Smoking among Women Following Heart Transplantation: Should We Be Concerned?

NIH Public Access Author Manuscript Prog Cardiovasc Nurs. Author manuscript; available in PMC 2010 June 27. NIH-PA Author Manuscript Published in final edited form as: Prog Cardiovasc Nurs. 2009 December ; 24(4): 119–123. doi:10.1111/j.1751-7117.2009.00049.x. Smoking Among Women Following Heart Transplantation: Should We Be Concerned? Lorraine Evangelista, RN, PhD 1, Alvina Ter-Galstanyan, BA 1, Debra K. Moser, RN, DNSc 2, and Kathleen Dracup, RN, DNSc 3 1 School of Nursing, University of California, Los Angeles, CA School of Nursing, University of Kentucky, Lexington, KY School of Nursing, University of California, San Francisco, CA Abstract NIH-PA Author Manuscript NIH-PA Author Manuscript The serious detrimental effects of smoking after heart transplantation (HTX) are well established, but data that demonstrate the effects on female HTX recipients are scarce. The purpose of this study was to describe tobacco use, exposure to second hand smoke (ESHS), and health perceptions of female HTX recipients and examine relationships between these variables of interest and demographic and clinical characteristics of women following HTX. Seventy-two women (mean age, 54.3 ± 12.7 years; mean time since transplant, 5.5 ± 4.5 years) were enrolled from a single HTX center. Demographic and clinical data, tobacco use, ESHS, and health perceptions were obtained through self-report and chart reviews. Tobacco use was verified by measurement of urine cotinine levels. Twenty-four women were nonsmokers before and after HTX. Eighteen (37.5%) of the 48 women who were former smokers before HTX had returned to tobacco abuse. Only 4 of the 18 accurately reported their smoking behaviors. Forty percent of nonsmokers reported ESHS. Tobacco use and ESHS were highest among African American women. Forty percent of the sample perceived their health status as fair-poor; the remaining 60% reported good-excellent health. In a multivariate analysis, current tobacco use (odds ratio [OR], 5.20; confidence interval [CI], 3.83–9.13) and ESHS (OR, 1.82; CI, 1.17–2.82) were independent predictors of lower health perceptions. Although a majority of the female recipients who used tobacco ceased smoking before HTX, a substantial proportion demonstrated recurrent tobacco use after HTX. Our findings suggest the need for aggressive screening and risk factor interventions to promote smoking cessation before and after HTX in this unique population of female HTX recipients. Almost 5000 heart transplantations (HTX) were done in the United States between 2006 and 2007; approximately 26% of HTX patients were women. 1 Although an increasing number of women need and receive HTX, little is known about their health risk behaviors after HTX. In the last decade, investigators have reported poorer overall outcomes in women than men, 2 and although both men and women have equivalent survival rates in the first year after HTX, the survival rates for women drop drastically thereafter. 1 Unfortunately, mechanisms underlying gender differences in survival are poorly understood and the effect of health risk behaviors like smoking on outcomes in women is unclear. Although the serious detrimental effects of smoking are well established in the general postheart HTX population, 3 - 6 there is a paucity of research examining its impact on female HTX recipients. © 2009 Wiley Periodicals, Inc. Address for correspondence: Lorraine Evangelista, RN, PhD, School of Nursing, University of California, 700 Tiverton Ave, Factor 4-258, Los Angeles, CA 90095-6918 levangel@ucla.edu.