Determinants of Intention to Quit Smoking Among Adults Undergoing Coronary Angiography
Main Article Content
Abstract
Introduction: Given the increased health risks associated with smoking among people living with cardiovascular disease, the prevalence of this behavior is of concern. Secondary prevention activities to support smoking cessation are essential to improve prognosis.
Objective: This study aimed to identify determinants of the intention to quit smoking among adults undergoing coronary angiography.
Method: Fifty smokers having undergone a coronary angiography in a tertiary cardiology center (Quebec, Canada) completed a self-administered questionnaire designed to measure concepts derived from the Reasoned action approach. Multiple linear regressions were conducted to identify determinants of the intention to quit smoking and beliefs most significantly associated with this intention.
Results: The intention to quit smoking scores were rather high, with a mean score of 5.4 on a scale of 7 (SD 1.27). Linear regression analyses suggest that perceived control (β = 0.51; p < 0.001) and subjective norm (β = 0.39; p = 0.02) are associated with the intention to quit smoking 1 month after a coronary angiography. The final model explains 59% of the variance of this intention. No sociodemographic, clinical, or behavioral variables appear associated with intention. The belief that it is possible to quit smoking despite withdrawal symptoms was the only variable strongly associated with the intention to quit smoking (β = 0.31; p = 0.01).
Discussion and Conclusion: These results suggest some determinants that could guide the development of interventions to promote smoking cessation among adult smokers who have undergone coronary angiography.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors hold the copyright on their papers without restrictions and retain it without restrictions after publication of the papers on the journal’s website.
References
Abu-Baker, N. N., Haddad, L. et Mayyas, O. (2010). Smoking behavior among coronary heart disease patients in Jordan: a model from a developing country. International journal of environmental research and public health, 7(3), 751–764. https://doi.org/10.3390/ijerph7030751
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T
Ajzen, I. (2012). Martin Fishbein’s Legacy: The Reasoned Action Approach. Annals of The American Academy of Political and Social Science, 640, 11-27. https://doi.org/10.1177/0002716211423363
Armitage, C. J. et Conner, M. (2001). Efficacy of the Theory of Planned Behaviour: a meta-analytic review. The British journal of social psychology, 40(Pt 4), 471–499. https://doi.org/10.1348/014466601164939
Armoon, B., Eslamian, A., Sepahvand, E., Bayani, A., Ahounbar, E., Zarepour, P., Pourjahani, F. et Mohammadi, R. (2021). Substance use and associated factors among Iranian university students: a meta-analysis. Journal of Substance Use, 27(4), 352–362. https://doi.org/10.1080/14659891.2021.1953165
Bakker, E. C., Nijkamp, M. D., Sloot, C., Berndt, N. C. et Bolman, C. A. (2015). Intention to abstain from smoking among cardiac rehabilitation patients: the role of attitude, self-efficacy, and craving. The Journal of cardiovascular nursing, 30(2), 172–179. https://doi.org/10.1097/JCN.0000000000000156
Berndt, N., Bolman, C., Mudde, A., Verheugt, F., de Vries, H. et Lechner, L. (2012). Risk groups and predictors of short-term abstinence from smoking in patients with coronary heart disease. Heart & lung : the journal of critical care, 41(4), 332–343. https://doi.org/10.1016/j.hrtlng.2012.03.001
Bernstein, S. L., Boudreaux, E. D., Cabral, L., Cydulka, R. K., Schwegman, D., Larkin, G. L., Adams, A. L., McCullough, L. B. et Rhodes, K. V. (2008). Nicotine dependence, motivation to quit, and diagnosis among adult emergency department patients who smoke: a national survey. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 10(8), 1277–1282. https://doi.org/10.1080/14622200802239272
Bhaumik, S. S., Placek, C., Kochumoni, R., Lekha, T. R., Prabhakaran, D., Hitsman, B., Huffman, M. D., Harikrishnan, S. et Goenka, S. (2019). Tobacco Cessation Among Acute Coronary Syndrome Patients in Kerala, India: Patient and Provider Perspectives. Qualitative health research, 29(8), 1145–1160. https://doi.org/10.1177/1049732318817047
Blankers, M., Buisman, R., Hopman, P., van Gool, R. et van Laar, M. (2016). Modelling intentions to provide smoking cessation support among mental health professionals in the Netherlands. Tobacco induced diseases, 14(1), 32. https://doi.org/10.1186/s12971-016-0096-5
Budnik, M. et Opolski, G. (2015). The assessment of coronary heart disease risk factors correlated with demographic and social data in post-coronary intervention patients in Polish population. Cardiology journal, 22(3), 276–284. https://doi.org/10.5603/CJ.a2015.0021
Busch, A. M., Fani Srour, J., Arrighi, J. A., Kahler, C. W. et Borrelli, B. (2015). Valued Life Activities, Smoking Cessation, and Mood in Post-Acute Coronary Syndrome Patients. International journal of behavioral medicine, 22(5), 563–568. https://doi.org/10.1007/s12529-014-9456-9
Chou, L. P., Chang, H. F., Kao, C., Lin, W. et Huang, C. L. (2013). Smoking cessation in Taiwanese male smokers with coronary artery disease: influencing factors and policy implications. International nursing review, 60(2), 244–250. https://doi.org/10.1111/inr.12004
Cohen J. (1992). A power primer. Psychological bulletin, 112(1), 155–159. https://doi.org/10.1037//0033-2909.112.1.155
Collège des médecins du Québec, Ordre des infirmières et infirmiers du Québec, Ordre des pharmaciens du Québec, & Ordre professionnel des inhalothérapeutes du Québec. (2020, janvier). Pratique professionnelle en abandon du tabac. https://www.oiiq.org/documents/20147/2943683/Pratique_Prof_Abandon_Tabac_VF.pdf/8070c287-b54e-6d4c-9b9b-ad29866053bf
Dallaire-Habel, S. (2024). Évolution et regroupements des symptômes psychologiques liés à la maladie coronarienne athérosclérotique [Thèse de doctorat, Université Laval]. CorpusUL. https://corpus.ulaval.ca/server/api/core/bitstreams/8ef268f2-d868-4fd2-b425-3f03b7d1897a/content
Dancey, C. P., Reidy, J. et Rowe, R. (2012). Statistics for the Health Sciences: A Non-Mathematical Introduction. Sage Publications Inc.
Eum, Y. H., Kim, H. J., Bak, S., Lee, S. H., Kim, J., Park, S. H., Hwang, S. E. et Oh, B. (2022). Factors related to the success of smoking cessation: A retrospective cohort study in Korea. Tobacco induced diseases, 20, 15. https://doi.org/10.18332/tid/144272
Faul, F., Erdfelder, E., Lang, A. G. et Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods, 39(2), 175–191. https://doi.org/10.3758/bf03193146
Fishbein, M. et Ajzen, I. (1975). Belief, attitude, intention and behavior: An introduction to theory of research. Reading, Mass: Addison-Westley.
Fishbein, M. et Ajzen, I. (2010). Predicting and Changing Behavior: The Reasoned Action Approach. Psychology Press. https://doi.org/10.4324/9780203838020
Godin, G.. (2012). Les comportements dans le domaine de la santé : comprendre pour mieux intervenir. Les Presses de l’Université de Montréal.
Goettler, D., Wagner, M., Faller, H., Kotseva, K., Wood, D., Leyh, R., Ertl, G., Karmann, W., Heuschmann, P. U., Störk, S. et German EUROASPIRE IV collaborators (2020). Factors associated with smoking cessation in patients with coronary heart disease: a cohort analysis of the German subset of EuroAspire IV survey. BMC cardiovascular disorders, 20(1), 152. https://doi.org/10.1186/s12872-020-01429-w
Gouvernement du Canada. (2022a). Enquête canadienne sur le tabac et la nicotine (ECTN) : sommaire des résultats pour 2020. https://www.canada.ca/fr/sante-canada/services/enquete-canadienne-tabac-nicotine/sommaire-2020.html
Gouvernement du Canada. (2022b). Les maladies du coeur au Canada. https://www.canada.ca/fr/sante-publique/services/publications/maladies-et-affections/maladies-coeur-canada.html
Gouvernement du Québec. (2015). Guide de pratiques visant à soutenir l’abandon du tabagisme à l’intention des conseillers en centres d’abandon du tabagisme et à la ligne j’Arrête. https://publications.msss.gouv.qc.ca/msss/fichiers/2015/15-006-02W.pdf
Gouvernement du Québec. (2018). Cadre de référence de l’approche de partenariat entre les usagers, leurs proches et les acteurs en santé et en services sociaux. (9782550814092; 2550814096). La Direction des communications du Ministère de la santé et des services sociaux. http://collections.banq.qc.ca/ark:/52327/3452391
Gouvernement du Québec. (2020). Soutien clinique à l’abandon du tabac. https://publications.msss.gouv.qc.ca/msss/fichiers/2019/19-006-03F.pdf
Gravely, S., Cummings, K. M., Hammond, D., Borland, R., McNeill, A., East, K. A., Loewen, R., Martin, N., Yong, H. H., Li, L., Liber, A., Levy, D. T., Quah, A. C. K., Ouimet, J., Hitchman, S. C., Thompson, M. E., Boudreau, C. et Fong, G. T. (2021). Self-Reported Quit Aids and Assistance Used By Smokers At Their Most Recent Quit Attempt: Findings from the 2020 International Tobacco Control Four Country Smoking and Vaping Survey. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 23(10), 1699–1707. https://doi.org/10.1093/ntr/ntab068
Havranek, E. P., Mujahid, M. S., Barr, D. A., Blair, I. V., Cohen, M. S., Cruz-Flores, S., Davey-Smith, G., Dennison-Himmelfarb, C. R., Lauer, M. S., Lockwood, D. W., Rosal, M., Yancy, C. W. et American Heart Association Council on Quality of Care and Outcomes Research, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, Council on Lifestyle and Cardiometabolic Health, and Stroke Council (2015). Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation, 132(9), 873–898. https://doi.org/10.1161/CIR.0000000000000228
Høie, M., Moan, I. S. et Rise, J. (2010). An extended version of the theory of planned behavour: Prediction of intentions to quit smoking using past behaviour as moderator. Addiction Research & Theory, 18(5), 572–585. https://doi.org/10.3109/16066350903474386
Höpner, J., Junge, U., Schmidt-Pokrzywniak, A., Fischer, C. et Mikolajczyk, R. (2020). Determinants of persistent smoking after acute myocardial infarction: an observational study. BMC cardiovascular disorders, 20(1), 384. https://doi.org/10.1186/s12872-020-01641-8
Institut de la statistique du Québec. (2025, 23 janvier). Tabac et vapotage : risques et cessation. https://statistique.quebec.ca/fr/document/tabac-vapotage-quebec/publication/tabac-vapotage-risques-cessation
Institut national d’excellence en santé et services sociaux. (2025). Stratégies de cessation tabagique — Durée de traitement et nombre annuel de tentatives d’arrêt (Mise à jour). État des connaissances rédigé par Isabelle Dufort. https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Medicaments/INESSS_Cessation_tabagique_avis.pdf
Jimeno Sánchez, J., Chabbar Boudet, M. C., Morlanes Gracia, P., Laita Monreal, S., López Perales, C. R., Cuko, G., Albarrán Martín, C. et Garza Benito, F. (2023). Intervención antitabaco en fase aguda del síndrome coronario agudo: ¿existe beneficio adicional en pacientes incluidos en un programa de rehabilitación cardiaca? [Anti-smoking intervention in the acute phase of acute coronary syndrome: Is there additional benefit in patients included in a cardiac rehabilitation program?]. Journal of healthcare quality research, 38(2), 105–111. https://doi.org/10.1016/j.jhqr.2022.06.005
Koçak, A., Yıldırım, O., Coşgun, A. et Türkkanı, M. H. (2023). Factors Affecting Smoking Cessation After Acute Myocardial Infarction. Thoracic research and practice, 24(3), 151–156. https://doi.org/10.5152/ThoracResPract.2023.22139
Lisy, A. N. et Thephilah, C. R. (2025). Factors Influencing Treatment Adherence and Lifestyle Modifications of Patients Living with Coronary Artery Disease (CAD) and Their Impact on Disease Outcomes: A Systematic Review. European Journal of Cardiovascular Medicine, 15(4), 1015–1023. https://ezproxy.uqar.ca/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=185331590&lang=fr&site=ehost-live&scope=site
McEachan, R., Taylor, N., Harrison, R., Lawton, R., Gardner, P. et Conner, M. (2016). Meta-Analysis of the Reasoned Action Approach (RAA) to Understanding Health Behaviors. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 50(4), 592–612. https://doi.org/10.1007/s12160-016-9798-4
Organisation mondiale de la Santé. (2020, 22 septembre). Le tabac est responsable de 20 % des décès dus aux cardiopathies coronariennes. https://www.who.int/fr/news/item/22-09-2020-tobacco-responsible-for-20-of-deaths-from-coronary-heart-disease
Organisation mondiale de la Santé. (2025, 31 juillet). Maladies cardiovasculaires. https://www.who.int/fr/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
Organisation mondiale de la Santé. (2025, 25 juin). Tabac. https://www.who.int/fr/news-room/fact-sheets/detail/tobacco
Park, B., Yang, J. et Kim, Y. (2023). Factors Influencing Cardiovascular Disease Preventive Behaviors among Rural Residents Based on a Socio-Ecological Model in South Korea: A Mixed Method Research. Health & Social Care in the Community, 051599, 1–11. https://doi.org/10.1155/2023/6051599
Ratté, C.-B., Pagé, J., Prémont-Boulet, J., De Lafontaine, M.-F., Dionne, C., Poirier, P., Denis, I. et Foldes-Busque, G. (2021). Effets des procédures de revascularisation sur l’anxiété, l’anxiété cardiaque et la dépression. Psycause : revue scientifique étudiante de l’École de psychologie de l’Université Laval, 11(2), 9–11. https://doi.org/10.51656/psycause.v11i2.51362
Samim, D., Méan, M., Clair, C. et Marques-Vidal, P. (2018). A 10-year observational study on the trends and determinants of smoking status. PloS one, 13(7), e0200010. https://doi.org/10.1371/journal.pone.0200010
SAS Institute Inc. (2023). SAS® Software (version 9.4). SAS Institute. Inc.
Son, Y. J. et Lee, H. J. (2020). Association between persistent smoking after a diagnosis of heart failure and adverse health outcomes: A systematic review and meta-analysis. Tobacco induced diseases, 18, 05. https://doi.org/10.18332/tid/116411
Streck, J. M., Rigotti, N. A., Livingstone-Banks, J., Tindle, H. A., Clair, C., Munafò, M. R., Sterling-Maisel, C. et Hartmann-Boyce, J. (2024). Interventions for smoking cessation in hospitalised patients. The Cochrane database of systematic reviews, 5(5), CD001837. https://doi.org/10.1002/14651858.CD001837.pub4
Sverre, E., Otterstad, J. E., Gjertsen, E., Gullestad, L., Husebye, E., Dammen, T., Moum, T. et Munkhaugen, J. (2017). Medical and sociodemographic factors predict persistent smoking after coronary events. BMC cardiovascular disorders, 17(1), 241. https://doi.org/10.1186/s12872-017-0676-1
Tapera, R., Mbongwe, B., Mhaka-Mutepfa, M., Lord, A., Phaladze, N. A. et Zetola, N. M. (2020). The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana. PloS one, 15(6), e0233462. https://doi.org/10.1371/journal.pone.0233462
Tseng, Y. F., Wang, K. L., Lin, C. Y., Lin, Y. T., Pan, H. C. et Chang, C. J. (2018). Predictors of smoking cessation in Taiwan: using the theory of planned behavior. Psychology, health & medicine, 23(3), 270–276. https://doi.org/10.1080/13548506.2017.1378820
von Haeften, I., Fishbein, M., Kasprzyk, D. et Montano, D. (2001). Analyzing data to obtain information to design targeted interventions. Psychology, Health & Medicine, 6(2), 151–164. https://doi.org/10.1080/13548500125076
Wu, L., He, Y., Jiang, B., Zuo, F., Liu, Q., Zhang, L. et Zhou, C. (2016). Additional follow-up telephone counselling and initial smoking relapse: a longitudinal, controlled study. BMJ open, 6(4), e010795. https://doi.org/10.1136/bmjopen-2015-010795
Xing, X., Shang, X., Deng, X., Guo, K., Fenfen, E., Zhou, L., Wang, Y., Yang, C., Yang, K. et Li, X. (2023). Efficacy and safety of pharmacological intervention for smoking cessation in smokers with diseases: A systematic review and network meta-analysis. Journal of evidence-based medicine, 16(4), 520–533. https://doi.org/10.1111/jebm.12570