Validity of self-reported adult secondhand smoke exposure

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Exposure of adults to secondhand smoke (SHS) has immediate adverse effects on the cardiovascular system and causes coronary heart disease. The current study evaluated brief self-report screening measures for accurately identifying adult cardiology patients with clinically significant levels of SHS exposure in need of intervention.

Design and setting

A cross-sectional study conducted in a university-affiliated cardiology clinic and cardiology inpatient service.


Participants were 118 non-smoking patients (59% male, mean age=63.6□years, SD=16.8) seeking cardiology services.

Main outcome measures

Serum cotinine levels and self-reported SHS exposure in the past 24□h and 7□days on 13 adult secondhand exposure to smoke (ASHES) items.


A single item assessment of SHS exposure in one's own home in the past 7□days was significantly correlated with serum cotinine levels (r=0.41, p<0.001) with sensitivity ≥75%, specificity >85% and correct classification rates >85% at cotinine cut-off points of >0.215 and >0.80□ng/mL. The item outperformed multi-item scales, an assessment of home smoking rules, and SHS exposure assessed in other residential areas, automobiles and public settings. The sample was less accurate at self-reporting lower levels of SHS exposure (cotinine 0.05–0.215□ng/mL).


The single item ASHES-7d Home screener is brief, assesses recent SHS exposure over a week's time, and yielded the optimal balance of sensitivity and specificity. The current findings support use of the ASHES-7d Home screener to detect SHS exposure and can be easily incorporated into assessment of other major vital signs in cardiology.

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