Evaluation and Challenges of a Smoking Cessation Program in the Eastern Mediterranean Region

Abstract

Introduction: Given the lack of studies on tobacco cessation interventions in the Eastern Mediterranean region, this paper presents findings from a smoking cessation program (SCP) in a tertiary referral center. The aim is to evaluate the predictors, facilitators, and barriers associated with successful smoking cessation from both participant and provider perspectives. Materials and Methods: A mixed-method approach was used. Part 1 was a retrospective cross-sectional quantitative study with a telephone-based survey conducted on a sample of 47 patients enrolled in the SCP between March 2014 and August 2017. Part 2 was a qualitative study comprising a focus group discussion among five practitioners from the SCP. Results: Only 37% reported being adherent to the prescribed treatment and 74.5% reported receiving behavioral counseling. In the multivariate logistic regression analysis, adhering to pharmacotherapy increased the odds of being a quitter at 1 and 6 months after quit date (QD), whereas completing behavioral counseling increased the odds of being a quitter at 1, 6, and 12 months after QD. Point prevalence abstinence at 1 month and prolonged abstinence at 6 and 12 months after QD were 42.2%, 32.6%, and 24.4%, respectively. The overall relapse rate reached 62.5%. Facilitators and barriers fell under three subthemes: (1) participant factors; (2) provider factors; and (3) system factors. The most common barriers for non-compliance to the program were stress factors, nicotine addiction, accessibility and availability of pharmacotherapy, cost of the program and medications, and time restrictions. Conclusion: Adherence to pharmacotherapy and receiving behavioral counseling increase the odds of smoking abstinence maintenance. Success or failed cessation is influenced by several underlying factors operating on multiple levels and understanding them might help improve tobacco cessation interventions.