[ETAP: A smoking scale for Primary Health Care]
Pilar María González Romero1, Francisco Javier Cuevas Fernández2, Itahisa Marcelino Rodríguez3
1Servicio de Urgencias, Hospital Universitario NS de Candelaria, Sta. Cruz de Tenerife, España.
Objective:
To obtain a scale of tobacco exposure to address smoking cessation.
Design:
Follow-up of a cohort. Scale validation.
Setting:
Primary Care Research Unit. Tenerife.
Participants:
A total of 6729 participants from the "CDC de Canarias" cohort.
Methods:
A scale was constructed under the assumption that the time of exposure to tobacco is the key factor to express accumulated risk. Discriminant validity was tested on prevalent cases of acute myocardial infarction (AMI; n=171), and its best cut-off for preventive screening was obtained. Its predictive validity was tested with incident cases of AMI (n=46), comparing the predictive power with markers (age, sex) and classic risk factors of AMI (hypertension, diabetes, dyslipidaemia), including the pack-years index (PYI).
Results:
The scale obtained was the sum of three times the years that they had smoked plus years exposed to smoking at home and at work. The frequency of AMI increased with the values of the scale, with the value 20 years of exposure being the most appropriate cut-off for preventive action, as it provided adequate predictive values for incident AMI. The scale surpassed PYI in predicting AMI, and competed with the known markers and risk factors.
Conclusion:
The proposed scale allows a valid measurement of exposure to smoking and provides a useful and simple approach that can help promote a willingness to change, as well as prevention. It still needs to demonstrate its validity, taking as reference other problems associated with smoking.
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