Patterns of smoking cessation in the first 3 years after stroke: the South London Stroke Register.
BACKGROUND
Stroke survivors are at high risk of recurrent strokes and other vascular events. Smoking is an established risk factor for stroke, with cessation recommended for secondary prevention. Little is known about patterns of smoking cessation after stroke.


METHODS
A prospective cohort of patients was identified.


METHODS
Data were derived from the population-based South London Stroke Register. Self-reported smoking status was measured at the time of stroke, at 3 months, and at 1 and 3 years after stroke. Stroke survivors, who were smoking at the time of stroke and were alive 3 years later, were included. Logistic regression was used to examine associations between age, sex, ethnicity, socioeconomic status, risk factors, stroke subtype, disability, and probability of attempting and maintaining smoking cessation.


RESULTS
Complete smoking data were available for 363 survivors with strokes between 1995 and 2003. In all, 71% of the smokers had attempted to quit within 3 years; 30% had quit and maintained cessation at 1 and 3 years; 10% had quit immediately after stroke, but had subsequently relapsed (smoking again at 1 and 3 years); and 25% of the smokers had quit after 3 months. Black ethnicity [odds ratio (OR): 6.20; confidence interval (CI): 2.39-16.10] and more severe disability (P=0.035) were predictors of attempts to quit. Older age (OR: 0.30; CI: 0.13-0.71) and black ethnicity (OR: 0.30; CI: 0.15-0.60) reduced the likelihood of smoking at 3 years. Among those attempting cessation, being older predicted maintenance (OR: 4.50; CI: 1.50-13.51).


CONCLUSIONS
The majority of smokers had attempted to quit after stroke; however, a minority achieved sustained cessation in the longer term. Cessation patterns are complex, and interventions should be targeted at multiple time points.
Ives
Sharon P
SP
Division of Health & Social Care Research, King's College London, London, UK. sharon.ives@kcl.ac.uk
Heuschmann
Peter U
PU
Wolfe
Charles D A
CD
Redfern
Judith
J
D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000523:psychology / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology / Q000523:psychology*; D000071939:Stroke Rehabilitation; D013997:Time Factors