Intention to abstain from smoking among cardiac rehabilitation patients: the role of attitude, self-efficacy, and craving.
BACKGROUND
Smoking cessation after developing coronary heart disease improves disease prognosis more than any other treatment. However, many cardiac patients continue to smoke after hospital discharge.


OBJECTIVE
The aim of this study was to investigate factors associated with the intention to (permanently) abstain from smoking among cardiac rehabilitation patients 2 to 4 weeks after discharge from hospital.


METHODS
A cross-sectional survey was conducted among 149 cardiac rehabilitation patients recruited from 2 cardiac rehabilitation centers in The Netherlands 2 to 4 weeks after hospital discharge, at the start of the cardiac rehabilitation period. Psychosocial cognitions including attitude toward nonsmoking, social influence, and self-efficacy were measured with a standardized and validated Dutch questionnaire based on the Attitude-Social Influence-Self-efficacy model. Anxiety was measured using the shortened version of the State-Trait Anxiety Inventory. Craving for cigarettes was assessed with 6 items measuring the urge to smoke. Intention toward nonsmoking was assessed with 2 visual analog scales indicating the strength and probability of the intention to permanently refrain from smoking.


RESULTS
Of all patients, 31% still smoked after hospital discharge. The smokers had a lower self-efficacy and intention to abstain from smoking and reported higher craving. Logistic regression analyses revealed that attitudes that embraced the advantages of not smoking, self-efficacy, and craving were significantly related to the intention to (permanently) abstain from smoking, whereas social influence and anxiety were not. Actual smoking behavior moderated the relation between self-efficacy and intention: only the quitters showed a significant positive relation. Anxiety did not moderate the relationship between psychosocial cognitive factors and intention.


CONCLUSIONS
The intention to (permanently) abstain from smoking, measured 2 to 4 weeks after hospitalization for a cardiac event, predominantly depends on attitude, self-efficacy, and craving. Interventions aimed at smoking cessation among cardiac rehabilitation patients should focus on these factors.
Esther C. Bakker, PhD Assistant Professor in Health Psychology, Faculty of Psychology and Educational Sciences, Department of Health Psychology, Open University of the Netherlands, Heerlen, The Netherlands. Marjan D. Nijkamp, PhD Assistant Professor in Health Psychology, Faculty of Psychology and Educational Sciences, Department of Health Psychology, Open University of the Netherlands, Heerlen, The Netherlands. Caroline Sloot, MSc Researcher, Faculty of Psychology and Educational Sciences, Department of Health Psychology, Open University of the Netherlands, Heerlen, The Netherlands. Nadine C. Berndt, PhD Researcher, Faculty of Psychology and Educational Sciences, Department of Health Psychology, Open University of the Netherlands, Heerlen, The Netherlands, and Consultant in Public Health, Cellule d'Expertise Médicale, Inspection Générale de la Sécurité Sociale, Ministère de la Sécurité, Luxembourg, Luxembourg. Catherine A. W. Bolman, PhD Associate Professor in Health Psychology, Faculty of Psychology and Educational Sciences, Department of Health Psychology, Open University of the Netherlands, Heerlen, The Netherlands.
Esther C
EC
Bakker
Marjan D
MD
Nijkamp
Caroline
C
Sloot
Nadine C
NC
Berndt
Catherine A W
CA
Bolman
D000368:Aged; D001294:Attitude to Health; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology* / Q000534:rehabilitation*; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D020377:Self Efficacy; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*