Leslie C. Moore, PhD, RN, MBA Assistant Professor, School of Nursing, Georgia College & State University, Milledgeville. Patricia C. Clark, PhD, RN, FAHA, FAAN Professor, School of Nursing, Georgia State University, Atlanta. Shih-Yu Lee, PhD, RNC Assistant Professor, School of Nursing, Georgia State University, Atlanta. Michael Eriksen, ScD Professor and Director, Public Health Institute, Georgia State University, Atlanta. Kimberly Evans, MSN, RN Student, School of Nursing, Georgia College & State University, Milledgeville. Cassie H. Smith, BSN, RN Student, School of Nursing, Georgia College & State University, Milledgeville. At the time of this work, the first author was a doctoral student in the Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta.
J Cardiovasc Nurs. 2013 Nov-Dec;28(6):524-33. doi: 10.1097/JCN.0b013e31826620d4.
Female smokers with coronary heart disease (CHD) are at an increased risk for negative health effects. The time of invasive cardiovascular (CV) interventions is a critical opportunity to make lifestyle changes to reduce future CV interventions.
The purpose of this study guided by the Health Belief Model was to determine which factors predict smoking cessation (SC) in women after an invasive CV procedure.
A correlational, prospective design was used. Data were collected from female smokers at the time of an invasive CV intervention (baseline) and 3 months later. Instruments measured commitment to stop smoking, perceived threat of CHD and future interventions, cessation self-efficacy, barriers to SC, benefits of SC, cues to action, and motivation. Analyses included χ2 and t tests and multiple, hierarchical, and logistic regression.
On average, women (N = 76) were middle aged (mean [SD] age, 55.9 [8.0] years), smoked 15.3 (9.8) cigarettes per day, and on average smoked for 33.6 (10.2) years. At baseline, fewer perceived barriers to SC, high cessation self-efficacy, and being more autonomously motivated to quit smoking explained 67% of variance in commitment to stop smoking (P < .001). At 3 months, of 54 women responding, only 8 had quit smoking. Women reported smoking fewer cigarettes per day at 3 months compared with baseline (paired t51 = 3.43, P < .01). Higher baseline cessation self-efficacy and lower CHD threat were predictors of SC at 3 months (χ2(4) = 18.67, n = 54; P = .001).
Although commitment, motivation, and self-efficacy to stop smoking were high, perceived threat of CHD and future invasive CV interventions were high, and perceived barriers to SC were low, most women continued to smoke after their heart catheterization. Referrals for assistance from healthcare providers to decrease anxiety and nicotine dependence and to address ongoing challenges to SC are needed.
患有冠心病 (CHD) 的女性吸烟者面临更大的健康风险。进行有创心血管 (CV) 干预的时机是进行生活方式改变以减少未来 CV 干预的关键机会。
本研究以健康信念模型为指导，旨在确定哪些因素可预测女性在进行有创 CV 手术后戒烟 (SC)。
采用相关性、前瞻性设计。在有创 CV 干预（基线）时和 3 个月后，从女性吸烟者那里收集数据。使用的工具包括戒烟承诺、对 CHD 和未来干预的感知威胁、戒烟自我效能、SC 障碍、SC 益处、行动线索和动机。分析包括 χ2 和 t 检验以及多元、分层和逻辑回归。
平均而言，女性（N=76）年龄在中年（平均[SD]年龄，55.9[8.0]岁），每天吸烟 15.3（9.8）支，平均吸烟 33.6（10.2）年。基线时，较少的 SC 障碍感知、高戒烟自我效能和更高的自主戒烟动机解释了戒烟承诺 67%的变异（P<0.001）。在 3 个月时，54 名回答的女性中，只有 8 人戒烟。与基线相比，女性报告在 3 个月时每天吸烟较少（配对 t51=3.43，P<0.01）。较高的基线戒烟自我效能和较低的 CHD 威胁是 3 个月时 SC 的预测因素（χ2(4)=18.67，n=54；P=0.001）。
尽管戒烟的承诺、动机和自我效能感较高，但对 CHD 和未来有创 CV 干预的感知威胁较高，SC 的感知障碍较低，但大多数女性在心脏导管插入术之后仍继续吸烟。需要向医疗保健提供者提供帮助以减少焦虑和尼古丁依赖并解决持续的 SC 挑战的转介。
