Patients who survive stroke are at high risk of recurrent strokes and other vascular events. Smoking is an established risk factor for stroke, with cessation recommended for secondary prevention. Little is known about patterns of smoking cessation after stroke, however. Ives and coworkers identified a prospective cohort of patients, and derived data from the population-based South London Stroke Register. Self-reported smoking status was measured at the time of stroke, at three months, and at one and three years after stroke. Stroke survivors, who were smoking at the time of stroke and were alive three years later, were included (it’s easy to figure out the exclusionary criteria in this study!). Logistic regression was used to examine associations between age, sex, ethnicity, socioeconomic status, risk factors, stroke subtype, disability, and probability of attempting and maintaining smoking cessation. Complete smoking data were available for 363 survivors with strokes between 1995 and 2003. In all, 71% of the smokers had attempted to quit within three years; 30% had quit and maintained cessation at one and three years; 10% had quit immediately after stroke, but had subsequently relapsed (smoking again at one and three years); and 25% of the smokers had quit after three months. Black ethnicity and more severe disability were predictors of attempts to quit. Older age and black ethnicity reduced the likelihood of smoking at three years. Among those attempting cessation, being older predicted maintenance.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that the majority of smokers had attempted to quit after stroke; however, only a minority achieved sustained cessation in the longer term. Cessation patterns are complex, and interventions should be targeted at multiple time points. Or, even better, patients should be taught self-management skills over several sessions. This would not only let them acquire skills useful in smoking cessation, but permit those conducting the program to determine if stroke patients actually can perform the skills over time.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Smoking cessation can be very hard for many people, particularly those addicted to nicotine. You undoubtedly have the best of intentions when you decide to quit smoking. That’s a necessary first step. However, if you relapse and again start smoking, don’t consider it a failure but a setback that you can overcome by talking to your health care provider or taking smoking cessation courses offered by such groups as the American Lung Association or the American Cancer Society (similar groups are available for such training in most countries). People successfully cease smoking every day. It may take you a few trials to succeed, but success breeds’ confidence. This self-efficacy can help you maintain your non-smoking status whether you have had a stroke or not. That is what happened to the 30% of the patients in the study who quit and maintained succession over one and three years.

SP Ives et al. Patterns of smoking cessation in the first 3 years after stroke: the South London Stroke Register. European Journal of Cardiovascular Prevention & Rehabilitation, 2008;15:329-335.