UCSF

Introduction: Smoking is a leading cause of cardiac diseases and deaths worldwide, killing 6 million people annually. Depression has been found to be an important comorbidity in persons with heart disease, and may play a significant role in patients' relapse to smoking after quit attempts. Despite the health hazards and the public's awareness of the tragic consequences of smoking, tobacco use remains surprisingly highly prevalent.

Objectives: To examine the relationships between demographic, clinical and health factors, smoking history and patterns, nicotine dependence and withdrawal symptoms, smoking outcome expectancies, social support, depression, and willingness to quit smoking after hospital discharge in adult Jordanian men who were smokers and were admitted to the hospital with a CVD diagnosis.

Methods: This cross-sectional study recruited adult men smokers from three hospitals. Data were collected using medical record abstraction and structured interviews.

Results: The sample included 167 men, 71% were cigarette smokers and 29% were waterpipe smokers. Their mean age was 50.7 (±6.9) years; 62.8% were nicotine dependent. 40.4% were classified as depressed [scored 10 (or higher) on Patient Health Questioannaire-9]. Willingness to quit smoking was positively correlated with depression score (r = 0.16, p = 0.04), and social support (r = 0.33, p < 0.01). A multiple logistic regression analysis showed that smokers who have no health insurance, who have no one available to encourage them to quitting smoking "at least sometimes", who had tried quitting smoking in the past, and had no difficulty with depressive symptoms while at work, taking care of things at home, or getting along with other people were less likely to quit smoking after hospital discharge.

Discussion: The high nicotine dependence in these men indicates that there is an urgent need for smoking cessation treatment, including behavioral counseling and pharmacological therapies, to achieve successful smoking cessation. This study showed a high prevalence of depressive symptoms. The presence of depression is associated with more severe nicotine withdrawal symptoms and is inversely associated with smoking cessation. Thus, screening all patients for tobacco use and depression is needed and should be incorporated in the care of these patients.