title: Long-term predictors of smoking cessation in a cohort of myocardial infarction survivors: a longitudinal study.
abstract: BACKGROUND
  Smoking has been causally linked to cardiovascular disease, and smoking cessation after myocardial infarction (MI) has been associated with a 50% reduction in mortality. Post-MI smokers are a vulnerable population for which efforts to encourage cessation should be maximized. We examined the determinants of smoking cessation after MI.
  
  
  METHODS
  A population-based cohort of 768 Israeli smokers was followed-up longitudinally after first MI. Data were collected at study entry on demographic, socioeconomic, smoking behaviour, and clinical variables. Psychosocial measures were obtained in a subsample (n = 330). Self-reported smoking status was assessed at 3-6 months, 1-2 years, 5 years, and 10-13 years after MI. Generalized estimating equation analyses determined which factors were significant predictors of smoking status.
  
  
  RESULTS
  Point abstinence rates throughout follow-up ranged from 55% to 70%, while continuous abstinence rates were 59% after 1-2 years, 44% after 5 years, and 35% after 10-13 years, among survivors. Variables most strongly associated with persistent smoking were young age, long duration and high intensity of pre-MI smoking, low education, poor family income, lack of a steady partner, non-diabetic status, and short hospital stay at the index MI. Significant psychosocial predictors were low sense of coherence and high depression.
  
  
  CONCLUSIONS
  Determinants of smoking cessation after MI are multifactorial and include demographic, socioeconomic, smoking behaviour, clinical and psychosocial measures. Post-MI hospitalization is a window of opportunity for smoking cessation interventions. Patients should be assessed for psychosocial characteristics and those with low sense of coherence and high depression should be provided with targeted help to quit.
authors: Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. yarivg@post.tau.ac.il
authors: Yariv
authors: Y
authors: Gerber
authors: Nira
authors: N
authors: Koren-Morag
authors: Vicki
authors: V
authors: Myers
authors: Yael
authors: Y
authors: Benyamini
authors: Uri
authors: U
authors: Goldbourt
authors: Yaacov
authors: Y
authors: Drory
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation; D015996:Survival Rate / Q000639:trends; D013997:Time Factors