascular aneurysm repair, and this risk increases with time. 6,7 Cigarette smoking is an important modifiable risk factor for SAH. 2,8 -12 Tobacco use is also a risk factor for the formation of multiple 13 and larger 14 aneurysms and therefore may be a risk factor for recurrent SAH after aneurysm repair. 8 Although it is known that up to 60% to 70% of SAH patients smoke cigarettes, 12,13 few studies have examined how many of these patients resume smoking after their hemorrhage or why they return. One study found that the proportion of smokers decreased from 58% before SAH to 30% 4 to 7 years later. 15 To the best of our knowledge, no studies have specifically analyzed risk factors for smoking resumption after SAH.Identification of risk factors for continued cigarette use after SAH may allow more effective substance use interventions while patients are in the hospital and may ultimately decrease the risk of recurrent SAH and other cardiovascular events. For instance, multidisciplinary hospital-based intervention programs increase the frequency of smoking cessation after myocardial infarction, 16,17 which results in reduced long-term mortality. 18 In this study, we sought to determine the frequency of continued cigarette use 3 months after SAH and to identify risk factors for smoking resumption. Patients and Methods Patient Population and Baseline AssessmentSix hundred twenty-six SAH patients admitted consecutively to our Neurological Intensive Care Unit (NICU) between July 1996 and November 2002 were prospectively enrolled in the Columbia University SAH Outc...

Factors Associated with Persistent Smoking after the Diagnosis of Cardiovascular Disease

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