Clinical and psychosocial factors predicting persistentsmoking in hospitalized patients with atheroscleroticvascular disease: A prespecified analysis of two randomizedcontrolled trials

INTRODUCTION: Smoking remains prevalent after hospitalization for atherosclerotic vascular disease, even with cessation programs. Understanding the clinical and psychosocial factors influencing long-term abstinence is essential for identifying patients who may benefit from tailored interventions. This study aimed to identify clinical and psychosocial factors associated with sustained smoking cessation in patients with atherosclerotic disease who were admitted to hospital for an elective or unplanned vascular event and enrolled in a cessation intervention study. METHODS: This is a prespecified analysis of two randomized intervention trials that recruited participants from three secondary care hospitals in Norway between 2021 and 2023. Patients who smoked at least one cigarette daily before admission were randomized to: 1) motivational counselling and proactive referral to municipal cessation services (intervention); or 2) brief advice and contact information (control). Data were collected from medical records, a questionnaire, and telephone interviews. Logistic regression analyses were used to identify the prespecified factors associated with smoking status at 12 months. RESULTS: In the total study population (n=262), 34% (n=88) reported 12-month sustained smoking abstinence. Anxiety diagnosis (adjusted odds ratio, AOR=4.2), shorter sleep duration per hour (AOR=1.3), living alone (AOR=2.2), somatic comorbidity per point on the Charlson score (AOR=1.5), and being in the precontemplation stage (AOR=2.9) were associated with persistent smoking. Increasing motivation per point on a 0-10 Likert scale (AOR=0.7), being in the preparation stage (AOR=0.4), and myocardial infarction or stroke as the index diagnosis (AOR=0.5) were associated with smoking abstinence. Results were generally consistent across intervention allocation groups. CONCLUSIONS: Motivation and readiness for smoking cessation were key predictors of abstinence. Living alone, anxiety disorders, and shorter sleep duration were associated with persistent smoking. These factors may help identify subgroups who could benefit from more targeted support. CLINICAL TRIAL REGISTRATION: The study is registered on the official website of ClinicalTrials.gov. IDENTIFIERS: NCT04772144 and NCT05049174.