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(Stroke. 2003;34:1859.)
© 2003 American Heart Association, Inc.

Original Contributions

Risk Factors for Continued Cigarette Use After Subarachnoid Hemorrhage

Jennifer Ballard, BA; Kurt T. Kreiter, PhD; Jan Claassen, MD; Robert G. Kowalski, BS; E. Sander Connolly, MD Stephan A. Mayer, MD

From the Division of Critical Care Neurology, Departments of Neurology (J.B., K.T.K., J.C., S.A.M.) and Neurosurgery (E.S.C., S.A.M.), Columbia University College of Physicians and Surgeons, New York, NY.

Reprint requests to Stephan A. Mayer, MD, Division of Critical Care Neurology, Neurological Institute, 710 W 168th St, Unit 39, New York, NY 10032. E-mail sam14{at}columbia.edu

Background and Purpose— Cigarette smoking is a risk factor for the formation and rupture of intracranial aneurysms. Few studies have examined predictors of resumption of cigarette smoking after a first episode of subarachnoid hemorrhage (SAH).

Methods— Of 620 SAH patients treated between July 1996 and November 2002, we prospectively evaluated continued cigarette use in 152 smokers alive at 3 months. Univariate and multivariate logistic regression analyses were used to identify potential demographic, social, and clinical predictors of continued cigarette use, defined as smoking 1 cigarette per week in the month before follow-up.

Results— Thirty-seven percent (56 of 152) resumed smoking after their SAH. Patients who continued smoking were younger, were more often black, had begun smoking at an earlier age, and had a higher frequency of prior alcohol or cocaine use and self-reported depression or anxiety than those who quit (all P<0.05). Smoking at 16 years of age (odds ratio [OR], 5.88; 95% confidence interval [CI], 2.33 to 14.29), self-reported depression (OR, 5.29; 95% CI, 2.10 to 13.35), and prior alcohol use (OR, 4.51; 95% CI, 1.45 to 14.05) independently predicted continued cigarette use. Smokers had a functional outcome similar to that of nonsmokers at 3 months but were more likely to resume alcohol consumption (OR, 3.88; 95% CI, 1.91 to 7.88).

Conclusions— More than one third of prior smokers continue to use nicotine after SAH. Young age at smoking onset and a history of depression or alcohol use are risk factors for continued cigarette use. Targeted smoking cessation programs are needed to reduce the high rate of smoking resumption after SAH.

Key Words: alcohol drinking • cerebral aneurysm • cigarette smoking • subarachnoid hemorrhage