High intensity smoking cessation interventions: Cardiac patients of low socioeconomic status and low intention to quit profit most

N Berndt; H de Vries; L Lechner; F Van Acker; E S Froelicher; F Verheugt; A Mudde; C Bolman

doi:10.1007/s12471-016-0906-7

High intensity smoking cessation interventions: Cardiac patients of low socioeconomic status and low intention to quit profit most

Neth Heart J. 2017 Jan;25(1):24-32. doi: 10.1007/s12471-016-0906-7.

Authors

N Berndt^{1

2}, H de Vries³, L Lechner⁴, F Van Acker^{4

5}, E S Froelicher⁶, F Verheugt⁷, A Mudde⁴, C Bolman⁴

Affiliations

¹ Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands. nadine.berndt@igss.etat.lu.
² Cellule d'Expertise Médicale, General Inspectorate of Social Security, Ministry of Social Security, Luxembourg, Luxembourg. nadine.berndt@igss.etat.lu.
³ Department of Health Promotion, Caphri School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
⁴ Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands.
⁵ Department of Remedial Education, Artesis Plantijn Hogeschool Antwerpen, Antwerpen, Belgium.
⁶ Department of Physiological Nursing, School of Nursing, and Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, California, USA.
⁷ Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.

Abstract

Background: Without assistance, smokers being admitted to the hospital for coronary heart disease often return to regular smoking within a year.

Objective: This study assessed the 12-month effectiveness of a telephone and a face-to-face counselling intervention on smoking abstinence among cardiac patients. Differential effects for subgroups varying in their socioeconomic status and intention to quit smoking were also studied.

Methods: A randomised controlled trial was used. During hospital stay, smokers hospitalised for coronary heart disease were assigned to usual care (n = 245), telephone counselling (n = 223) or face-to-face counselling (n = 157). Eligible patients were allocated to an intervention counselling group and received nicotine patches. After 12 months, self-reported continued abstinence was assessed and biochemically verified in quitters. Effects on smoking abstinence were tested using multilevel logistic regression analyses applying the intention-to-treat approach.

Results: Compared with usual care, differential effects of telephone and face-to-face counselling on continued abstinence were found in patients with a low socioeconomic status and in patients with a low quit intention. For these patients, telephone counselling increased the likelihood of abstinence threefold (OR = 3.10, 95 % CI 1.32-7.31, p = 0.01), whereas face-to-face counselling increased this likelihood fivefold (OR = 5.30, 95 % CI 2.13-13.17, p < 0.001). Considering the total sample, the interventions did not result in stronger effects than usual care.

Conclusion: Post-discharge telephone and face-to-face counselling interventions increased smoking abstinence rates at 12 months compared with usual care among cardiac patients of low socioeconomic status and low quit intentions. The present study indicates that patients of high socioeconomic status and high quit motivation require different cessation approaches.

Keywords: Coronary heart disease; Face-to-face counselling; Intention to quit; Smoking cessation; Socioeconomic status; Telephone counselling.