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Factors Associated With Continued Smoking in Lebanese Patients With Acute Coronary Syndrome

Noureddine, Samar, PhD, RN, FAHA, FAAN; Massouh, Angela, PhD, RN

doi: 10.1097/JCN.0000000000000514
ARTICLES: Smoking in ACS

Background: Smoking in patients with acute coronary syndrome (ACS) increases their risk for recurrent events and death.

Objectives: The aim of this study was to describe the smoking trajectory among patients hospitalized with ACS and associated factors.

Methods: Forty patients with ACS who were smokers were interviewed in the hospital about smoking history, nicotine dependence, depression, self-efficacy, and social support. Phone interviews at 1, 3, 6, and 12 months after discharge assessed smoking status and related factors.

Results: Most patients (≥80%) were middle-aged married men, with high nicotine dependence (52.5%) and low self-efficacy for smoking cessation (mean [SD], 38.3 [27.19]) at baseline. Although 85% intended to quit after discharge, 62.5% continued smoking after 1 year. Persistent smoking was associated with lower self-efficacy (P < .01) and higher depression (P = .025).

Conclusion: Smoking cessation intervention must start in the hospital and continue for 6 months. The program must target self-efficacy, manage depression, and involve the patient’s family.

Samar Noureddine, PhD, RN, FAHA, FAAN Professor, Hariri School of Nursing, American University of Beirut, Lebanon.

Angela Massouh, PhD, RN Assistant Professor, Hariri School of Nursing, American University of Beirut, Lebanon.

The authors have no funding or conflicts of interest to disclose.

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Correspondence Samar Noureddine, PhD, RN, FAHA, Hariri School of Nursing, American University of Beirut, Maamari St, Beirut 1107 2020, Lebanon (

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