Smoking Behaviors and Disease Awareness in Cohabiting Relatives of Advanced COPD Patients: A Cross-Sectional Study

Abstract

Objectives: This study aimed to evaluate smoking behavior, nicotine dependence, and Chronic Obstructive Pulmonary Disease (COPD) awareness among cohabiting relatives and examine their associations with household exposure dynamics and patient clinical outcomes. Methods: In this single-center, cross-sectional study, 1 cohabiting relative of each of 50 patients diagnosed with Global Initiative for Chronic Obstructive Lung Disease (GOLD) group E COPD was enrolled. Data were collected via face-to-face interviews. Nicotine dependence among active smokers was measured using the Fagerström Test for Nicotine Dependence; smoking-COPD awareness was assessed using a researcher-developed 5-item true/false questionnaire. Results: Active smokers comprised 38% (n = 19) of relatives. Although 94% to 100% correctly identified smoking roles and indoor smoke harms, a critical thirdhand smoke knowledge gap was identified: 68% (n = 34) held the misconception that smoking exclusively on the balcony adequately protects patients. This misconception persisted in 69% (31/45) of those abstractly acknowledging thirdhand smoke harms and was significantly associated with older age (odds ratio [OR], 2.64 per 10-year increase; 95% confidence interval [CI], 1.38–5.06). Patient hospitalizations and home protective practices were driven by the relative’s smoking status rather than awareness level. The frequent hospitalization rate (≥2) was 84% when the relative smoked compared with 45% when they did not (adjusted OR, 6.34; 95% CI, 1.52–26.55; P = .011). Conclusions: Cohabiting relatives demonstrate high general knowledge regarding tobacco smoke harms, yet the misconception that balcony smoking provides sufficient protection is widespread. Interventions should combine targeted education with structured smoking-cessation support.