Spousal Smoking and Incidence of First Stroke

The Health and Retirement Study


      Few prospective studies have investigated the relationship between spousal cigarette smoking and the risk of incident stroke.


      Stroke-free participants in the U.S.-based Health and Retirement Study (HRS) aged ≥50 years and married at baseline (n=16,225) were followed, on average, 9.1 years between 1992 and 2006) for proxy or self-report of first stroke (1130 events). Participants were stratified by gender and own smoking status (never-smokers, former smokers, or current smokers), and the relationship assessed between the spouse's smoking status and the risk of incident stroke. Analyses were conducted in 2007 with Cox proportional hazards models. All models were adjusted for age; race; Hispanic ethnicity; Southern birthstate; parental education; paternal occupation class; years of education; baseline income; baseline wealth; obesity; overweight; alcohol use; and diagnosed hypertension, diabetes, or heart disease.


      Having a spouse who currently smoked was associated with an increased risk of first stroke among never-smokers (hazard ratio=1.42, 95% CI=1.05, 1.93) and former smokers (hazard ratio=1.72, 95% CI=1.33, 2.22). Former smokers married to current smokers had a stroke risk similar to respondents who themselves smoked.


      Spousal smoking poses important stroke risks for never-smokers and former smokers. The health benefits of quitting smoking likely extend to both the individual smoker and his or her spouse.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • USDHHS
        The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General.
        CDC, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta GA2006
        • Qureshi A.I.
        • Suri M.F.K.
        • Kirmani J.F.
        • Divani A.A.
        Cigarette smoking among spouses: another risk factor for stroke in women.
        Stroke. 2005; 36: E74-E76
        • Bonita R.
        • Duncan J.
        • Truelsen T.
        • Jackson R.T.
        • Beaglehole R.
        Passive smoking as well as active smoking increases the risk of acute stroke.
        Tob Control. 1999; 8: 156-160
        • Iribarren C.
        • Darbinian J.
        • Klatsky A.L.
        • Friedman G.D.
        Cohort study of exposure to environmental tobacco smoke and risk of first ischemic stroke and transient ischemic attack.
        Neuroepidemiology. 2004; 23: 38-44
        • Donnan G.A.
        • McNeil J.J.
        • Adena M.A.
        • O'Malley H.M.
        • Doyle A.E.
        • Neill G.C.
        Smoking as a risk factor for cerebral ischemia.
        Lancet. 1989; 2: 643-647
        • Lee P.N.
        • Chamberlain J.
        • Alderson M.R.
        Relationship of passive smoking to risk of lung-cancer and other smoking-associated diseases.
        Br J Cancer. 1986; 54: 97-105
        • Howard G.
        • Wagenknecht L.E.
        • Cai J.W.
        • Cooper L.
        • Kraut M.A.
        • Toole J.F.
        Cigarette smoking and other risk factors for silent cerebral infarction in the general population.
        Stroke. 1998; 29: 913-917
        • You R.X.
        • Thrift A.G.
        • McNeil J.J.
        • Davis S.M.
        • Donnan G.A.
        Ischemic stroke risk and passive exposure to spouses' cigarette smoking.
        Am J Public Health. 1999; 89: 572-575
        • Sandler D.P.
        • Comstock G.W.
        • Helsing K.J.
        • Shore D.L.
        Deaths from all causes in non-smokers who lived with smokers.
        Am J Public Health. 1989; 79: 163-167
        • Juster F.
        • Suzman R.
        An overview of the health and retirement study.
        J Hum Resour. 1995; 30: S7-S56
        • Heeringa S.G.
        • Connor J.
        Technical description of the Health and Retirement Study sample design.
        Survey Research Center, University of Michigan, Ann Arbor MI1995
        • Ofstedal M.B.
        • McAuley G.F.
        • Herzog A.R.
        Documentation of cognitive functioning measures in the health and retirement study.
        Survey Research Center, University of Michigan, Ann Arbor MI2002 (
        • Lackland D.T.
        • Egan B.M.
        • Jones P.J.
        Impact of nativity and race on “stroke belt” mortality.
        Hypertension. 1999; 34: 57-62
        • Glymour M.M.
        • Avendano M.P.
        • Berkman L.F.
        Is the stroke belt worn from childhood?.
        Stroke. 2007; 38: 2415-2421
        • St. Clair P.
        • Blake D.
        • Bugliari D.
        • et al.
        RAND HRS data documentation, Version G.
        2007 (
        • Carpenter J.
        • Bithell J.
        Bootstrap confidence intervals: when, which, what?.
        Stat Med. 2000; 19: 1141-1164
        • Rust K.
        • Rao J.
        Variance estimation for complex surveys using replication techniques.
        Stat Methods Med Res. 1996; 5: 283-310
        • Howard G.
        • Goff D.C.
        A call for caution in the interpretation of the observed smaller relative importance of risk factors in the elderly.
        Ann Epidemiol. 1998; 8: 411-414
        • Engstad T.
        • Bonaa K.H.
        • Viitanen M.
        Validity of self-reported stroke: the Tromso study.
        Stroke. 2000; 31: 1602-1607
        • Beckett M.
        • Weinstein M.
        • Goldman N.
        • Lin Y.H.
        Do health interview surveys yield reliable data on chronic illness among older respondents?.
        Am J Epidemiol. 2000; 151: 315-323
        • Bergmann M.M.
        • Byers T.
        • Freedman D.S.
        • Mokdad A.
        Validity of self-reported diagnoses leading to hospitalization: a comparison of self-reports with hospital records in a prospective study of American adults.
        Am J Epidemiol. 1998; 147: 969-977
        • Magaziner J.
        • Bassett S.S.
        • Hebel J.R.
        • Gruber-Baldini A.
        Use of proxies to measure health and functional status in epidemiologic studies of community-dwelling women aged 65 years and older.
        Am J Epidemiol. 1996; 143: 283-292