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Letters
October 1, 2003

Passive Smoke Exposure and Risk of Death From Coronary Heart Disease

Author Affiliations
 

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(13):1708-1709. doi:10.1001/jama.290.13.1708-a

In Reply: Although we agree with Dr Jay that exposure to SHS may cause some misclassification in smoking status, it is unlikely to be a serious flaw for several reasons. The vast majority of patients in our review were men. Smoking prevalence was likely to have been lower in women at the time these studies took place, hence a smaller proportion of men quitting smoking would have had smoking wives. Furthermore, many studies have suggested that smokers are far more likely to quit if they have spouses who do not smoke, and the smoker who quits may also persuade other household members to reduce or stop smoking.1,2 Hence, significantly fewer patients with CHD who quit smoking are likely to have been exposed to SHS at home, compared with the general population. Although exposure in the workplace was possible, most patients in this review had experienced a myocardial infarction or cardiac surgery and about half were older than 55 years, suggesting that many may not have returned to work. These points are supported by 2 large studies in our review, which used biochemical measurements, and found virtually no discrepancies with reported smoking status. Nevertheless, we strongly support calls to ban smoking in public places.

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