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Lin CH, Wang CY, Chen KF, Chiu SP, Huang WT, Fan SY. The trajectory of smoking cessation after treatment and its related factors in Taiwan. Sci Rep 2024; 14:13270. [PMID: 38858540 PMCID: PMC11164964 DOI: 10.1038/s41598-024-64311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/07/2024] [Indexed: 06/12/2024] Open
Abstract
Smoking has multiple negative effects on health; therefore, the Taiwanese government provides smoking cessation clinics to smokers. This study aimed to explore the trajectory of smoking cessation after smokers received treatment and the variables related to different trajectories. A retrospective longitudinal study was conducted, in which 735 adult smokers who received smoking cessation medications were recruited. The participants' demographic characteristics, chronic diseases, smoking characteristics, and cigarette dependence were collected from chart review. The amount of smoking was collected at baseline, and at 1 week, 1 month, 3 months, and 6 months after treatment. The Proc Traj procedure for group-based modeling and multinomial logistic regression were used for statistical analysis. Three trajectories were identified: early quitters (28.03%), late quitters (11.43%) and reducers (60.54%). Compared with early quitters, reducers were younger and had a higher probability of severe cigarette dependence. Compared with early quitters, late quitters had a higher number of taking smoking cessation medications. The findings revealed that approximately 60% of participants who received smoking cessation treatment could not completely quit smoking, and that age, number of medications taken, and cigarette dependence were significant predictors of different trajectories.
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Affiliation(s)
- Chia-Hong Lin
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Cing-Ya Wang
- Community Nursing Room, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Kuan-Fen Chen
- Community Nursing Room, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Shu-Pi Chiu
- Community Nursing Room, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Wan-Ting Huang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Sheng-Yu Fan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 701, Taiwan.
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Albasheer O, Alhazmi AH, Alharbi A, Makeen AM, Alqassim AY, Al-Musawa HI, Alabah AE, Alhazmi AK, Khormi NA, Hamzi YA, Sharhah EYA, Salami RM, Alshareef M, Suwaydi H, Elkhobby A. Effectiveness and determinants of smoking cessation in the Saudi Arabian Region of Jazan: A cross-sectional study. Tob Induc Dis 2023; 21:06. [PMID: 36721860 PMCID: PMC9865635 DOI: 10.18332/tid/156842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Smoking cessation has significant health benefits. The purpose of this study is to assess the efficacy and related factors of smoking cessation therapies in the Jazan Region of Saudi Arabia. METHODS This is a cross-sectional study that took place at smoking cessation clinics in primary healthcare centers between January 2019 and January 2020. RESULTS This study enrolled a total of 103 people. The success rate for quitting smoking was 36% at three months, with a 13% relapse rate at six months. Age (p=0.017), occupation (p=0.046), daily cigarette intake (p=0.015), and number of visits (p=0.001) were all found to be significant determinants of smoking cessation. In the multivariate analysis, only the number of visits increased the likelihood to quit smoking (AOR=0.31; 95% CI: 0.15-0.63). Self-efficacy was cited as the primary reason for quitting smoking by 71% of the participants, whereas family support, smoking cessation therapies, and friends' support were cited as predictive variables by 18%, 10%, and 1% of the participants, respectively. CONCLUSIONS Smokers who received the smoking cessation intervention package were three times more likely to succeed in giving up smoking when compared to those who received the routine service. Regular follow-up during smoking cessation interventions significantly enhanced the quit rate. It is recommended that pharmacotherapy strategies and intense therapy performed face-to-face with a cessation counselor be combined to improve the quit rate.
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Affiliation(s)
- Osama Albasheer
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | - Abdulaziz H. Alhazmi
- Emerging and Epidemic Infectious Diseases Research Unit, Medical Research Center, Jazan University, Jazan City, Saudi Arabia,Microbiology and Parasitology Department, College of Medicine, Jazan University, Jazan City, Saudi Arabia
| | - Abdullah Alharbi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | - Anwar M. Makeen
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | - Ahmad Y. Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | | | - Amjad E. Alabah
- Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | | | - Nawaf A. Khormi
- Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | - Yazeed A. Hamzi
- Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia
| | | | | | - Mohammed Alshareef
- Family Medicine and Primary Health Care, Ministry of Health, Jazan City, Saudi Arabia
| | - Hassan Suwaydi
- Family Medicine and Primary Health Care, Ministry of Health, Jazan City, Saudi Arabia
| | - Ahmed Elkhobby
- Family Medicine and Primary Health Care, Ministry of Health, Jazan City, Saudi Arabia
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Park S, Lee KS, Choi M, Lee M. Factors associated with quality of life in patients with benign prostatic hyperplasia, 2009-2016. Medicine (Baltimore) 2022; 101:e30091. [PMID: 36086750 PMCID: PMC9512327 DOI: 10.1097/md.0000000000030091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/29/2022] [Indexed: 11/25/2022] Open
Abstract
This study analyzed the factors affecting the health-related quality of life of patients with benign prostatic hyperplasia (BPH) according to age. We also aimed to determine appropriate strategies to improve their quality of life. Data from the Korea Health Panel Survey (2009-2016) were used in this study. A total of 3806 patients with BPH were divided into 2 groups: younger adults (aged under 65 years) and older adults (aged over 65 years). In addition, a logistic regression analysis was conducted to identify factors affecting the quality of life of young and older patients with BPH. In younger adult patients with BPH, the higher the level of education, the higher the quality of life by a factor of 1.379, and the more intense the physical activity, the lower the quality of life by a factor of 0.791. Also, the longer the sitting time, the lower the quality of life by a factor of 0.765. In contrast, for older adult patients with BPH, the quality of life improved by factors of 1.601 and 2.921, respectively, for health insurance and higher income level. In addition, it was found that the quality of life decreased by a factor of 0.754 in patients who drink alcohol. In order to improve the quality of life of the middle-aged adult population with BPH, it is necessary to reduce sitting time through constant physical activity. Moreover, the cost of medical care should be reduced and the quality of life increased through reductions in surgical treatment, as the burden of medical expenses will degrade the quality of life for older adults.
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Affiliation(s)
- Sewon Park
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Kyu-Sung Lee
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mankyu Choi
- Department of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea
| | - Munjae Lee
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, South Korea
- Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, South Korea
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Airagnes G, Lemogne C, Le Faou AL, Matta J, Romanello L, Wiernik E, Melchior M, Goldberg M, Limosin F, Zins M. Do the associations between the use of electronic cigarettes and smoking reduction or cessation attempt persist after several years of use? Longitudinal analyses in smokers of the CONSTANCES cohort. Addict Behav 2021; 117:106843. [PMID: 33581677 DOI: 10.1016/j.addbeh.2021.106843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We examined whether duration of electronic cigarette (e-cigarette) use could be associated with smoking reduction or cessation attempt. METHODS 5,409 current smokers at baseline enrolled in the French CONSTANCES cohort in 2015 or 2016 were included. Duration of e-cigarette use was categorized as follows: never; former user for more than one year; former user for less than one year; new user for less than one year; return to use for less than one year; regular use for one to two years; regular use for more than two years. Two outcomes were considered at one-year of follow-up: change in the number of cigarettes per day and cessation attempt. RESULTS Compared to never users, former users had an increase in the number of cigarettes per day at follow-up (B = 0.95[95%CI:0.57-1.33] and B = 1.03[95%CI:0.47-1.59] for former users of more than one year and less than one year, respectively). Compared to never users, all categories of current users had a decrease in the number of cigarettes per day (B = -3.31[95%CI:-4.07;-2.54] and B = -4.18[95%CI:-5.06;-3.29] for new users of less than one year and users of more than two years, respectively). Compared to never users, former users had a decreased likelihood of cessation attempt (OR = 0.80[95%CI:0.67-0.95] and OR = 0.77[95%CI:0.60-0.99] for former users of more than one year and less than one year, respectively). Compared to never users, all categories of current users had an increased likelihood of cessation attempt (OR = 3.12[95%CI:2.32;4.19] and OR = 3.36[95%CI:2.39;4.72] for new users of less than one year and users of more than two years, respectively). CONCLUSIONS E-cigarette use was associated with smoking reduction and cessation attempt for individuals who have used it for less than one year and additional benefits are expected to occur with a longer duration of use. Former users of e-cigarettes had poorer outcomes than those who have never used them.
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Affiliation(s)
- Guillaume Airagnes
- AP-HP. Centre-University of Paris, Department of Psychiatry and Addictology, Paris, France; INSERM, Population-based Epidemiological Cohorts, UMS 011, Villejuif, France; University of Paris, Faculty of Medicine, Paris, France.
| | - Cédric Lemogne
- AP-HP. Centre-University of Paris, Department of Psychiatry and Addictology, Paris, France; University of Paris, Faculty of Medicine, Paris, France; Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
| | - Anne-Laurence Le Faou
- AP-HP. Centre-University of Paris, Department of Psychiatry and Addictology, Paris, France; University of Paris, Faculty of Medicine, Paris, France
| | - Joane Matta
- INSERM, Population-based Epidemiological Cohorts, UMS 011, Villejuif, France
| | - Lucile Romanello
- INSERM, Population-based Epidemiological Cohorts, UMS 011, Villejuif, France
| | - Emmanuel Wiernik
- INSERM, Population-based Epidemiological Cohorts, UMS 011, Villejuif, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Marcel Goldberg
- INSERM, Population-based Epidemiological Cohorts, UMS 011, Villejuif, France
| | - Frédéric Limosin
- AP-HP. Centre-University of Paris, Department of Psychiatry and Addictology, Paris, France; University of Paris, Faculty of Medicine, Paris, France; Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
| | - Marie Zins
- INSERM, Population-based Epidemiological Cohorts, UMS 011, Villejuif, France; University of Paris, Faculty of Medicine, Paris, France
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Sadarang RAI. Factors Associated With Quitting Smoking in Indonesia. J Prev Med Public Health 2021; 54:137-144. [PMID: 33845534 PMCID: PMC8046601 DOI: 10.3961/jpmph.20.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: The aim of this study was to identify factors associated with quitting smoking in Indonesia Methods: Data on 11 115 individuals from the fifth wave of the Indonesia Family Life Survey were analyzed. Quitting smoking was the main outcome, defined as smoking status based on the answer to the question “do you still habitually (smoke cigarettes/smoke a pipe/use chewing tobacco) or have you totally quit?” Logistic regression was performed to identify factors associated with successful attempts to quit smoking. Results: The prevalence of quitting smoking was 12.3%. The odds of successfully quitting smoking were higher among smokers who were female (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 2.08 to 3.33), were divorced (aOR, 2.45; 95% CI, 1.82 to 3.29), did not chew tobacco (aOR, 3.01; 95% CI, 1.79 to 5.08), found it difficult to sacrifice smoking at other times than in the morning (aOR, 1.29; 95% CI, 1.14 to 1.46), and not smoke when sick (aOR, 1.32; 95% CI, 1.14 to 1.54). About 59% of variance in successful attempts to quit smoking could be explained using a model consisting of those variables. Conclusions: Female sex, being divorced, not chewing tobacco, and nicotine dependence increased the odds of quitting smoking and were associated with quitting smoking successfully. Regular and integrated attempts to quit smoking based on individuals’ internal characteristics, tobacco use activity, and smoking behavior are needed to quit smoking.
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Affiliation(s)
- Rimawati Aulia Insani Sadarang
- Department of Public Health, Faculty of Medicine and Health Sciences, Universitas Islam Negeri Alauddin Makassar, Gowa, Indonesia
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Park HY, Choe YR, Oh IJ, Kim MS, Kho BG, Shin HJ, Park CK, Kim YI, Kim YC, Ahn HR, Kweon SS. Efficacy of an inpatient smoking cessation program at a single regional cancer center: A prospective observational study. Medicine (Baltimore) 2021; 100:e24745. [PMID: 33578625 PMCID: PMC10545313 DOI: 10.1097/md.0000000000024745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/21/2020] [Accepted: 01/16/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Smoking is the leading cause of preventable death and a risk factor for cancer, but smoking cessation is difficult even in patients who need hospitalization. This study aimed to investigate the usefulness of an inpatient smoking cessation consultation program and to analyze the clinical factors associated with abstinence. In this observational study, patients received regular counseling for 6 months, and abstinence was objectively assessed via urine and exhaled carbon monoxide testing. Cessation rates were assessed at 4 weeks and 6 months, and clinical characteristics associated with cessation success were investigated. Of the 571 patients referred to participate in the program, 170 (29.8%) were enrolled, and only 2 (1.2%) used smoking cessation drugs in addition to counseling. The smoking cessation rate was 77.6% after 4 weeks and 59.1% after 6 months. The cessation rates were significantly higher in patients with cancer than in those without cancer at both timepoints (63.8% vs 21.9%, P < .001, 53.6% vs 12.5%, P < .001), and they were also higher in the first admission group than in the re-admission group (87.4% vs 74.7%, P = .033, 88.5% vs 76.1%, P = .037). In patients with lung cancer, progression-free survival and overall survival tended to be better in those enrolled in the program (P = .158, P = .183). In conclusion, the inpatient smoking cessation program was associated with a high abstinence rate. Most patients maintained cessation without medication, suggesting that initial admission, along with a cancer diagnosis, can provide enough motivation to abstain from smoking. In addition, the smoking cessation effort showed potential to improve survival during lung cancer treatment.
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Affiliation(s)
- Ha-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju
- Jeonnam Tobacco Control Center, Chonnam National University Hwasun Hospital, Jeonnam
| | - Yu-Ri Choe
- Jeonnam Tobacco Control Center, Chonnam National University Hwasun Hospital, Jeonnam
- Department of Family Medicine, Chonnam National University Hwasun Hospital, Jeonnam
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju
- Jeonnam Tobacco Control Center, Chonnam National University Hwasun Hospital, Jeonnam
| | - Min-Seok Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju
| | - Bo Gun Kho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju
| | - Hong-Joon Shin
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju
| | - Cheol Kyu Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju
- Jeonnam Tobacco Control Center, Chonnam National University Hwasun Hospital, Jeonnam
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju
| | - Hye-Ran Ahn
- Jeonnam Tobacco Control Center, Chonnam National University Hwasun Hospital, Jeonnam
| | - Sun-Seog Kweon
- Jeonnam Tobacco Control Center, Chonnam National University Hwasun Hospital, Jeonnam
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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Park S, Ryu JM, Lee M. Quality of Life in Older Adults with Benign Prostatic Hyperplasia. Healthcare (Basel) 2020; 8:healthcare8020158. [PMID: 32512888 PMCID: PMC7349344 DOI: 10.3390/healthcare8020158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 12/01/2022] Open
Abstract
The purpose of this study is to identify factors that affect health-related quality of life (HRQOL) of older patients with Benign Prostatic Hyperplasia (BPH) and suggest ways to improve the same. Through this, we will improve the self-management practice of patients and promote the treatment of BPH in older patients. The 2015 Korea Health Panel Survey data were used in this study. A total of 422 BPH patients aged 65 or older were included. Logistic regression analysis was conducted to identify factors affecting the HRQOL of older patients with BPH. General characteristics of factors affecting older patients with BPH included income level and type of insurance. In addition, among medical-related characteristics and health behavior factors, subjective health status, unmet medical care needs, moderate physical activity, sitting time, and drinking influenced the HRQOL. Therefore, in order to improve the HRQOL of adult patients with BPH, it is necessary to improve medical accessibility by strengthening primary care. In addition, it is necessary to increase the amount of activity in daily life through healthcare medical devices.
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Meshefedjian GA. The smoking spectrum: review of the existing evidence and future directions. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-018-01009-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Weinberger AH. Tobacco Use and Socioeconomically Disadvantaged Groups. Nicotine Tob Res 2017; 19:1399-1400. [DOI: 10.1093/ntr/ntx199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 11/14/2022]
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Lim YK, Shin DW, Kim HS, Yun JM, Shin JH, Lee H, Koo HY, Kim MJ, Yoon JY, Cho MH. Persistent smoking after a cardiovascular event: A nationwide retrospective study in Korea. PLoS One 2017; 12:e0186872. [PMID: 29049380 PMCID: PMC5648241 DOI: 10.1371/journal.pone.0186872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022] Open
Abstract
Smoking is a major risk factor of cardiovascular disease (CVD) such as stroke and ischemic heart disease. Prior studies have observed people continued smoking even after being diagnosed with CVD. However, population-level data regarding smoking behavior changes among people who are diagnosed with CVD are still lacking. From the National Health Insurance sample cohort database, we identified 1,700 patients diagnosed as having CVD between 2003 and 2012, and underwent the national health screening examination in the year before and after the CVD event. We found that 486 (28.6%) were smokers before the CVD event. Among them, 240 (49.4%) continued to smoke despite the diagnosis. We observed that a higher smoking amount and longer smoking duration before the diagnosis were associated with persistent smoking. Our finding that approximately 50% of smokers continue smoking even after CVD events supports the need for an assessment of patients' smoking statuses during follow-up after a CVD event and for health-care providers to offer the appropriate smoking cessation interventions to those who continue smoking.
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Affiliation(s)
- Yoo Kyoung Lim
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyeon Suk Kim
- School of Nursing, Shinhan University, Uijeongbu, Republic of Korea
| | - Jae Moon Yun
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Hyun Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyejin Lee
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Yeon Koo
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Yeon Yoon
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mi Hee Cho
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
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