Predicting Factors of Preparation Practices for Smoking Cessation among Persons with Stroke

Abstract

Stroke is a leading cause of morbidity and mortality worldwide, including in Thailand,where it ranks among the top causes of death within non-communicable diseases, particularly affecting the elderly and individuals with high-risk health behaviors. Globally, stroke is the second leading cause of death. Major risk factors for stroke include hypertension, diabetes,dyslipidemia, cardiac arrhythmias, and, notably, smoking, which is a modifiable risk factor. Empirical evidence shows that smokers have twice the risk of stroke compared to non-smokers,with risk increasing proportionally to the amount and duration of smoking. Nicotine and carbon monoxide in cigarette smoke contribute to arterial narrowing, stiffening, and impaired blood flow, thereby increasing the likelihood of thrombosis and ischemic stroke. Moreover, smoking elevates low-density lipoprotein cholesterol and blood pressure, both of which exacerbate stroke severity.

Previous studies have found that stroke patients who continue to smoke have twice the risk of recurrence and mortality compared to those who quit smoking. Therefore, smoking cessation is critically important and serves as a key health promotion goal to prevent complications and recurrence, enhance recovery, reduce disease burden, and improve quality of life. However,smoking cessation is a complex process requiring strong intention and preparatory behaviors to achieve success. Literature reviews identify factors such as attitudes, social support, and behavioral control as influential in sustaining cessation behaviors and achieving successful quitting. Thus,effective preparatory behaviors for smoking cessation constitute a crucial process driving successful quitting. This study focuses on the preparatory behavioral stage of smoking cessation.

The theoretical framework for this study is Ajzen’s Theory of Planned Behavior,which posits that health behavior is primarily determined by attitude toward the behavior (beliefs about the behavior’s consequences), subjective norm (perceived social pressure or expectations from significant others), perceived behavioral control, and behavioral intention. This study aimed to examine factors predicting preparation practices for smoking cessation, specifically attitude towards quitting, subjective norm regarding quitting, perceived behavioral control over quitting,and intention to quit. The sample comprised 116 individuals with stroke who were current smokers, recruited from the outpatient clinic of the Prasat Neurological Institute between September 2022 and May 2023, using purposive sampling criteria that included an age of at least 18 years and continued smoking in the 6 months preceding enrollment. Research instruments included a demographic questionnaire, a cognitive impairment screening test, questionnaires assessing attitudes towards quitting, subjective norms regarding quitting, perceived behavioral control over quitting, intention to quit, and preparation practices for smoking cessation. The research participants completed the questionnaires without assistance. Data were analyzed using descriptive statistics and multiple logistic regression analysis.

The majority of the sample were male (87.93%), aged 18 to 85 years, with a mean age of 54 years. Most participants (74.14%) had at least a secondary education level, and 85.34% were employees or laborers. Hypertension was present in 49.13% of the sample, and diabetes in 35.34%. Approximately 30.17% had family members who smoked. Participants had smoked for 2 to 50 years, with 56.03% exhibiting a low level of nicotine dependence and 22.41% moderate dependence. The variables of attitude, subjective norms, perceived behavioral control, and intention to quit smoking collectively predicted preparation practices for smoking cessation with statistical significance (p < .05). The predictive model correctly classified 69% of cases. Perceived behavioral control had the strongest influence on preparation practices for smoking cessation (OR = 1.06, 95% CI = 1.02–1.10, p = .004). These findings can be applied to develop care models focused on enhancing perceived behavioral control to promote appropriate and sustained preparation practices for smoking cessation, thereby increasing the success rate of smoking cessation.

Keywords : Planned behavior, Preparation practices for smoking cessation, Smoking cessation, Stroke

Author Contributions:
SN: Conceptualization, Method and design, Tool validation, Data collection, Data analysis,Writing and revising manuscript
NP: Conceptualization, Method and design, Data analysis, Writing, revising, and editing manuscript, Corresponding with editor-in-chief
SJ: Conceptualization, Method and design, conclusion, Recommendation, Revising the manuscript