title: Smoking Cessation in Pulmonary Care Subjects: A Mixed Methods Analysis of Treatment-Seeking Participation and Preferences.
abstract: BACKGROUND
  African-American smokers experience disproportionate COPD morbidity. As a front-line COPD behavioral management strategy, smoking cessation is less prevalent among African-American smokers. Identifying barriers and predictors to smoking cessation in this population is important to bridging this disparity.
  
  
  METHODS
  In this study, the predictors of enrollment and attendance to a 3-session urban hospital smoking cessation program were examined. A retrospective chart review was conducted for all pulmonary clinic patients who smoked and were referred to the cessation program between June 2013 and May 2014. Demographic, smoking behavior, cardiopulmonary, and health status variables were extracted (N = 253). Second, a qualitative assessment of the beliefs and barriers for smoking cessation and physical activity were examined in a sub-sample of the population (n = 41).
  
  
  RESULTS
  One-hundred forty-seven of the pulmonary subjects (58%) enrolled in the cessation program, and 40 attended all sessions (16% of the total sample). Participants with COPD (odds ratio = 4.65, P = .030), or had a mother who had cancer (odds ratio = 4.49, P = .027), were more likely to attend the program. Qualitatively, pulmonary care patients who wanted to quit smoking and be more physically active cited: strong beliefs about the inability to engage in these behaviors, belief that quitting and increased activity might exacerbate poor health, and an inability to obtain pharmacotherapy as barriers to adopting these behaviors.
  
  
  CONCLUSIONS
  Smoking cessation program attendance in this sample of mostly African-American smokers was poor. Increased knowledge about cessation benefits and access to full-course pharmacotherapy, particularly in those without a COPD diagnosis and who do not have a maternal history of cancer, may be high-priority targets to promote cessation program uptake in this population. Increased knowledge and access to safe forms of physical activity may also be beneficial.
authors.affiliation: Center of Biomedical Research Excellence (COBRE) in Cardiovascular Health and the Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware. fredap@udel.edu.
authors.forename: Freda
authors.initials: F
authors.lastname: Patterson
authors.affiliation: Treatment Research Institute, Philadelphia, Pennsylvania.
authors.forename: David S
authors.initials: DS
authors.lastname: Zaslav
authors.affiliation: Temple University Lung Center, Temple University Health System, Ambulatory Care Center, Philadelphia, Pennsylvania.
authors.forename: Diana
authors.initials: D
authors.lastname: Kolman-Taddeo
authors.affiliation: Department of Epidemiology and Biostatistics, College of Health Sciences, Temple University, Philadelphia, Pennsylvania.
authors.forename: Hillary
authors.initials: H
authors.lastname: Cuesta
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Temple University School of Medicine Episcopal Campus, Philadelphia, Pennsylvania.
authors.forename: Mary
authors.initials: M
authors.lastname: Morrison
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Presbyterian Medical Center, Philadelphia, Pennsylvania.
authors.forename: Frank T
authors.initials: FT
authors.lastname: Leone
authors.affiliation: Temple University Lung Center, Temple University Health System, Ambulatory Care Center, Philadelphia, Pennsylvania.
authors.forename: Aditi
authors.initials: A
authors.lastname: Satti
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000368:Aged; D003324:Coronary Artery Disease / Q000523:psychology; D015444:Exercise; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000191:economics; D010349:Patient Compliance; D057240:Patient Preference; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology; D012189:Retrospective Studies; D012907:Smoking; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D000068580:Varenicline / Q000191:economics
chemical_list: D018722:Nicotinic Agonists; D000068580:Varenicline
keywords: COPD; mixed methods; physical activity; prevention; pulmonary care; smoking cessation