地域医療と健康教育

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Smoking-related Attitudes, Behaviors and Cessation Efforts among Coronary Heart Disease Patients in Hungary

Haddad L, Bakai J, Ghadban R, Ferrell A

Background: Smoking is a serious public health problem in Hungary, where at least 25% of people smoke daily and cardiovascular disease (CVD) is a leading cause of mortality of older adults. Smoking cessation is the most effective way to prevent cardiovascular disease, but many patients with CVD continue smoking after hospital discharge.
Objective: The purpose of this study was to reveal the factors, including demographics, socioeconomic status, and psychosocial barriers, that are related to persistent smoking after a diagnosis of coronary heart disease (CHD), a type of CVD.
Methodology: This study used a descriptive cross-sectional design and included 315 cardiac patients engaged in a comprehensive, outpatient cardiological rehabilitation (CR) program in Sopron, Hungary. All patients were diagnosed with coronary heart disease (CHD) at least 6 months prior to study commencement. Data were collected at the 3rd week of admission for the inpatient sample and after 12 weeks of discharge for the outpatient sample.
Results: The study sample consisted of smokers (54%), former smokers (25%), and nonsmokers (21%). Smokers had a significant reduction in cigarettes smoked after the CHD diagnosis (22 vs. 14, p<0.05). Negative health effects (n=225), doctor’s orders (n=205), and cigarette cost (n=173) were the main self-reported reasons for smoking reduction. The biggest barriers to smoking cessation were missing of cigarettes (M=2.9; SD=1.6), withdrawal symptoms (M=2.8, SD=1.4), weight gain (M=2.4, SD=1.6), fear of failing to quit (M=2.2, SD=1.5), and encouragement from family members to smoke (M=2.2, SD=1.5). In regression model for barriers to cessation, social support significantly predicted perceived barriers (t=-2.53, p=0.0121*), emotional wellbeing (t=-2.21, p=0.0280*), work stress (t=3.01, p=0.0029*), and household stress (t=2.55, p=0.0114*). In regression models for desire and confidence to quit smoking, social support significantly predicted desire (t=2.66, p=0.0086*) and confidence (t=3.75, p=0.0002*) to quit smoking.
Conclusion: Given these findings, it is likely that nicotine dependence plays a strong role in persistent tobacco use after CHD diagnosis. These findings support those of other similar studies and may lead to the development of effective cessation interventions for patients who smoke and suffer from cardiovascular disease.