Patterns and predictors of smoking relapse among inpatient smoking intervention participants: a 1-year follow-up study in Korea

Abstract

OBJECTIVES This study aimed to identify relapse patterns in smokers who participated in an inpatient treatment program and to investigate factors related to relapse. METHODS The participants comprised 463 smokers who participated in an inpatient treatment operated by the Daejeon Tobacco Control Center from 2015 to 2018. Participants received high-intensity smoking cessation intervention for 5 consecutive days, including pharmacotherapy and behavioral support, and continued with follow-up for 1 year to determine whether they maintained smoking cessation after discharge from inpatient treatment. Kaplan-Meier and Cox proportional hazard models were used in the analysis. RESULTS Participants’ relapse rate within 1 year was 72.8%, and 59.8% of participants smoked again within 6 months after participation. A higher number of counseling sessions was significantly associated with a lower risk of relapse (hazard ratio [HR], 0.23; 95% confidence interval [CI], 0.17 to 0.32 for ≥9 vs. ≤5 counseling sessions). Conversely, higher relapse rates were significantly associated with the use of nicotine replacement therapy (NRT) (HR, 1.91; 95% CI, 1.43 to 2.55 for use vs. no use), and higher levels of baseline expired carbon monoxide (CO) (HR, 1.58; 95% CI, 1.21 to 2.06 for expired CO concentrations of 10-19 ppm vs. expired CO concentrations <10 ppm). CONCLUSIONS High-intensity smoking cessation interventions in hospital settings can be effective for smoking cessation in smokers with high nicotine dependence. In addition, the results suggest that for quitters to maintain long-term abstinence, they should receive regular follow-up counseling for 1 year after completing a high-intensity smoking cessation intervention.

Keywords

• smoking cessation
• nicotine
• maintenance
• survival analysis