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Susmita Parashar, MD, MPH, MS; Nazeera Dawood, MD, MPH; Kimberly J. Reid, MPH; John Spertus, MD, MPH; Viola Vaccarino, MD, PhD

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In reply

We appreciate the feedback from Shah et al on our article.¹ They raise concern on the use of "economic burden" instead of annual income as a potential predictor of smoking cessation after a myocardial infarction (MI) in our study. To assess economic burden, at the time of MI hospitalization, we asked patients whether they avoided health care services in the prior year due to costs. Although our bivariate analysis showed that annual income less than $10 000 was a significant predictor of not quitting smoking, we chose to use "economic burden" for the following reasons: (1) We focused specifically on patients' self-reported financial burden rather than inferring it from their reported income because patients with higher income may avoid health care services because of, for example, personal debts, . . . [Full Text of this Article]

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