Smoking, smoking cessation, and understanding of the role of multiple cardiac risk factors among the urban poor

Objective. To determine in a population of low socioeconomic status (SES) patients: (a) rates of current smoking and smoking cessation, (b) persons' understanding of the adverse health impact of multiple cardiovascular disease (CVD) risk factors, and (c) if the diagnosis of other CVD risk factors, specifically hypertension or hypercholesterolemia, was related to smoking cessation. Design. Cross-sectional interview survey. Setting. Community clinics and eligibility centers of the Harris County Hospital District (HD), which provides primary care to over 166,000 indigent persons in Houston, Texas. Subjects. Randomly selected adults attending an HD setting for eligibility screening or primary care. Results. Over 93% of subjects approached participated (n = 547). Their mean age was 40.7 years, 55% were female, and 39% had >9 years of education. The ethnic distribution was 54% Hispanic, 28% black, and 14% non-Hispanic white. Current smoking ranged from 10% among Hispanic females to 56% among black males. The percentage of ever smokers who had quit was 24% among black males, 44% among black females, 43% among Hispanic males, and 70% among Hispanic females. The majority recognized the increase in danger from smoking in the presence of hypertension or hypercholesterolemia. Among patients who were smokers when they found out they had hypertension (n = 70), 65% reported it increased their desire to quit. After adjustment for other variables including age and known CVD, predictors of being an ex-smoker were being female (OR 2.1, 95% CI 1.3-3.5), being Hispanic (OR 2.8 95% CI 1.5-5.7), and having hypertension (OR 2.3, 95% CI 1.3-4.2). Conclusion. In this low SES population, there was substantial smoking cessation, widespread acknowledgment of the cumulative effect of smoking and other CVD risk factors, and some evidence that smoking cessation increased after the diagnosis of hypertension. (C) 1996 Academic Press, Inc.