Trends in Active Cigarette Smoking Among Stroke Survivors in the United States, 1999 to 2018

Background and Purpose— Patients who continue to smoke after a stroke face a higher risk of recurrent stroke. While several effective drugs for smoking cessation became available over the past 2 decades, whether active smoking has decreased among stroke survivors is unknown. We, therefore, evaluated trends in active smoking among stroke survivors during this period. Methods— We performed trends analyses using cross-sectional data collected every 1 to 2 years from 2 US health surveys spanning 1999 to 2018. In the National Health and Nutrition Examination Survey (NHANES) and the Behavioral Risk Factor Surveillance System (BRFSS) survey, participants were asked about prior stroke and active tobacco smoking. In NHANES, serum cotinine levels were available as a secondary measure of active smoking. We used multivariable logistic regression models for survey data to assess trends in active smoking among participants with and without prior stroke. Results— Among 49 375 participants in NHANES during 1999 to 2016 and 3 621 741 participants in BRFSS during 2011 to 2018, the prevalence of stroke was ≈3%. The overall prevalence of active smoking among stroke survivors was 24% in NHANES and 23% in BRFSS. Among individuals without prior stroke, the odds of smoking decreased over time in both NHANES (odds ratio, 0.95 per 2 years [95% CI, 0.93–0.96]) and BRFSS (odds ratio, 0.96 per year [95% CI, 0.96–0.96]). In contrast, there was no decrease in smoking among stroke survivors in NHANES (odds ratio, 1.00 [95% CI, 0.93–1.07]) or BRFSS (odds ratio, 0.99 [95% CI, 0.98–1.004]). Results were consistent in secondary analysis using biochemical ascertainment of active smoking in NHANES and in sensitivity analyses accounting for potential demographic changes in stroke epidemiology. Conclusions— In contrast to the general population, the prevalence of active smoking among stroke survivors has not decreased during the past 2 decades.

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Abstract WMP111: Trends in Active Tobacco Smoking Among Stroke Survivors in The United States: An Analysis of the National Health and Nutrition Examination Survey, 1999-2016

Stroke ◽

10.1161/str.51.suppl_1.wmp111 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Neal S Parikh ◽

Abhinaba Chatterjee ◽

Alexander E Merkler ◽

Mackenzie P Lerario ◽

Costantino Iadecola ◽

...

Keyword(s):

Smoking Cessation ◽

National Health ◽

The United States ◽

Self Report ◽

Stroke Survivors ◽

Nutrition Examination Survey ◽

Active Smoking ◽

Cross Sectional ◽

Health And Nutrition ◽

Prior Stroke

Background: Active smoking after stroke is associated with worse outcomes. Since several smoking cessation drugs have become available during the last two decades, we sought to determine whether the rate of active smoking among stroke survivors has decreased. Methods: We performed a trends analysis using cross-sectional data from all nine available consecutive cycles of the continuous phase of the National Health and Nutrition Examination Survey from 1999 to 2016. Participants in each cycle were asked about their medical history and health-related behaviors. We included participants 20 years of age and older who answered questions regarding smoking. Patients with prior stroke were identified based on self-report, which has been validated against expert chart review. Active smoking was defined based on self-report. We used multivariable logistic regression methods for survey data to assess for trends in active smoking among all participants and those with prior stroke. Models were adjusted for demographics. Results: We included 49,440 participants in our analysis, of whom 1,921 (2.7%) reported a prior stroke. The mean age of stroke survivors was 64.8 (standard error, 0.5) years, and 57% were women. The average prevalence of active smoking over 1999-2016 was 22.2% for the whole sample and 24.3% among stroke survivors. In the overall population, the adjusted prevalence of active smoking decreased over the study period (odds ratio [OR] per cycle, 0.96; 95% confidence interval [CI], 0.94-0.97). The rate did not decrease among stroke survivors (OR, 1.01; 95% CI, 0.93-1.09) (Fig). Conclusion: Despite the availability of several effective smoking cessation therapies, the rate of active smoking among stroke survivors has not decreased in the past two decades. Effective strategies for smoking cessation for secondary stroke prevention are needed.

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Abstract MP28: Nationwide Racial Disparities in Smoking Cessation After Stroke in the United States

Stroke ◽

10.1161/str.52.suppl_1.mp28 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Neal S Parikh ◽

Melvin Parasram ◽

Yongkang Zhang ◽

Saad Mir ◽

Halina White ◽

...

Keyword(s):

United States ◽

Smoking Cessation ◽

Racial Disparities ◽

Race And Ethnicity ◽

Recurrent Stroke ◽

The United States ◽

Smoking History ◽

Behavioral Risk ◽

Stroke Survivors ◽

Cross Sectional

Introduction: Black Americans face a higher risk of recurrent stroke than White Americans, and the reasons are unclear. Smoking after stroke is associated with a higher risk of recurrence. We investigated whether there are racial disparities in smoking cessation among stroke survivors in the United States. Methods: We performed a cross-sectional analysis of data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, an annual, nationally representative health survey. Respondents are asked about medical conditions and health-related behaviors. We pooled data from 2013-2018, during which race and ethnicity were uniformly reported. We included respondents with prior stroke and any smoking history. The exposure was self-reported race, and the outcome was smoking cessation. We calculated the quit ratio, defined as the proportion of former smokers among ever smokers; this is a standard measure in population-based studies of smoking cessation. Survey procedures were used to estimate frequencies and summarize quit ratios by race. Multiple logistic regression was used to assess the association of Black race with smoking cessation, as compared to White race, while adjusting for age, gender, Hispanic ethnicity, education, income, health insurance, and the number of smoking-related health conditions (heart disease, lung disease, cancer) that may prompt cessation. Results: Among 4,374,011 Americans with a history of stroke and any smoking, the median age was 67 years (IQR, 58-76), and 45.7% were women; 15.4% were Black, 74.8% were White, and 9.8% reported other race. The crude quit ratio was 51.4% (95% CI, 49.0-53.7) in Black and 63.2% (95% CI, 62.4-64.1) in White stroke survivors. In unadjusted analyses, Black stroke survivors were less likely to have quit smoking than White stroke survivors (OR, 0.61; 95% CI, 0.55-0.68). This remained the case after accounting for differences in demographics and smoking-related comorbidities (OR, 0.85; 95% CI, 0.74-0.98). Conclusion: In this nationwide study, Black stroke survivors had lower smoking quit rates than White stroke survivors, even after accounting for group differences. Expanding access to smoking-cessation interventions may reduce disparities in recurrent stroke.

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Association between food insecurity and access to a mental health professional: cross-sectional analysis of NHANES 2007–2014

BMC Public Health ◽

10.1186/s12889-021-10818-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nina Camille Burruss ◽

Marina Girgis ◽

Karen Elizabeth Green ◽

Lingyi Lu ◽

Deepak Palakshappa

Keyword(s):

Mental Health ◽

Health Professional ◽

Food Insecurity ◽

Mental Health Professional ◽

The United States ◽

Bivariate Analysis ◽

Cross Sectional ◽

The Past ◽

Cross Sectional Analysis ◽

Sectional Analysis

Abstract Background To determine if individuals with food insecurity (FI) were less likely to have seen a mental health professional (MHP) within the past year than individuals without FI. Methods This is a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) conducted in the United States between 2007 and 2014. All participants 20 years of age or older were eligible for this study. We excluded participants who were pregnant, missing FI data, or missing data from the Patient Health Questionnaire (PHQ-9). The primary outcome was self-reported contact with a MHP in the past 12 months. We used multivariable logistic regression models to test the association between FI and contact with a MHP, controlling for all demographic and clinical covariates. Results Of the 19,789 participants, 13.9% were food insecure and 8.1% had major depressive disorder (MDD). In bivariate analysis, participants with FI were significantly more likely to have MDD (5.3% vs 2.8%, p < 0.0001) and to have been seen by a MHP in the preceding 12 months (14.0% vs 6.9%, p < 0.0001). In multivariable models, adults with FI had higher odds of having seen a MHP (OR = 1.32, CI: 1.07, 1.64). Conclusions This study demonstrates that individuals with FI were significantly more likely to have seen a MHP in the preceding 12 months compared to individuals without FI. Given the growing interest in addressing unmet social needs in healthcare settings, this data suggests that visits with MHPs may be a valuable opportunity to screen for and intervene on FI.

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Inadequate Therapy for Asthma Among Children in the United States

PEDIATRICS ◽

10.1542/peds.105.s2.272 ◽

2000 ◽

Vol 105 (Supplement_2) ◽

pp. 272-276

Author(s):

Jill S. Halterman ◽

C. Andrew Aligne ◽

Peggy Auinger ◽

John T. McBride ◽

Peter G. Szilagyi

Keyword(s):

Severe Asthma ◽

Asthma Management ◽

The United States ◽

Asthma Therapy ◽

National Guidelines ◽

Cross Sectional ◽

Asthma Morbidity ◽

The Past ◽

Maintenance Medication ◽

Inadequate Therapy

Objective. Childhood asthma morbidity and mortality are increasing despite improvements in asthma therapy. We hypothesized that a substantial number of children with moderate to severe asthma are not taking the maintenance medications recommended by national guidelines. The objective of this study was to describe medication use among US children with asthma and determine risk factors for inadequate therapy. Methods. The National Health and Nutrition Examination Survey (NHANES) III 1988–1994 provided cross-sectional, parent-reported data for children 2 months to 16 years of age. Analysis focused on children with moderate to severe asthma (defined as having any hospitalization for wheezing, ≥2 acute visits for wheezing, or ≥3 episodes of wheezing over the past year). We defined these children as adequately treated if they had taken a maintenance medication (inhaled corticosteroid, cromolyn, or theophylline) during the past month. Demographic variables were analyzed for independent associations with inadequacy of therapy. The statistical analysis used SUDAAN software to account for the complex sampling design. Results. A total of 1025 children (9.4%) had physician-diagnosed asthma. Of those with moderate to severe asthma (n = 524), only 26% had taken a maintenance medication during the past month. Even among children with 2 or more hospitalizations over the previous year, only 32% had taken maintenance medications. In a logistic regression analysis, factors significantly associated with inadequate therapy included: age ≤5 years, Medicaid insurance, and Spanish language. Children surveyed after 1991, when national guidelines for asthma management became available, were no more likely to have taken maintenance medications than children surveyed before 1991. Conclusion. Most children with moderate to severe asthma in this nationally representative sample, including those with multiple hospitalizations, did not receive adequate asthma therapy. These children may incur avoidable morbidity. Young children, poor children, and children from Spanish-speaking families appear to be at particularly high risk for inadequate therapy.

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Abstract P271: Influenza and Herpes Zoster Vaccination in United States Stroke Survivors: A Nationwide Analysis

Stroke ◽

10.1161/str.52.suppl_1.p271 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Mu Ji Hwang ◽

Setareh Salehi Omran ◽

Saad Mir ◽

Alexander E Merkler ◽

Hooman Kamel ◽

...

Keyword(s):

United States ◽

Herpes Zoster ◽

Influenza Vaccination ◽

Vaccination Rate ◽

Behavioral Risk ◽

Stroke Survivors ◽

Cross Sectional ◽

Vaccination Rates ◽

Increased Risk ◽

Prior Stroke

Introduction: Patients with stroke face an increased risk of contracting influenza and herpes zoster. We compared vaccination rates in stroke survivors versus the general United States population. Methods: We performed a cross-sectional analysis of data from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System, which is an annual, nationally representative, health survey. Respondents are asked about medical conditions and care. We used the most recent years with complete data for influenza (2018) and zoster (2017). We utilized survey procedures to estimate CDC-recommended vaccination rates for influenza (annual vaccination for all) and zoster (one-time vaccination for those at least 50 years old). Multiple logistic regression was used to compare the odds of vaccination in those with and without prior stroke, while adjusting for demographics (including income and health insurance) and comorbidities that may influence vaccination rates (obesity, diabetes, heart disease, cancer, pulmonary disease, and smoking). Results: In 2018, 8,254,136 (3.4%; 95% CI, 3.3-3.5) Americans were stroke survivors. The influenza vaccination rate was 44.4% (95% CI, 42.8-46.2) in stroke survivors and 32.8% (95% CI, 32.5-33.1) otherwise. In unadjusted models, stroke survivors were more likely to have had an influenza vaccination in the past year than those without stroke (OR, 1.6; 95% CI, 1.5-1.8). In 2017, 5,839,186 (5.7%; 95% CI, 5.5-5.9) Americans over 50 years old (i.e., eligible for zoster vaccination) were stroke survivors. The zoster vaccination rate was 30.3% (95% CI, 28.8-32.0) in stroke survivors and 27.6% (95% CI, 27.3-28.0) in those without prior stroke. Stroke survivors were more likely to have had zoster vaccination than those without stroke (OR, 1.14; 95% CI, 1.06-1.23). However, after accounting for demographics and comorbidities, stroke survivors were not more likely to be vaccinated for influenza (OR, 1.01; 95% CI, 0.93-1.10) or zoster (OR, 1.00; 95% CI, 0.90-1.12). Conclusion: Stroke survivors were not vaccinated at higher rates than expected based on demographics and comorbidities, and absolute vaccination rates were low, especially for zoster. Efforts to increase vaccination after stroke may be needed.

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Abstract WP365: STARS PLUS Patient Transition Pilot Program

Stroke ◽

10.1161/str.44.suppl_1.awp365 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Alexandra Graves ◽

Angie West ◽

Miranda N Bretz ◽

Marie Welch ◽

Lynn Toth ◽

...

Keyword(s):

Health Outcomes ◽

Stroke Prevention ◽

Recurrent Stroke ◽

Age Groups ◽

The United States ◽

Lifestyle Changes ◽

Older Age ◽

Stroke Survivors ◽

Pilot Program

Background: As the leading cause of adult disability and the fourth leading cause of death in the United States, stroke prevention strategies are imperative. Arguably equal attention should be given towards both primary and secondary prevention of stroke. While much is known about medications and lifestyle changes to prevent recurrent stroke, additional research is needed to effectively ensure stroke survivors are following the recommended guidelines. Research shows that support after discharge from the hospital post-stroke is frequently inadequate. Purpose: The purpose of the Steps Against Recurrent Stroke (STARS) Plus Patient Transition Pilot Program was to design and deliver a program to facilitate optimal recovery for stroke survivors and prevent recurrent stroke. The program began at discharge from the hospital and continued through the first year of rehabilitation and recovery. Patients could opt in based on perceived benefits of support with medication management, timed educational mailings and calls about stroke recovery and recurrent stroke prevention. Results: Twelve hospitals participated; 261 patients enrolled and contact was established with 193. Outcomes were gathered based on patient self-report of health status using the Standard Form 12 (SF-12) Health Survey at 30, 90, 180 and 360 days. A total of 72 patients completed each follow-up in the full 12 months of the program. A dependent sample t-test was completed comparing participants’ 30 and 360 day follow-up scores. Results demonstrated an overall increase in subjective pain. A repeated MANOVA was conducted to compare 30 and 360 day SF-12 scores across age and subscales. Results revealed that those in the younger and older age groups reported poorer health outcomes. Conclusion: STARS Plus Program found no statistically significant change in perceived health benefits, although the majority found the program to be beneficial. Future programs should consider targeting pain management in all ages and education targeted at younger and older age groups, as they reported poorer health outcomes. The findings from this program should contribute to the guidance and insight for others developing transitional interventions for stroke survivors.

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Abstract T P139: Rising Rates of the Metabolic Syndrome Among Stroke Survivors in the United States

Stroke ◽

10.1161/str.45.suppl_1.tp139 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Michael McManus ◽

Daniela Markovic ◽

Natalie Valle ◽

Bruce Ovbiagele ◽

Amytis Towfighi

Keyword(s):

United States ◽

Metabolic Syndrome ◽

Stroke Risk ◽

Recurrent Stroke ◽

Temporal Trends ◽

The United States ◽

Self Report ◽

Stroke Survivors ◽

Middle Aged ◽

The Metabolic Syndrome

BACKGROUND: Metabolic syndrome (MetS), a constellation of cardiometabolic risk factors clustering together, affects >47 million US adults and has been independently linked to primary and recurrent stroke risk. Prevalence and trends in MetS among stroke survivors in the United States are unknown. OBJECTIVES: To evaluate recent temporal trends in age and sex-specific MetS prevalence among adults with/without stroke in the US. METHODS: Prevalence of MetS was assessed among fasting adults ≥35 years who participated in National Health and Nutrition Examination Surveys 1999-2010 (n=9,343). Prevalence estimates were weighted to obtain nationally representative estimates (n=430,371,669). MetS was defined by the 2009 harmonized definition. Stroke was determined by self-report. RESULTS: In all groups except men 35-64 years, MetS prevalence was similar among adults with and without stroke in 1999-2002 (Table). MetS prevalence rates were flat from 1999 to 2010 among those without stroke, but increased among stroke survivors, such that up to 80% of men and 86% of women with stroke had MetS, with the greatest rise among the middle-aged. Stroke survivors aged 35-64 years were ~3 times more likely to have MetS than their counterparts without stroke (OR 3.24, 95% CI 1.60-6.55 for men and OR 2.55, 95% CI 1.45-4.50 for women). DISCUSSION: Due to a differential rise in MetS in stroke survivors over the last 10 years, as many as 9 out of 10 stroke survivors now have MetS, suggesting that Mets may increasingly be placing people at risk for stroke. Intensified efforts aimed at identifying and treating MetS, especially among middle-aged individuals, may be warranted to avert stroke risk.

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The association of gout with an increased risk of hypertension and diabetes mellitus among stroke survivors in New Zealand: A cross-sectional study using routinely collected electronic health data

JRSM Cardiovascular Disease ◽

10.1177/2048004019863239 ◽

2019 ◽

Vol 8 ◽

pp. 204800401986323 ◽

Cited By ~ 2

Author(s):

Dina Eufemia D San Gabriel ◽

Julia Slark

Keyword(s):

Diabetes Mellitus ◽

New Zealand ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cross Sectional Study ◽

Stroke Survivors ◽

Sectional Study ◽

Cross Sectional ◽

Increased Risk

Background There is a paucity of data relating to the association of gout with the occurrence of hypertension and diabetes mellitus in patients with stroke. This study aimed to determine the association of gout with the risk of hypertension and diabetes mellitus in a cohort of stroke patients from Auckland, Aotearoa New Zealand. Methods A cross-sectional study was conducted among stroke survivors in South and East Auckland, New Zealand from the years 2010 to 2014. Electronic health record data were collected and analysed using Statistical Package for Social Science version 23. Multivariate logistic regression modelling adjusted for age, gender, and ethnicity was conducted to determine the association of gout with the risk of hypertension and diabetes mellitus in patients discharged with a diagnosis of stroke. Results The age-, gender-, and ethnicity-adjusted odds ratio for having hypertension and diabetes mellitus among stroke survivors with gout history were 3.25 (95% confidence interval 1.32–8.03) and 1.94 (95% confidence interval 1.12–3.36), respectively. Māori stroke survivors with gout history had the highest risk of having diabetes mellitus with age- and gender-adjusted odds ratio of 5.10 (95% confidence interval 1.90–18.93). Conclusion The findings from this study suggest gout may be independently associated with an increased risk of hypertension and diabetes mellitus in patients with stroke. Māori who are the indigenous population of New Zealand show a greater risk of diabetes mellitus associated with a gout diagnosis compared to other populations. This finding highlights the importance of the need for further research with Māori stroke survivors and other indigenous populations.

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E-Cigarette Advice to Patients From Physicians and Dentists in the United States

American Journal of Health Promotion ◽

10.1177/0890117117710876 ◽

2017 ◽

Vol 32 (5) ◽

pp. 1228-1233 ◽

Cited By ~ 5

Author(s):

Olivier Drouin ◽

Robert C. McMillen ◽

Jonathan D. Klein ◽

Jonathan P. Winickoff

Keyword(s):

United States ◽

The United States ◽

Fisher Exact Test ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Exact Test ◽

The Past ◽

Random Digit Dialing ◽

Potential Benefits ◽

Nationally Representative

Purpose: To report on adults’ recall of discussion by physicians and dentists about e-cigarettes. Design: A nationally representative cross-sectional survey (Internet and random digit dialing) in the United States. Participants: Adults who ever used e-cigarettes. Measures: Participant-reported discussion about the potential benefits and harms of e-cigarettes with their doctor, dentist, or child’s doctor in the past 12 months. Analysis: Fisher exact test for the analysis between benefits and harms for each type of provider and for rates of advice between provider types. Results: Among the 3030 adults who completed the survey, 523 (17.2%) had ever used e-cigarettes. Of those who had seen their doctor, dentist, or child’s doctor in the last year, 7.3%, 1.7%, and 10.1%, respectively, reported discussing potential harms of e-cigarettes. Conversely, 5.8%, 1.7%, and 9.3% of patients who had seen their doctor, dentist, or child’s doctor in the last year reported that the clinician discussed the potential benefits of e-cigarettes. Each clinician type was as likely to discuss harms as benefits. Rates of advice were similar between doctors and child’s doctors but lower for dentists. Rates were comparable when the analysis was limited to current e-cigarette users, participants with children, or those who reported using both e-cigarettes and combusted tobacco. Conclusions: Few physicians and dentists discuss either the harms or benefits of e-cigarettes with their patients. These data suggest an opportunity to educate, train, and provide resources for physicians and dentists about e-cigarettes and their use.

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Health-related Quality of Life Using WHODAS 2.0 and Associated Factors 1 Year After Stroke in Korea: a Multi-center and Cross-sectional Study

10.21203/rs.3.rs-593276/v1 ◽

2021 ◽

Author(s):

HeyJean Lee ◽

Jung-Kook Song ◽

Jiyoung Moon ◽

Keonyeop Kim ◽

Hyeung-Keun Park ◽

...

Keyword(s):

Associated Factors ◽

Recurrent Stroke ◽

Cross Sectional Study ◽

The Self ◽

Stroke Survivors ◽

Sectional Study ◽

Cross Sectional ◽

Neurological Sequelae ◽

Whodas 2.0 ◽

General Weakness

Abstract Background: The self-perceived level of disability for stroke survivors in community is little known. We aimed to characterize HRQoL 1 year after stroke and to investigate how socio-demographic and stroke-related factors and medical adherence explain the self-perceived level of disability among a Korean stroke population.Methods: This study was a multi-center and cross-sectional study. A total of 426 ischemic stroke survivors at 1 year after onset recruited from 11 university hospitals underwent a one-session assessment including: socioeconomic variables, the modified Rankin Scale (mRS), various neurological sequelae, the modifed Morisky scale (MMS), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 36-items. The relationship between disability and different variables was analyzed using ordinal logistic regression. Results: The prevalence of disability by global WHODAS 2.0 score was 62.6% (41.6% for mild; 16.0% for moderate; 5.0% for severe) in subjects. Prevalence of severe disability was higher in Participation in society (16.8%) and Getting around (11.8%) than in the other domains. Low MMS motivation was the only factor determining the significant association between all six domains of disability after adjustment. Different predictors for specific domains were age, mRS, dysarthria, trouble seeing, cognition problem and MMS-motivation for Understanding and communicating; age, recurrent stroke, mRS, hemiplegia, facial palsy, general weakness and MMS-motivation for Getting around; age, education, mRS, hemiplegia and MMS-motivation for Self-care; age, education, recurrent stroke, hemiplegia, dysarthria and MMS-motivation for Getting along with people; age, education, income, mRS, hemiplegia, dysarthria, MMS-knowledge and MMS-motivation for Life activities; living without spouse, recurrent stroke, mRS, hemiplegia, dysarthria, trouble seeing, cognition problem, general weakness and MMS-motivation for Participation in society.Conclusions: Self-perceived disability by the WHODAS 2.0 had almost double the prevalence compared to hemiplegia, one of the most common neurological sequelae 1 year after stroke. Each domain of disability increased with various associated factors. Interventions promoting medical adherence of motivation seem to help high HRQoL in all domains.

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