Ethnicity and smoking status are associated with awareness of smoking related genitourinary diseases, "Beyond the Abstract," by Lindsay Lombardo, DO and Courtney M. P. Hollowell, MD, FACS

BERKELEY, CA ( - Cigarette smoking is the single leading cause of preventable death in the United States. Many campaigns against smoking focus on raising awareness of smoking-related illness such as lung cancer, heart disease, emphysema, and oropharyngeal cancer. However, there has been no effort to raise awareness of the relationship between smoking and genitourinary disease. Awareness of the relationship between a behavior and its health consequence is a major contributing factor to the motivation to make a lifestyle change. As urologists, we are in a unique position to educate patients about the increased risk of genitourinary diseases in smokers. Smoking cessation should be included in the treatment plan for patients with bladder cancer, as it has been shown to reduce recurrence, and erectile dysfunction, as it has been shown to improve erectile tumescence and time to arousal.[1, 2, 3, 4, 5, 6]

In an effort to better understand patients’ knowledge of the various risks of smoking and to determine what factors are associated with decreased awareness, we surveyed a convenience sample of 535 patients in a urology clinic. Our data revealed that 25.2%, 33.5% and 24.2% of patients who presented to a tertiary urology clinic recognized smoking as a risk factor for bladder cancer, kidney cancer and erectile dysfunction, respectively. This was compared to 94% recognizing smoking as a risk factor for lung cancer. Hispanic and black patients were less likely to know the association of bladder cancer and smoking as compared to white patients. Current smokers were also less aware of the causal effects of smoking and bladder cancer, kidney cancer, and erectile dysfunction as compared to former smokers. Respondents with advanced education (an associate, bachelor or graduate degree) were more likely to be aware of smoking as a risk factor for bladder cancer and erectile dysfunction, but not for kidney cancer.[7]

Since our study was a cross-sectional analysis of urology patients, of whom some may have been previously informed of the deleterious effects of smoking on GU diseases, awareness among the general population may be even poorer. In our paper, overall knowledge of smoking-related GU diseases was low, but vulnerable populations, including African Americans and Hispanics, were even less likely to have knowledge of the risk of smoking in GU diseases. How do we reach the general population and especially these vulnerable groups who are most at risk for decreased awareness?

The Centers for Disease Control and Prevention spent $54 million on a 90-day antismoking campaign in 2012, “Tips From Former Smokers”, featuring stories of people affected personally by smoking. It appeared on radio, TV, billboards, and social media such as Facebook and Twitter.[8] The long-term effect of the campaign is unclear at this time, but the CDC reported a doubling of calls to the national quit line (1-800-QUIT-NOW) and tripling of traffic on the website. Of note, none of the featured patients had GU-related illness, though the CDC website lists bladder and kidney cancer as smoking-related cancers. The CDC is planning another campaign -- which may present an opportunity to feature a bladder cancer patient -- in order to increase awareness. Also, according to consumer reports, pharmaceutical companies spent over $300 million in 2007 on ad campaigns for the top three ED drugs.[9] Collaboration with pharmaceutical companies regarding educating patients about smoking cessation as an additional treatment for ED may provide an opportunity to raise awareness about the relationship between ED and smoking.

Aside from big media, education regarding smoking-related GU diseases must start in our clinics. With this study, we hope to reveal the importance of educating urology patients about the impact of smoking on genitourinary diseases. We must educate our patients, engage in smoking cessation conversations with our tobacco-using patients, and promote public awareness.


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  2. Hunt, J. D., van der Hel, O. L., McMillan, G. P. et al.: Renal cell carcinoma in relation to cigarette smoking: meta-analysis of 24 studies. Int J Cancer, 114: 101, 2005
  3. Harte, C. B., Meston, C. M.: Association between smoking cessation and sexual health in men. BJU Int, 109: 888, 2012
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  5. Lammers, R. J., Witjes, W. P., Hendricksen, K. et al.: Smoking status is a risk factor for recurrence after transurethral resection of non-muscle-invasive bladder cancer. Eur Urol, 60: 713, 2011
  6. Guay, A. T., Perez, J. B., Heatley, G. J.: Cessation of smoking rapidly decreases erectile dysfunction. Endocr Pract, 4: 23, 1998
  7. Bjurlin, M. A., Cohn, M. R., Freeman, V. L. et al.: Ethnicity and smoking status are associated with awareness of smoking related genitourinary diseases. J Urol, 188: 724, 2012
  8. Rigotti, N. A., Wakefield, M.: Real People, Real Stories: A New Mass Media Campaign That Could Help Smokers Quit. Annals of Internal Medicine, 157: 907, 2012
  9. Berman, J.: Are Erectile Dysfunction Ads Too Sexy?: ABC News, 2009


Written by:
Lindsay Lombardo, DO and Courtney M. P. Hollowell, MD, FACS as part of Beyond the Abstract on This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Division of Urology, Department of Surgery, Cook County Hospital, Cook County Health and Hospitals System, Chicago, Illinois 60612 USA

Ethnicity and smoking status are associated with awareness of smoking related genitourinary diseases - Abstract


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