Background Little is known about the prevalence of secondhand smoke exposure (SHSe) among cancer survivors. We sought to determine the prevalence, trends, and correlates of SHSe among non-smoking adult cancer survivors in the United States (US). Methods Interview and serum cotinine data for non-smoking adults, aged 20 years and older, with a history of cancer (N=686) were obtained from consecutive 2-year cross-sectional cycles of the National Health and Nutrition Examination Survey from 1999–2012. SHSe was defined as serum cotinine 0.05–10ng/mL among non-smokers. We calculated and trended the prevalence of SHSe among non-smoking cancer survivors. Multivariable logistic regression was used to examine the associations of SHSe with sociodemographic, smoking, and clinical characteristics. Survey weights were applied in estimating prevalence rates, adjusted odds ratios, and confidence intervals (CI). Results The weighted aggregate SHSe and self-reported indoor SHSe prevalence rates over the study period were 28.26% (95% CI: 24.97%, 31.55%) and 4.53% (95% CI: 3.48%, 5.57%), respectively. SHS exposure declined from 39.61% (95% CI: 27.88%, 51.34%) in 1999/2000 to 15.68% (95% CI: 9.38%, 21.98%) in 2011/2012 (p<0.001 for trend). Age ≥60 years was protective against SHSe while being black, having less than high school education, poverty, and a smoking-related cancer history were associated with higher odds of SHSe. Conclusion Fortunately, SHSe among non-smoking cancer survivors in the US is on the decline, although certain sub-groups remain disproportionately burdened. Impact These findings highlight clinical and public health imperatives to target socioeconomically disadvantaged non-smoking cancer survivors to reduce their SHSe.

Reversible cerebral vasoconstriction syndrome (RCVS), is rare in the pediatric population and is characterized by severe headaches and other neurologic symptoms. We present a case of RCVS occurring concomitantly with posterior reversible encephalopathy syndrome in an 8-year-old African American child with sickle cell disease (HbSS). Imaging studies including computed tomography, magnetic resonance imaging and cerebral angiography of the brain showed acute hemorrhagic stroke and a beaded appearance of peripheral cerebral vessels. In this report, we focus on the typical features of RCVS and discuss the underlying risk factors that may increase the risk in patients with HbSS disease.

Spurred on by recent health care reforms and the Triple Aim’s goals of improving population health outcomes, reducing health care costs, and improving the patient experience of care, emphasis on population health is increasing throughout medicine. Population health has the potential to improve patient care and health outcomes for individual patients. However, specific population health activities may not be in every patient’s best interest in every circumstance, which can create ethical tensions for individual physicians and other health care professionals. Because individual medical professionals remain committed primarily to the best interests of individual patients, physicians have a unique role to play in ensuring population health supports this ethical obligation. Using widely recognized principles of medical ethics—nonmaleficence/beneficence, respect for persons, and justice—this article describes the ethical issues that may arise in contemporary population health programs and how to manage them. Attending to these principles will improve the design and implementation of population health programs and help maintain trust in the medical profession.

Recent research provides important guidance for clinicians caring for hospitalized patients with serious illnesses, including symptom management, ACP, moral distress, and outcomes of critical illness.