Patient and healthcare system factors associated with participation in municipal smoking cessation programs after hospitalization for atherosclerotic vascular disease in Norway: A prespecified analysis of two randomized controlled trials
TL;DR
Older patients, those living alone, and patients with lower level of education were less likely to participate in a municipal smoking cessation program, highlighting the need for targeted referral strategies and tailored support for these groups.
Abstract
Introduction Persistent smoking after hospitalization for an atherosclerotic vascular event remains common, and only a small proportion attend cardiac rehabilitation or community-based lifestyle support, including smoking cessation programs. This study aimed to identify patient and healthcare system factors associated with participation in a municipal smoking cessation program among patients with atherosclerotic vascular disease included in a smoking cessation trial. Methods A prespecified secondary analysis was conducted of two randomized cessation trials with patients recruited between 2021 and 2023 at three hospitals in Norway. Hospitalized patients with established atherosclerotic vascular disease who smoked at least one cigarette daily were randomized to motivational counseling with proactive referral to the municipal cessation program (intervention) or brief advice and contact information (control). Data were collected from medical records and self-report questionnaires. Associations between patient and healthcare system factors and program participation were explored using logistic regression analyses, adjusting for age, site and group allocation. Results In all, 268 of 280 patients were eligible at 6 months (median age 65 years, 39% women). Participation in the cessation program was 42% (56/134) in the intervention and 9% (12/134) in the control group. Among participants, 57% (39/68) quit smoking, compared with 30% (59/200) among non-participants. In the total sample, older age (adjusted odds ratio, AOR=0.65 per 10 year increase; 95% CI: 0.47–0.90), living alone versus with others (AOR=0.30; 95% CI: 0.14–0.65), and lower versus higher education (AOR=0.40; 95% CI: 0.18–0.89) were negatively associated with participation. Analysis restricted to the intervention group yielded consistent findings. Conclusions Participation in a municipal smoking cessation program among hospitalized patients with atherosclerotic vascular disease remained suboptimal, despite proactive motivational counseling and proactive referral. Older patients, those living alone, and patients with lower level of education were less likely to participate, highlighting the need for targeted referral strategies and tailored support for these groups.